Possible Causes of Transient blood pressure elevation Drug use (cocaine, meth, tobacco) Obesity (wrong cuff size) White coat HTN, anxiety Pain Hypertensive Disorders of Pregnancy

Categories of Hypertension During Pregnancy Preeclampsia-eclampsia Chronic hypertension Chronic hypertension with superimposed preeclampsia Gestational hypertension

Chronic Hypertension Diagnosis: elevated blood pressure > 140/90 prior to 20 weeks gestation x2 at least 4 hours apart

Gestational Hypertension Diagnosis: HTN (BP > 140/90) after 20 wks pregnancy without proteinuria or other criteria for preeclampsia

Preeclampsia without severe features Diagnosis: 1. BP > 140/90 x2 at least 4 hours apart 2. proteinuria: >300 mg on 24 hour urine or P/C ratio fo 0.3 or greater Urinary protein levels do not correlate with severity

Preeclampsia with severe features BP > 160/110 at least four hours apart unless meds are started before that time Thrombocytopenia < 100,000 LFT’s 2x normal or RUQ/epigastric pain Renal insufficiency: Cr 1.1 or doubling of baseline Pulmonary edema New-onset cerebral/visual disturbances ***ANY ONE OF THE ABOVE CRITERIA in combination with hypertension is sufficient for the diagnosis*** Proteinuria is not necessary if any are present

HELLP Syndrome AST or ALT > 2x normal LDH > 600 Bili > 1.2 mg/dL Platelets < 100,000 DIC panel (fibrinogen, PT, PTT) should be ordered if plts <50,000 or signs/sx of bleeding Atypical HELLP may not meet BP criteria for preeclampsia diagnosis