A 35-year-old woman at 28 weeks gestation presents with blood pressure 158/104 mmHg on two occasions 6 hours apart. Urine dipstick shows trace protein. Platelets are 180,000. Liver enzymes are normal. She has no headache or visual disturbance. What is the most appropriate classification?

• A Gestational hypertension ✓
• B Preeclampsia without severe features
• C Chronic hypertension
• D Preeclampsia with severe features

Explanation

Gestational hypertension is defined as new-onset hypertension after 20 weeks gestation with systolic at least 140 or diastolic at least 90 on two occasions at least 4 hours apart, without proteinuria or severe features. Preeclampsia requires hypertension plus proteinuria greater than 300 mg in 24 hours or a protein-to-creatinine ratio at least 0.3, or severe features such as platelets below 100,000, elevated liver enzymes, renal insufficiency, pulmonary edema, or cerebral or visual symptoms. Trace protein on dipstick is insufficient for preeclampsia diagnosis.

Reference: Williams Obstetrics, 26th ed.

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