Match each clinical presentation to the most appropriate diagnosis regarding hypertensive disorders of pregnancy.
- A 22-year-old at 38 weeks gestation with newly elevated blood pressure of 148/92 mm Hg, 24-hour urine protein of 150 mg, and no systemic symptoms. Blood pressure normalizes by 6 weeks postpartum.Gestational hypertension
- A 34-year-old at 14 weeks gestation with blood pressure of 144/94 mm Hg on two occasions 4 hours apart, and negative urinalysis for protein.Chronic hypertension in pregnancy
- A 29-year-old at 35 weeks gestation with blood pressure of 162/112 mm Hg, right upper quadrant pain, platelet count of 90,000/mm³, and 24-hour urine protein of 200 mg.Preeclampsia with severe features
- A 37-year-old at 32 weeks gestation with a history of essential hypertension on labetalol who develops a sudden blood pressure exacerbation to 175/115 mm Hg and new-onset visual scotomata.Superimposed preeclampsia with severe features
Answer
The presentations map to Gestational hypertension, Chronic hypertension in pregnancy, Preeclampsia with severe features, and Superimposed preeclampsia with severe features, based on gestational age at onset, proteinuria, and the presence or absence of severe features.
Hypertensive disorders of pregnancy are rigorously categorized based on three factors: the timing of onset relative to 20 weeks gestation, the presence or absence of proteinuria, and the presence or absence of severe end-organ features. Identifying these parameters is critical for accurate diagnosis and maternal-fetal risk stratification.
Step-by-Step Solution
Key Concept
Classification of hypertensive disorders of pregnancy relies on gestational age of onset (before or after 20 weeks), presence of proteinuria, and presence of severe features.