QuestionSBA
QuestionChoice
Gestational (or pregnancy-induced) hypertension is defined by two blood pressure readings of ≥140/90 mmHg on two occasions (at least 4 hours apart) after 20 weeks gestation in a previously normotensive patient. Gestational hypertension does not have associated proteinuria or other clinical features of pre-eclampsia.
49822
a
Gestational hypertension
QuestionChoice
Pre-eclampsia is defined as new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. Whilst headache can be a symptom of pre-eclampsia, the headache this woman is describing sounds more like a tension headache than the classic frontal headache seen in pre-eclampsia.
49824
c
Pre-eclampsia
QuestionChoice
Eclampsia is the presence of tonic-clonic seizures on a background of pre-eclampsia (new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement).
49825
d
Eclampsia
QuestionChoice
HELLP syndrome is a subtype of severe pre-eclampsia characterised by haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). It is much rarer than gestational hypertension, and there is no suggestion of any of these manifestations.
49826
e
HELLP syndrome
QuestionChoice
The patient is hypertensive but has no past medical history, which suggests the hypertension is new, indicating gestational hypertension rather than chronic hypertension.
49823
b
Chronic hypertension
Concept
Chapter
# Summary


Chronic hypertension and gestational hypertension are common conditions that may affect pregnant women. They are defined by consistently high blood pressure readings over a certain threshold. Typical signs and symptoms include elevated blood pressure readings, with gestational hypertension specifically presenting after 20 weeks of gestation with no proteinuria. Differential diagnosis may include preeclampsia and chronic kidney disease. Investigations primarily focus on blood pressure monitoring and urinalysis. Management strategies include the use of safe anti-hypertensive medications, such as labetalol, methyldopa, and nifedipine, and regular monitoring.


# Definition


Chronic hypertension refers to high blood pressure that predates pregnancy or is diagnosed before 20 weeks of gestation. Gestational hypertension, on the other hand, is the onset of high blood pressure after 20 weeks gestation without the presence of proteinuria.


# Epidemiology


Both chronic and gestational hypertension are common conditions amongst pregnant women. It is crucial to manage these conditions effectively to prevent complications such as preeclampsia and low birth weight.


# Aetiology


The causes of chronic and gestational hypertension are multifactorial, often involving genetic predisposition, lifestyle factors, and physiological changes during pregnancy.


# Signs and Symptoms


They are primarily asymptomatic but are detected through elevated blood pressure readings. Gestational hypertension specifically presents after 20 weeks of gestation with no proteinuria.


# Differential Diagnosis


- Preeclampsia: Characterized by high blood pressure and damage to another organ system, most often the liver and kidneys, after 20 weeks of gestation.
- Chronic Kidney Disease: Typically presents with proteinuria, haematuria, and a rise in serum creatinine.

# Investigations

Investigations primarily focus on blood pressure monitoring and urinalysis. Regular monitoring and testing are recommended to track the course of the condition and evaluate the effectiveness of treatments.

# Management

Management strategies for chronic and gestational hypertension in pregnancy include:

- Discontinuation of some anti-hypertensive medications (particularly ACE inhibitors or ARBs) and switching to pregnancy-safe alternatives such as labetalol.
- Regular blood pressure monitoring.
- For gestational hypertension above 140/90 mmHg, offer pharmacological treatment; first line management is oral labetalol.
- If labetalol is not tolerated, alternatives include methyldopa and nifedipine.
- Regular urinalysis is recommended for all women.

# NICE Guidelines

[NICE - Hypertension in
pregnancy: diagnosis and
management](https://www.nice.org.uk/guidance/ng133/resources/hypertension-in-pregnancy-diagnosis-and-management-pdf-66141717671365)


117
116
Hypertension without proteinuria in pregnancy
Topic
38
Obstetrics
Video
Concept
116
Hypertension without proteinuria in pregnancy
642
bjWyPRB
images/videos/endocrinology.png
Quesmed Tutorial: Obstetrics 2
Condition
553
Pre-eclampsia, gestational hypertension
UkmlaTopic
18
Obstetrics and gynaecology
Condition
554
Pre-eclampsia, gestational hypertension
UkmlaTopic
21
Perioperative medicine and anaesthesia
10001
Presentation
304
Headache
UkmlaTopic
1
Acute and emergency
Presentation
305
Headache
UkmlaTopic
3
Cancer
Presentation
306
Headache
UkmlaTopic
5
Child health
Presentation
307
Headache
UkmlaTopic
12
General practice and primary healthcare
Presentation
308
Headache
UkmlaTopic
17
Neurosciences
Presentation
309
Headache
UkmlaTopic
18
Obstetrics and gynaecology
An 18-year-old primigravida woman attends her general practitioner at 22 weeks gestation with a 1-day history of a headache. She describes the headache as a "tight band" around both sides of the head. There are no visual changes or other associated symptoms. She has not utilised any analgesia. She has no past medical history.

She appears well, and her observations are as follows:

- Heart rate: 66 beats per minute
- Blood pressure: 144/98 mmHg
- Respiratory rate: 18 breaths per minute
- Oxygen saturations: 100% on room air
- Temperature: 36.7°C

Urinalysis is normal.

What is the most likely diagnosis?
a