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Last Updated: 9/10/2014  

Preeclampsia

Prevention
  • Use low-dose aspirin to prevent preeclampsia in pregnant women with moderate or high risk for preeclampsia, including those with chronic hypertension or chronic medical conditions, such as diabetes or chronic kidney disease, or those with a history of preeclampsia.

Screening
  • Monitor all pregnant patients for preeclampsia by checking blood pressure and evaluating for proteinuria.

Diagnosis
  • Use blood pressure as a key criterion for diagnosing preeclampsia.

  • Quantitate proteinuria and determine renal function in patients with suspected preeclampsia. Define significant proteinuria as urinary protein excretion of ≥300 mg/24 h or >165 mg/12 h or urine protein-to-creatinine ratio ≥0.3 mg/dL or 30 mg/mmol.

  • Diagnose preeclampsia in pregnant patients after 20 weeks' gestation with new hypertension (blood pressure consistently ≥140/90 mm Hg) and proteinuria.

  • Obtain liver function tests and a CBC to determine the severity of preeclampsia.

  • Classify the severity of preeclampsia based on level of blood pressure and the presence of complications; define severe disease in patients with blood pressure ≥160/110 mm Hg or complications.

  • Assess fetal well-being in women with preeclampsia.

Therapy
  • Administer antihypertensive therapy to patients with blood pressure ≥160/110 mm Hg, using labetolol as the first-line agent in most patients.

  • Restrict the activity of women with severe preeclampsia.

  • Administer magnesium sulfate in patients with eclampsia or severe preeclampsia.

  • Give antenatal corticosteroids to women with preterm pregnancies of 24 to 34 weeks' gestation complicated by preeclampsia.

  • Base timing of delivery on severity of disease and gestational age.

DOI: 10.7326/d944
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Christy M. Isler, MD has nothing to disclose. Nikolaos P. Polyzos, MD, PhD has nothing to disclose.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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