gynecology and obstetrics
Preeclampsia and Eclampsia
Diagnosis of Preeclampsia and Eclampsia
: New onset after 20 weeks gestation of Hypertension (blood pressure [BP] BP criteria for preeclampsia are one of the following: Systolic BP≥140 mm Hg and/or diastolic BP≥90 mm Hg(at least2 measurements taken at least 4 hours apart) Systolic BP≥160 mm Hg and/or diastolic BP≥110 mm Hg (at least 1 measurement) Proteinuria is defined as > 300 mg/24 hours. Alternatively, proteinuria is diagnosed based on a protein/creatinine ratio ≥ 0.3 or a dipstick reading of 2+; the dipstick test is used only if other quantitative methods are not available. Absence of proteinuria on less accurate tests (eg, urine dipstick testing, routine urinalysis) does not rule out preeclampsia. In the absence of proteinuria, preeclampsia is also diagnosed if pregnant women meet diagnostic criteria for new-onset hypertension and have new onset of any of the following signs of end-organ damage: Thrombocytopenia (platelets < 100,000/mcL) Renal insufficiency (serum creatinine > 1.1 mg/dL or doubling of serum creatinine in women without renal disease) Impaired liver function (aminotransferases > 2 times normal) Pulmonary edema New-onset headache (unresponsive to medication and not accounted for by alternative diagnoses) Visual symptoms The following points help differentiate among other hypertensive disorders in pregnant women: Chronic hypertensionis identified if hypertension precedes pregnancy, is present at<20 weeks gestation, or persists for>6 weeks (usually>12 weeks) postpartum (even if hypertension is first documented at>20 weeks gestation). Chronic hypertension may be masked during early pregnancy by the physiologic decrease in BP. Gestational hypertensionis new-onset hypertension at>20 weeks gestation without proteinuria or other findings of preeclampsia; it resolves by 12 weeks (usually by 6 weeks) postpartum. Preeclampsia superimposed on chronic hypertensionis diagnosed when new unexplained proteinuria develops or proteinuria worsens after 20 weeks in a woman known to have hypertension with BP elevations above baseline or when preeclampsia with severe features develops after 20 weeks in a woman known to have hypertension and proteinuria. Women with chronic hypertension are at high risk of preeclampsia and should be monitored closely. If preeclampsia is diagnosed, tests include complete blood count (CBC), platelet count, uric acid, liver tests, bloodureanitrogen (BUN), creatinine, and, if creatinine is abnormal, creatinine clearance. The fetus is assessed using a nonstress test or biophysical profile (including assessment of amniotic fluid volume) and tests that estimate fetal weight. Preeclampsia with severe featuresis differentiated from mild forms by new onset of one or more of the following: Systolic BP>160 mm Hg or diastolic BP>110 mm Hg on 2 occasions≥4 hours apart Thrombocytopenia, platelet count<100,000/mcL Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT)>2 times normal Symptoms of liver capsule distention (eg, right upper quadrant or epigastric pain) Progressive renal insufficiency (serum creatinine > 1.1 mg/dL or doubling of serum creatinine in women without renal disease) Pulmonary edema Central nervous system (CNS) dysfunction (eg, blurred vision, scotomata, altered mental status, severe headache unrelieved byacetaminophen) HELLP syndromeis suggested by microangiopathic findings (eg, schistocytes, helmet cells) on peripheral blood smears, elevated liver enzymes, and a low platelet count. 1.American College of Obstetricians and Gynecologists (ACOG): Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222.Obstet Gynecol135 (6):e237–e260, 2020. 