Definition of "Gestational hypertension"

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Gestational hypertension (aka pregnancy-induced hypertension, PIH) is development of new HTN in a pregnant woman after 20 weeks gestation, without any signs of preeclampsia (including proteinuria). HTN is defined as >140/90mmHg.

Patient information

What is gestational hypertension?
It's high blood pressure that happens after 20 weeks gestation. We define high blood pressure as a pressure >140/90mmHg.

What's up with the 20 weeks gestation?
If you get it any earlier, we call that chronic hypertension. That just means that we say that you've had it always, and it's not due to the pregnancy.

Risk factors
  • Maternal:
    • Obesity
    • 35yo+
    • PH of DM, HTN, renal disease
    • Adolescent pregnancy
    • New paternity
    • Thrombophilias, for example, anti-phospholipid syndrome, protein C/S deficiency, factor V Leiden
    • Having donated a kidney
  • Pregnancy:
    • Multiple gestation
    • Placental abnormalities, including hyperplacentosis, placental ischemia
  • FH:
    • Of pre-eclampsia
    • African descent

Patient information

What makes it more likely to have high blood pressure, due to the pregnancy?
There are features that relate to the mother. To the pregnancy. Or family history. The mother could be obese, be old, have other risk factors for heart disease, teen pregnancy. The pregnancy could be twins/triplets, or there could be problems with the placenta. Other people in the family could have had a pregnancy involving impending seizure, or be of African descent.

Ix
  • BP → monitor if can be kept below 140/90
  • Urine dipstick → proteinuria → pre-eclampsia

Patient information

How do we monitor high blood pressure, due to pregnancy?
Using a blood pressure machine. And testing urine for protein, as that can indicate impending seizure, which we call pre-eclampsia.

Tx
  • Drugs, if the HTN is severe, which are limted as many antihypertensives negatively affect the fetus. Those which can be used include:
    • Labetalol (mixed alpha/beta blocker)
    • Nifedipine (CCB)
    • Hydralazine (causes arterial vasodilation, via nitric oxide)
    • Diazoxide (potassium channel activator)

Source: 2011/pdf/PD2011_064.pdf">NSW Health

Patient information

What can we do in high blood pressure, due to pregnancy?
Drugs to decrease blood pressure.

Prognosis
  • Usually results within 12 weeks of birthing. If it doesn't, the mother may have had undiagnosed chronic HTN
  • Can progress into pre-eclampsia, and it's life threatening complications (HELLP syndrome, and eclampsia)

Patient information

What bad things can happen due to high blood pressure, due to pregnancy?
Things progress on a step-wise scale. Pre-eclampsia, adds protein in urine, indicating problems with the kidney, or some other end organ problem. Eclampsia, also adds seizure.

What about HELLP syndrome, what's that?
It's just a variation of pre-eclampsia. It stands for hemolysis, elevated liver enzymes, and low platelets. It basically just means impending coagulation throughout the body, which we call DIC. Liver enzymes representing the liver. And death of red blood cells and platelets, representing the blood system.

See also
  • Maternal HTN (category)
  • Pre-eclampsia (+proteinuria)
  • Eclampsia (+proteinuria, +seizure)

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Definition of Gestational hypertension | Autoprac


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