ObstetricsTier 2Topic

Risk factors for common pregnancy-associated diseases - hypertension

Spectrum

Spectrum: gestational hypertension (new BP >=140/90 after 20 weeks, no proteinuria/end-organ involvement) -> pre-eclampsia (+ proteinuria or other end-organ dysfunction) -> eclampsia (+ seizures) -> HELLP syndrome (haemolysis, elevated liver enzymes, low platelets)
Chronic hypertension = pre-existing, or diagnosed before 20 weeks

Abnormal placentation - failure of trophoblastic invasion/remodelling of spiral arteries -> placental hypoperfusion -> release of anti-angiogenic factors (sFlt-1) -> systemic endothelial dysfunction
Risk factors: nulliparity, prior pre-eclampsia, chronic hypertension, pre-existing diabetes, multiple pregnancy, obesity, antiphospholipid syndrome, maternal age >=40, family history, interpregnancy interval >10 years
High-risk women -> low-dose aspirin from before 16 weeks reduces incidence

Hypertension: BP >=140/90 on two occasions >=4 hours apart, after 20 weeks gestation, in a previously normotensive woman
Pre-eclampsia = hypertension + one of: proteinuria (UPCR >=30mg/mmol or >=300mg/24h), renal impairment, liver involvement, neurological features, thrombocytopenia/haemolysis, or fetal growth restriction
Severe features: BP >=160/110, symptoms (headache, visual disturbance, epigastric pain), or any end-organ feature above -> expedite delivery planning

Antihypertensives: labetalol, oral nifedipine, methyldopa (all safe); avoid ACEi/ARB (teratogenic)
Magnesium sulfate for seizure prophylaxis in severe pre-eclampsia/eclampsia
Delivery is the only definitive treatment - timing balances maternal severity against fetal gestational age

Usually resolves within days-weeks postpartum, but BP can peak 3-6 days after delivery
Recurrence risk in future pregnancies is significant, especially after early-onset/severe first episode

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