ABC | Volume 114, Nº5, May 2020

Statement Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease – 2020 Arq Bras Cardiol. 2020; 114(5):849-942 or “severe” is not recommended. Diagnosis occurs with the appearance of hypertension, with onset from week 20 of gestation, with one or more of the following related conditions: • Proteinuria (> 0.3 g/24 h) and/or maternal organic dysfunctions, such as evidence of maternal acute renal lesions (creatinine ≥ 1 mg/dL); • Hepatic dysfunction (elevated hepatic transaminases, > 40 IU/L); • With or without abdominal pain (upper quadrant or epigastric); • Neurological complications (including eclampsia, altered mental state, blindness, stroke, clonus, intense headaches, persistent visual scotoma); • Hemolysis or thrombocytopenia and/or uteroplacental dysfunction (restricted fetal growth, abnormal analysis of umbilical artery Doppler waveform or stillbirth). The existence of proteinuria is not mandatory for diagnosis, and it may occur for the first time during the intrapartum period. In this manner, it is ideal to identify pregnant women with a risk of developing preeclampsia. Recommendations for screening, such as investigating proteinuria to this end, are fallible; the only consensual routine is to measure arterial pressure regularly during prenatal consultations. 272,273 4.3.2.1 HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) This is a severe manifestation of preeclampsia, and it should not be considered as a separate entity. 4.3.3. Chronic (Preexisting) Hypertension with Superimposed Preeclampsia This occurs in 25% of pregnant women with chronic hypertension. It is diagnosedwhenapregnantwomanwith chronic essential hypertension develops maternal organic dysfunctions compatible with preeclampsia. As a routine increase in arterial pressure may occur after week 20 of gestation, elevations in arterial pressure alone donot qualify for diagnosis of superimposed preeclampsia, in the samemanner that restricted fetal growthmay be part of the clinical picture of chronic hypertension. In cases of kidney disease with underlying proteinuria, an increase in proteinuria is also not a diagnostic parameter for superimposed preeclampsia; if, however, there is no preexisting proteinuria, its appearance within the context of elevated arterial pressure is sufficient for diagnosis. 4.3.4. Gestational Hypertension Gestational hypertension is a recent hypertension that arises after week 20 of gestation, in the absence of proteinuria, without any biochemical or hematological abnormalities. It is generally not accompanied by IUGR, and outcomes are frequently positive; however, approximately one quarter of women with gestational hypertension (especially those who present before week 34) evolve to preeclampsia and present unfavorable outcomes. In general, it resolves itself within 6 weeks postpartum. 52 4.3.4.1. Key Points • Consider hypertensive pregnant women, when SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg; Figure 8 – Classification of hypertensive syndromes. HELLP: hemolysis, elevated liver enzymes, and low platelet count; DAP: diastolic arterial pressure; SAP: systolic arterial pressure. PAS ≥ 140 mmHg e/ou PAD ≥ 90 mmHg < 20 weeks of gestation ≥ 20 weeks of gestation Chronic, preexisting hypertension (due to any cause) Risk of development Superimposed Preeclampsia Target organ involvement (symptoms, clinical or laboratory abnormalities) Without involvement of organs Gestational hypertension Involvement of organs Preeclampsia (Consider as a situation of alert) HELLP syndrome Eclampsia 896