Hypertension In Pregnancy – How to Differentiate 4 Types?

Hypertension in pregnancy is defined as BP > or = 140/90 mmHg measure 2 times with at least a 6 hr interval Within 7 days. Or > or = 160/110 mmHg measured even 1 time.

How Do We Measure BP?

Proper BP measurement includes these things.

  • Void full bladder – to avoid sympathetic reflex
  • Not in a cold environment – to avoid increased peripheral resistance
  • No stress
  • Cuff cover 2/3rd of arms-length and the diaphragm cover 80% of arm circumference
  • Hand on the level of the heart
  • Lateral supine or sitting position is preferable in pregnant mothers because a gravid uterus compresses the inferior vena cava on vertebrae and result in supine hypotension syndrome.

Classification Of Hypertension In Pregnancy

There are 4 types.

  • Gestational
  • Preeclampsia
  • Chronic
  • superimposed preeclampsia on chronic hypertension

1&2 called pregnancy-induced hypertension. They usually occur from 20-week antepartum to 12 weeks postpartum.

Gestestional Hypertension

It is a type of pregnancy-induced hypertension like preeclampsia but unlike preeclampsia, there are no proteinuria and severity symptoms here.
Can be mild (If BP < 160/110) and severe (> or = 160/110). in mild cases we need to evaluate the patient every week. in severe cases the patient should be admitted and start antihypertensive.


it is a multisystem disorder of unknown etiology characterized by the development of hypertension to the extent of 140/90mmHg or more with proteinuria after 20th week in previously normotensive and proteinuric women. It accounts for 5-10% of all pregnancy.

Proteinuria defined as at least

  • 300 mg protein/24 hr
  • 100 mg protein /L
  • 1+ on dipstick

Chronic Hypertension in Pregnancy

It is defined as the presence of hypertension of any cause before the 20th week of gestation and its presence beyond the 12 weeks after delivery.

Superimposed Preeclampsia On Chronic Hypertension

To diagnose superimposed preeclampsia, the mother must be hypertensive before the pregnancy and one of the following criteria must be fulfilled.

The criteria are

  • Worsening of hypertension (BP > 160/110)
  • Worsening of proteinuria
Hypertension in Pregnancy

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