**Question:** True about hypertension in pregnancy

A. Hypertensive disorders are more common in nulliparous women.
B. Proteinuria is a key diagnostic feature of preeclampsia.
C. Eclampsia is a severe form of preeclampsia.
D. Maternal mortality is significantly reduced in high-income countries.

**Core Concept:** Hypertensive disorders in pregnancy encompass a group of conditions characterized by elevated blood pressure and proteinuria. These conditions can lead to serious maternal and fetal complications, and are classified into gestational hypertension, preeclampsia, and eclampsia.

**Why the Correct Answer is Right:**
A. Hypertensive disorders are more common in nulliparous women (first-time pregnant individuals) compared to multiparous women (those who have given birth before) due to the unique immunologic and placental changes that occur in pregnancy.
B. Proteinuria (excess protein in the urine) is a key diagnostic feature of preeclampsia, as it indicates endothelial dysfunction and impaired placentation. Proteinuria is present in approximately 90% of cases of preeclampsia.
C. Eclampsia is a severe form of preeclampsia characterized by seizures. While both preeclampsia and eclampsia are severe complications of hypertension in pregnancy, they are not distinct entities but rather different manifestations of a single disease process.
D. Maternal mortality has significantly decreased globally in recent decades due to improved obstetric care, early diagnosis, and management of hypertensive disorders in pregnancy.

**Why Each Wrong Option is Incorrect:**
A. While hypertension is more common in nulliparous women, the core issue is not the parity (number of previous pregnancies) but the presence of preeclampsia. Preeclampsia occurs independently of parity.
B. Proteinuria is a feature of preeclampsia, not eclampsia. Eclampsia is characterized by seizures, not proteinuria.
D. While maternal mortality has decreased globally, it is essential to recognize that maternal mortality rates remain high in low-resource settings, highlighting the need for targeted interventions in these regions.

**Clinical Pearl:**
Hypertensive disorders in pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are serious complications that can lead to severe maternal and fetal morbidity and mortality. Early diagnosis, appropriate management, and close monitoring are crucial to improve outcomes. This highlights the importance of clinical acumen and awareness of the signs and symptoms of these conditions.