A 25-year-old primigravida at 38 weeks gestation has blood pressure readings of 144/92 mmHg and 146/94 mmHg taken 6 hours apart. Urine dipstick shows trace protein. Serum creatinine, platelet count, liver enzymes, and uric acid are all normal. She is asymptomatic. According to ISSHP 2018 and ACOG 2020 criteria, what is the correct diagnosis?

• A Pre-eclampsia without severe features
• B Pre-eclampsia with severe features due to systolic BP ≥160 mmHg
• C Chronic hypertension
• D Gestational hypertension ✓

Explanation

Gestational hypertension is defined as new-onset BP ≥140/90 mmHg after 20 weeks WITHOUT proteinuria or other severe features. Trace protein on dipstick is not diagnostic of significant proteinuria (requires ≥1+ on dipstick or ≥300 mg/24 hours or protein/creatinine ratio ≥0.3). Pre-eclampsia requires both hypertension AND proteinuria or end-organ dysfunction. Her BP does not reach 160/110, so severe features are absent.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.