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Last reviewed: 9 Nov 2023
Last updated: 12 Jan 2023



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
  • edema
  • visual disturbances
  • seizures
  • breathlessness
  • oliguria
  • hyper-reflexia with sustained clonus
Other diagnostic factors

Risk factors

  • nulliparity
  • preeclampsia in a previous pregnancy
  • family history of preeclampsia
  • body mass index (BMI) >30
  • maternal age >40 years
  • multiple (twin) pregnancy
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

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

Investigations to consider

  • coagulation screen
More investigations to consider

Treatment algorithm


before delivery


after delivery



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

Clinical Director

Maternity Investigation Team

Healthcare Services Investigation Branch




JJW is 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.

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.

Peer reviewers

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




Not disclosed.

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