Pre-eclampsia

Last reviewed: 25 Apr 2022
Last updated: 06 Oct 2021

Summary

Definition

History and exam

Key diagnostic factors

  • >20 weeks' gestation
  • systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg and previously normotensive
  • headache
  • upper abdominal pain
More key diagnostic factors

Other diagnostic factors

  • reduced fetal movement
  • fetal growth restriction
  • oedema
  • visual disturbances
  • seizures
  • breathlessness
  • oliguria
  • hyper-reflexia with sustained clonus
Other diagnostic factors

Risk factors

  • nulliparity
  • pre-eclampsia in a previous pregnancy
  • family history of pre-eclampsia
  • body mass index (BMI) >30
  • maternal age >40 years
  • multiple (twin) pregnancy
  • sub-fertility
  • gestational hypertension
  • pre-existing diabetes
  • polycystic ovary syndrome (PCOS)
  • autoimmune disease
  • renal disease
  • pre-existing cardiovascular disease and chronic hypertension
  • interval of ≥10 years since previous pregnancy
  • high-altitude residence
More risk factors

Diagnostic investigations

1st investigations to order

  • urinalysis
  • fetal ultrasound
  • umbilical artery Doppler velocimetry
  • amniotic fluid assessment
  • fetal cardiotocography
  • FBC
  • liver function tests
  • serum creatinine
  • placental growth factor
More 1st investigations to order

Investigations to consider

  • coagulation screen
More investigations to consider

Treatment algorithm

ACUTE

before delivery

ONGOING

after delivery

Contributors

Authors

James J. Walker, MD, FRCPS (Glas), FRCP (Edin), FRCOG
James J. Walker

Clinical Director

Maternity Investigation Team

Healthcare Services Investigation Branch

Hampshire

UK

Disclosures

JJW is President of the Baby Lifeline Training Company and Medical Director of Action on Pre-eclampsia. He lectures and teaches on pre-eclampsia and maternal safety both nationally and internationally, and is the author of national and local reports into safety investigations for the Healthcare Services Investigation Branch and national and local bodies.

Lara Morley, MRCOG, MBChB, BSc, PgCert

Clinical Research Training Fellow

Leeds Institute of Cardiovascular and Metabolic Medicine

University of Leeds

Leeds

UK

Disclosures

LM declares that she has no competing interests.

Peer reviewers

Thomas R. Easterling, MD

Professor

Department of Obstetrics & Gynecology

University of Washington

Seattle

WA

Disclosures

TRE declares that he has no competing interests.

Andrew Shennan, MBBS, MD FRCOG

Professor of Obstetrics

Maternal and Fetal Research Unit

St Thomas' Hospital

King's College London

London

UK

Disclosures

Not disclosed.

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