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
Other diagnostic factors
- reduced fetal movement
- fetal growth restriction
- edema
- visual disturbances
- seizures
- breathlessness
- oliguria
- hyper-reflexia with sustained clonus
Risk factors
- nulliparity
- preeclampsia in a previous pregnancy
- family history of preeclampsia
- body mass index (BMI) >30
- maternal age >40 years
- multiple gestations
- subfertility
- gestational hypertension
- preexisting diabetes
- polycystic ovary syndrome (PCOS)
- autoimmune disease
- renal disease
- preexisting cardiovascular disease and chronic hypertension
- migraine
- interval of ≥10 years since previous pregnancy
- high-altitude residence
- hypothyroidism
Diagnostic tests
1st tests to order
- urinalysis
- fetal ultrasound
- umbilical artery Doppler velocimetry
- amniotic fluid assessment
- fetal cardiotocography
- CBC
- liver function tests
- serum creatinine
- placental growth factor
Tests to consider
- coagulation screen
Treatment algorithm
before delivery
after delivery
Contributors
Authors
James J. Walker, MD, FRCPS (Glas), FRCP (Edin), FRCOG

Clinical Director
Maternity Investigation Team
Healthcare Services Investigation Branch
Hampshire
UK
Divulgaciones
JJW is Honorary President of the Baby Lifeline Training Company and Honorary Medical Director of Action on Pre-eclampsia. He lectures and teaches on preeclampsia 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 as Clinical Director.
Lara Morley, MBCHB, BSc, PgCert, PhD, MRCOG, FHEA
NIHR-Clinical Lecturer and Subspecialty Trainee in Reproductive Medicine and Surgery
Leeds Institute of Cardiovascular and Metabolic Medicine
University of Leeds
Leeds
UK
Divulgaciones
LM declares that she has no competing interests.
Jacqueline Clarke, MBBS, PgG Cert, MRCOG, PG Cert
Consultant Obstetrician
Leeds Teaching Hospitals Trust
Leeds
UK
Divulgaciones
JC declares that she has no competing interests.
Revisores por pares
Lauren Theilen, MD, MS
Assistant Professor
University of Utah
UT
Divulgaciones
LT 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
Divulgaciones
Not disclosed.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
American College of Obstetricians and Gynecologists. Practice bulletin no. 222: gestational hypertension and preeclampsia. Jun 2020 [internet publication].Texto completo
Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022 Mar;27:148-69. Resumen
National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. Apr 2023 [internet publication].Texto completo
Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019 May;145 Suppl 1:1-33.Texto completo Resumen
National Institute for Health and Care Excellence. PLGF-based testing to help diagnose suspected preterm pre-eclampsia. Jul 2022 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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