Pre-eclampsia classification: Difference between revisions
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* The percentage of false-negative proteinuria is high. | * The percentage of false-negative proteinuria is high. | ||
<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> | |||
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!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 }} | |||
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| ❑ 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]] | |||
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Revision as of 06:07, 7 October 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]
Classification
- Preeclampsia may be classified based on presence of proteinuria into two subtypes according to new guidline:
- Preeclampsia with proteinuria
- Preeclampsia without proteinuria
- The percentage of false-negative proteinuria is high.
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 |