A 28-year-old primigravida at 32 weeks gestation attends antenatal clinic. Which clinical finding best distinguishes between preeclampsia and gestational hypertension in the context of routine antenatal care?

Question

Accepted Answer

C. Presence of proteinuria (≥0.3 g/24 hours or 1+ on dipstick) with hypertension. ## Distinguishing Preeclampsia from Gestational Hypertension

### Pathophysiologic Basis

**Key Point:** Proteinuria is the cardinal feature that separates preeclampsia (hypertension + proteinuria ± end-organ dysfunction) from gestational hypertension (hypertension alone without proteinuria or end-organ signs). This distinction is critical for risk stratification and management in antenatal care.

### Diagnostic Comparison Table

| Feature | Gestational Hypertension | Preeclampsia (without severe features) | Preeclampsia (with severe features) |
|---------|--------------------------|----------------------------------------|-------------------------------------|
| **BP threshold** | ≥140/90 mmHg (new onset) | ≥140/90 mmHg + proteinuria | ≥160/110 mmHg or proteinuria ≥5 g/24 h |
| **Proteinuria** | Absent | Present (≥0.3 g/24 h or 1+ dipstick) | Present (usually ≥2 g/24 h) |
| **Onset** | After 20 weeks | After 20 weeks | After 20 weeks |
| **End-organ dysfunction** | None | May be absent | Present (creatinine, platelets, liver enzymes, pulmonary edema, cerebral symptoms) |
| **Prognosis** | Generally benign | Requires monitoring | High risk of maternal/fetal morbidity |

### High-Yield Discriminator

**High-Yield:** The **presence of proteinuria** is the single best discriminator in routine antenatal care. A woman with elevated BP but NO proteinuria has gestational hypertension; if proteinuria develops, she has preeclampsia. This distinction determines the intensity of monitoring and timing of delivery.

### Clinical Pearl

**Clinical Pearl:** In Indian antenatal clinics, dipstick urinalysis (1+ or more = ≥0.3 g/24 h) is the practical screening tool. A negative dipstick with hypertension = gestational hypertension. A positive dipstick + hypertension = preeclampsia (until proven otherwise). Quantitative 24-hour urine protein confirms the diagnosis.

### Mnemonic

**Mnemonic:** **GH vs PE** — **G**estational **H**ypertension = **H**ypertension alone; **P**r**E**eclampsia = **P**roteinuria + **E**levated BP.

[cite:Park 26e Ch 7; Harrison 21e Ch 297]

Answer

A. Headache and visual disturbances reported by the patient

Answer

B. Elevated serum creatinine (>1.1 mg/dL) in the absence of prior renal disease

Answer

D. Systolic blood pressure ≥140 mmHg on two occasions 4 hours apart

A 28-year-old primigravida at 32 weeks gestation attends antenatal clinic. Which clinical finding best distinguishes between preeclampsia and gestational hypertension in the context of routine antenatal care?

Explanation

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