Preeclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks' gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement.
All pregnant women presenting with hypertension and either proteinuria or evidence of systemic involvement require close assessment and monitoring for preeclampsia and its complications.
Delivery is the definitive treatment; the decision about when and how to deliver should only be made after a thorough assessment of the risk and benefits to the mother and baby.
Other mainstays of management include antihypertensive therapy, seizure control, and fluid restriction.
Maternal mortality is highest after delivery, so vigilance should be maintained in the postpartum period.
Preeclampsia can occur in subsequent pregnancies; therefore, women should be counseled about the risk.
Preeclampsia is a disorder of pregnancy that is associated with new-onset hypertension (defined as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg), most often after 20 weeks' gestation and frequently near term. Although often accompanied by new-onset proteinuria, hypertension and other signs or symptoms of preeclampsia may present in the absence of proteinuria in some women.
HELLP syndrome is a subtype of severe preeclampsia characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). The diagnosis and management of HELLP syndrome is not discussed in detail in this topic (see our topic on HELLP syndrome for more information).
History and exam
- preeclampsia in a previous pregnancy
- family history of preeclampsia
- body mass index (BMI) >30
- maternal age >40 years
- multiple (twin) pregnancy
- gestational hypertension
- preexisting diabetes
- polycystic ovary syndrome (PCOS)
- autoimmune disease
- renal disease
- preexisting cardiovascular disease and chronic hypertension
- interval of ≥10 years since previous pregnancy
- high-altitude residence
James J. Walker, MD, FRCPS (Glas), FRCP (Edin), FRCOG
Maternity Investigation Team
Healthcare Services Investigation Branch
JJW is President of the Baby Lifeline Training Company and 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.
Lara Morley, MRCOG, MBChB, BSc, PgCert
Clinical Research Training Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine
University of Leeds
LM declares that she has no competing interests.
Thomas R. Easterling, MD
Department of Obstetrics & Gynecology
University of Washington
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
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