1. 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

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

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

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

5. 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

6. 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

8. 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