From the Guidelines
Preeclampsia is characterized by new hypertension, new proteinuria, symptoms of headache or visual disturbance, epigastric pain or vomiting, and reduced fetal movements, which can rapidly worsen and lead to serious complications for both mother and baby if left untreated. The signs and symptoms of preeclampsia include:
- New hypertension
- New proteinuria
- Symptoms of headache or visual disturbance, or both
- Epigastric pain or vomiting, or both
- Reduced fetal movements, small for gestational age infant 1 Additionally, severe pre-eclampsia may present with right upper quadrant/epigastric pain due to liver oedema + hepatic haemorrhage, headache + visual disturbance (cerebral oedema), occipital lobe blindness, hyperreflexia + clonus, convulsions (cerebral oedema), and HELLP syndrome: haemolysis, elevated liver enzymes, low platelet count 1. According to the most recent guidelines, pre-eclampsia is defined as gestational hypertension accompanied by one or more of the following new-onset conditions at or after 20 weeks of gestation: (i) proteinuria; (ii) evidence of other maternal organ dysfunction; or (iii) uteroplacental dysfunction 1. Any pregnant woman experiencing these symptoms should seek immediate medical attention, as preeclampsia can rapidly worsen and lead to serious complications for both mother and baby. The only definitive treatment is delivery of the baby, though medications may be used to manage symptoms and prevent complications until delivery is possible. First-trimester screening and prevention of pre-eclampsia is recommended in all pregnant women, and all pregnant women with hypertension should be periodically assessed for proteinuria in the second half of pregnancy to screen for pre-eclampsia 1. Significant proteinuria as a diagnostic criterion for pre-eclampsia is defined as >0.3 g/24 h or albumin-to-creatinine ratio (ACR) > 30 mg/mmol, and an ACR < 30 mg/mmol reliably rules out proteinuria in pregnancy 1. When pre-eclampsia is clinically suspected, a soluble fms-like tyrosine kinase (sFlt)-to-placental growth factor (PlGF) ratio < 38 can be used to exclude the development of pre-eclampsia in the next week 1.
From the Research
Signs and Symptoms of Preeclampsia
- Hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) 2
- Proteinuria (> 300 mg/24 h), although proteinuria is no longer required for the diagnosis of preeclampsia 2
- Renal impairment 2
- Thrombocytopenia 2
- Epigastric pain 2
- Liver dysfunction 2
- Hemolysis-elevated liver enzymes-low platelet count (HELLP) syndrome 2
- Visual disturbances 2
- Headache 2
- Seizures 2
Severity Criteria
- Severe hypertension (SBP ≥ 160 mm Hg and/or DBP ≥ 110 mmHg) 2
- Thrombocytopenia < 100.000/μL 2
- Liver transaminases above twice the normal values 2
- HELLP syndrome 2
- Renal failure 2
- Persistent epigastric or right upper quadrant pain 2
- Visual or neurologic symptoms 2
- Acute pulmonary edema 2
Treatment and Management
- Antihypertensive medications and magnesium sulfate 2
- Delivery is proposed for patients with preeclampsia without severe features after 37 weeks of gestation and in case of severe preeclampsia after 34 weeks of gestation 2
- Conservative management of severe preeclampsia may be considered in selected patients between 24 and 34 weeks of gestation 2
- Antenatal corticosteroids should be administered to less than 34 gestation week preeclamptic women to promote fetal lung maturity 2
- Termination of pregnancy should be discussed if severe preeclampsia occurs before 24 weeks of gestation 2
- Neuraxial analgesia and anesthesia are strongly considered as first line anesthetic techniques in preeclamptic patients, in the absence of thrombocytopenia 2