Illness script

Hypertensive Disorders of Pregnancy

New or elevated blood pressure after 20 weeks gestation, ranging from gestational HTN to preeclampsia/eclampsia.

This illness script for Hypertensive Disorders of Pregnancy covers the classic presentation, who it affects, how you work it up, the mechanism, and first-line treatment—written for USMLE Step 1 and clerkship clinical reasoning.

Updated Jul 18, 2026All scripts

01

Who it affects

  • Nulliparity, extremes of maternal age (<18 or >35)
  • Chronic HTN, diabetes, renal disease, obesity
  • Prior preeclampsia or family history
  • Multiple gestation, molar pregnancy, antiphospholipid syndrome
  • African American women at higher risk

02

Diagnostics & workup

  • BP ≥140/90 on two occasions ≥4h apart after 20 weeks
  • Gestational HTN: HTN without proteinuria/end-organ damage
  • Preeclampsia: HTN + proteinuria (≥300mg/24h, P/C ratio ≥0.3) OR end-organ dysfunction
  • Severe features: BP ≥160/110, plt <100k, Cr >1.1, LFTs 2x, pulmonary edema, cerebral/visual sx
  • Eclampsia: new-onset grand mal seizures
  • Labs: CBC, LFTs, creatinine, uric acid, urine protein; assess for HELLP

03

Pathophysiology

  • Abnormal placental spiral artery remodeling → placental ischemia
  • Release of anti-angiogenic factors (sFlt-1, soluble endoglin) into maternal circulation
  • Widespread endothelial dysfunction → vasospasm, capillary leak
  • End-organ hypoperfusion: kidneys, liver, brain, placenta
  • HELLP: microangiopathic hemolysis, elevated LFTs, low platelets

04

Treatment

  • Definitive treatment is delivery of the placenta
  • Deliver at ≥37wk (gestational HTN/mild preeclampsia); ≥34wk with severe features
  • Acute severe HTN: IV labetalol, hydralazine, or oral nifedipine
  • Seizure prophylaxis/treatment: IV magnesium sulfate (watch for toxicity → calcium gluconate)
  • Betamethasone for fetal lung maturity if <34 weeks
  • Low-dose aspirin for prevention in high-risk patients; monitor for HELLP/eclampsia

Keep reading

View full library

Educational use only. This illness script is a study framework, not medical advice. Confirm decisions with current guidelines and your clinical supervisors.