Preeclampsia is new high blood pressure after 20 weeks of pregnancy with protein in the urine or signs of organ damage. It can progress to seizures (eclampsia), stroke or HELLP syndrome, and delivery is the only cure.
Key symptoms
- Often no symptoms; found at a routine check
- Severe or persistent headache
- Blurred vision or seeing spots
- Right upper abdominal or epigastric pain
- Sudden swelling of the face and hands, shortness of breath
What you find on exam
- Blood pressure 140/90 or higher on two readings 4 hours apart
- Severe range: 160/110 or higher
- Brisk reflexes or clonus
- Lung crackles from pulmonary edema; fetal heart rate and fundal height
Tests
- Urine protein-to-creatinine ratio or 24-hour urine protein
- Blood count with platelets
- Liver enzymes, creatinine and LDH to look for HELLP
- Fetal growth ultrasound and nonstress test
Treatment basics
- Severe features: magnesium sulfate to prevent seizures
- Treat severe blood pressure within 30 to 60 minutes: IV labetalol, IV hydralazine or oral nifedipine
- Deliver at 37 weeks without severe features, or at 34 weeks or earlier if unstable with severe features
- Betamethasone if delivery is likely before 34 weeks
- Low-dose aspirin from 12 weeks in future high-risk pregnancies
Red flags
- Seizure (eclampsia)
- Blood pressure 160/110 or higher with headache or vision changes
- Low platelets, rising liver enzymes or shortness of breath
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.