Preeclampsia is a systemic disease of pregnancy characterized by new-onset blood pressure elevations after 20 weeks' gestation with accompanying evidence of end organ damage. Traditionally, this was evidenced by proteinuria, but preeclampsia can now be diagnosed in the absence of proteinuria when there are other features suggestive of end organ damage such as refractory headache suggestive of neurologic compromise, renal dysfunction, or hepatic dysfunction.
Rather than comprising a single, unified diagnosis, preeclampsia disorders exist across a spectrum. This wide spectrum is generally divided into 2 categories: preeclampsia with and preeclampsia without severe features.
The criteria for preeclampsia with severe features is:
- Thrombocytopenia (platelet count <100 000/µL)
- Liver dysfunction (liver function tests >2 times the upper limit of normal)
- Renal dysfunction (creatinine >1.1 mg/dL or doubling of the patient's baseline)
- Pulmonary edema
- Neurologic dysfunction
Common risk factors for preeclampsia include nulliparity (first pregnancy), chronic hypertension, pregestational renal disease, pregestational diabetes, obesity, use of assisted reproductive technology, and a family history of preeclampsia spectrum disorders. Complications of pregnancy can also increase the risk of preeclamptic spectrum disorders, including molar pregnancies and multifetal pregnancies.
Clinical presentations are variable. Initial presentations may include any combination of abdominal pain and tenderness (right upper quadrant or epigastric), nausea, vomiting, edema, malaise, headache, and/or visual changes. The initial disease process may also be asymptomatic.
Complications of preeclampsia include seizures, placental abruption, postpartum hemorrhage, disseminated intravascular coagulation (DIC), pulmonary edema, acute renal failure, and hemorrhagic stroke. Any of these significant complications can result in maternal and/or fetal death.
Related topic: Eclampsia