Tests to do to diagnose gestational hypertension

Gestational hypertension is the most common medical complication in pregnant women and one of the major causes of maternal mortality worldwide. Therefore, the diagnosis of gestational hypertension is very important to prevent complications and take timely intervention measures.

Gestational hypertension is a common complication in pregnant women. This is when the systolic blood pressure is above 140 mmHg and the diastolic blood pressure is greater than 90 mmHg.
There are 5 groups of hypertension in pregnancy:
Gestational hypertension: Blood pressure above 140/90 mmHg, no proteinuria, blood pressure returns to normal within 12 weeks postpartum. Preeclampsia: blood pressure above 140/90 mmHg after 20 weeks of pregnancy. In severe cases, blood pressure can be as high as 160/110 mmHg. Proteinuria over 300mg/24 hours or test strip less than or equal to 2+. Protein or creatinine urine greater than or equal to 0.3. Severe cases of preeclampsia are accompanied by symptoms such as elevated liver enzymes, fetal growth retardation, headache or blurred vision, pain in the epigastrium or right upper quadrant. Eclampsia: Preeclampsia and eclampsia are seizures that cannot be explained by other causes. Grafted preeclampsia on chronic hypertension Chronic hypertension: Blood pressure above 140/90 mmHg diagnosed before 20 weeks of pregnancy or before pregnancy. Or hypertension is diagnosed after 12 weeks of pregnancy and persists beyond 12 weeks postpartum. The cause of gestational hypertension is still unknown, however certain conditions can increase the risk of developing this condition such as:
Chronic high blood pressure Kidney disease Diabetes High blood pressure during pregnancy previous pregnancy Pregnant women over 40 years old or younger than 20 years old Twins or triplets

Diagnosis of gestational hypertension should be confirmed by 2 different blood pressure measurements (4 to 6 hours apart) with the patient sitting or possibly lying on the left side. Holter measurements give more accurate results than stationary meters.
Diagnosis of hypertension is when systolic blood pressure is greater than or equal to 140 mmHg and/or diastolic blood pressure is greater than or equal to 90 mmHg.
Mild: 140-159/ 90-109 mmHg Severe: >160/110mmHg

The basic tests to monitor pregnant women with high blood pressure include:
Total blood cell analysis Fasting blood sugar, glucose tolerance test Total cholesterol, HDL, LDL, triglycerides Electrolytes Total urinalysis, Proteinuria Bun, creatinine Electrocardiogram All pregnant women should be evaluated for proteinuria in early pregnancy to detect pre-existing kidney disease and in mid-pregnancy to screen for preeclampsia. Dipstick tests ≥ 1+ should include additional tests including the ACR ratio, which can be determined rapidly in one urine sample at a time. An ACR value < 30 mg/mmol can rule out urine protein in pregnancy, but a positive test should be followed up with a 24-hour urinalysis. In cases of proteinuria > 2 g/day, the patient should be closely monitored. However, 24-hour urine results are often inaccurate and delay the diagnosis of preeclampsia. Therefore, an ACR threshold of 30 mg/mmol can be used to define significant proteinuria. In addition to baseline tests, the following tests may be considered:
Adrenal ultrasound and stool metanephrine testing Serum and urine fractions in hypertensive pregnant women with clinical presentation suggestive of pheochromocytoma. Uterine artery doppler ultrasound (done after 20 weeks of pregnancy) is useful to detect patients at higher risk of gestational hypertension, preeclampsia, and intrauterine growth retardation.

A ratio of sFlt1 (soluble fms-like tyrosine kinase1): PIGF (placental growth factor) ≤ 38 can be used to rule out preeclampsia during the next week when clinically suspected. Gestational hypertension is the most common complication in pregnant women and can lead to preeclampsia. Early diagnosis based on test results can prevent and prompt intervention.
Vinmec International General Hospital offers a Package Maternity Care Program for pregnant women right from the first months of pregnancy with a full range of antenatal care visits, periodical 3D and 4D ultrasounds and routine tests to ensure that the mother is healthy and the fetus is developing comprehensively. Pregnant women will be consulted and checked for health under the close supervision of experienced and specialized obstetricians, helping mothers gain more knowledge to protect their health during pregnancy as well as minimize complications affecting mother and child.