From the Guidelines
If you suspect preeclampsia, you should order blood pressure monitoring, urinalysis for protein, complete blood count, comprehensive metabolic panel, uric acid level, and liver function tests, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1. When suspecting preeclampsia, it is crucial to confirm hypertension and assess for proteinuria, as these are key diagnostic criteria.
- Begin with blood pressure measurement to confirm hypertension (≥140/90 mmHg) on two occasions at least 4 hours apart, as suggested by the ISSHP guidelines 1.
- Collect a 24-hour urine specimen to quantify protein (significant if ≥300 mg/24 hours) or perform a protein-to-creatinine ratio, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1.
- Order a complete blood count to check for thrombocytopenia, comprehensive metabolic panel to assess renal function (creatinine, BUN) and electrolytes, liver function tests (AST, ALT) to detect liver involvement, and uric acid levels which are often elevated in preeclampsia, as stated in the ISSHP guidelines 1. Additionally, consider fetal assessment with ultrasound for growth, amniotic fluid measurement, and non-stress testing or biophysical profile depending on gestational age, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1. These tests are crucial because preeclampsia is a multisystem disorder characterized by new-onset hypertension and often proteinuria after 20 weeks gestation, which can lead to serious maternal and fetal complications if not promptly diagnosed and managed, as highlighted in the ISSHP guidelines 1.
From the Research
Diagnosis and Management of Suspected Preeclampsia
When suspecting preeclampsia, the following steps can be taken:
- Identify women at increased risk and detect early signs and symptoms in the 2nd half of pregnancy 2
- Recognize clinical signs and symptoms, such as edema, proteinuria, hemoconcentration, hypoalbuminemia, liver function and/or coagulation abnormalities, and increased urate levels 3
- Assess disease severity, including severe hypertension, thrombocytopenia, liver transaminases, HELLP syndrome, renal failure, and visual or neurologic symptoms 4
Laboratory Tests and Evaluations
The following laboratory tests and evaluations may be useful in diagnosing and managing preeclampsia:
- Urine protein-to-creatinine ratio or 24-hour urine protein excretion 4
- Complete blood count, liver function tests, and coagulation studies 4
- Fetal monitoring, including non-stress tests and biophysical profiles 2
- Maternal and fetal evaluation, including assessment of gestational age, maternal and fetal status, and presence of labor or rupture of membranes 2
Treatment and Management
Treatment and management of preeclampsia depend on the severity of the disease and gestational age:
- Antihypertensive medications and magnesium sulfate may be used to prevent intracranial hemorrhages and seizures 4
- Delivery is the only definitive treatment for preeclampsia, and the decision to deliver depends on gestational age, maternal and fetal conditions, and severity of preeclampsia 2, 4
- Expectant management may be considered in selected patients with severe preeclampsia between 24 and 34 weeks of gestation 2
- Antenatal corticosteroids may be administered to promote fetal lung maturity in patients with preeclampsia at less than 34 weeks of gestation 4