Hypertensi
                        on 
            Disorders                                               Gestational HTN
                         in                                         Transient HTN of 
                                                                     pregnancy
          Pregnancy                                                 Preeclampsia
                                                                        Mild
                                                                        Severe
             Classification of the 
            American College of                                     Eclampsia
              Obstetricians and 
                 Gynecologists                                      Chronic HTN preceding 
                                                                     pregnancy
                                                                    Chronic HTN with 
                                                                     superimposed pregnancy-
                                                                     induced hypertension
                                                                        Superimposed 
                                                                         preeclampsia
                                                                        Superimposed eclampsia
       Gestational 
      Hypertension
                S
                                Gestational HTN
               sustained systolic blood pressure at or above 
                140mmHg, or a diastolic blood pressure of 
                90mmHg or greater
               increase in BP must be present on at least 
                two separate occasions, 6 hours or more 
                apart
               HTN in late pregnancy (>20 weeks gestation) 
                in the absence of other findings suggestive of 
                preeclampsia
               if BP returns to baseline by 12 weeks 
                postpartum = dx. of Transient hypertension 
                of pregnancy
                        Gestational HTN
            5-10% of pregnancies that proceed beyond 1st 
             trimester develop gestational HTN
            increased incidence of up to 30% in multiple 
             gestation
            15-25% of women initially diagnosed with 
             gestational HTN develop preeclampsia
            Earlier onset of gestational HTN are more likely to 
             progress to preeclampsia
                              Pathophysiology
                                     Changes seen in patients
               Cardiovascular effects
                  Elevated BP
                  Increased cardiac output
               Hematologic effects
                  Third spacing of fluid due to increased blood 
                   pressure and decreased plasma oncotic 
                   pressure
               Renal effects
                  Atheroscleroticlike changes in renal vessels 
                   (glomerular endotheliosis)  decreased 
                   glomerular filtration rate and proteinuria 
                  Uric acid filtration is decreased