Definitions/diagnostic criteria for the hypertensive disorders in pregnancy

• New onset of systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on at least 2 occasions 4 hours apart after 20 weeks of gestation in a previously normotensive individual

• No proteinuria
• No signs/symptoms of preeclampsia-related end-organ dysfunction (eg, thrombocytopenia, renal insufficiency, elevated liver transaminases, pulmonary edema, cerebral or visual symptoms)

• New onset of systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on at least 2 occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive individual. Patients with systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg should have blood pressure confirmed within a short interval (minutes) to facilitate timely administration of antihypertensive therapy.

• Proteinuria (≥300 mg per 24-hour urine collection [or this amount extrapolated from a timed collection], or protein:creatinine ratio ≥0.3, or urine dipstick reading ≥2+ [if other quantitative methods are not available]).

In a patient with new-onset hypertension without proteinuria, the diagnosis of preeclampsia can still be made if any features of severe disease are present.

• Systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg on 2 occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time)
• Thrombocytopenia (platelet count <100,000/microL)
• Impaired liver function as indicated by liver transaminase levels at least twice the normal concentration or severe persistent right upper quadrant or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses, or both
• Progressive renal insufficiency (serum creatinine concentration >1.1 mg/dL [97 micromol/L] or doubling of the serum creatinine concentration in the absence of other renal disease)
• Pulmonary edema
• Persistent cerebral or visual disturbances

• A generalized seizure in a patient with preeclampsia that cannot be attributed to other causes

• Hemolysis, Elevated Liver enzymes, and Low Platelets. Hypertension may be present (HELLP in such cases is often considered a variant of preeclampsia).

Hypertension diagnosed or present before pregnancy or on at least two occasions before 20 weeks of gestation. Hypertension that is first diagnosed during pregnancy and persists for at least 12 weeks postpartum is also considered chronic hypertension.

• Blood pressure criteria during pregnancy are:
  • Systolic ≥140 mmHg and/or diastolic ≥90 mmHg
• Prepregnancy and 12 weeks postpartum blood pressure criteria are:
  • Stage 1 – Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
  • Stage 2 – Systolic ≥140 mmHg or diastolic ≥90 mmHg

• A sudden increase in blood pressure that was previously well-controlled or an escalation of antihypertensive therapy to control blood pressure
• New onset of proteinuria or a sudden increase in proteinuria in a patient with known proteinuria before or early in pregnancy
• Significant new end-organ dysfunction consistent with preeclampsia after 20 weeks of gestation or postpartum

• Systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg despite escalation of antihypertensive therapy
• Thrombocytopenia (platelet count <100,000/microL)
• Impaired liver function as indicated by liver transaminase levels at least twice the normal concentration or severe persistent right upper quadrant or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses, or both
• New-onset or worsening renal insufficiency
• Pulmonary edema
• Persistent cerebral or visual disturbances