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Potentially life-threatening emergency
Preeclampsia
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Potentially life-threatening emergency

Preeclampsia

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Contributors: Stefanie Hollenbach MD, Mitchell Linder MD
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Synopsis

Preeclampsia is a potentially life-threatening pregnancy complication that occurs in approximately 4%-9% of pregnancies; preeclampsia with severe features develops in 1%-7% of pregnancies. Of the women affected by the most severe forms of preeclampsia, 10%-20% will eventually develop HELLP syndrome.

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
Patients without these signs and symptoms meet the criteria for preeclampsia without severe features.

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

Codes

ICD10CM:
014.90 – Unspecified pre-eclampsia, unspecified trimester

SNOMEDCT:
398254007 – Pre-eclampsia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Chronic hypertension – Two or more blood pressure elevations ≥140/90 mm Hg prior to 20 weeks' gestation.
  • Gestational hypertension – Two or more blood pressure elevations ≥140/90 mm Hg after 20 weeks' gestation of pregnancy without evidence of end organ damage (absence of proteinuria and/or neurologic, renal, hepatic sequelae).
  • Gestational thrombocytopenia – Typical onset in the second or third trimester of isolated thrombocytopenia with a steady (not precipitous) decrease as the end of pregnancy approaches.
  • Idiopathic thrombocytopenia – Platelet trend tends to be more stable than that of HELLP syndrome with onset at any time during pregnancy. Especially consider if low platelets have been noted pregestationally.
  • Systemic lupus erythematosus (SLE) – First presentation or flare can look significantly like HELLP syndrome. SLE doesn't improve with delivery.
  • Catastrophic antiphospholipid antibody syndrome
  • Thrombotic thrombocytopenic purpura – Neurologic manifestations (confusion, aphasia, weakness) are more prominent.
  • Hemolytic uremic syndrome – More likely to occur postpartum; renal dysfunction is predominant.
  • Primary gastrointestinal pathologies – Viral hepatitis (A, B, C), cholangitis, cholecystitis, acute pancreatitis.

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References

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Last Reviewed: 11/20/2017
Last Updated: 03/13/2019
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Potentially life-threatening emergency
Preeclampsia
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Preeclampsia (Mild) : Proteinuria, New onset hypertension
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