Laboring Under Pressure Episode 3: Hypertensive Disorders of Pregnancy with Dr. Kiersten Williams

Emergency Medical Minute

Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS3

Show Pearls

• Hypertensive disorders of pregnancy are one of the leading causes of maternal mortality worldwide.

• Hypertension (HTN) complicates 2-8% of pregnancies

• The definition of HTN in pregnancy is a systolic >140 or diastolic >90, measured 4 hours apart

• There is a range of HTN disorders

• Chronic HTN which could have superimposed preeclampsia (preE) on top

• Gestational HTN in which there are no lab abnormalities

• PreE w/o severe features

• Protein in urine

• Urine protein >300 mg in 24 hours

• Urine Protein to Creatinine ratio of .3

• +2 Protein on urine dipstick

• PreE w/ severe features

• Systolics above 160 mmHg

• Diastolics above 110 mmHg

• Headache, especially not going away with meds, or different than previous headaches

• Visual changes, anything that lasts more than a few minutes

• RUQ pain, which could present as heartburn

• Pulmonary edema

• Low platelets, if