Diagnosis of Pregnancy Induced Hypertension

In pregnancy-induced hypertension, signs precede symptoms, and the disease can be easily diagnosed if the pregnant female is examined regularly before the condition becomes severe enough to give rise to symptoms.

Key points

Edema is the first sign to appear, and dependent edema of a mild to moderate degree is so common that it can be disregarded unless the face and fingers are involved, which is more significant. In severe hypertension, there is edema of the vulva and the anterior abdominal wall.

Hypertension is diagnosed if there is a sustained rise in blood pressure greater than 140/90 mmHg or a diastolic pressure greater than 90 mmHg on at least 2 occasions at least 4 hours apart.

In practice, diastolic blood pressure greater than 90 mmHg is considered abnormal. But if previous blood pressure is known, an increase in systolic pressure by 30 mmHg, an increase in diastolic pressure by 15 mmHg, or an increase in mean arterial blood pressure by 20 mmHg also could be considered.

It is obvious that important clinical decisions depend on the accurate measurement of blood pressure. Therefore, all health care personnel must have good training in the accurate measurement of blood pressure. It should be measured when the patient is resting in a seated or, if lying, in a left lateral position; the arm should not be hanging and the cuff should be large enough for the subject’s wrist. (Ideally, it should cover 2/3 of the arm.) The manometer should be kept at the level of the heart. The health care person should be trained to identify Korotkoff sounds on auscultation and to get the correct systolic and diastolic blood pressure.

Proteinuria is an important finding in assessing the severity of hypertension. It is defined as a protein concentration of 300 mg/l or more in at least two random urine specimens collected at least 6 hours apart.

Vaginal secretions and discharges are common in pregnancy, and when mixed with urine, they give a positive result for a urine test. The patient should be advised to clean the vulva with water and separate the labia minor with her fingers when collecting urine in order to prevent contamination. A catheter sample can also be obtained. The exclusion of urinary tract infections and renal diseases is important before diagnosing proteinuria with hypertension.