Definitions for the hypertensive disorders of pregnancy

• New onset of systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on at least 2 occasions 4 hours apart after 20 weeks of gestation in a previously normotensive individual

• No proteinuria
• No signs/symptoms of preeclampsia-related end-organ dysfunction (eg, thrombocytopenia, renal insufficiency, elevated liver transaminases, pulmonary edema, cerebral or visual symptoms)

• New onset of systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on at least 2 occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive individual or systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy

• Proteinuria (≥300 mg per 24-hour urine collection [or this amount extrapolated from a timed collection], or protein:creatinine ratio ≥0.3, or urine dipstick reading ≥2+ [if other quantitative methods are not available])

Or, in the absence of proteinuria, new-onset hypertension with the new onset of any of the following:

• Thrombocytopenia (platelet count <100,000/microL)
• Renal insufficiency (serum creatinine of >1.1 mg/dL [97 micromol/L] or a doubling of the serum creatinine concentration in the absence of other renal disease)
• Impaired liver function as indicated by liver transaminase levels at least twice the normal concentration
• Pulmonary edema
• Persistent cerebral or visual symptoms

• Systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg on 2 occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time)
• Thrombocytopenia (platelet count <100,000/microL)
• Impaired liver function as indicated by liver transaminase levels at least twice the normal concentration or severe persistent right upper quadrant or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses, or both
• Progressive renal insufficiency (serum creatinine concentration >1.1 mg/dL [97 micromol/L] or a doubling of the serum creatinine concentration in the absence of other renal disease)
• Pulmonary edema
• Persistent cerebral or visual disturbances

• In a patient with preeclampsia, a generalized seizure that cannot be attributed to other causes

• Presence of HELLP; hypertension may be present (HELLP in such cases is often considered a variant of preeclampsia)

• Hypertension diagnosed or present before pregnancy or on at least two occasions before 20 weeks of gestation. Hypertension that is first diagnosed during pregnancy and persists for at least 12 weeks post-delivery is also considered chronic hypertension.
  • The blood pressure criteria are systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Ideally, this diagnosis is based on at least 2 elevated blood pressure measurements taken at least 4 hours apart. In the setting of severe hypertension (systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg), the diagnosis can be confirmed in a shorter interval to facilitate timely treatment.

• A sudden increase in blood pressure that was previously well-controlled or an escalation of antihypertensive therapy to control blood pressure
• New onset of proteinuria or a sudden increase in proteinuria in a patient with known proteinuria before or early in pregnancy
• Significant new end-organ dysfunction consistent with preeclampsia after 20 weeks of gestation or postpartum.