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
Key diagnostic factors
- >20 weeks' gestation
- systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg and previously normotensive
- upper abdominal pain
Other diagnostic factors
- reduced fetal movement
- fetal growth restriction
- visual disturbances
- hyper-reflexia with sustained clonus
- 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
1st investigations to order
- fetal ultrasound
- umbilical artery Doppler velocimetry
- amniotic fluid assessment
- fetal cardiotocography
- liver function tests
- serum creatinine
- placental growth factor
Investigations to consider
- coagulation screen
- Chronic hypertension
- Gestational hypertension
- Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication
- Gestational hypertension and preeclampsia
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