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Difficulty: MediumObstetric Complications

Match each clinical presentation of a pregnant patient with the most appropriate hypertensive disorder of pregnancy diagnosis.

  • A 26-year-old G1P0 at 36 weeks gestation presents with a blood pressure of 148/94 mm Hg. A 24-hour urine collection yields 150 mg of protein. Fetal heart rate tracing is reactive (Category I). Laboratory values are normal.Gestational hypertension
  • A 31-year-old G2P1 at 34 weeks gestation presents with a blood pressure of 165/112 mm Hg, right upper quadrant pain, and a platelet count of 85,000/mm³. Fetal heart tracing is Category I.Preeclampsia with severe features
  • A 35-year-old G3P2 at 14 weeks gestation presents with a blood pressure of 144/92 mm Hg on two occasions. Urinalysis and basic metabolic panel are normal. Fetal heart tones are reassuring.Chronic hypertension
  • A 29-year-old G1P0 at 33 weeks gestation with known hypertension on methyldopa presents with a blood pressure of 172/114 mm Hg, new-onset 24-hour urine protein of 550 mg, and a Category II fetal heart rate tracing.Superimposed preeclampsia

Answer

L1 matches Gestational hypertension, L2 matches Preeclampsia with severe features, L3 matches Chronic hypertension, L4 matches Superimposed preeclampsia.
Gestational hypertension requires BP ≥ 140/90 mm Hg after 20 weeks without significant proteinuria. Preeclampsia with severe features involves BP ≥ 160/110 mm Hg or end-organ damage (e.g., thrombocytopenia, right upper quadrant pain). Chronic hypertension is diagnosed when BP ≥ 140/90 mm Hg is present before 20 weeks. Superimposed preeclampsia occurs when a patient with known chronic hypertension develops new-onset proteinuria or severe features after 20 weeks.

Step-by-Step Solution

1
Evaluate the gestational age at the onset of hypertension.
Presentations before 20 weeks indicate chronic hypertension (Patient 3). Presentations after 20 weeks indicate gestational hypertension, preeclampsia, or superimposed preeclampsia.
The 20-week threshold distinguishes pre-existing (chronic) conditions from pregnancy-induced conditions.
2
Assess for the presence of proteinuria and end-organ damage in patients presenting after 20 weeks.
Patient 1 lacks significant proteinuria (< 300 mg/24hr) and end-organ damage, indicating gestational hypertension. Patient 2 has severe blood pressure, thrombocytopenia, and right upper quadrant pain, indicating preeclampsia with severe features.
Proteinuria (≥ 300 mg/24 hr) or end-organ dysfunction (e.g., low platelets, liver involvement) differentiates preeclampsia from gestational hypertension.
3
Identify any worsening of baseline parameters in patients with pre-existing hypertension.
Patient 4 has chronic hypertension but presents with suddenly worsening blood pressure and new-onset proteinuria, pointing to superimposed preeclampsia.
Superimposed preeclampsia is diagnosed when a patient with chronic hypertension develops new signs of preeclampsia, such as proteinuria or severe features.

Key Concept

Differentiating hypertensive disorders of pregnancy based on gestational age of onset, blood pressure severity, presence of proteinuria, and end-organ dysfunction.
Estimated Time:1m 30s
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Topics

Obstetric Complications

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