Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Gestational Hypertension

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In one line

·Blood pressure 140/90 or higher after 20 weeks of pregnancy with no protein in the urine and no organ damage.

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Normal physiology

·In a healthy pregnancy, blood vessels all over the body—especially in the uterus and placenta—relax and widen so more blood can reach the baby. Blood pressure normally drops in the first half of pregnancy (because vessels are more relaxed) and then climbs back up near term as blood volume peaks. The endothelium (the smooth lining inside every blood vessel) releases nitric oxide (a gas that tells vessel walls to relax) and balances clotting signals so blood flows freely without clots forming.

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What goes wrong

·The spiral arteries in the uterus don't remodel properly—they stay narrow and muscular instead of widening into floppy, high-flow pipes. The endothelium (the smooth lining of blood vessels) doesn't release enough nitric oxide to relax vessel walls, and it may release extra endothelin-1 (a chemical that squeezes vessels tight). Blood flow to the placenta drops, oxygen delivery to the baby falls, and the placenta responds by dumping inflammatory signals and clotting factors into mom's blood. The result: vessels all over the body stiffen, and blood pressure climbs to force blood through the narrow pipes.

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Hallmark signs

·Blood pressure 140/90 mmHg or higher on two separate readings at least 4 hours apart after 20 weeks of pregnancy
·No protein in the urine (proteinuria is absent)
·Headache (usually in the front or back of the head)
·Vision changes (blurry vision, seeing spots or flashing lights, or temporary vision loss)
·Swelling (edema) in the face, hands, or feet
·Upper belly pain (especially under the ribs on the right side)
·Sudden weight gain (more than 2 pounds in a week or 6 pounds in a month)
·Nausea or vomiting (especially new or worsening in the second half of pregnancy)

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Red flags · escalate now

·Blood pressure 160/110 mmHg or higher (severe high blood pressure (hypertension)) — the mother or baby can be hurt quickly
·New severe headache that does not go away with rest or medicine
·Vision changes: blurry sight, flashing lights, spots, or losing vision for a few seconds
·Pain under the ribs on the right side or in the upper belly
·Signs the baby is in trouble: fewer kicks than usual, or the baby is not growing as expected on ultrasound

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Workup

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Treatment

·Measure blood pressure twice, at least 4 hours apart, at rest; confirm ≥140/90 mmHg after 20 weeks; check urine for protein with dipstick or 24-hour collection
·Start low-dose aspirin 81 mg daily, ideally between 12–28 weeks (preferably before 16 weeks), if the patient has risk factors for preeclampsia (history of preeclampsia, chronic high blood pressure (hypertension), diabetes, kidney disease, autoimmune disease, multiple gestation)
·Start antihypertensive medication (labetalol, nifedipine extended-release, or methyldopa) if blood pressure stays ≥140/90 mmHg; AVOID ACE inhibitors, ARBs, atenolol, and diuretics
·If blood pressure reaches ≥160/110 mmHg (hypertensive emergency), give IV labetalol (20 mg initial bolus) or IV hydralazine (5–10 mg) within 30–60 minutes
·Monitor weekly or twice-weekly for signs of preeclampsia: check blood pressure, urine protein, symptoms (headache, vision changes, upper belly pain), and labs (CBC, creatinine, liver enzymes); schedule fetal ultrasound and non-stress tests
·Plan delivery at 37 weeks (full term) if gestational high blood pressure (hypertension) is stable and uncomplicated; deliver earlier (34–37 weeks) if blood pressure is uncontrolled despite medication, preeclampsia develops, or fetal growth restriction appears

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NCLEX trap

·Gestational high blood pressure (hypertension) means high blood pressure after 20 weeks but NO protein in the urine and NO damage to organs like the liver or kidneys. Preeclampsia means high blood pressure AND protein in the urine OR signs that organs are hurt — it is more dangerous. The urine protein test is the line that divides them.
·Keep the medicine going and keep checking. Gestational high blood pressure (hypertension) can turn into preeclampsia at any moment. You need to catch it early, so do not drop your guard just because one number improved.
·ACE inhibitors and ARBs harm the baby's kidneys and can cause serious birth defects during pregnancy. Use labetalol, nifedipine, or methyldopa instead — they are proven safe for the baby.
·If gestational high blood pressure (hypertension) gets severe or turns into preeclampsia, deliver at 37 weeks or sooner. The baby is safer outside if the placenta is starting to fail. Waiting can be dangerous.
·Mild ankle swelling is normal in pregnancy because extra fluid pools in the lower legs. Look for sudden puffiness of the face, hands, or upper legs — that signals fluid backup from failing kidneys or leaky blood vessels, which is worrisome.
·Gestational high blood pressure (hypertension) is a stepping stone to preeclampsia. Stay alert for protein in the urine, bad headaches, blurred vision, or pain under the ribs. Check blood pressure and urine at every visit — never skip the exam.

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