Gestational Hypertension


Gestational Hypertension, Postpartum Hypertension

  • Definitions
  1. Gestational Hypertension
    1. Hypertension in Pregnancy with onset beyond 20 weeks gestation and NO Proteinuria
    2. Preeclampsia will develop in 50% of those with Gestational Hypertension
  2. Postpartum Hypertension
    1. Hypertension onset after delivery
  • Precautions
  1. Preeclampsia will develop in 50% of those with Gestational Hypertension onset 24-35 weeks
    1. Barton (2001) Am J Obstet Gynecol 184(5): 979-83 [PubMed]
  2. Severe Gestational Hypertension is associated with worse outcomes than mild PIH
    1. Treat with same management protocol as Severe Preeclampsia
    2. Buchbinder (2002) Am J Obstet Gynecol 186:66-71 [PubMed]
  • Labs
  1. Initial
    1. Complete Blood Count with Platelet Count
    2. Serum Electrolytes including Serum Potassium
    3. Serum Creatinine and Blood Urea Nitrogen
    4. Lactate Dehydrogenase (LDH, obtain as initial baseline, and if HELLP develops)
    5. Serum transaminases (AST, ALT)
    6. Spot Urine Protein to Creatinine Ratio (or 24 Hour Urine Protein)
  2. Later
    1. Repeat initial labs weekly (other than LDH)
  • Monitoring
  1. Initial evaluation (at time of diagnosis)
    1. Estimate Fetal Growth
    2. Estimate amniotic fluid index (AFI) weekly
    3. Non-Stress Test (NST) 1-2 times weekly
    4. Biophysical Profile (BPP) if NST not reactive
    5. Further evaluation if BPP <8
  2. Repeat Testing
    1. Ultrasound every 4 weeks starting at 28 weeks gestation (assess Fetal Growth)
    2. Other testing as indicated for significant maternal status changes
  • Management
  • Gestational Hypertension
  1. Clinic visits at least weekly
    1. Monitor for development of Preeclampsia (and esp. Severe Preeclampsia)
    2. Blood Pressure Monitoring
    3. PIH Symptom assessment
    4. Repeat labs (CBC, BMP/chem, AST, ALT, Urine Protein to Creatinine Ratio)
  2. Gestational Hypertension with Severe Features (treated as Severe Preeclampsia)
    1. Gestational Hypertension AND
    2. End organ injury OR severe range Hypertension (SBP>160 or DBP>110 mmHg on two readings)
      1. See Severe Preeclampsia for end organ injury criteria
  3. Hypertension Management with Medications
    1. See PIH Blood Pressure Management
    2. Indicated only for Gestational Hypertension with Severe Features (>160/110 mmHg)
    3. Contrast with chronic Hypertension in which medications are started when >140/90 mmHg
  4. Delivery timing
    1. Recommended at 37 weeks (or at time of diagnosis)
  • Management
  • Postpartum Hypertension
  1. Obtain labs as above (if not already performed)
  2. Monitor for Preeclampsia With Severe Features
  3. Hypertension Management with Medications
    1. Treat confirmed elevated Blood Pressures >150/100 mmHg
  • Complications
  • Pregnancy Related
  1. Superimposed Preeclampsia (50% for Gestational Hypertension)