A 24-year-old primigravida is found at her 30-week antenatal visit to have blood pressure of 146/94 mmHg on two occasions 6 hours apart. Urine dipstick shows no proteinuria. She has no headache, visual symptoms, or epigastric pain. Liver enzymes, platelet count and serum creatinine are normal. Her booking blood pressure at 11 weeks was 112/70 mmHg. What is the most likely diagnosis?

• A Gestational hypertension ✓
• B White coat hypertension
• C Chronic hypertension
• D Pre-eclampsia

Explanation

Gestational hypertension is new-onset hypertension of at least 140/90 mmHg after 20 weeks of gestation in a previously normotensive woman, without proteinuria or severe features. Normal booking pressure excludes chronic hypertension, and absence of proteinuria and end-organ dysfunction excludes pre-eclampsia. White coat hypertension requires normal office readings outside the clinic setting; here both readings are elevated, so clinic-based hypertension after 20 weeks fits gestational hypertension.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.