Patient presents up to 6 weeks postpartum.
Decision
What is the blood pressure?
Background
Pre-eclampsia is characterized by elevated blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) after 20 weeks’ gestation, with clinical signs and laboratory abnormalities involving the hematologic, renal, hepatic, pulmonary, and/or neurologic systems. If the patient presents with features of pre-eclampsia and new onset seizures, a diagnosis of eclampsia is given.
Along with elevated blood pressure, proteinuria is a hallmark of pre-eclampsia. A random urine dipstick reading of 1+ is suggestive, but not diagnostic of this criterion. If other quantitative measures are not available, a urine dipstick reading of 2+ is more suggestive of pre-eclampsia. Criteria for pre-eclampsia with severe features includes severe blood pressure elevation (systolic blood pressure >160 mm Hg or diastolic blood pressure >110 mm Hg on 2 occasions, 4 hours apart, in addition to the renal, hepatic (thrombocytopenia), pulmonary, and neurologic criteria for pre-eclampsia. From an emergency medicine standpoint, a blood pressure of 160/110 mm Hg is considered severe hypertension in pregnancy, and treatment with antihypertensives should be initiated without waiting for obstetrics/gynecology (ob/gyn) specialist input.
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