1. Hypertensive Disorders of Pregnancy
Laura Chambers-Kersh
Resident School 10/5/16

2. OBJECTIVES
Review and differentiate the diagnosis and management of gestational hypertension (GHTN), preeclampsia (with and without severe features), and chronic hypertension in pregnancy
Explain potential duration of disease presentation, including postpartum follow-up
Review preeclampsia prevention and risk factors
Touch briefly on epidemiology and racial disparities

3. Chronic Hypertension 3% of pregnancies
25% go on to develop superimposed preeclampsia

4. Gestational Hypertension
50% of women diagnosed with gestational HTN between 24 and 35 weeks will develop preeclampsia

5. Preeclampsia 4.6% of pregnancies worldwide, 3.4% in the US
Accounts for 15% of all US preterm births
Causes 18% of maternal deaths in the US
Abalos E, Cuesta C, Grosso AL, Chou D, Say L SO. Eur J Obstet Gynecol Reprod Biol Sep;
170(1):1-7. Epub 2013 Jun 7.
Ananth CV, Keyes KM, Wapner RJ SOBMJ. 2013;347:f6564. 
Goldenburg RL, Rouse DJ. New England Journal of Medicine 1998; 339:
The Preeclampsia Foundation (PF):
Population Reference Bureau 2002:

6. Racial Disparities
Adverse outcome
African Americans
Hispanic
Preeclampsia
1.30
(1.28, 1.33)
0.89
(0.87, 0.94)
Preterm birth
1.34
(1.32, 1.36)
0.91
(0.90, 0.93)
abruption
1.23
(1.19, 1.27)
0.63
(0.61, 0.66)
Fetal death
1.89
(1.81, 1.98)
0.86
(0.81, 0.92)
2012 cross-sectional study examining racial-ethnic disparities in pregnancy among Medicaid recipients in 14 southern states
3-year data set ( ) for approximately 1.5 million birth
Rates are shown after adjusting for age, hospital stay and c-section
OR, 95% CI
Zhang S, Cardarelli K, Shim R, Ye J, Booker KL, Rust G. Matern Child Health J Oct;17(8):
doi: /s

7. Eclampsia
Antepartum 53%
intrapartum 19%
postpartum 28%

8. Chronic Hypertension Outcomes
26% get superimposed preeclampsia
% abruption
28% preterm delivery
20% NICU admission
17% birth weight < 2500 gm
4% perinatal mortality