How are hypertensive disorders diagnosed during pregnancy?

Updated: Jun 12, 2018
  • Author: Michael P Carson, MD; Chief Editor: Edward H Springel, MD, FACOG  more...
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Determining whether elevated blood pressure identified during pregnancy is due to chronic hypertension or to preeclampsia is sometimes a challenge, especially if no recorded blood pressures from the first half of the gestation are available. Clinical characteristics obtained via history, physical examination, and certain laboratory investigations may be used to help clarify the diagnosis. Fetal well-being must also be considered with the workup of the mother.

Preeclampsia is rare before the third trimester, and the diagnosis of severe hypertension or preeclampsia in the first or early second trimester necessitates exclusion of gestational trophoblastic disease and/or molar pregnancy. Mild lower extremity edema is common in normal pregnancy, but rapidly increasing or nondependent edema may be a signal of developing preeclampsia. However, edema is no longer included among the criteria for the diagnosis of preeclampsia.

New seizures in pregnancy suggest preeclampsia-eclampsia, but primary neurologic disorders must be excluded.

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