Revised Diagnostic Criteria for Preeclampsia

Preeclampsia is a disorder of pregnancy associated with new-onset hypertension, which occurs most often after 20 weeks of gestation and frequently near term. Although often accompanied by new-onset proteinuria, hypertension and other signs or symptoms of preeclampsia may present in some women in the absence of proteinuria.

Risk Factors for Preeclampsia

  • Nulliparity
  • Multifetal gestations
  • Preeclampsia in a previous pregnancy
  • Chronic hypertension
  • Pregestational diabetes
  • Gestational diabetes
  • Thrombophilia
  • Systemic lupus erythematosus
  • Prepregnancy body mass index greater than 30
  • Antiphospholipid antibody syndrome
  • Maternal age 35 years or older
  • Kidney disease
  • Assisted reproductive technology
  • Obstructive sleep apnea

 

Revised Diagnostic Criteria for Preeclampsia

Blood pressure

  • Systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure
  • Systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg or more. (Severe hypertension can be confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy).

and
Proteinuria

  • 300 mg or more per 24 hour urine collection (or this amount extrapolated from a timed collection)
    or
  • Protein/creatinine ratio of 0.3 mg/dL or more or
  • Dipstick reading of 2+ (used only if other quantitative methods not available)

Or in the absence of proteinuria, new-onset hypertension with the new onset of any of the following:

  • Thrombocytopenia: Platelet count less than 100,000 x 109/L
  • Renal insufficiency: Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease
  • Impaired liver function: Elevated blood concentrations of liver transaminases to twice normal concentration
  • Pulmonary edema
    • New-onset headache unresponsive to medication and not accounted for by alternative diagnoses or visual symptoms

 

Severe Features

  • Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time)
  • Thrombocytopenia (platelet count less than 100,000 × 109/L)
  • Impaired liver function as indicated by abnormally elevated blood concentrations of liver enzymes (to twice the upper limit normal concentration), and severe persistent right upper quadrant or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses
  • Renal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)
  • Pulmonary edema
  • New-onset headache unresponsive to medication and not accounted for by alternative diagnoses
  • Visual disturbances

 

References:

  1. Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019 Jan;133(1):e1-e25. [Medline]
  2. Sutton ALM, Harper LM, Tita ATN. Hypertensive Disorders in Pregnancy. Obstet Gynecol Clin North Am. 2018 Jun;45(2):333-347. [Medline]

 

Created Sep 13, 2019.