A 35-year-old primigravida at 38 weeks of gestational age has a blood pressure reading of 150/100 mm Hg obtained during a routine visit. Her baseline blood pressure during the pregnancy was 120/70 mm Hg. The patient denies any headache, visual changes, nausea, vomiting, or abdominal pain. Her repeat BP is 160/90 mm Hg, and urinalysis is negative for protein. Which of the following is the most likely diagnosis?
Preeclampsia
Chronic hypeension with superimposed preeclampsia
Eclampsia
Gestational hypeension
Explanation: Hypeension in pregnancy is defined as blood pressure of 140/90 mmHg or greater on at least two separate occasions that are 6 h or more apa. Gestational hypeension- maternal blood pressure reaches 140/90 mm Hg or greater for the first time during pregnancy, after 20 weeks and proteinuria is not present. Preeclampsia- blood pressure increases to 140/90 mm Hg after 20 weeks of gestation and proteinuria is present (300 mg in 24 h or 1+ protein or greater on dipstick). Eclampsia- is present when women with preeclampsia develop seizures. Chronic hypeension is defined as BP >140/90 mm Hg before pregnancy or diagnosed before 20 weeks of gestation, or hypeension first diagnosed after 20 weeks of gestation and persistent after 12 weeks postpaum.
Pregnancy induced Hypeension