Gestational Hypertension

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  1. Gestational Hypertension (GHTN): After 20 weeks gestation, blood pressure (BP) of systolic of 140 or greater OR diastolic of 90 or greater, two values at least 4 hour apart.
  2. Preeclampsia: GHTN with proteinuria.
  3. Proteinuria: Protein/creatinine of 0.3 or greater OR a 24 hour urine protein of 300 or greater.
  4. Severe features:
    1. Systolic BP of 160 or greater OR diastolic of 110 or greater
    2. Thrombocytopenia, 100,000 or less
    3. Impaired liver function as indicated by AST or ALT more than 2 times normal or by severe persistent right upper quadrant (RUQ) ore epigastric pain.
    4. Renal insufficiency as indicated by a serum creatinine of 1.1 or greater or doubling of serum creatinine.
    5. Pulmonary edema
    6. New onset headache unresponsive to medication and not accounted for by alternative diagnoses
    7. Visual disturbances

What is the difference between GHTN and preeclampsia?

Nothing really. Treatment is identical. One has proteinuria, preeclampsia, and the other does not.

Patients at risk

  • Nulliparity
  • Twins
  • Young, age < 19
  • Age 35 or older
  • BMI >30
  • History of preeclampsia
  • Family history of preeclampsia
  • Chronic hypertension
  • Diabetes before pregnancy
  • Gestational diabetes
  • Thrombophilia
  • Lupus
  • Antiphospholipid antibody syndrome
  • Kidney disease
  • Assisted reproductive technology
  • Obstructive sleep apnea


  • Aspirin 162 mg po daily from 12 to 36 weeks.
  • Who should get the aspirin?
  1. Any diagnosis
    1. History of preeclampsia
    2. Twins
    3. Chronic hypertension
    4. Diabetes before pregnancy
    5. Renal disease
    6. Autoimmune disease ( Lupus, antiphospholipid antibody syndrome)
    7. Nulliparity
  2. Any two diagnoses
    1. Obesity
    2. Family history of preeclampsia
    3. Sociodemographic characteristics (African American race, low socioeconomic status)
    4. Age 35 years or older
    5. Inter deliver interval of 10 years or longer
    6. History of low birth weight or IUGR
    7. Previous adverse pregnancy outcome


The ultimate treatment is delivering the baby. This is done at 37-38 weeks in mild cases and sooner, if necessary in severe cases. The HROB physician will make the decision regarding timing and location of delivery at the time of diagnosis or during monitoring.

Management in Clinic

If the patient has mild disease, the fetus is well and the gestational age is less than 38 weeks, we will follow the patient and fetus in the clinic. This will include twice-weekly visits with NST every visit. Ultrasound for AFI every week and growth scans every three weeks. Discuss the case with the HROB physician at EVERY visit.


Notify the inpatient hospitalist physician of the impending induction at 37 weeks of gestation or sooner. TigerText "Kusko Wards Doctor" or "Yukon Wards Doctor" OR Call 543-6434 or 543-6413 to reach them. Once you have handed off the patient at the 37 plus week visit, the patient now is the responsibility of the inpatient physician. They need no further outpatient appointments and need no more follow up from outpatient staff or case managers.

Worsening diseases

Since you will discussing the case at every visit with the HROB physician, you and the HROB physician will develop a plan of management for worsening disease. If the patient is unstable, they will be transferred to the OB unit for monitoring.

Antenatal Steroid and BIB labs

If iatrogenic preterm delivery is likely, obtain BIB labs as soon as possible and strongly consider antenatal steroids (betamethasone) to decrease neonatal complications.

Severe Hypertension

Definition of severe hypertension is persistent blood pressure of 160 or greater systolic or 110 or greater diastolic. Persistent is over 20-30 minutes. This can occur both before and after the birth of the baby. This is an EMERGENCY to prevent severe maternal morbidity or mortality. See the guideline for details, but the primary goal is to reduce blood pressure quickly. Agents of choice are nifedipine oral or labetalol IV. All units seeing OB patients have one or both of these products. When the severe hypertension occurs in an outpatient setting, transfer of patient to ED or OB should not delay treatment with Nifedipine.

Future Health

Patients with a history of GHTN have a 10% chance of developing hypertension later in live. Patients with preeclampsia have a 5% chance of developing hypertension later in live. All of these patients should have long term health monitoring.


YKHC Clinical Guidelines
Common/Unique Medical Diagnoses