Hypertensive syndrome that occurs in pregnant women after 20 weeks' gestation, consisting 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.
Can occur in subsequent pregnancies; therefore, women should be counseled about the risk.
A hypertensive syndrome that occurs in pregnant women after 20 weeks' gestation, consisting of new-onset, persistent hypertension (defined as a BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) with one or more of the following: 1) proteinuria (defined as urinary excretion of ≥0.3 g/24 hours of protein); 2) evidence of systemic involvement, such as renal insufficiency (elevated creatinine), liver involvement (elevated transaminases and/or right upper quadrant pain), neurologic complications, hematologic complications; 3) fetal growth restriction.
History and exam
- preeclampsia in previous pregnancy
- family history of preeclampsia
- BMI >30
- maternal age >35 years
- multiple (twin) pregnancy
- gestational hypertension
- pregestational diabetes
- polycystic ovary syndrome (PCOS)
- autoimmune disease
- renal disease
- chronic hypertension
- BP ≥80 mmHg diastolic at booking
- interval of 10 years or more since previous pregnancy
- high-altitude residence
Academic Department of Obstetrics and Gynaecology
Leeds Teaching Hospitals Trust
JJW is Medical Director of Action on Pre-eclampsia (unpaid position). JJW lectures on preeclampsia at educational meetings (unpaid). He is a member of the International Society for the study of Hypertension in Pregnancy, and contributes towards guideline development in hypertension in pregnancy.
Clinical Research Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine
University of Leeds
LM declares that she has no competing interests.
Department of Obstetrics & Gynecology
University of Washington
TRE declares that he has no competing interests.
Professor of Obstetrics
Maternal and Fetal Research Unit
St Thomas' Hospital
King's College London
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