II. Criteria
-
Blood Pressure >140/90 on 2 Blood Pressure readings 4-6 hours apart
- Assumes normal Blood Pressure before pregnancy (and before 20 weeks gestation)
- See Chronic Hypertension in Pregnancy
- Blood Pressure >160/110 on 2 occasions meets criteria for Severe Preeclampsia
- Start Antihypertensives if systolic Blood Pressure >160 or diastolic Blood Pressure >110 for >15 minutes
- See Severe Hypertension Management in Pregnancy
- Other findings in Preeclampsia (not required for diagnosis)
- Evaluate for features consistent with Severe Preeclampsia (e.g. Headache, abnormal labs such as Thrombocytopenia)
- See Severe PIH Management (includes IV Magnesium and delivery at >=34 weeks)
- Urine Protein 24 Hour: >300 mg
- Generalized Edema (affecting hands and face)
- Not reliable due to high False Positive and False Negative Rate in pregnancy
- Evaluate for features consistent with Severe Preeclampsia (e.g. Headache, abnormal labs such as Thrombocytopenia)
III. Findings
- Symptoms are typically absent in Mild Preeclampsia (consider Severe Preeclampsia if present)
- Typically, no Headache, visual changes or Epigastric Pain
- Signs are typically mild (contrast with Severe Preeclampsia)
- Urine Output maintained >500 ml/24h
- Urinalysis with no more than 1 to 2+ Protein
IV. Evaluation: Maternal
- Monitor Blood Pressure 1-2 times weekly
- Obtain Preeclampsia labs weekly
- Complete Blood Count with Platelets
- Aspartate transaminase (AST)
- Alanine transaminase (ALT)
- Lactate Dehydrogenase (LDH)
- Serum Creatinine
- Urine Protein to Creatinine Ratio
- Consider quantifying abnormal values with Urine Protein 24 Hour collection
V. Evaluation: Fetal (starting at 26-28 weeks)
- Fetal Safety Assessment: Abnormal results prompt intervention, possible delivery
- Option 1
- Non-Stress Test weekly and
- Amniotic fluid index weekly and
- Biophysical Profile weekly
- Option 2
- Non-Stress Test twice weekly and
- Amniotic fluid index twice weekly
- Additional Measures
- Monitor fetal movevement with kick counts
- Interpretation
- Non-reassuring Non-Stress Test prompts repeat Biophysical Profile, anmniotic fluid index
- Consider intervention for Biophysical Profile <6/8 or amniotic fluid index <5 cm
- Option 1
- Fetal Growth Assessment
- Ultrasound for Fetal Growth every 3-4 weeks
- Consider concurrent Doppler Ultrasound of umbilical artery systolic/diastolic ratios
- Consider intervention if estimated fetal weight <10th percentile, or decreased ratio
VI. Management: Mild Preeclampsia
- See Severe PIH Management
- See Delivery Indications in PIH
- Co-management with obstetrics
- Term Gestation: Delivery at 37 weeks is preferred
- Preterm gestation
- Maternal and Fetal Monitoring as above until Gestational age >37-38 weeks
- Consider earlier delivery when Fetal Lung Maturity adequate or clinical worsening
VII. References
- Fontaine (2000) in ALSO, B:1-36
- Marlow (2021) Crit Dec Emerg Med 35(2): 19-23
- Sibai in Gabbe (2002) Obstetrics, p. 945-74
- Farahi (2024) Am Fam Physician 109(3): 251-60 [PubMed]
- Leeman (2008) Am Fam Physician 78:93-100 [PubMed]
- Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
- (2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
- Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]