Pre-eclampsia classification: Difference between revisions
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|❑ New onset of [[hypertension]] | |❑ 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]] | ([[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 | |❑ 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]] | ||
Latest revision as of 14:27, 27 March 2021
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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]
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.