Pre-eclampsia

Definition & Clinical Presentation

Complete diagnostic criteria

Pre-eclampsia Definition

New-onset hypertension (BP ≥140/90 mmHg) after 20 weeks gestation PLUS one or more of the following:

1 Proteinuria

Any one of the following indicates proteinuria:

  • •

    24-hour urine protein: ≥ 300 mg
  • •

    Spot urine P/C ratio: ≥ 0.3 mg/mg (protein/creatinine)
  • •

    Urine dipstick: ≥ 2+ (only if quantitative testing unavailable)

2 Organ Dysfunction

Any one system dysfunction:

🫘 Renal

Creatinine ≥1 mg/dL

Liver Liver

Transaminases >40 IU/L ± RUQ pain

🧠 Neurological

Eclampsia, severe headache, visual scotomata, altered mental status

🩸 Hematological

Platelets <150 × 10⁹/L, DIC, hemolysis

3 Uteroplacental

  • • IUGR (intrauterine growth restriction)
  • • Abnormal Doppler studies
  • • Stillbirth

Severe Pre-eclampsia

≥1 criterion indicates severe disease

  • •BP ≥160/110 mmHg (two readings 6h apart)
  • •Rapidly increasing proteinuria (>3g/24h)
  • •Oliguria <400 mL/24h (or <0.4 mL/kg/h)
  • •Cerebral irritability or visual disturbance
  • •Pulmonary edema or cyanosis
  • •HELLP syndrome
  • •Progressive deterioration

Common Symptoms

  • • Severe persistent headache
  • • Visual disturbances
  • • Epigastric/RUQ pain (liver capsule distension)
  • • Nausea/vomiting
  • • Hyperreflexia, clonus (≥3 beats)

🚨 Red Flags

  • • Thunderclap/worst headache ever
  • • Focal neurological signs
  • • Seizures
  • • Altered consciousness
  • • Persistent vomiting
  • • Symptoms >48h despite treatment

HELLP Syndrome

Triad: Hemolysis + Elevated Liver enzymes + Low Platelets

Criteria

ALT/AST >70 IU/L + hemolysis + plt <100

Mortality

>1%

Peak Risk

24-72h PP

Complications (>5%): DIC, abruption, acute renal failure, pulmonary edema

1 Severity Spectrum

Normal
<140/90
Blood Pressure: <140/90 mmHg
Proteinuria: None
Organ function: Normal
Symptoms: None
Pre-eclampsia
≥140/90
BP: ≥140/90 after 20wk
PLUS ≥1 of:
• Proteinuria (≥300mg/24h)
• Organ dysfunction
• Uteroplacental dysfunction
Severe
≥160/110
BP: ≥160/110 (6h apart)
OR any of:
• Cerebral/visual symptoms
• Pulmonary edema
• Progressive deterioration
HELLP
>1%
Mortality >1%
• Hemolysis
• EL Liver enzymes (>70)
• LP Low Platelets (<100)
Peak risk: 24-72h postpartum

2 Build a Patient Case

Patient Presentation

Select findings to generate a diagnosis

3 Pathophysiology

Core defect and key consequences

Core Defect Cascade

Deficient placentation

Placental ischemia

Release of antiangiogenic factors

Widespread endothelial dysfunction

Key Consequences

Vasoconstriction

↑ SVR, ↑ afterload, ↑ blood pressure, relative hypovolemia

Capillary Leak

↓ colloid osmotic pressure, tissue/pulmonary edema

End-Organ Effects

🧠
CNS
Vasospasm → headache, visual changes, seizures
NOT cerebral edema
🫘
Renal
Glomerular endotheliosis → proteinuria, oliguria
Liver
Liver
Ischemia → ↑transaminases, HELLP, rupture (rare)
🩸
Coagulation
Thrombocytopenia, qualitative platelet dysfunction