Gestational Hypertension (PIH), Preeclampsia (Toxemia) and Eclampsia

by Veronica Gillispie, MD, FACOG

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    Now let's discuss hypertension disorders of pregnancy. There are three disorders that we need to discuss. And we'll start with gestational hypertension. So gestational hypertension or blood pressures greater than 140 over 90. Two blood pressure readings 6 hours apart, diagnosed after 20 weeks of gestation without proteinuria. If those blood pressures exist before 20 weeks, that's considered chronic hypertension. Moving on from gestational hypertension is preeclampsia. Preeclampsia is hypertension with the same blood pressures that we just discussed with proteinuria. So that means protein in the urine. Let's look at preeclampsia in a little more detail. So the blood pressures again greater than 140 over 90, but less than 160 over 110. A protein/creatinine ratio of 0.3. A 24 hour urine protein of greater than 300 milligrams. And absence of severe features. All of these features constitute preeclampsia with mild features. Now preeclampsia can also be diagnosed with severe features. So those are blood pressures greater than 160 over 110. New onsets cerebral or visual disturbances. This often manifest as a unrelenting headache or a headache not relieved by tylenol. Patients will often have visual disturbances such as floaters, spots before their eyes. Any of those would give us the diagnosis of preeclampsia with severe features. Patients may also experience pulmonary edema. Also as part of preeclampsia with severe features is something called HELLP syndrome. Again this is another manifestation of preeclampsia with severe features. So you can have preeclampsia with severe features and not have HELLP syndrome. We're going to talk about help syndrome in a little bit more detail. And then also if the patient has renal insufficiency. Then that gives them diagnosis of preeclampsia with severe features. So HELLP syndrome. That stands for Hemolysis Elevated Liver Enzymes and Low Platelets. Hemolysis is diagnosed by an elevated...

    About the Lecture

    The lecture Gestational Hypertension (PIH), Preeclampsia (Toxemia) and Eclampsia by Veronica Gillispie, MD, FACOG is from the course Antenatal Care. It contains the following chapters:

    • Hypertensive Disorders of Pregnancy
    • Pre-eclampsia
    • Eclampsia
    • Treatment

    Included Quiz Questions

    1. Chronic hypertension
    2. Gestational hypertension
    3. Pre-ecclampsia
    4. Ecclampsia
    5. Can not make a diagnosis of hypertension until you have 3 abnormal blood pressure values each 24 hrs apart
    1. Preeclampsia with severe features
    2. Preeclampsia
    3. Chronic hypertension
    4. Gestational hypertension
    5. Eclampsia
    1. Gestational hypertension
    2. Chronic hypertension
    3. Preeclampsia without severe features
    4. Eclampsia
    5. Preeclampsia with severe features
    1. Preeclampsia with HELLP syndrome, start magnesium sulfate and anti-hypertensives to stabilize the patient.
    2. Preeclampsia with HELLP syndrome, do an immediate cesarean section, then start magnesium sulfate post-partum
    3. Preeclampsia with severe features, start alpha-methyldopa
    4. Ecclampsia, start magnesium sulfate and deliver the baby
    5. Ecclampsia, start magnesium sulfate and labetalol
    1. Elevated creatinine
    2. Elevated lactate dehydrogenase
    3. Elevated aspartate transaminase
    4. Elevated alanine transaminase
    5. Low platelets
    1. Seizures
    2. Proteinuria
    3. Renal insufficiency
    4. Headaches
    5. Blood pressure greater than 160/100
    1. Delivery of the baby
    2. Magnesium sulfate
    3. Anti-hypertensives
    4. Expectant management is sufficient
    5. Anti-epileptics

    Author of lecture Gestational Hypertension (PIH), Preeclampsia (Toxemia) and Eclampsia

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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