Brown et al reported the ISSHP classification of hypertensive disorders in pregnancy. The type of hypertension may have prognostic implications for the mother and fetus.
ISSHP is the International Society of Hypertension in Pregnancy.
Patient selection: pregnant woman with hypertension (systolic blood pressure >= 140 mm Hg and/or diastolic blood pressure >= 90 mm Hg.
Clinical Features
Classification
onset of hypertension prior to pregnancy
chronic hypertension
onset of hypertension during pregnancy prior to 20 weeks of gestation
chronic hypertension
onset of pregnancy during pregnancy >= 20 weeks of gestation AND without signs of pre-eclampsia
gestational hypertension
onset of pregnancy during pregnancy >= 20 weeks of gestation AND with signs of pre-eclampsia
pre-eclampsia
Signs of pre-eclampsia - one or both of the following:
(1) proteinuria (protein to creatinine ratio >= 30 mg/mmol)
(2) evidence of organ damage in kidneys, liver, or CNS OR hemolysis OR thrombocytopenia OR fetal growth restriction
Gestational hypertension may be transient or persistent. Some patients with gestational hypertension can progress to pre-eclampsia.
In addition, hypertension prior to 20 weeks gestation may include:
(1) white coat hypertension
(2) masked hypertension
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