Preeclampsia: diagnosis and management

Half an hour for the pressure. She is 34 weeks, 168/112 mmHg, a headache she describes as the worst she has had, and a platelet count of 88 x 10^9/L that came back while you were walking to see her. Treat severe-range pressure inside 30 to 60 minutes; the rest of the hour is seizure prophylaxis, fluid discipline, fetal assessment and birth planning.[3][1]

Overview and definition

Preeclampsia is a maternal multisystem syndrome of placental origin, not a blood pressure problem with proteinuria attached. Framing it that way is what lets you diagnose the woman whose dipstick is clean and whose platelets are falling.[1][17]

• Hypertension — systolic 140 mmHg or more and/or diastolic 90 mmHg or more, arising de novo at or after 20 weeks.[1][2]
• Plus at least one of: proteinuria, maternal organ dysfunction, or uteroplacental dysfunction.[1]
• Superimposed preeclampsia — any of those new features appearing at or after 20 weeks in a woman with pre-existing chronic hypertension.[1][3]

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2. [2]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
3. [3]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
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