Hypertension (high blood pressure) in pregnancy may be new onset or may have existed before pregnancy. In pregnancy-induced hypertension (synonyms: EPH-gestosis; eclampsia; premature gestosis; gestational hypertension; gestosis; gravidity-gestosis; gravidity toxicosis; HELLP syndrome; hypertension in pregnancy (HIS); hypertensive encephalopathy of pregnancy (HES); graft gestosis; Preeclampsia; graft gestosis; preeclampsia; pregnancy hypertension; pregnancy-induced hypertension; pregnancy toxicosis; late gestosis; toxicosis; hypertensive pregnancy disorder; ICD-10-GM O11-O16: Edema, proteinuria, and hypertension during pregnancy, childbirth, and the puerperium), the following forms can be distinguished:
- Gestational hypertension [pregnancy-induced hypertension] (ICD-10-GM O13): new onset of blood pressure ≥ 140-90 mmHg during pregnancy in a previously normotensive pregnant woman (with normal blood pressure) without additional criteria defining preeclampsia
- Gestational proteinuria: new-onset proteinuria in pregnancy ≥ 300mg/d or protein/creatinine percent ≥ 30 mg/mmol without additional criteria fulfilling the condition of preeclampsia and without preexisting renal cause
- Preeclampsia (PE) (EPH-gestosis or proteinuric hypertension; ICD-10-GM O14.-: preeclampsia): any elevated blood pressure (even preexisting) ≥ 140-90 mmHg in pregnancy with at least one new-onset organ manifestation that cannot be attributed to any other cause:
- Organ manifestation in preeclampsia can typically be detected mostly in the kidney by proteinuria ≥ 300mg/d or protein/creatinine percent ≥ 30 mg/mmol.
- In the absence of proteinuria, preeclampsia is likely if there are new functional impairment/pathologic findings of typical organ systems in addition to hypertension: Kidney, liver, respiratory system, hematologic system, placenta (SGA: small for Gestational Age/”small related to gestational age”/intrauterine growth retardation (UGR)). Central nervous system (CNS).
- HELLP syndrome (H = hemolysis/dissolution of erythrocytes (red blood cells) in the blood), EL = elevated liver enzymes, LP = low platelets; ICD-10-GM O14.2: HELLP syndrome); often associated with preeclampsia.
- Eclampsia (ICD-10 O15.-): chronic chronic seizures occurring during pregnancy (often associated with preeclampsia) that cannot be attributed to any other neurologic cause (e.g., epilepsy).
- Chronic hypertension in pregnancy (ICD-10-GM O16: Unspecified maternal hypertension): hypertension diagnosed preconceptionally (before conception) or in the first trimester (third trimester of pregnancy).
Notice. There are also gestational edema (water retention during pregnancy) and gestational proteinuria [pregnancy-induced] without hypertension (ICD-10-GM O12.-). Peak incidence: first-time mothers and women over 35 years of age are more commonly affected. The prevalence (disease incidence) of hypertensive pregnancy disorders is 6-8%. The prevalence of gestosis is 5-7% (in Western Europe). The incidence (frequency of new cases) of preeclampsia is 2% (in Europe). Course and prognosis: If blood pressure values are ≥ 160 mmHg systolic or ≥ 110 mmHg diastolic, admission to the hospital should be made. The same applies in case of clinical or laboratory suspicion of HELLP syndrome (see above ), especially in case of persistent upper abdominal pain as well as eclampsia, preeclampsia with severe neurological prodromal phase (precursor phase of diseases), dyspnea (shortness of breath) and/or hypertensive crises with vital threat (immediate transport via ambulance to the hospital). Regardless of the maternal situation (maternal situation), there are fetal (child) indications for admission to the clinic.In gestational hypertension, blood pressure values normalize within the first 12 weeks after delivery. HELLP syndrome can have life-threatening courses. In industrialized countries, hypertensive disorders of pregnancy (HES) account for 20-25% of perinatal deaths (deaths during delivery and up to day 7 postpartum) and are the second leading cause of prenatal and postnatal mortality.10-15% of all maternal deaths are due to preeclampsia.
