From the Guidelines
Preeclampsia is diagnosed when a pregnant woman develops new-onset hypertension (blood pressure ≥140/90 mmHg) after 20 weeks of gestation along with either proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3) or evidence of end-organ damage, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1.
Key Diagnostic Criteria
- New-onset hypertension (blood pressure ≥140/90 mmHg) after 20 weeks of gestation
- Proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3)
- Evidence of end-organ damage, such as:
- Thrombocytopenia (platelet count <100,000/μL)
- Renal insufficiency (serum creatinine >1.1 mg/dL)
- Liver involvement (elevated transaminases at least twice normal)
- Pulmonary edema
- Cerebral/visual symptoms
Severe Features of Preeclampsia
- Blood pressure ≥160/110 mmHg on two occasions at least 4 hours apart
- Thrombocytopenia
- Impaired liver function
- Severe persistent right upper quadrant pain
- Progressive renal insufficiency
- Pulmonary edema
- New-onset cerebral or visual disturbances
Management
- Women with preeclampsia should be assessed in hospital when first diagnosed, and thereafter, some may be managed as outpatients once it is established that their condition is stable and they can be relied on to report problems and monitor their BP 1.
- Magnesium sulfate is typically administered for seizure prophylaxis in severe preeclampsia
- Antihypertensive therapy is indicated for persistent blood pressure readings ≥160/110 mmHg, with labetalol, hydralazine, or nifedipine being first-line options
- Delivery is the definitive treatment and should be considered if the woman has reached 37 weeks’ gestation or develops any severe features of preeclampsia 1
From the Research
Preeclampsia Criteria
The criteria for preeclampsia have undergone changes over the years. According to 2, preeclampsia was formerly defined as a multisystemic disorder characterized by new onset of hypertension (i.e. systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg) and proteinuria (> 300 mg/24 h) arising after 20 weeks of gestation in a previously normotensive woman. However, the American College of Obstetricians and Gynecologists has stated that proteinuria is no longer required for the diagnosis of preeclampsia.
Blood Pressure Cut-off
- The classical diagnosis of preeclampsia is usually based on the fulfillment of 3 criteria: pregnancy > 20 weeks of gestation, proteinuria (2+ on dipstick or > 300 mg/24 h) and arterial hypertension ≥ 140/90 mm Hg 3.
- A new blood pressure cut-off of 130/80 mmHg has been proposed for the definition of preeclampsia, based on the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on pregnant women 3.
Severity Criteria
- Severe hypertension (SBP ≥ 160 mm Hg and/or DBP ≥ 110 mmHg), thrombocytopenia < 100.000/μL, liver transaminases above twice the normal values, HELLP syndrome, renal failure, persistent epigastric or right upper quadrant pain, visual or neurologic symptoms, and acute pulmonary edema are all severity criteria for preeclampsia 2.