Hypertensive disorders of pregnancy

1. Big picture

Hypertensive disorders of pregnancy are among the most important causes of maternal mortality, perinatal mortality, fetal growth restriction, placental abruption, preterm birth, eclampsia, HELLP syndrome, stroke, renal failure, pulmonary edema, and disseminated intravascular coagulation (DIC).

The examiner wants you to think in this order:

Pregnant woman with high blood pressure
        ↓
Is she ≥20 weeks?
        ↓
Is there proteinuria or organ dysfunction?
        ↓
Are there severe features?
        ↓
Is the mother stable?
        ↓
Is the fetus compromised?
        ↓
Stabilize mother → prevent seizure → control BP → decide timing of delivery

Core oral-exam sentence:

Hypertensive disorders in pregnancy are diagnosed by elevated blood pressure, but their danger comes from systemic endothelial dysfunction, maternal organ injury, and placental insufficiency; severe disease requires urgent maternal stabilization, magnesium sulfate when indicated, antihypertensive treatment, fetal assessment, and delivery planning.

Pre-eclampsia usually develops after 20 weeks and is diagnosed by hypertension with proteinuria or maternal organ dysfunction; it can progress to eclampsia and HELLP syndrome and contributes significantly to maternal and perinatal morbidity and mortality. ([World Health Organization][1])

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