Diagnosing Preeclampsia – Key Definitions

WHAT IS IT?

Preeclampsia is a pregnancy specific hypertensive disease with multi-system involvement. It usually occurs after 20 weeks of gestation and can be superimposed on another hypertensive disorder. While preeclampsia was historically defined by the new onset of hypertension in combination with proteinuria, some women will present with hypertension and multisystemic signs in the absence of proteinuria. The presence of multisystemic signs is an indication of disease severity.

KEY POINTS:

The ACOG Task Force on Hypertension and Pregnancy has released the following definitions:

Blood Pressure Criteria:

Mild Hypertension – systolic bp > 140 mm hg or diastolic bp > 90 mm hg or both
Severe Hypertension – systolic bp > 160 mm hg or diastolic bp > 110 mm hg or both

Proteinuria Criteria:

24 hour urine collection > 300 mg protein or single voided urine protein/creatinine ratio > 3.0 mg/dl

Preeclampsia:

mild hypertension and proteinuria

Preeclampsia with severe features: (1) severe hypertension and proteinuria or (2) mild hypertension with or without proteinuria and one of the following:

Thrombocytopenia: platelets < 100,000/microliter
Elevated transaminase: twice normal concentration and/or severe persistent right upper quadrant or epigastric pain
New development renal insufficiency: serum creatinine >1.1 mg/dl or doubling of serum creatinine in the absence of other renal disease
Pulmonary edema
New onset cerebral or visual disturbances

The following are not diagnostic criteria for the diagnosis of preeclampsia or preeclampsia with severe features:

Clinically evident edema
Rapid weight gain
Massive proteinuria
Fetal growth restriction
Uric acid
- Hyperuricemia in hypertensive pregnancy is not a diagnostic marker, but is an important finding as a risk factor for adverse maternal and fetal outcomes
  - Small for gestational age (SGA) infant
  - Prematurity
  - Risk for adverse maternal outcomes if include patients with preeclampsia and risks increase with increasing concentration of uric acid