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Difficulty: MediumObstetric Complications

Match each clinical presentation of a pregnant patient with the most accurate diagnosis regarding her hypertensive disorder.

  • A 28-year-old G1P0 at 38 weeks gestation presents with blood pressures of 145/92 mm Hg and 148/90 mm Hg recorded 6 hours apart. She reports no headache, visual changes, or abdominal pain. A 24-hour urine collection yields 150 mg of protein, and serum laboratory studies are normal.Gestational hypertension
  • A 35-year-old G2P1 at 32 weeks gestation presents with a blood pressure of 165/112 mm Hg and complains of a severe, unrelenting frontal headache. Her platelet count is 120,000/mm³ and serum creatinine is 0.8 mg/dL.Preeclampsia with severe features
  • A 24-year-old G1P0 at 36 weeks gestation has a blood pressure of 150/95 mm Hg. She complains of severe right upper quadrant pain. Laboratory testing reveals a platelet count of 85,000/mm³, aspartate aminotransferase of 120 U/L, and a peripheral smear showing schistocytes.HELLP syndrome
  • A 31-year-old G3P2 at 16 weeks gestation presents for a routine prenatal visit. Her blood pressure is 152/96 mm Hg, and a repeat measurement 4 hours later is 148/94 mm Hg. Urinalysis demonstrates no proteinuria, and she is entirely asymptomatic.Chronic hypertension
  • A 22-year-old G1P0 at 39 weeks gestation presents to the emergency department actively exhibiting generalized tonic-clonic seizure activity. Her blood pressure is 155/100 mm Hg, and a catheterized urine specimen shows 3+ protein on a dipstick.Eclampsia

Answer

The correct pairings differentiate the hypertensive disorders of pregnancy based on gestational age at onset, the degree of blood pressure elevation, and the presence or absence of proteinuria, end-organ dysfunction, hemolysis, or seizures.
Each clinical presentation strictly aligns with standard diagnostic criteria for hypertensive disorders in pregnancy, which rely on gestational age limits, specific blood pressure thresholds, quantified proteinuria, and clinical signs of systemic organ involvement.

Step-by-Step Solution

1
Evaluate the gestational age at the onset of hypertension.
Hypertension presenting before 20 weeks of gestation (e.g., 16 weeks) indicates chronic hypertension, whereas onset at or after 20 weeks indicates a pregnancy-induced disorder.
The 20-week mark is the fundamental threshold distinguishing chronic hypertension from gestational hypertension and preeclampsia.
2
Assess for the presence of proteinuria or end-organ dysfunction in patients with hypertension onset after 20 weeks.
The absence of both significant proteinuria (<300 mg/day) and end-organ damage points directly to gestational hypertension.
Proteinuria or evidence of end-organ damage distinguishes preeclampsia from simple gestational hypertension.
3
Identify severe features or specific life-threatening syndromes in patients meeting criteria for preeclampsia.
A severe headache or blood pressure ≥160/110 mm Hg indicates preeclampsia with severe features. Hemolysis, elevated liver enzymes, and low platelets indicate HELLP syndrome. The presence of generalized seizures indicates eclampsia.
Accurately categorizing the severity and identifying specific complications dictates the urgency of obstetric and medical management.

Key Concept

Classification and Diagnostic Criteria for Hypertensive Disorders of Pregnancy
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Topics

Obstetric Complications

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