Which obstetric condition is defined by new-onset hypertension after 20 weeks gestation with proteinuria or end-organ dysfunction?

• A. Preeclampsia
• B. Gestational hypertension
• C. Chronic hypertension
• D. HELLP syndrome

Answer: (A)

Preeclampsia is defined by new-onset hypertension after 20 weeks gestation accompanied by proteinuria or evidence of end-organ dysfunction. Hypertension is typically a blood pressure of 140/90 mmHg or higher on two occasions at least four hours apart. Proteinuria is usually assessed as ≥300 mg of protein in a 24-hour urine collection, a protein/creatinine ratio ≥0.3, or dipstick proteinuria of 1+ when more precise measurements aren’t available. End-organ dysfunction can include signs such as markedly elevated liver enzymes, impaired kidney function, low platelets, pulmonary edema, or new cerebral or visual symptoms. This combination distinguishes preeclampsia from gestational hypertension, which is high blood pressure after 20 weeks without proteinuria or end-organ involvement, and from chronic hypertension, which exists before pregnancy or before 20 weeks. HELLP syndrome is a severe form or complication of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets, and it can accompany preeclampsia but does not define the condition on its own.