Sign in Subscribe
Education

Gestation Hypertension and Eclampsia

mLpenguin

• 1 min read
Gestation Hypertension and Eclampsia
Photo by Joshua Chehov / Unsplash

Gestational Hypertension

Definition/Cause

  • New-onset BP ≥140/90 mmHg after 20 weeks gestation
  • No proteinuria or end-organ damage
  • Etiology: Unknown; possibly abnormal placentation → vascular dysfunction

Clinical Symptoms

  • Often asymptomatic
  • No proteinuria, edema may be present
  • Normal labs

Management

  • Monitor BP and symptoms closely
  • Weekly labs: CBC, liver function tests, urine protein
  • Deliver at 37 weeks if stable
  • Antihypertensives if BP ≥160/110: labetalol, hydralazine, or nifedipine

Preeclampsia

Definition/Cause

  • BP ≥140/90 mmHg after 20 weeks + proteinuria (≥300 mg/24 hr or protein/creatinine ≥0.3)
  • OR signs of end-organ damage
  • Caused by abnormal placental spiral artery remodeling → endothelial dysfunction

Clinical Symptoms

  • Headache, visual changes, RUQ/epigastric pain, edema
  • Proteinuria on dipstick or 24-hour urine
  • Mild lab changes possible

Management

  • If <37 weeks and stable: expectant management with close monitoring
  • If ≥37 weeks: delivery
  • Antihypertensives if BP ≥160/110
  • Consider magnesium sulfate for seizure prophylaxis (if progressing)
    • Prevent neruodegenerative diseases (cerebral palsy) in infant

Preeclampsia with Severe Features

Definition/Cause

  • Preeclampsia + one or more of the following:
    • BP ≥160/110 mmHg
    • Platelets <100,000
    • Elevated liver enzymes with RUQ pain
    • Creatinine >1.1 mg/dL or doubling
    • Pulmonary edema
    • CNS symptoms (headache, vision changes)

Clinical Symptoms

  • Severe hypertension
  • Persistent headache, scotoma, RUQ pain
  • Signs of end-organ dysfunction

Management

  • Magnesium sulfate for seizure prophylaxis
    • Prevent neruodegenerative diseases (cerebral palsy) in infant
  • Antihypertensives (labetalol, hydralazine, nifedipine)
  • Immediate delivery at ≥34 weeks or any gestational age if unstable

Eclampsia

Definition/Cause

  • New-onset generalized tonic-clonic seizures in a woman with preeclampsia
  • Seizures not attributable to other neurologic disorders

Clinical Symptoms

  • Seizures
  • May have headache, visual changes, RUQ pain beforehand
  • Hypertension and proteinuria present

Management

  • ABC stabilization
  • Magnesium sulfate IV bolus (repeat if seizure recurs)
  • Antihypertensives
  • Delivery once stabilized (after maternal stabilization - not emergent C-section unless fetal distress)
    • Delivery before 34wk → steroid
      • Fetal lung maturation