Pre-eclampsia classification: Difference between revisions
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{{Pre-eclampsia}} | {{Pre-eclampsia}} | ||
{{CMG}}; {{AE}} {{Sara.Zand}} | {{CMG}}; {{AE}} {{Sara.Zand}} | ||
==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]] ≥ 160 mmHg, [[diastolic blood pressure]] ≥ 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== | |||
*[[ Preeclampsia]] may be classified according to presence of [[proteinuria]] into two groups:<ref>{{cite journal|title=Gestational Hypertension and Preeclampsia|journal=Obstetrics & Gynecology|volume=135|issue=6|year=2020|pages=e237–e260|issn=0029-7844|doi=10.1097/AOG.0000000000003891}}</ref><ref name="WoelkersBarton2015">{{cite journal|last1=Woelkers|first1=Doug|last2=Barton|first2=John|last3=Dadelszen|first3=Peter von|last4=Sibai|first4=Baha|title=[71-OR]|journal=Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health|volume=5|issue=1|year=2015|pages=38|issn=22107789|doi=10.1016/j.preghy.2014.10.075}}</ref><ref name="BrownLindheimer2001">{{cite journal|last1=Brown|first1=Mark A.|last2=Lindheimer|first2=Marshall D.|last3=Swiet|first3=Michael de|last4=Assche|first4=Andre Van|last5=Moutquin|first5=Jean-Marie|title=THE CLASSIFICATION AND DIAGNOSIS OF THE HYPERTENSIVE DISORDERS OF PREGNANCY: STATEMENT FROM THE INTERNATIONAL SOCIETY FOR THE STUDY OF HYPERTENSION IN PREGNANCY (ISSHP)|journal=Hypertension in Pregnancy|volume=20|issue=1|year=2001|pages=ix–xiv|issn=10641955|doi=10.1081/PRG-100104165}}</ref><ref name="BrownMagee2018">{{cite journal|last1=Brown|first1=Mark A.|last2=Magee|first2=Laura A.|last3=Kenny|first3=Louise C.|last4=Karumanchi|first4=S. Ananth|last5=McCarthy|first5=Fergus P.|last6=Saito|first6=Shigeru|last7=Hall|first7=David R.|last8=Warren|first8=Charlotte E.|last9=Adoyi|first9=Gloria|last10=Ishaku|first10=Salisu|title=Hypertensive Disorders of Pregnancy|journal=Hypertension|volume=72|issue=1|year=2018|pages=24–43|issn=0194-911X|doi=10.1161/HYPERTENSIONAHA.117.10803}}</ref> | |||
:*[[ Preeclampsia]] with [[proteinuria]] | |||
:*[[ Preeclampsia]] without [[proteinuria]] | |||
::*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: | |||
:*Early [[ preeclampsia]] before 34 week of [[gestation]] | |||
:*Late [[ preeclampsia]] after delivery | |||
*[[Preeclampsia]] may be classified into:<ref name="BrownMagee2018">{{cite journal|last1=Brown|first1=Mark A.|last2=Magee|first2=Laura A.|last3=Kenny|first3=Louise C.|last4=Karumanchi|first4=S. Ananth|last5=McCarthy|first5=Fergus P.|last6=Saito|first6=Shigeru|last7=Hall|first7=David R.|last8=Warren|first8=Charlotte E.|last9=Adoyi|first9=Gloria|last10=Ishaku|first10=Salisu|title=Hypertensive Disorders of Pregnancy|journal=Hypertension|volume=72|issue=1|year=2018|pages=24–43|issn=0194-911X|doi=10.1161/HYPERTENSIONAHA.117.10803}}</ref><ref name="GrillRusterholz2009">{{cite journal|last1=Grill|first1=Simon|last2=Rusterholz|first2=Corinne|last3=Zanetti-Dällenbach|first3=Rosanna|last4=Tercanli|first4=Sevgi|last5=Holzgreve|first5=Wolfgang|last6=Hahn|first6=Sinuhe|last7=Lapaire|first7=Olav|title=Potential markers of preeclampsia – a review|journal=Reproductive Biology and Endocrinology|volume=7|issue=1|year=2009|pages=70|issn=1477-7827|doi=10.1186/1477-7827-7-70}}</ref> | |||
:*[[Preterm]] [[preeclampsia]] onset between 34 weeks and 1 day and 37 weeks | |||
:*[[Term]] [[preeclampsia]] onset after 37 weeks and 1 day | |||
*[[Preeclampsia]] with severe feature includes the following characteristics: | |||
::*[[Systolic blood pressure]]≥ 160 mmHg,[[diastolic blood pressure]]≥ 110 mmHg, in two occasionS apart 4 hours | |||
::*[[Thrombocytopnea]] ([[platelet count]] <100,000/dl0 | |||
::*[[Pulmonary edema]] | |||
::*New onset [[ headache]] unresponsed to medications | |||
::*[[Visual]] disturbances | |||
::*[[ Liver]] enzyme level > 2 times upper limit normal concentrations or persistent [[epigasteric]] or [[right upper quadrant pain]] | |||
::*Serum [[creatinin]] >1.1 mg/dl or doubling serum [[creatinine]] level in the absent of other causes of [[renal insufficiency]] | |||
<span style="font-size:85%">'''Abbreviations:''' '''[[ALT]]:''' [[alanine aminotransferase]] ; '''[[AST]]:'''[[Aspartate aminotransferase]] ;'''ISSHP:'''International Society for the Study of Hypertension in Pregnancy; '''ACOG:'''American College of Obstetricians and Gynecologists </span> | |||
{| class="wikitable" border="1" | |||
! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF|ISSHP 2001/ACOG 2002 }}!! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF| ISSHP 2018 }}!! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF| ACOG 2013}}!! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF| ACOG 2018 }} | |||
|- | |||
|❑ New onset of [[hypertension]] ([[blood pressure]] ≥140 mmHg [[systolic]] and/or ≥90 mmHg [[diastolic]]) after 20 weeks of [[gestation]] '''and '''<br> ❑ [[proteinuria]] ([[urine protein]]/[[creatinine]] ≥30 mg/mmol (0.3 mg/mg)or ≥300 mg/day or at least (‘1+’) on [[dipstick testing]] | |||
|❑ New onset of [[hypertension]] | |||
([[blood pressure]] of ≥140 mmHg [[systolic]] and/or ≥90 mmHg [[diastolic]]) after 20 weeks of [[gestation]] accompanied by one '''or''' more of the following:<br> ❑ '''[[Proteinuria]]''' <br>❑ '''[[Maternal organ dysfunction]]''' including:<br> ❑ ''[[Renal insufficiency ]]''([[creatinine]] > 90 μmol/L; 1 mg/dL)<br> ❑ ''[[Liver]] involvement'' (elevated [[transaminases]] with or without [[right upper quadrant]] or [[epigastric]] or [[abdominal pain)]] <br> ❑ ''[[Neurological complications]]'' in [[eclampsia]] ([[ altered mental status]], [[blindness]], [[stroke]],[[hyperreflexia]] with [[clonus]], severe [[headaches]] with [[hyperreflexia]], persistent [[visual scotomata)]] )<br> ❑ ''[[Hematological complications]]'' ([[thrombocytopenia]] with [[platelet count]] below 150,000/dL, [[ DIC]], [[hemolysis]] | |||
|❑ New onset of [[hypertension]] ([[blood pressure ]] of ≥140 mmHg [[systolic]] and/or ≥90 mmHg [[diastolic]]) after 20 weeks of [[gestation]] on two occasions at least 4 hours apart accompanied by one or more of the following: <br> ❑ ''' [[Proteinuria]]'''<br> ❑ ''' [[Maternal organ dysfunction]]''' including: <br> ❑ ''[[ Renal insufficiency]]'' ([[serum creatinine]]> 1.1 mg/dL) <br> ❑ ''Impaired [[liver function]]'' (ALA or ASA ≥ 70 U/l)<br>❑ ''[[Cerebral]]'' or [[visual symptoms]] <br>❑ ''[[Thrombocytopenia]]'' ([[platelet count]] < 100,000/dL <br>❑ ''[[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]]<br>❑ [[Systolic blood pressure]] of 160 mm Hg or more or [[diastolic blood pressure]] of 110 mm Hg or more<br>❑ '''And'''<br>❑'''[[Proteinuria]]'''<br>❑ 300 mg or more per 24 hour [[urine]] collection<br>❑ [[Protein/creatinine ratio ]]of 0.3 mg/dL or more or Dipstick of 2+<br>❑ '''Or in the absence of [[proteinuria]], new-onset [[hypertension]] with the new onset of any of the following''':<br>❑ [[Thrombocytopenia]] ([[Platelet count]] less than | |||
100,000/dl<br>❑ '''[[Renal insufficiency]]'''( Serum [[creatinine]]>1.1 mg/dL or a doubling of the serum [[ creatinine]] concentration in the absence of other [[renal disease]])<br>❑ '''Impaired [[liver function]] '''(Elevated [[blood]] level of [[liver transaminases]] to twice normal level)<br>❑ '''[[Pulmonary edema]]'''<br>❑ ''' New-onset [[headache]]''' unresponsive to medication and not accounted for by alternative diagnoses or [[visual symptoms]] | |||
|} | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category: | [[Category:Up-to-date]] | ||
Latest revision as of 14:27, 27 March 2021
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Pre-eclampsia Microchapters |
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Pre-eclampsia classification On the Web |
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American Roentgen Ray Society Images of Pre-eclampsia classification |
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Risk calculators and risk factors for Pre-eclampsia classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]
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 ≥ 160 mmHg, diastolic blood pressure ≥ 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
- Preeclampsia may be classified according to presence of proteinuria into two groups:[1][2][3][4]
- Preeclampsia with proteinuria
- Preeclampsia without proteinuria
- 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:
- Early preeclampsia before 34 week of gestation
- Late preeclampsia after delivery
- Preeclampsia may be classified into:[4][5]
- Preterm preeclampsia onset between 34 weeks and 1 day and 37 weeks
- Term preeclampsia onset after 37 weeks and 1 day
- Preeclampsia with severe feature includes the following characteristics:
- Systolic blood pressure≥ 160 mmHg,diastolic blood pressure≥ 110 mmHg, in two occasionS apart 4 hours
- Thrombocytopnea (platelet count <100,000/dl0
- Pulmonary edema
- New onset headache unresponsed to medications
- Visual disturbances
- Liver enzyme level > 2 times upper limit normal concentrations or persistent epigasteric or right upper quadrant pain
- Serum creatinin >1.1 mg/dl or doubling serum creatinine level in the absent of other causes of renal insufficiency
Abbreviations: ALT: alanine aminotransferase ; AST:Aspartate aminotransferase ;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 ≥140 mmHg systolic and/or ≥90 mmHg diastolic) after 20 weeks of gestation and ❑ proteinuria (urine protein/creatinine ≥30 mg/mmol (0.3 mg/mg)or ≥300 mg/day or at least (‘1+’) on dipstick testing |
❑ New onset of hypertension
(blood pressure of ≥140 mmHg systolic and/or ≥90 mmHg diastolic) after 20 weeks of gestation accompanied by one or more of the following: |
❑ New onset of hypertension (blood pressure of ≥140 mmHg systolic and/or ≥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 ≥ 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 |
References
- ↑ "Gestational Hypertension and Preeclampsia". Obstetrics & Gynecology. 135 (6): e237–e260. 2020. doi:10.1097/AOG.0000000000003891. ISSN 0029-7844.
- ↑ 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. ISSN 2210-7789.
- ↑ 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. ISSN 1064-1955.
- ↑ 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. ISSN 0194-911X.
- ↑ Grill, Simon; Rusterholz, Corinne; Zanetti-Dällenbach, 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. ISSN 1477-7827.