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Preeclampsia: Clinical features and diagnosis

Authors
Phyllis August, MD, MPH
Baha M Sibai, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Preeclampsia is a multi-system disorder characterized by the new onset of hypertension and proteinuria or end-organ dysfunction or both in the last half of pregnancy (table 1). Although most affected pregnancies deliver at term or near term with good maternal and fetal outcomes, these pregnancies are at increased risk for maternal and/or fetal mortality or serious morbidity [1,2].

This topic will discuss the clinical features, diagnosis, and differential diagnosis of preeclampsia. Pathogenesis, management, and long-term prognosis are reviewed separately. (See "Preeclampsia: Pathogenesis" and "Preeclampsia: Management and prognosis".)

DEFINITIONS OF PREGNANCY-RELATED HYPERTENSIVE DISORDERS

There are four major hypertensive disorders related to pregnancy [3,4]:

Preeclampsia – Preeclampsia refers to the new onset of hypertension and either proteinuria or end-organ dysfunction or both after 20 weeks of gestation in a previously normotensive woman (table 1). Severe hypertension and signs/symptoms of end-organ injury are considered the severe spectrum of the disease (table 2) [4]. In 2013, the American College of Obstetricians and Gynecologists removed proteinuria as an essential criterion for diagnosis of preeclampsia with severe features. They also removed massive proteinuria (5 grams/24 hours) and fetal growth restriction as possible features of severe disease because massive proteinuria has a poor correlation with outcome and fetal growth restriction is managed similarly whether or not preeclampsia is diagnosed [4]. Oliguria was also removed as a characteristic of severe disease.

Eclampsia refers to the development of grand mal seizures in a woman with preeclampsia, in the absence of other neurologic conditions that could account for the seizure. (See "Eclampsia".)

                                         

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 01 00:00:00 GMT+00:00 2016.
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