Hypertensive disorders of pregnancy include gestational hypertension, chronic hypertension, preeclampsia/eclampsia, and chronic hypertension with superimposed preeclampsia. Preeclampsia is defined as hypertension after 20 weeks gestation plus signs or symptoms of end-organ damage. Proteinuria is no longer required to make the diagnosis of preeclampsia. Hydralazine, labetalol, and nifedipine are all considered first-line medications for the acute treatment of severe hypertension in pregnancy. Patients with preeclampsia with severe features require magnesium sulfate therapy for prophylaxis against eclampsia. Magnesium sulfate is the drug of choice for treatment of eclamptic seizures. The definitive treatment of preeclampsia, eclampsia, and HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is delivery. Depending on maternal condition and gestational age, transfer to a tertiary facility may be required.