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([[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]] | ([[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]]'' | | ❑ 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 | | ❑ [[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]] | 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 06:33, 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 according to new guidelines into three groups:[1][2][3][4]
- Preeclampsia with proteinuria
- Preeclampsia without proteinuria
- Preeclampsia with severe features
- The percentage of false-negative proteinuria especially on the dipstick 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 |
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.
- ↑ 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.