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 disorder of pregnancy associated with new-onset hypertension (defined as a blood pressure ≥140 mmHg systolic and/or ≥90 mmHg diastolic), which occurs most often after 20 weeks of gestation and frequently near term. Although often accompanied by new-onset proteinuria, hypertension and other signs or symptoms of preeclampsia may present in some women in the absence of proteinuria.
History and exam
- preeclampsia in previous pregnancy
- family history of preeclampsia
- BMI >30
- maternal age >40 years
- multiple (twin) pregnancy
- gestational hypertension
- preexisting diabetes
- polycystic ovary syndrome (PCOS)
- autoimmune disease
- renal disease
- pre-existing cardiovascular disease and chronic hypertension
- interval of ≥10 years since previous pregnancy
- high-altitude residence
James J. Walker, MD, FRCPS (Glas), FRCP (Edin), FRCOG
Academic Department of Obstetrics and Gynaecology
Leeds Teaching Hospitals Trust
JJW is a Medical Director of Action on Preeclampsia (UK) (honorary). He has carried out previous consultancy work for SPI (Swiss Precision Instruments), paid, but not in the last 5 years. Expert witness in medico-legal cases both for plaintiff and defendant on various obstetric topics including preeclampsia. JJW has no current grants in the subject. He lectures on preeclampsia by invitation but not on behalf of companies. No current patents. Nil else.
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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