According to ISSHP (International Society for the Study of Hypertension in Pregnancy) 2018 classification, which of the following is correctly classified as 'pre-existing hypertension with co-existent pre-eclampsia'?
- A New-onset hypertension at 24 weeks with proteinuria in a previously normotensive woman
- B Known hypertensive patient on methyldopa who develops new-onset proteinuria, thrombocytopenia and raised LFTs at 30 weeks ✓
- C Patient with BP > 140/90 on two occasions before 20 weeks with no proteinuria
- D Gestational hypertension developing into eclampsia without proteinuria
Correct answer: B. Known hypertensive patient on methyldopa who develops new-onset proteinuria, thrombocytopenia and raised LFTs at 30 weeks
Explanation
ISSHP 2018 classifies hypertension complicating pregnancy into pre-existing hypertension (diagnosed before 20 weeks) versus gestational hypertension or pre-eclampsia (arising at/after 20 weeks). Pre-existing hypertension with co-existent pre-eclampsia refers to a previously hypertensive woman who develops new end-organ features at or after 20 weeks — such as new proteinuria, thrombocytopenia, or hepatic dysfunction. Option A is de novo pre-eclampsia; Option C is isolated pre-existing hypertension; Option D is gestational hypertension progressing to eclampsia.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.