Chronic Hypertension
Chronic hypertension in pregnancy requires prepregnancy medication review when possible, baseline maternal evaluation, fetal surveillance planning as indicated, and treatment thresholds that reflect current evidence rather than older more permissive approaches.
Clinical points
- Patients with chronic hypertension need review of current antihypertensives before or early in pregnancy, including avoidance of contraindicated agents.
- Baseline renal, hepatic, and urine protein assessment is often useful for later comparison if superimposed preeclampsia is suspected.
- Current practice changed after the CHAP study, with broader support for treatment thresholds of 140/90 rather than reserving therapy for very severe values alone.
- Care should also address fetal growth surveillance and aspirin prophylaxis when indicated.
Gestational Hypertension & Preeclampsia
New-onset hypertension after 20 weeks requires evaluation for proteinuria, severe features, maternal organ dysfunction, and fetal effects. Contemporary guidance emphasizes standardized diagnosis, timely escalation, and individualized timing of delivery.
Clinical points
- Preeclampsia is no longer defined solely by hypertension plus proteinuria; severe features and end-organ findings matter.
- Maternal symptoms such as severe headache, vision changes, dyspnea, and right upper quadrant pain require urgent reassessment.
- Laboratory follow-up typically includes platelet count, liver assessment, kidney function, and proteinuria evaluation as clinically indicated.
- Timing of delivery depends on gestational age, disease severity, maternal status, and fetal status.
HELLP Syndrome
HELLP syndrome remains a high-risk obstetric condition that may overlap with or complicate preeclampsia. Distinguishing HELLP from other thrombotic, hepatic, hematologic, and microangiopathic processes is essential.
Clinical points
- Think about HELLP in patients with hypertension or preeclampsia plus thrombocytopenia, transaminitis, hemolysis, right upper quadrant pain, nausea, or malaise.
- Differential diagnosis may include acute fatty liver of pregnancy, TTP, HUS, severe hepatitis, and other thrombotic or hepatic disorders.
- Maternal stabilization and delivery planning depend on severity, gestational age, and maternal-fetal condition.
- Older dexamethasone-focused articles are no longer adequate as primary guidance.
Reference links
- ACOG Practice Bulletin: Gestational Hypertension and Preeclampsia
- AAFP classic review: HELLP syndrome recognition and management
- ISSHP guidance resource
HELLP is best treated as part of a modern severe-feature hypertensive disorders framework rather than through isolated legacy articles.
Eclampsia
Eclampsia is an obstetric emergency requiring maternal stabilization, seizure treatment, severe blood-pressure management, and expedited obstetric decision-making.
Clinical points
- Any seizure in a pregnant or postpartum patient with suspected hypertensive disease should prompt urgent evaluation for eclampsia.
- Airway, oxygenation, maternal stabilization, and antihypertensive therapy for severe-range blood pressure are immediate priorities.
- Magnesium sulfate remains a cornerstone of seizure prophylaxis and treatment in this setting.
- Postpartum eclampsia and postpartum preeclampsia remain important diagnoses and should not be overlooked after delivery.
Low-dose Aspirin Prevention
Low-dose aspirin prophylaxis is now a standard preventive topic on hypertensive disorders pages because it directly affects risk reduction in appropriate patients.
Clinical points
- Assess preeclampsia risk factors early in pregnancy.
- Current ACOG/SMFM guidance supports low-dose aspirin for patients at high risk and selected patients with multiple moderate-risk factors.
- Practice implementation is increasingly checklist-based rather than dependent on memory alone.
- This section pairs well with a future Perinatology aspirin-eligibility wizard.
Postpartum Follow-up
Postpartum hypertensive disease remains clinically important because severe hypertension, readmission, stroke, and delayed complications may occur after discharge.
Clinical points
- Postpartum blood pressure assessment and symptom review are important even after apparently stable delivery hospitalization.
- Patients should receive counseling about warning symptoms such as severe headache, vision change, shortness of breath, chest pain, or severe blood pressure elevation.
- Follow-up intensity should reflect disease severity and ongoing treatment needs.
- Hypertensive disorders should be documented clearly in the postpartum record because they affect long-term preventive care.
Long-term Cardiovascular Risk
Hypertensive disorders of pregnancy are now widely recognized as markers of increased later cardiovascular risk, making transition to long-term preventive care an important part of management.
Clinical points
- A history of preeclampsia or other hypertensive disorders of pregnancy should be communicated to primary care clinicians.
- Patients benefit from counseling about later risk of chronic hypertension and cardiovascular disease.
- Postpartum and interpregnancy care should include attention to blood pressure, weight, exercise, diabetes risk, and other modifiable cardiovascular factors.
- This area has become more prominent in recent literature than on older legacy obstetric pages.
Updated references
General Resources
Additional resources and related Perinatology links.