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Reliable, easy-to-read patient information on common medical conditions β€” written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Pre-eclampsia classification

Introduction

Overview

Overview

In the new classification, proteinuria is not the main indicator for diagnosis of preeclampsia.The percentage of false-negative proteinuria, especially on the dipstick, is high. Preeclampsia may be classified according to the time of event into two groups: Early (preeclampsia before 34 weeks of gestation) and Late (preeclampsia after delivery). Preeclampsia with severe feature includes the following characteristics: systolic blood pressure β‰₯ 160 mmHg, diastolic blood pressure β‰₯ 110 mmHg, in two occasions apart 4 hours, thrombocytopnea (platelet count <100,000/dl), pulmonary edema, new-onset headache unresponsive to medications, visual disturbances, liver enzyme level > 2 times upper limit normal concentrations or persistent epigastric or right upper quadrant pain, and serum creatinine >1.1 mg/dl or doubling serum creatinine level in the absent of other causes of renal insufficiency.

Classification

Classification

  • The percentage of false-negative proteinuria especially on the dipstick is high. It is not the main criteria for the diagnosis of preeclampsia.
  • Preeclampsia may be classified according to the time of event into two groups:
  • Preeclampsia with severe feature includes the following characteristics:

Abbreviations: ALT: alanine aminotransferaseΒ ; AST:Aspartate aminotransferaseΒ ;ISSHP:International Society for the Study of Hypertension in Pregnancy; ACOG:American College of Obstetricians and Gynecologists

ISSHP 2001/ACOG 2002 ISSHP 2018 ACOG 2013 ACOG 2018
❑ New onset of hypertension (blood pressure β‰₯140 mmHg systolic and/or β‰₯90 mmHg diastolic) after 20 weeks of gestation and
❑ proteinuria (urine protein/creatinine β‰₯30 mg/mmol (0.3 mg/mg)or β‰₯300 mg/day or at least (β€˜1+’) on dipstick testing 		❑ New onset of hypertension

(blood pressure of β‰₯140 mmHg systolic and/or β‰₯90 mmHg diastolic) after 20 weeks of gestation accompanied by one or more of the following:
❑ Proteinuria
❑ Maternal organ dysfunction including:
❑ Renal insufficiency (creatinine > 90 ΞΌmol/L; 1 mg/dL)
❑ Liver involvement (elevated transaminases with or without right upper quadrant or epigastric or abdominal pain)
❑ Neurological complications in eclampsia (altered mental status, blindness, stroke,hyperreflexia with clonus, severe headaches with hyperreflexia, persistent visual scotomata) )
❑ Hematological complications (thrombocytopenia with platelet count below 150,000/dL, DIC, hemolysis

❑ New onset of hypertension (blood pressure of β‰₯140 mmHg systolic and/or β‰₯90 mmHg diastolic) after 20 weeks of gestation on two occasions at least 4 hours apart accompanied by one or more of the following:
❑ Proteinuria
❑ Maternal organ dysfunction including:
❑ Renal insufficiency (serum creatinine> 1.1 mg/dL)
❑ Impaired liver function (ALA or ASA β‰₯ 70 U/l)
❑ Cerebral or visual symptoms
❑ Thrombocytopenia (platelet count < 100,000/dL
❑ Pulmonary edema 		❑ 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
❑ And
❑Proteinuria
❑ 300 mg or more per 24 hour urine collection
❑ Protein/creatinine ratio of 0.3 mg/dL or more or Dipstick of 2+
❑ 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/dl
❑ Renal insufficiency( Serum creatinine>1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)
❑ Impaired liver function (Elevated blood level of liver transaminases to twice normal level)
❑ Pulmonary edema
❑ New-onset headache unresponsive to medication and not accounted for by alternative diagnoses or visual symptoms

References

References

  1. ↑ “Gestational Hypertension and Preeclampsia”. Obstetrics & Gynecology. 135 (6): e237–e260. 2020. doi:10.1097/AOG.0000000000003891. ISSNΒ 0029-7844.
  2. ↑ Woelkers, Doug; Barton, John; Dadelszen, Peter von; Sibai, Baha (2015). “[71-OR]”. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health. 5 (1): 38. doi:10.1016/j.preghy.2014.10.075. ISSNΒ 2210-7789.
  3. ↑ Brown, Mark A.; Lindheimer, Marshall D.; Swiet, Michael de; Assche, Andre Van; Moutquin, Jean-Marie (2001). “THE CLASSIFICATION AND DIAGNOSIS OF THE HYPERTENSIVE DISORDERS OF PREGNANCY: STATEMENT FROM THE INTERNATIONAL SOCIETY FOR THE STUDY OF HYPERTENSION IN PREGNANCY (ISSHP)”. Hypertension in Pregnancy. 20 (1): ix–xiv. doi:10.1081/PRG-100104165. ISSNΒ 1064-1955.
  4. ↑ 4.0 4.1 Brown, Mark A.; Magee, Laura A.; Kenny, Louise C.; Karumanchi, S. Ananth; McCarthy, Fergus P.; Saito, Shigeru; Hall, David R.; Warren, Charlotte E.; Adoyi, Gloria; Ishaku, Salisu (2018). “Hypertensive Disorders of Pregnancy”. Hypertension. 72 (1): 24–43. doi:10.1161/HYPERTENSIONAHA.117.10803. ISSNΒ 0194-911X.
  5. ↑ Grill, Simon; Rusterholz, Corinne; Zanetti-DΓ€llenbach, Rosanna; Tercanli, Sevgi; Holzgreve, Wolfgang; Hahn, Sinuhe; Lapaire, Olav (2009). “Potential markers of preeclampsia – a review”. Reproductive Biology and Endocrinology. 7 (1): 70. doi:10.1186/1477-7827-7-70. ISSNΒ 1477-7827.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]