Gestational hypertension and gestational proteinuria
THE CONTEXT
Gestational hypertension describes newly elevated blood pressure without proteinuria in a previously normotensive woman during the specified pregnancy or immediate postpartum period.
Definition and diagnostic features
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Gestational hypertension requires blood pressure of at least 140/90 mm Hg on at least two occasions separated by 4 or more hours, without proteinuria, beyond the 20th week of pregnancy or within the first 48 hours of delivery.
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There should be no evidence of an underlying cause of hypertension. Other evidence of pre-eclampsia, such as edema or proteinuria, is generally absent.
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Hemoconcentration, thrombocytopenia, raised serum uric acid, and hepatic dysfunction are generally absent.
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Blood pressure should return to normal within 12 weeks after delivery; the diagnosis is retrospective.
Course and management
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Gestational hypertension is associated with a higher incidence of essential hypertension in later life than pre-eclampsia.
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Some women develop proteinuria and evolve to pre-eclampsia. The passage describes gestational hypertension and pre-eclampsia as two phases of the same disorder.
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The hypertensive effect may represent a stress response.
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Blood pressure management and decisions about delivery do not differ materially between gestational hypertension and pre-eclampsia. Severe hypertension with symptoms or abnormal laboratory values suggests delivery.
Severe gestational hypertension
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Severe gestational hypertension is defined by systolic blood pressure of 160 mm Hg or diastolic blood pressure of 110 mm Hg on at least two occasions at least 4 hours apart.
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A single reading may establish this definition if acute antihypertensive drugs are used before 4 hours.
Gestational proteinuria
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Gestational proteinuria is urinary protein exceeding 0.3 g in 24 hours during or under the influence of pregnancy, without hypertension, edema, or renal infection.
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The proteinuria may be orthostatic. Evaluation may include blood tests and frequent blood pressure monitoring to exclude pre-eclampsia.