Hypertensive Disorders of Pregnancy
NGN Nursing Study Guide | Preeclampsia • Eclampsia • HELLP • Magnesium Sulfate
The Big Picture
Hypertension is one of the most common and most dangerous complications of pregnancy and a leading
cause of maternal and fetal harm. It is grouped into four categories. The key skill for your exam is telling
them apart and recognizing when a client is crossing into severe, life-threatening territory.
Disorder When it appears Defining features
Before 20 weeks (or
Chronic hypertension BP ≥ 140/90; persists beyond 12 weeks postpartum
pre-pregnancy)
Gestational New BP ≥ 140/90; NO proteinuria, NO severe features;
After 20 weeks
hypertension resolves postpartum
Preeclampsia After 20 weeks New hypertension PLUS proteinuria OR severe features
Eclampsia After 20 weeks Preeclampsia PLUS new-onset tonic-clonic seizures
Preeclampsia Up Close
How it is diagnosed: BP ≥ 140/90 on two readings at least 4 hours apart after 20 weeks, PLUS
proteinuria (dipstick 2+, protein/creatinine ratio ≥ 0.3, or ≥ 300 mg in 24 hours). If proteinuria is absent but
severe features are present, it still counts as preeclampsia.
What is going wrong: the placenta implants abnormally, triggering widespread vasospasm and blood
vessel damage. That reduces blood flow to vital organs, which is why this disease hits the brain, liver,
kidneys, and the placenta itself.
SEVERE FEATURES — this client is now high-risk
• BP ≥ 160/110
• Platelets < 100,000/mm³ (thrombocytopenia)
• Rising liver enzymes, or right upper quadrant / epigastric pain
• Rising creatinine or worsening kidney function
• Pulmonary edema
• New, severe headache that will not go away
• Visual changes: blurring, flashing lights, spots
For personal study use only — not for redistribution. Page 1
, TEACH THE CLIENT — warning signs to report immediately
• Severe or constant headache
• Vision changes (blurring, seeing spots or flashes)
• Pain in the upper right belly or stomach area
• Sudden swelling of the face or hands
• Decreased fetal movement
Magnesium Sulfate (very high yield)
This is the single most tested topic in this unit. Understand it and you will pick up easy points.
MAGNESIUM SULFATE — key facts
Why it is given: to PREVENT seizures (seizure prophylaxis). It is a CNS depressant. It does not lower blood
pressure — that is a separate medication.
Therapeutic range: 4–7 mEq/L.
Monitor every hour: respiratory rate, deep tendon reflexes (DTRs), urine output, level of consciousness, and
the fetal heart rate.
MAGNESIUM TOXICITY — recognize it in order
Magnesium leaves the body through the kidneys, so low urine output lets it build up and tip into toxicity.
Watch the signs appear in this order:
1. Loss of deep tendon reflexes — the EARLIEST sign
2. Respiratory depression (rate < 12/min)
3. Decreased urine output (< 30 mL/hr)
4. Decreased level of consciousness
5. Respiratory and cardiac arrest
ANTIDOTE: calcium gluconate — keep it at the bedside.
Other Treatment You Must Know
• Lowering dangerous BP: labetalol, hydralazine, or nifedipine. The goal is a safer range, not a
normal BP.
• Fetal lung maturity: betamethasone (a corticosteroid) if preterm birth is likely.
• The only cure: delivery of the baby AND the placenta. Everything else just buys time and keeps
mother and baby safe until then.
HELLP Syndrome
For personal study use only — not for redistribution. Page 2
NGN Nursing Study Guide | Preeclampsia • Eclampsia • HELLP • Magnesium Sulfate
The Big Picture
Hypertension is one of the most common and most dangerous complications of pregnancy and a leading
cause of maternal and fetal harm. It is grouped into four categories. The key skill for your exam is telling
them apart and recognizing when a client is crossing into severe, life-threatening territory.
Disorder When it appears Defining features
Before 20 weeks (or
Chronic hypertension BP ≥ 140/90; persists beyond 12 weeks postpartum
pre-pregnancy)
Gestational New BP ≥ 140/90; NO proteinuria, NO severe features;
After 20 weeks
hypertension resolves postpartum
Preeclampsia After 20 weeks New hypertension PLUS proteinuria OR severe features
Eclampsia After 20 weeks Preeclampsia PLUS new-onset tonic-clonic seizures
Preeclampsia Up Close
How it is diagnosed: BP ≥ 140/90 on two readings at least 4 hours apart after 20 weeks, PLUS
proteinuria (dipstick 2+, protein/creatinine ratio ≥ 0.3, or ≥ 300 mg in 24 hours). If proteinuria is absent but
severe features are present, it still counts as preeclampsia.
What is going wrong: the placenta implants abnormally, triggering widespread vasospasm and blood
vessel damage. That reduces blood flow to vital organs, which is why this disease hits the brain, liver,
kidneys, and the placenta itself.
SEVERE FEATURES — this client is now high-risk
• BP ≥ 160/110
• Platelets < 100,000/mm³ (thrombocytopenia)
• Rising liver enzymes, or right upper quadrant / epigastric pain
• Rising creatinine or worsening kidney function
• Pulmonary edema
• New, severe headache that will not go away
• Visual changes: blurring, flashing lights, spots
For personal study use only — not for redistribution. Page 1
, TEACH THE CLIENT — warning signs to report immediately
• Severe or constant headache
• Vision changes (blurring, seeing spots or flashes)
• Pain in the upper right belly or stomach area
• Sudden swelling of the face or hands
• Decreased fetal movement
Magnesium Sulfate (very high yield)
This is the single most tested topic in this unit. Understand it and you will pick up easy points.
MAGNESIUM SULFATE — key facts
Why it is given: to PREVENT seizures (seizure prophylaxis). It is a CNS depressant. It does not lower blood
pressure — that is a separate medication.
Therapeutic range: 4–7 mEq/L.
Monitor every hour: respiratory rate, deep tendon reflexes (DTRs), urine output, level of consciousness, and
the fetal heart rate.
MAGNESIUM TOXICITY — recognize it in order
Magnesium leaves the body through the kidneys, so low urine output lets it build up and tip into toxicity.
Watch the signs appear in this order:
1. Loss of deep tendon reflexes — the EARLIEST sign
2. Respiratory depression (rate < 12/min)
3. Decreased urine output (< 30 mL/hr)
4. Decreased level of consciousness
5. Respiratory and cardiac arrest
ANTIDOTE: calcium gluconate — keep it at the bedside.
Other Treatment You Must Know
• Lowering dangerous BP: labetalol, hydralazine, or nifedipine. The goal is a safer range, not a
normal BP.
• Fetal lung maturity: betamethasone (a corticosteroid) if preterm birth is likely.
• The only cure: delivery of the baby AND the placenta. Everything else just buys time and keeps
mother and baby safe until then.
HELLP Syndrome
For personal study use only — not for redistribution. Page 2
