A 39-year-old G2P1001 at 39 weeks’ gestational age is sent to labor and delivery from her obstetrician’s office because of a blood pressure reading of 150/100 mm Hg obtained during a routine OB visit. Her baseline blood pressures during the pregnancy were 100 to 120/60 mm Hg to 70 mm Hg. On arrival to labor and delivery, the patient reports no headache, visual changes, nausea, vomiting, or abdominal pain. The heart rate strip is reactive and the tocodynamometer shows irregular uterine contractions. The patient’s cervix is 3 cm dilated. Her repeat blood pressure is 160/90 mm Hg. Hematocrit is 34.0%, platelets are 90,000 mL, SGOT is 22 units per liter, SGPT is 15 units per liter, and urinalysis is negative for protein.
Which of the following is the most correct diagnosis?
A. PreeclampsiaIn 2013, and the ACOG task force published new evidence based recommendations about hypertension in pregnancy. They recognize four categories of hypertension in pregnancy. These are as follows: (i) preeclampsia-eclampsia, (ii) chronic hypertension, (iii) chronic hypertension with superimposed preeclampsia, and (iv) gestational hypertension. Preeclampsia is defined as blood pressure of 140/90 mm Hg or greater on at least two separate occasions that are 6 hours or more apart after 20 weeks’ gestation, in conjunction with proteinuria greater than 300 mg per 24-hour urine collection (or a dipstick reading of +1 if other quantitative methods are not available). In recognition of the syndromic nature of preeclampsia, the task force removed the dependence of the diagnosis on the presence of proteinuria. In the absence of proteinuria, preeclampsia is diagnosed as hypertension in association with thrombocytopenia, impaired liver function, new renal insufficiency, pulmonary edema, or new-onset cerebral or visual disturbances. Gestational hypertension is blood pressure elevation after 20 weeks’ gestation without proteinuria or the aforementioned systemic findings. Chronic hypertension is hypertension that predates pregnancy. Superimposed preeclampsia is chronic hypertension in association with preeclampsia. Eclampsia is present when women with preeclampsia develop seizures.