## Distinguishing Preeclampsia with Severe Features from Gestational Hypertension ### Key Diagnostic Criterion **Key Point:** The hallmark discriminator between preeclampsia with severe features and gestational hypertension is the presence of end-organ dysfunction (proteinuria ≥300 mg/24 h, thrombocytopenia, elevated creatinine, pulmonary edema, cerebral/visual symptoms) OR severe hypertension (≥160/110 mmHg). ### Comparison Table | Feature | Gestational Hypertension | Preeclampsia with Severe Features | | --- | --- | --- | | **BP threshold** | ≥140/90 mmHg | ≥160/110 mmHg OR ≥140/90 with end-organ dysfunction | | **Proteinuria** | Absent | ≥300 mg/24 h (or 2+ on dipstick) | | **Symptoms** | None or mild | Epigastric pain, headache, visual changes, dyspnea | | **Lab abnormalities** | Normal | Thrombocytopenia (<100 K), elevated transaminases, elevated creatinine | | **Onset** | After 20 weeks | After 20 weeks | | **Resolution postpartum** | Within 12 weeks | Within 12 weeks | ### Clinical Pearl **Clinical Pearl:** Gestational hypertension is a diagnosis of exclusion—it is elevated BP without proteinuria or systemic features. The moment proteinuria or end-organ dysfunction appears, the diagnosis shifts to preeclampsia (with or without severe features). **High-Yield:** The ACOG 2013 criteria define severe features of preeclampsia as: - Systolic BP ≥160 mmHg or diastolic ≥110 mmHg (on two occasions ≥15 min apart), OR - Proteinuria ≥5 g/24 h, OR - Platelet count <100,000/μL, OR - Serum creatinine >1.1 mg/dL, OR - Pulmonary edema, OR - Cerebral/visual symptoms ### Why This Matters Gestational hypertension carries minimal maternal/fetal risk and expectant management is safe until term. Preeclampsia with severe features mandates delivery at ≥34 weeks and close monitoring before that, making accurate discrimination clinically critical. [cite:ACOG Practice Bulletin 202]
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