Which of the following statements is true regarding gestational blood pressures?
A. Pre-eclampsia is diagnosed in pregnant women who have a BP greater than 130/80 mm Hg in the third trimester
B. Pre-eclampsia can occur even if the blood pressure is within the accepted "normal" range of BP
C. Gestational HTN is defined as a rise in systolic blood pressure of 15 mm Hg and a diastolic blood pressure rise of 30 mmHg
D. Gestational HTN is diagnosed if the patient has proteinuria and ankle edema regardless of BP measures
ANS: B
Determination of the woman's nonpregnant blood pressure is important in the evaluation of blood pressure during pregnancy. Gestational HTN is defined as a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mmHg or higher that occurs after 20 weeks of gestation in a woman with previously normal blood pressure (ACOG, 2002). The past "30–15 rule," which followed elevations of systolic blood pressure increases by more than 30 mm Hg or diastolic increases of more than 15 mm Hg over baseline, has not been proven to be a good prognostic indicator. However, pre-eclampsia may still occur even if the blood pressure is still within the accepted "normal" range, and women who demonstrate the 30–15 rule still warrant close observation. A certain degree of caution should also be displayed for women with a blood pressure of 120/75 mm Hg or higher in midpregnancy or 130/85 mm Hg in later pregnancy (Lindheimer & Akbari, 2000).
Evaluation should include the presence of edema, blood pressure measurement, urine dip or 24-hour urine for proteinuria, CBC or platelet count, liver enzymes, reflex testing, retinal changes, hepatomegaly, or right upper quadrant tenderness.
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