BP ≥140/90 mmHg After 20 Weeks
New-onset hypertension after mid-pregnancy anchors the diagnostic pathway.
- ≥140: Systolic threshold (mmHg)
- ≥90: Diastolic threshold (mmHg)
- >20 wks: Onset window (gestation)
- 2×: Readings required (≥4h apart)
Why 20 weeks matters
Placeholder: onset timing separates gestational disease from pre-existing hypertension.
Proteinuria ≥300 mg/24h
Protein loss in urine signals renal involvement alongside elevated BP.
- ≥300mg: 24h threshold (protein/24h)
- ≥0.3: Spot ratio (protein:creatinine)
- ≥1+: Dipstick proxy (if no lab access)
- organ dysfx: Alt criteria (if no proteinuria)
Measuring proteinuria
Placeholder: 24h collection remains reference standard for confirmation.
Gestational Hypertension (BP Only)
Elevated BP after 20 weeks without proteinuria or organ signs.
- Absent: Proteinuria (by definition)
- ~25%: Progression risk (to preeclampsia)
- <12 wks: Resolution (postpartum)
- Weekly: Monitoring (BP + urine)
Follow-up pathway
Placeholder: close monitoring watches for evolving organ involvement.
Preeclampsia (BP + Proteinuria/Organ Involvement)
Hypertension combined with proteinuria or organ dysfunction defines preeclampsia.
- BP+protein: Core criteria (or organ signs)
- BP≥160/110: Severe features (or symptoms)
- 2–8%: Global incidence (of pregnancies)
- Delivery: Definitive tx (timing-dependent)
Severe feature escalation
Placeholder: severe features prompt urgent delivery planning discussions.
Chronic Hypertension Differentiation
Pre-existing hypertension before 20 weeks changes the classification path.
- <20 wks: Onset cutoff (pre-existing)
- ~20%: Superimposed PE (add proteinuria)
- >12 wks: Persists (postpartum)
- Pre-pregnancy: Baseline needed (BP record)
Superimposed preeclampsia
Placeholder: new proteinuria on chronic hypertension signals superimposed disease.
Placeholder: onset timing before or after 20 weeks is the key differentiator.