Which clinical finding best distinguishes between gestational hypertension and preeclampsia in a pregnant woman at 32 weeks of gestation?

Explanation

## Distinguishing Gestational Hypertension from Preeclampsia **Key Point:** Proteinuria is the cardinal discriminating feature that separates preeclampsia from gestational hypertension. Its presence converts a diagnosis of gestational hypertension to preeclampsia. ### Comparison Table | Feature | Gestational Hypertension | Preeclampsia | | --- | --- | --- | | **Blood pressure** | ≥140/90 mmHg after 20 weeks | ≥140/90 mmHg after 20 weeks | | **Proteinuria** | Absent | ≥300 mg/24 h or ≥1+ dipstick | | **Maternal symptoms** | None typically | Headache, visual changes, epigastric pain | | **Edema** | May occur | May occur | | **Onset** | After 20 weeks | After 20 weeks (usually >28 weeks) | | **Resolves postpartum** | Yes | Yes | **High-Yield:** The 2013 ACOG criteria and WHO guidelines define preeclampsia as hypertension (SBP ≥140 or DBP ≥90) PLUS proteinuria or other maternal/fetal complications. Without proteinuria or complications, it remains gestational hypertension [cite:Park 26e Ch 5]. **Clinical Pearl:** A woman with new-onset hypertension after 20 weeks but NO proteinuria and NO symptoms is classified as gestational hypertension. The moment proteinuria appears (even without symptoms), the diagnosis becomes preeclampsia, escalating risk and management intensity. ### Why Proteinuria Is the Discriminator Proteinuria indicates glomerular endotheliosis and systemic endothelial dysfunction — the pathophysiological hallmark of preeclampsia. Its presence mandates: - Closer fetal monitoring - Earlier delivery consideration - Antihypertensive therapy initiation - Magnesium sulfate prophylaxis (if ≥34 weeks) **Mnemonic:** **CHIP** = **C**onvulsions, **H**ypertension, **I**ncreased liver enzymes, **P**roteinuria — all features of preeclampsia, but proteinuria is the sine qua non that distinguishes it from gestational hypertension alone.