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 a 24-hour urine collection or protein/creatinine ratio ≥0.3) or evidence of end-organ damage, as defined by the most recent guidelines 1. The diagnostic criteria for preeclampsia include:
- New-onset hypertension (blood pressure ≥140/90 mmHg) after 20 weeks of gestation
- Proteinuria (≥300 mg in a 24-hour urine collection or protein/creatinine ratio ≥0.3)
- Evidence of end-organ damage, such as:
- Thrombocytopenia (platelet count <100,000/μL)
- Impaired liver function (elevated liver enzymes to twice the normal concentration)
- New development of renal insufficiency (serum creatinine >1.1 mg/dL)
- Pulmonary edema
- New-onset cerebral or visual disturbances Severe features of preeclampsia include:
- Blood pressure ≥160/110 mmHg on two occasions at least 4 hours apart
- Thrombocytopenia
- Impaired liver function with severe right upper quadrant pain
- Progressive renal insufficiency
- Pulmonary edema
- New-onset headache unresponsive to medication and not accounted for by alternative diagnoses According to the most recent guidelines, the management of preeclampsia should prioritize the reduction of maternal and fetal morbidity and mortality, and should include close monitoring, antihypertensive medications, and magnesium sulfate for seizure prophylaxis if severe features are present 1. The 2020 study 1 provides the most recent and highest quality evidence for the diagnosis and management of preeclampsia, and should be prioritized in clinical practice. In contrast, the 2007 study 1 provides outdated guidelines that are no longer recommended. The 2018 study 1 provides a comprehensive overview of the management of hypertensive disorders in pregnancy, including preeclampsia, and should be considered in conjunction with the 2020 study 1.
From the Research
Criteria for Preeclampsia
- Preeclampsia is characterized by new onset of hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) and proteinuria (> 300 mg/24 h) arising after 20 weeks of gestation in a previously normotensive woman 2
- However, the American College of Obstetricians and Gynecologists has stated that proteinuria is no longer required for the diagnosis of preeclampsia 2
- Severe hypertension is defined as systolic blood pressure ≥ 160 mmHg and/or diastolic blood pressure ≥ 110 mmHg 2
- Other severity criteria include 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 2
Diagnosis and Treatment
- The diagnosis of preeclampsia is based on the presence of hypertension and proteinuria, as well as other clinical signs and symptoms 2
- Treatment depends on the severity of preeclampsia and may include antihypertensive medications such as labetalol, nifedipine, and hydralazine 3, 4, 5
- Magnesium sulfate is also used to prevent seizures and intracranial hemorrhages 2, 3
- The decision to deliver the baby is based on gestational age, maternal and fetal conditions, and severity of preeclampsia 2
Comparison of Antihypertensive Medications
- Labetalol, nifedipine, and hydralazine are commonly used antihypertensive medications for the treatment of preeclampsia 3, 4, 5
- Studies have compared the effectiveness of these medications in reducing blood pressure and preventing adverse outcomes 3, 4, 5, 6
- The choice of medication depends on the individual patient's needs and medical history 6