## Distinguishing Preeclampsia from Gestational Hypertension **Key Point:** The hallmark discriminator between preeclampsia (with severe features) and gestational hypertension is the presence of **end-organ dysfunction** — manifested as proteinuria, thrombocytopenia, elevated liver enzymes, or renal insufficiency. Gestational hypertension is hypertension *alone* without these systemic features. ### Comparison Table | Feature | Gestational Hypertension | Preeclampsia (Severe Features) | | --- | --- | --- | | **BP threshold** | ≥140/90 mmHg after 20 wks | ≥160/110 mmHg (or ≥140/90 + end-organ signs) | | **Proteinuria** | Absent | Present (≥1+ on dipstick or ≥0.3 g/24 h) | | **Thrombocytopenia** | Absent | Present (<100,000/μL indicates severe features) | | **Liver dysfunction** | Absent | May occur (elevated transaminases) | | **Renal dysfunction** | Absent | May occur (Cr >1.1 mg/dL) | | **Maternal/fetal risk** | Low | High | | **Postpartum resolution** | By 12 weeks | By 12 weeks | **High-Yield:** The presence of **any one** end-organ dysfunction sign (proteinuria, thrombocytopenia, elevated liver enzymes, renal insufficiency, pulmonary edema, cerebral symptoms) converts gestational hypertension to preeclampsia. In this case, the combination of proteinuria AND thrombocytopenia is pathognomonic for preeclampsia with severe features. **Clinical Pearl:** A woman with BP 160/110 mmHg alone (without proteinuria or thrombocytopenia) would still be classified as gestational hypertension with severe range BP — the end-organ signs are what make it preeclampsia. **Mnemonic: HELLP-P** — Hemolysis, Elevated Liver enzymes, Low Platelets, Proteinuria — these are the end-organ manifestations that distinguish preeclampsia from isolated hypertension.
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