Regarding the clinical features, diagnostic criteria, and management of gestational hypertension and preeclampsia, all of the following statements are correct EXCEPT:

Explanation

## Gestational Hypertension and Preeclampsia: Definitions, Diagnosis, and Management ### Definition of Gestational Hypertension **Key Point:** Gestational hypertension is defined as new-onset hypertension (BP ≥140/90 mmHg) first detected after 20 weeks of gestation **without proteinuria or other clinical/laboratory features of preeclampsia** [cite:ACOG Guidelines on Hypertension in Pregnancy]. ### Diagnostic Criteria for Severe Preeclampsia **High-Yield:** Severe preeclampsia is diagnosed when **systolic BP ≥160 mmHg OR diastolic BP ≥110 mmHg on two occasions at least 4 hours apart** (or one reading ≥180/120 mmHg if urgent intervention is needed), OR when preeclampsia is accompanied by severe features (severe headache, visual disturbances, epigastric pain, pulmonary edema, thrombocytopenia <100,000/μL, elevated liver enzymes, acute kidney injury) [cite:ACOG Guidelines 2017]. ### Pulmonary Edema in Preeclampsia: Mechanism **Clinical Pearl:** The mechanism of pulmonary edema in preeclampsia is **NOT primarily decreased plasma oncotic pressure** (though severe proteinuria does occur). Instead, pulmonary edema in preeclampsia is caused by: 1. **Increased capillary permeability** due to endothelial dysfunction 2. **Decreased plasma oncotic pressure** (secondary to proteinuria) — a minor contributor 3. **Left ventricular dysfunction** and increased pulmonary capillary wedge pressure 4. **Fluid overload** from aggressive IV hydration or oliguric renal failure **Warning:** The primary mechanism is endothelial dysfunction and increased capillary permeability, NOT oncotic pressure alone. This is a common misconception. ### Timing of Delivery in Preeclampsia **High-Yield:** Delivery is the definitive treatment for preeclampsia, BUT the timing is **NOT uniform**. Current guidelines recommend: | Gestational Age | Maternal Condition | Fetal Status | Recommendation | |---|---|---|---| | <34 weeks | Stable | Reassuring | Expectant management with corticosteroids for fetal lung maturity | | <34 weeks | Severe features | Any | Delivery after corticosteroids (if time permits) | | ≥34 weeks | Any | Any | Delivery is recommended [cite:ACOG 2017] | | ≥37 weeks | Any | Any | Delivery is recommended | **Key Point:** Delivery at ≥34 weeks is recommended, but **NOT "regardless of maternal or fetal condition."** If the mother is stable and the fetus is reassuring at <34 weeks, expectant management with close monitoring and corticosteroids is appropriate. Delivery should be individualized based on severity of preeclampsia, maternal symptoms, fetal well-being, and gestational age [cite:ACOG 2017]. ### Summary Table: Gestational Hypertension vs Preeclampsia | Feature | Gestational HTN | Preeclampsia | Severe Preeclampsia | |---------|---|---|---| | Onset | >20 weeks | >20 weeks | >20 weeks | | BP criteria | ≥140/90 mmHg | ≥140/90 mmHg | ≥160/110 mmHg | | Proteinuria | Absent | Present (≥0.3 g/24 h) | Often present | | Severe features | None | May have | Must have ≥1 | | Maternal risk | Low | Moderate–high | High | | Delivery timing | At term | ≥37 weeks (or earlier if severe) | ≥34 weeks (or earlier if unstable) | **Mnemonic:** **SEVERE** features of preeclampsia = **S**ystolic BP ≥160, **E**pigastric pain, **V**isual disturbances, **E**levated liver enzymes, **R**enal dysfunction, **E**clampsia or pulmonary edema [cite:ACOG 2017].