Materiały źródłowe

• #1 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria, typically presenting after 20 weeks of gestation or postpartum. […] The major hypertensive disorders that occur in pregnant patients are described below. During pregnancy, hypertension is defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Severe hypertension is defined as systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg. […] Preeclampsia refers to the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria in a previously normotensive patient, typically after 20 weeks of gestation or postpartum.

• #2 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Hypertensive disorders of pregnancy constitute a leading cause of maternal and perinatal mortality worldwide. Preeclampsia, with or without severe features, is a disorder of pregnancy associated with new-onset hypertension, usually with accompanying proteinuria, which occurs most often after 20 weeks of gestation and frequently near term. […] Early diagnosis and prompt management are essential to preventing maternal and neonatal complications through symptomatic management and delivery planning. […] This activity reviews the clinical presentation, complications, and management of preeclampsia. […] The parameters for initial identification of hypertension in the context of pregnancy-induced hypertension constituting the „mild range” are specifically defined as a systolic blood pressure (SBP) of 140 mm Hg or more or diastolic blood pressure (DBP) of 90 mm Hg or more on 2 occasions at least 4 hours apart; or shorter interval timing in cases of „severe range” hypertension with SBP of 160 mm Hg or more or DBP of 110 mm Hg or more, all of which must be identified after 20 weeks of gestation.

• #3 What Is Preeclampsia

  https://preeclampsia.org/what-is-preeclampsia

  Preeclampsia is diagnosed by the elevation of the expectant patient’s blood pressure usually after the 20th week of pregnancy and is unique to human pregnancy. According to guidelines released by the American College of Obstetricians and Gynecologists, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). […] Preeclampsia is now diagnosed by persistent high blood pressure that develops during pregnancy or the postpartum period that is associated with high levels of protein in the urine OR the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances. […] Preeclampsia and related hypertensive disorders of pregnancy impact 5-8% of all births in the United States. […] Preeclampsia and other hypertensive disorders of pregnancy can be devastating diseases, made worse by delays in diagnosis or management, seriously impacting or even killing both women and their babies before, during or after birth.

• #4 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Management of preeclampsia begins with early diagnosis and intervention, focusing on adequate blood pressure control and seizure prevention. […] The first choice for seizure prophylaxis in patients with preeclampsia with severe features is IV magnesium sulfate therapy. […] Early diagnosis, timely medical intervention, and appropriate maternal and fetal surveillance significantly improve maternal and fetal outcomes. […] Delayed delivery of the fetus in preeclamptic patients in the late preterm period increases the risk of severe hypertension, with severe consequences such as eclampsia, HELLP syndrome, pulmonary edema, myocardial infarction, acute respiratory distress syndrome, stroke, renal and retinal injury, and fetal complications including fetal growth restrictions, placental abruption, or fetal or maternal death.

• #5 Preeclampsia and Eclampsia – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/preeclampsia-and-eclampsia

  Preeclampsia is new onset or worsening of existing hypertension with proteinuria after 20 weeks gestation. Diagnosis is by measuring blood pressure and urine protein and by tests to evaluate for end-organ damage (eg, pulmonary edema, impaired liver or kidney function). […] Diagnosis of Preeclampsia and Eclampsia: Preeclampsia: New onset after 20 weeks gestation of hypertension plus new unexplained proteinuria (300 mg/24 hours or a urine protein/creatinine ratio of 0.3) and/or signs of end-organ damage. Blood pressure (BP) criteria for preeclampsia are one of the following: Systolic BP 140 mm Hg and/or diastolic BP 90 mm Hg (at least 2 measurements taken at least 4 hours apart). […] In the absence of proteinuria, preeclampsia may be diagnosed if pregnant women meet diagnostic criteria for new-onset hypertension and also have new-onset signs of end-organ damage.

• #6 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher. (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.) […] In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia. […] Severe preeclampsia accounts for approximately 25% of all cases of preeclampsia.

• #7 Screening for Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p117.html

  Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, which one of the following statements about the diagnosis of preeclampsia in this patient is accurate? […] The criteria for the diagnosis of preeclampsia include elevated blood pressure (140/90 mm Hg or greater on two occasions four hours apart, after 20 weeks’ gestation) and either proteinuria (300 mg per dL or greater on a 24-hour urine protein test, urine protein-to-creatinine ratio of 0.3 or greater, or urine protein dipstick reading greater than 1 if quantitative analysis is not available) or in the absence of proteinuria, findings of thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. […] Known clinical risk factors for preeclampsia include multifetal gestation, nulliparity, advanced maternal age, African American race, and obesity.

• #8 Evaluation of Preeclampsia at Term

  https://www.exxcellence.org/list-of-pearls/evaluation-of-preeclampsia-at-term/?categoryName=&searchTerms=&featured=False

  Gravidas at term (37 weeks) with new onset/worsening hypertension or symptoms suggesting end organ effects, such as persistent headache, visual changes, right upper quadrant or epigastric pain, should be evaluated for preeclampsia. Preeclampsia (with or without severe features) at term requires hospital admission for management and delivery at the time of diagnosis. […] Preeclampsia diagnosis includes elevated blood pressures (SBP 140 or DBP 90) on two occasions separated by 4 hours. If severe hypertension is present (SBP 160 or DBP 110), the diagnosis can be confirmed after a shortened interval (e.g. 15 minutes) to expedite initiation of anti-hypertensive therapy. […] In addition to BP criteria, diagnosis is supported by laboratory findings of proteinuria or one of the following: thrombocytopenia, renal insufficiency, impaired liver function.

• #9 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher. (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.) […] In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia. […] Severe preeclampsia accounts for approximately 25% of all cases of preeclampsia.

• #10 What Is Preeclampsia

  https://preeclampsia.org/what-is-preeclampsia

  Preeclampsia is diagnosed by the elevation of the expectant patient’s blood pressure usually after the 20th week of pregnancy and is unique to human pregnancy. According to guidelines released by the American College of Obstetricians and Gynecologists, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). […] Preeclampsia is now diagnosed by persistent high blood pressure that develops during pregnancy or the postpartum period that is associated with high levels of protein in the urine OR the new development of decreased blood platelets, trouble with the kidneys or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances. […] Preeclampsia and related hypertensive disorders of pregnancy impact 5-8% of all births in the United States. […] Preeclampsia and other hypertensive disorders of pregnancy can be devastating diseases, made worse by delays in diagnosis or management, seriously impacting or even killing both women and their babies before, during or after birth.

• #11 Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines – The ObG Project

  https://www.obgproject.com/2017/01/08/diagnosing-preeclampsia-key-definitions/

  Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines […] Preeclampsia is a pregnancy specific hypertensive disease with multi-system involvement. It usually occurs after 20 weeks of gestation and can be superimposed on another hypertensive disorder. While preeclampsia was historically defined by the new onset of hypertension in combination with proteinuria, some women will present with hypertension and multisystemic signs in the absence of proteinuria. The presence of multisystemic signs is an indication of disease severity. […] ACOG defines gestational hypertension as “hypertension without proteinuria or severe features develops after 20 weeks of gestation and blood pressure levels return to normal in the postpartum period.” […] Women with gestational hypertension with severe range blood pressures (a systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 mm Hg or higher) should be diagnosed with preeclampsia with severe features. […] Preeclampsia diagnosis, above, with any of the following: Severe hypertension […] Note: The following are not diagnostic criteria for the diagnosis of preeclampsia or preeclampsia with severe features.

• #12 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher. (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.) […] In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia. […] Severe preeclampsia accounts for approximately 25% of all cases of preeclampsia.

• #13 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Also, a patient with new-onset hypertension without proteinuria can be diagnosed if any of the following is present: platelet count below 100,000/L; serum creatinine level above 1.1 mg/dL or doubling of serum creatinine in the absence of other renal disease; liver transaminase levels at least twice the normal concentrations; pulmonary edema; cerebral or visual symptoms. […] Preeclampsia is part of a spectrum of hypertensive disorders that complicate pregnancy. […] Preeclampsia/eclampsia is characterized by a BP of 140/90 mm Hg or greater after 20 weeks’ gestation in a woman with previously normal BP and who has proteinuria (0.3 g protein in 24-h urine specimen). […] Eclampsia is defined as seizures that cannot be attributable to other causes, in a woman with preeclampsia. […] Proteinuria is defined as the presence of at least 300 mg of protein in a 24-hour urine collection, a protein (mg/dL)/creatinine (mg/dL) ratio greater than or equal to 0.3, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable).

• #14 How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/diagnosed

  A health care provider will check a pregnant woman’s blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform blood tests and more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other symptoms. […] The American College of Obstetricians and Gynecologists provides the following criteria for a diagnosis of gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome. […] Mild preeclampsia is diagnosed when a pregnant woman has: Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours) or a protein-to-creatinine ratio greater than 0.3 or Blood tests that show kidney or liver dysfunction or Fluid in the lungs and difficulty breathing or Visual impairments.

• #15 Review of Laboratory Testing and Biomarker Screening for Preeclampsia

  https://www.mdpi.com/2673-8430/4/2/10

  The purpose of this review is to elucidate the different laboratory and biomarker testing methods available for screening and diagnosis of preeclampsia. These include routine testing, such as blood pressure readings, qualitative and quantitative urine testing, complete blood count with platelets, serum creatinine levels, liver chemistries, and serum bilirubin levels. […] Routine screening for preeclampsia consists of evaluating for signs of end-organ dysfunction through routine blood pressure measurements and urine protein assessment. Serum biomarkers whose imbalance has been associated with preeclampsia are not yet routinely used in preeclampsia screening. […] ACOG states that significant proteinuria during pregnancy can be diagnostic of preeclampsia and is specifically defined as a 24 h protein >300 mg or a protein-to-creatinine ratio of ≥0.3 protein/mg creatinine.

• #16 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Also, a patient with new-onset hypertension without proteinuria can be diagnosed if any of the following is present: platelet count below 100,000/L; serum creatinine level above 1.1 mg/dL or doubling of serum creatinine in the absence of other renal disease; liver transaminase levels at least twice the normal concentrations; pulmonary edema; cerebral or visual symptoms. […] Preeclampsia is part of a spectrum of hypertensive disorders that complicate pregnancy. […] Preeclampsia/eclampsia is characterized by a BP of 140/90 mm Hg or greater after 20 weeks’ gestation in a woman with previously normal BP and who has proteinuria (0.3 g protein in 24-h urine specimen). […] Eclampsia is defined as seizures that cannot be attributable to other causes, in a woman with preeclampsia. […] Proteinuria is defined as the presence of at least 300 mg of protein in a 24-hour urine collection, a protein (mg/dL)/creatinine (mg/dL) ratio greater than or equal to 0.3, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable).

• #17 Pre-eclampsia – Wikipedia

  https://en.wikipedia.org/wiki/Pre-eclampsia

  Pre-eclampsia is routinely screened during prenatal care. […] Pre-eclampsia is diagnosed when a pregnant woman develops: Blood pressure 140 mmHg systolic or 90 mmHg diastolic on two separate readings taken at least four to six hours apart after 20 weeks of gestation in an individual with previously normal blood pressure. […] In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of pre-eclampsia: Evidence of kidney dysfunction (oliguria, elevated creatinine levels), Impaired liver function (noted by liver function tests), Thrombocytopenia (platelet count 100,000/microliter), Pulmonary edema, Ankle edema (pitting type), Cerebral or visual disturbances. […] Pre-eclampsia is a progressive disorder, and these signs of organ dysfunction are indicative of severe pre-eclampsia.

• #18 Pregnancy – preeclampsia | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-preeclampsia

  Preeclampsia is a serious condition of pregnancy, usually characterised by high blood pressure, protein in the urine and severe swelling. […] There is no cure for preeclampsia, except birth of the baby and delivery of the placenta. […] Preeclampsia is diagnosed when high blood pressure (140/90 mm Hg or higher) occurs together with one or more of the following after 20 weeks pregnancy: protein in the urine determined by analysis of a urine sample, swelling and fluid in the feet hands and face, liver function abnormalities determined by a blood test for liver function, kidney function abnormalities determined by a blood test for kidney function, blood clotting abnormalities determined by a blood test for platelet count, onset of headaches or visual disturbances, fetal growth restriction determined by fetal ultrasound.

• #19 Pre-eclampsia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/326

  Pre-eclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks’ gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. […] All pregnant women presenting with hypertension and either proteinuria or evidence of systemic involvement require close assessment and monitoring for pre-eclampsia and its complications. […] Pre-eclampsia is a disorder of pregnancy that is associated with new-onset hypertension (defined as a systolic blood pressure 140 mmHg and/or a diastolic blood pressure 90 mmHg), most often after 20 weeks’ gestation and frequently near term. […] Although often accompanied by new-onset proteinuria, hypertension and other signs or symptoms of pre-eclampsia may present in the absence of proteinuria in some women.

• #20 Preeclampsia Tests

  https://www.preeclampsia.org/preeclampsia-tests

  Preeclampsia, in all of its forms, can mean a lot of testing, both during and after pregnancy. […] The first test for preeclampsia is to check your blood pressure at each prenatal checkup. […] Preeclampsia is diagnosed by persistent high blood pressure that develops for the first time after mid-pregnancy or right after delivery. […] A urine sample is also usually tested at each visit with a dipstick to make sure your kidneys are healthy. […] Any excess amount of protein found in a urine sample is known as „proteinuria.” […] Proteinuria may or may not be present in patients who are diagnosed with preeclampsia. […] High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions six hours apart. […] Severe high blood pressure, which is a reading at or greater than 160/110, requires treatment right away both during pregnancy and in the first weeks after delivery.

• #21 Preeclampsia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751

  A diagnosis of preeclampsia happens if you have high blood pressure after 20 weeks of pregnancy and at least one of the following findings: […] In pregnancy, high blood pressure is diagnosed if the systolic pressure is 140 millimeters of mercury (mm Hg) or higher or if the diastolic pressure is 90 millimeters of mercury (mm Hg) or higher. […] If you have high blood pressure, your health care provider will order additional tests to check for other signs of preeclampsia: […] Your health care provider will ask you for a 24-hour urine sample or a single urine sample to determine how well the kidneys are working. […] Preeclampsia is often diagnosed during a regularly scheduled prenatal appointment.

• #22 Evaluation of Preeclampsia at Term

  https://www.exxcellence.org/list-of-pearls/evaluation-of-preeclampsia-at-term/?categoryName=&searchTerms=&featured=False

  Rapid identification of preeclampsia with severe features allows initiation of magnesium sulfate for maternal seizure prevention. […] The diagnosis of superimposed preeclampsia is based on the new development of thrombocytopenia, liver dysfunction, renal insufficiency, severe or persistent RUQ or epigastric pain, pulmonary edema; or new-onset headache unresponsive to acetaminophen and not accounted for by alternative diagnoses or visual disturbances, as well as sudden difficulty in maintaining normal blood pressure ranges on previously effective medication. […] Initial evaluation for pre-eclampsia includes: Blood pressure, Clinical evaluation with review of symptoms, Laboratory tests for proteinuria, CBC, creatinine, AST, and ALT, Assessment of fetal wellbeing with antenatal testing. […] Initial management includes: Delivery with mode determined by fetal presentation, and usual maternal/fetal obstetric considerations, Anti-hypertensive therapy for severe hypertension, Magnesium for seizure prophylaxis for preeclampsia with severe features. […] BP monitoring should continue for at least 72 hours (about 3 days) postpartum, and again 7-10 days postpartum, or earlier if symptoms are present. Blood pressure monitoring should continue until the patient is confirmed to be normotensive or the diagnosis of chronic hypertension is confirmed.

• #23 Preeclampsia Tests

  https://www.preeclampsia.org/preeclampsia-tests

  Preeclampsia, in all of its forms, can mean a lot of testing, both during and after pregnancy. […] The first test for preeclampsia is to check your blood pressure at each prenatal checkup. […] Preeclampsia is diagnosed by persistent high blood pressure that develops for the first time after mid-pregnancy or right after delivery. […] A urine sample is also usually tested at each visit with a dipstick to make sure your kidneys are healthy. […] Any excess amount of protein found in a urine sample is known as „proteinuria.” […] Proteinuria may or may not be present in patients who are diagnosed with preeclampsia. […] High blood pressure is traditionally defined as blood pressure of 140/90 or greater, measured on two separate occasions six hours apart. […] Severe high blood pressure, which is a reading at or greater than 160/110, requires treatment right away both during pregnancy and in the first weeks after delivery.

• #24 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Serial confirmations 6 hours apart increase the predictive value. […] Although more convenient, a urine dipstick value of 1+ or more (30 mg/dL) is not reliable in the diagnosis of proteinuria. […] The risk factors that are shared by cardiovascular disease and preeclampsia are as follows: endothelial dysfunction, obesity, hypertension, hyperglycemia, insulin resistance, dyslipidemia. […] The mechanisms by which preeclampsia occurs is not certain, and numerous maternal, paternal, and fetal factors have been implicated in its development. […] The factors considered to be the most important include the following: maternal immunologic intolerance, abnormal placental implantation, genetic, nutritional, and environmental factors, cardiovascular and inflammatory changes. […] Immunologic factors have long been considered to be key players in preeclampsia.

• #25 Preeclampsia Tests

  https://www.preeclampsia.org/preeclampsia-tests

  If protein is detected in your urine dipstick screening test, you may be asked to collect all of your urine in a jug for 12 or 24 hours to determine the amount of protein being lost. […] Any amount of protein in your urine over 300 mg in one day may indicate preeclampsia. […] Most providers will draw blood again to compare and look for changes in your liver and platelets if you have symptoms of severe preeclampsia. […] Preeclampsia symptoms can also appear for the first time after delivery, sometimes even without having symptoms before the birth of your baby. […] If your blood pressure is high three months after delivery, you should see a doctor who provides regular care for women who develop chronic hypertension. […] After pregnancy, you and your provider may decide to pursue additional tests to uncover underlying conditions that may have contributed to you developing preeclampsia. […] Women who have had preeclampsia in pregnancy may be at higher risk of heart disease, stroke, diabetes, renal failure, clot formation, and chronic high blood pressure later in life.

• #26 Preeclampsia labs: List of tests, results, and next steps

  https://www.medicalnewstoday.com/articles/preeclampsia-labs

  Preeclampsia tests include blood pressure readings, urine tests to look for protein, and other lab tests to check for changes in the blood or liver. […] Health professionals will measure a persons blood pressure at each prenatal appointment. They may order lab tests if there are signs or symptoms of potential preeclampsia, such as an increase in blood pressure. […] If a pregnant person gets a high blood pressure reading, especially after the 20th week of pregnancy, a medical professional will perform further tests. […] Doctors typically use the following lab tests to diagnose preeclampsia: […] Initially, doctors test for protein in the urine using a dipstick screening test. […] If the test shows protein is present, the doctor may ask the person to collect all their urine in a jug for 24 hours to determine the amount of protein they excrete in a day.

• #27 Preeclampsia Work Up | ACOG

  https://www.acog.org/education-and-events/creog/curriculum-resources/cases-in-high-value-care/preeclampsia-work-up

  A spot urine protein:creatinine ratio was sent and resulted at 0.23 mg/dL. […] ACOG currently recommends diagnosing preeclampsia with either a 24 hour value or a P:C in a single voided urine. […] A P:C ratio is sufficient to assess for proteinuria in the diagnosis of preeclampsia. […] SUA is not necessary or recommended for the diagnosis of preeclampsia.

• #28 Review of Laboratory Testing and Biomarker Screening for Preeclampsia

  https://www.mdpi.com/2673-8430/4/2/10

  The preferred UPCR is calculated from a random urine spot sample that is obtained from a clean catch. UPCR is defined as the urine protein concentration (in mg/dL) divided by the urine creatinine concentration (in mg/dL). […] Non-routine serum testing for preeclampsia includes testing for angiogenic markers like sFlt-1 and PlGF. A randomized control trial conducted in 2019 utilizing sFlt-1 and PlGF for patients with potential preeclampsia, showed that the sFlt-1/PIGF ratio, when used with standard clinical practices for diagnosis of preeclampsia, improved clinical precision in diagnosing preeclampsia without changes in the admission rate. […] The combination of using sFlt-1 and PlGF markers for preeclampsia diagnosis has high sensitivity and specificity for prediction of early onset preeclampsia.

• #29 Review of Laboratory Testing and Biomarker Screening for Preeclampsia

  https://www.mdpi.com/2673-8430/4/2/10

  The preferred UPCR is calculated from a random urine spot sample that is obtained from a clean catch. UPCR is defined as the urine protein concentration (in mg/dL) divided by the urine creatinine concentration (in mg/dL). […] Non-routine serum testing for preeclampsia includes testing for angiogenic markers like sFlt-1 and PlGF. A randomized control trial conducted in 2019 utilizing sFlt-1 and PlGF for patients with potential preeclampsia, showed that the sFlt-1/PIGF ratio, when used with standard clinical practices for diagnosis of preeclampsia, improved clinical precision in diagnosing preeclampsia without changes in the admission rate. […] The combination of using sFlt-1 and PlGF markers for preeclampsia diagnosis has high sensitivity and specificity for prediction of early onset preeclampsia.

• #30 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

  The diagnostic criteria for preeclampsia are summarized in the table. Preeclamptic patients with severe hypertension or signs of significant end-organ dysfunction meet criteria for the severe end of the disease spectrum. […] Patients with suspected preeclampsia should have a complete blood count with platelets, creatinine level, liver chemistries, and determination of urinary protein excretion. […] The value of any laboratory or imaging test as a screening tool, including routine assessment of proteinuria at each visit, has not been established.

• #31 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  A thorough medical history should be obtained to identify medical conditions that increase the risk for preeclampsia, including diabetes mellitus, hypertension, vascular and connective tissue disease, nephropathy, and antiphospholipid antibody syndrome. […] There currently is no single reliable, cost-effective screening test for preeclampsia. […] A baseline laboratory evaluation should be performed early in pregnancy in women who are at high risk for preeclampsia. […] Once the diagnosis of preeclampsia has been made, an expanded set of laboratory tests should be performed. […] The urinary protein-to-creatinine ratio is not sensitive enough to differentiate mild and severe preeclampsia if significant proteinuria exists. […] A baseline sonogram should be considered at 25 to 28 weeks of gestation to evaluate fetal growth in pregnant women at high risk for preeclampsia.

• #32 Blood Tests for Preeclampsia

  https://www.myactivehealth.com/hwcontent/content/special/hw20592.html

  A woman who may have signs of early or mild preeclampsia will have her blood tested to detect additional signs of preeclampsia. A woman who has preeclampsia may have specific blood tests to help assess her health. […] Increased uric acid in the blood is often the earliest laboratory finding related to preeclampsia. […] A high hematocrit value can be a sign of preeclampsia. […] The number of platelets in the blood may be measured. Preeclampsia may cause an abnormally low platelet count. […] Preeclampsia can cause problems with blood clotting that increase the partial thromboplastin time. […] The amounts of electrolytes in the body may change if preeclampsia is causing kidney damage or is causing fluid to leak out of blood vessels into surrounding tissues (edema). […] These tests check the amount of certain substances found in the blood that are normally removed from the body by the kidneys. These substances, which include blood urea nitrogen and creatinine, increase in the blood if the kidneys have been damaged. […] These tests monitor enzymes that indicate how well the liver is working.

• #33 Preeclampsia Testing | Choose the Right Test

  https://arupconsult.com/content/preeclampsia-testing

  Preeclampsia is defined as the presence of hypertension plus one or more new-onset manifestations of physiologic dysfunction associated with the condition. […] The classification criteria for preeclampsia are the same, regardless of whether hypertension is gestational or chronic, although recommended testing varies based on the hypertensive subtype. […] In patients newly diagnosed with gestational hypertension, the ISSHP recommends performing the following laboratory tests to rule out current preeclampsia: Serum creatinine, Urinary albumin-creatinine ratio, urinary protein-creatinine ratio, or 24-hour urine total protein, Liver enzymes, Platelet count, Serum PlGF or (in appropriate populations) sFlt-1:PlGF ratio. […] Testing for preeclampsia should be performed in any individual with symptoms suggestive of the condition, both pre- and postdelivery.

• #34 Biomarkers and point of care screening approaches for the management of preeclampsia | Communications Medicine

  https://www.nature.com/articles/s43856-024-00642-4

  Several preventive strategies with mixed efficacy, among them the administration of aspirin prior to 16-weeks gestation, have been suggested to potentially mitigate PE risk. […] However, the effectiveness of these strategies hinges on the availability of screening technologies capable of detecting PE biomarkers at the earliest gestational stages, thereby enabling timely intervention. […] In combination with BP criteria, biomarker tests measure protein in urine, components of the blood, and liver-related biomolecules to identify PE and/or the onset of HELLP syndrome. […] For diagnosis of PE, the proteinuria measurement uses a semi-quantitative dipstick test (2+) or a 24h urine collection (300mg in 24h) to assess the protein content in urine. […] PoC testing enables clinical assessments to be conducted either at or in close proximity to the patients location.

• #35 Biomarkers and point of care screening approaches for the management of preeclampsia | Communications Medicine

  https://www.nature.com/articles/s43856-024-00642-4

  The primary objective of PoC is to shift away from lengthy multi-step laboratory processes and, in doing so, deliver faster results. […] In this context, PoC tests for PE are better suited for screening or monitoring purposes. […] Here, the primary goal becomes the early detection and timely intervention, which can potentially mitigate the diseases severity, prevent its onset, or provide insights into its progression and the efficacy of the interventions utilized. […] Recognizing PE at its onset not only optimizes opportunities for surveillance and the application of therapeutic interventions, but also significantly improves maternal and neonatal outcomes. […] The effectiveness of this screening is improved by integrating multiple variables into predictive algorithms. […] The PRAECIS Study, whose findings have since undergone FDA clearance, is one example of this approach.

• #36 Preeclampsia Testing | Choose the Right Test

  https://arupconsult.com/content/preeclampsia-testing

  Preeclampsia is a pregnancy-related multisystem progressive disorder characterized by hypertension (systolic blood pressure [BP] 140 mmHg and/or diastolic BP 90 mmHg) and one or more additional signs of physiologic dysfunction. […] Laboratory testing for preeclampsia includes markers of maternal organ and uteroplacental function. Test selection may differ depending on the indication for testing (eg, risk assessment versus diagnosis) and stage of pregnancy. […] Because multiple organs are involved and presentation can vary greatly from case to case, a range of tests may be needed to diagnose preeclampsia. […] Soluble fms-like tyrosine kinase 1 and placental growth factor (sFlt-1:PlGF) ratio testing is useful in appropriate populations to assess for angiogenic imbalance, which is indicative of uteroplacental dysfunction. […] When used in the context of suspected preeclampsia, sFlt-1:PlGF testing has a negative predictive value of approximately 96%. […] The sFlt-1:PlGF ratio has a positive predictive value of approximately 65%; thus, an abnormal result (sFlt-1:PlGF 40) alone is insufficient to diagnose preeclampsia with severe features.

• #37 Preeclampsia Testing for Early Detection | Labcorp

  https://womenshealth.labcorp.com/providers/pregnancy/preeclampsia-screening

  Labcorps second and third trimester preeclampsia test uses two biomarkers (sFlt-1 and PlGF) to assess the risk of preeclampsia progressing to severe features within the subsequent two weeks with test sensitivity up to 93.5%. […] Induced delivery is the main treatment option for most women, but patients must be managed based on gestational week, presence or absence of fetal or maternal distress or progression to severe preeclampsia features. […] Its also important to note that the risk for postpartum preeclampsia remains even after delivery, so the mother must be monitored closely in the postpartum period.

• #38

  https://www.archivesofmedicalscience.com/Utility-of-biochemical-tests-in-prediction-diagnostics-and-clinical-management-of,93764,0,2.html

  The most useful, modern biochemical test that may help in making crucial clinical decisions in patients with preeclampsia is the sFlt-1/PlGF (soluble fms-like tyrosine kinase 1/placental growth factor) ratio. […] The purpose of this review was to summarize and emphasize the role of the serum assessment of many different popular biochemical markers, including new ones, in the prediction, diagnostics and clinical management of preeclampsia. […] The significant progress in the efficacy of the diagnosis of preeclampsia, a particularly atypical form of the disease or the related complications, may be the use of the serum measurement of the angio- and antiangiogenic markers, including PlGF and sFlt-1. The most accurate one of these markers is the sFlt-1/PlGF ratio. […] At present, in spite of the considerable development in the research and clinical practice regarding preeclampsia, the diagnosis of this disease is still sometimes difficult.

• #39 Preeclampsia Testing for Early Detection | Labcorp

  https://womenshealth.labcorp.com/providers/pregnancy/preeclampsia-screening

  Similar to common pregnancy symptoms, early signs of preeclampsia can include a rise in blood pressure, swelling, protein in the urine, changes in vision, nausea and headache. […] First trimester preeclampsia screening at 11-14 weeks gestation can help you avoid missing the window for early detection and intervention. […] When administered early, prophylactic aspirin treatment may help reduce the risk and severity of preeclampsia and allow for a decision to be made on whether a patient may need additional care including possible referral to a larger health center or tertiary care facility. […] Labcorps first-trimester preeclampsia screening test uses a combination of maternal factors plus two biochemical markers (PlGF and PAPPA) and two biophysical markers (MAP and UtAPI) delivering test sensitivity of up to 90%, compared to less than 50% sensitivity from using maternal history and demographics alone.

• #40 Preeclampsia | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/preeclampsia

  Your health care provider will ask you for a 24-hour urine sample or a single urine sample to determine how well the kidneys are working. […] Your primary care provider will likely recommend close monitoring of your baby’s growth, typically through ultrasound. […] A nonstress test is a simple procedure that checks how your baby’s heart rate reacts when your baby moves. A biophysical profile uses an ultrasound to measure your baby’s breathing, muscle tone, movement and the volume of amniotic fluid in your uterus.

• #41 Preeclampsia | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/preeclampsia

  Preeclampsia is a serious condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). […] To diagnose preeclampsia, your provider measures your blood pressure and tests your urine for protein. […] Your provider may check your baby’s health with: Ultrasound. Non-stress test (NST). This test checks your baby’s heart rate. Biophysical profile. This test combines the NST to check your baby’s heartbeats with an ultrasound to check your baby’s movements and level of amniotic fluid. […] Treatment depends on how severe the preeclampsia is and how far along you are in your pregnancy. Even if you have preeclampsia without severe features, you need treatment to keep it from getting worse. […] If you have preeclampsia with severe features (this includes very high blood pressure), you will most likely stay in the hospital so your provider can closely monitor you and your baby. Your provider may treat you with medicines called antenatal corticosteroids. […] Your provider uses your blood pressure measurements, blood and urine tests to diagnose postpartum preeclampsia.

• #42 Pre-eclampsia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/326

  Key diagnostic factors include 20 weeks’ gestation, systolic BP 140 mmHg and/or diastolic BP 90 mmHg and previously normotensive, headache, and upper abdominal pain. […] Other diagnostic factors include reduced fetal movement, fetal growth restriction, oedema, visual disturbances, seizures, breathlessness, oliguria, and hyper-reflexia with sustained clonus. […] 1st investigations to order include urinalysis, fetal ultrasound, umbilical artery Doppler velocimetry, amniotic fluid assessment, fetal cardiotocography, FBC, liver function tests, serum creatinine, and placental growth factor.

• #43 How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/diagnosed

  A health care provider will check a pregnant woman’s blood pressure and urine during each prenatal visit. If the blood pressure reading is considered high (140/90 or higher), especially after the 20th week of pregnancy, the health care provider will likely perform blood tests and more extensive lab tests to look for extra protein in the urine (called proteinuria) as well as other symptoms. […] The American College of Obstetricians and Gynecologists provides the following criteria for a diagnosis of gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome. […] Mild preeclampsia is diagnosed when a pregnant woman has: Systolic blood pressure (top number) of 140 mmHg or higher or diastolic blood pressure (bottom number) of 90 mmHg or higher and either Urine with 0.3 or more grams of protein in a 24-hour specimen (a collection of every drop of urine within 24 hours) or a protein-to-creatinine ratio greater than 0.3 or Blood tests that show kidney or liver dysfunction or Fluid in the lungs and difficulty breathing or Visual impairments.

• #44 Preeclampsia: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/preeclampsia/?srsltid=AfmBOoohZQkA-DoiboX8bFtrNLLMv6wJ-jRUTT0imHeQIIRbHEmCHBBm

  Preeclampsia is diagnosed with hypertension and proteinuria (300mg in 24-hour collection OR protein/creatinine ratio 0.3 mg/dL). If blood pressure is not noted as severe (160/110) and there are no other symptoms, then the individual is diagnosed with preeclampsia without severe features. […] Preeclampsia with severe features is diagnosed with a systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 mm Hg or higher. However, women with gestational hypertension without proteinuria should be diagnosed with preeclampsia with severe features if they have any of the following: […] Blood pressure, urinalysis, and physical exam with lead to a diagnosis.

• #45 How do health care providers diagnose preeclampsia, eclampsia, and HELLP syndrome? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/diagnosed

  Severe preeclampsia occurs when a pregnant woman has any of the following: Systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher on two occasions at least 4 hours apart while the patient is on bed rest or Urine with 5 or more grams of protein in a 24-hour specimen or 3 or more grams of protein on 2 random urine samples collected at least 4 hours apart or Test results suggesting kidney or liver damage for example, blood tests that reveal low numbers of platelets or high liver enzymes or Severe, unexplained stomach pain that does not respond to medication or Symptoms that include visual disturbances, difficulty breathing, or fluid buildup. […] HELLP syndrome is diagnosed when laboratory tests show hemolysis (burst red blood cells release hemoglobin into the blood plasma), elevated liver enzymes, and low platelets. There also may or may not be extra protein in the urine. […] Health care providers look for an increase in blood pressure and either protein in the urine, fluid buildup, or both for a diagnosis of superimposed preeclampsia.

• #46 Preeclampsia: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1476919-overview

  Preeclampsia with severe features is defined as the presence of one of the following symptoms or signs in the presence of preeclampsia: SBP of 160 mm Hg or higher or DBP of 110 mm Hg or higher, on two occasions at least 4 hours apart while the patient is on bed rest (unless antihypertensive therapy has previously been initiated); impaired hepatic function as indicated by abnormally elevated blood concentrations of liver enzymes (to double the normal concentration), severe persistent upper quadrant or epigastric pain that does not respond to pharmacotherapy and is not accounted for by alternative diagnoses, or both; progressive renal insufficiency (serum creatinine concentration 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease); new-onset cerebral or visual disturbances; pulmonary edema; thrombocytopenia (platelet count 100,000/L).

• #47 Defining and Diagnosing Preeclampsia

  https://blog.thesullivangroup.com/defining-and-diagnosing-preeclampsia

  Preeclampsia is a disease unique to pregnancy and postpartum; it typically occurs after 20 weeks of pregnancy and impacts both mother and baby. […] Early recognition of important signs and symptoms of the disease and any abrupt changes of patient status requires an astute and experienced care provider. […] Diagnosis requires at least two measurements of a BP of 140/90 more than 4 hours apart. […] Diagnosing preeclampsia no longer requires a 24-hour urine collection; the use of the PC ratio (albumin to creatinine ratio) has superseded urine collection. […] Diagnosis of preeclampsia with severe features includes: BP of 160/105 to 110, thrombocytopenia 100,000, impaired liver function (AST/ALT 2-times normal), oliguria 500ml/24 hours, serum creatinine 1mg/dl, CNS symptoms, and pulmonary edema or cyanosis.

• #48 Preeclampsia and Eclampsia – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/preeclampsia-and-eclampsia

  Preeclampsia with severe features is diagnosed in patients with new onset of persistent severe hypertension and/or signs or symptoms of end-organ damage. The blood pressure criterion is systolic BP 160 mm Hg and/or diastolic BP 110 mm Hg on at least 2 measurements taken at least 4 hours apart. […] Eclampsia is new onset of tonic-clonic, focal, or multifocal seizures with no other known causes (eg, epilepsy, cerebral arterial ischemia or infarction, intracranial hemorrhage, or drug use).

• #49 Preeclampsia, Eclampsia & HELLP – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/preeclampsia-eclampsia-hellp-diagnosis/

  Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm. […] Preeclampsia = new onset hypertension with proteinuria (most often) or organ dysfunction. […] Preeclampsia with severe features = preeclampsia complicated by severe hypertension or organ dysfunction. […] Superimposed Preeclampsia = new onset/worsening of hypertension, proteinuria or end organ dysfunction in patients with preexisting hypertension and/or proteinuria. […] Preeclampsia with Severe Features: Preeclampsia with ≥ 160mmHg Systolic or ≥ 110mmHg Diastolic, or if any end organ features are present. […] HELLP Syndrome: Variant of preeclampsia. […] Diagnosis requires all of: Hemolysis: LDH ≥600 IU/L, Elevated Liver Enzymes – AST or ALT > 2X upper limit of normal, Low Platelets – Platelet count <100,000/μL.

• #50 Preeclampsia, Eclampsia & HELLP – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/preeclampsia-eclampsia-hellp-diagnosis/

  Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm. […] Preeclampsia = new onset hypertension with proteinuria (most often) or organ dysfunction. […] Preeclampsia with severe features = preeclampsia complicated by severe hypertension or organ dysfunction. […] Superimposed Preeclampsia = new onset/worsening of hypertension, proteinuria or end organ dysfunction in patients with preexisting hypertension and/or proteinuria. […] Preeclampsia with Severe Features: Preeclampsia with ≥ 160mmHg Systolic or ≥ 110mmHg Diastolic, or if any end organ features are present. […] HELLP Syndrome: Variant of preeclampsia. […] Diagnosis requires all of: Hemolysis: LDH ≥600 IU/L, Elevated Liver Enzymes – AST or ALT > 2X upper limit of normal, Low Platelets – Platelet count <100,000/μL.

• #51 Preeclampsia, Eclampsia & HELLP – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/preeclampsia-eclampsia-hellp-diagnosis/

  Eclampsia: Preeclampsia with generalized tonic-clonic seizures, without other cause (epilepsy or drug use), or coma. […] Recommended Investigations: Urinalysis: protein determination, Complete blood count + Peripheral blood smear, Haptoglobin level, Electrolytes, BUN, creatinine, LDH, AST, ALT, bilirubin.

• #52 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis/print

  The diagnostic criteria for preeclampsia are summarized in the table. Preeclamptic patients with severe hypertension or signs of significant end-organ dysfunction meet criteria for the severe end of the disease spectrum. […] In a patient with preeclampsia, the presence of one or more of the following indicates a diagnosis of „preeclampsia with severe features”. […] The diagnostic evaluation of a pregnant or postpartum woman with persistent systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. […] The differential diagnosis of preeclampsia with severe features includes but is not limited to: Antiphospholipid syndrome, Acute fatty liver of pregnancy, Thrombotic thrombocytopenic purpura (TTP), Hemolytic uremic syndrome (HUS). […] The laboratory findings in these disorders overlap with those in preeclampsia with severe features.

• #53 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  A thorough medical history should be obtained to identify medical conditions that increase the risk for preeclampsia, including diabetes mellitus, hypertension, vascular and connective tissue disease, nephropathy, and antiphospholipid antibody syndrome. […] There currently is no single reliable, cost-effective screening test for preeclampsia. […] A baseline laboratory evaluation should be performed early in pregnancy in women who are at high risk for preeclampsia. […] Once the diagnosis of preeclampsia has been made, an expanded set of laboratory tests should be performed. […] The urinary protein-to-creatinine ratio is not sensitive enough to differentiate mild and severe preeclampsia if significant proteinuria exists. […] A baseline sonogram should be considered at 25 to 28 weeks of gestation to evaluate fetal growth in pregnant women at high risk for preeclampsia.

• #54 Preeclampsia: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis/print

  The diagnostic criteria for preeclampsia are summarized in the table. Preeclamptic patients with severe hypertension or signs of significant end-organ dysfunction meet criteria for the severe end of the disease spectrum. […] In a patient with preeclampsia, the presence of one or more of the following indicates a diagnosis of „preeclampsia with severe features”. […] The diagnostic evaluation of a pregnant or postpartum woman with persistent systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. […] The differential diagnosis of preeclampsia with severe features includes but is not limited to: Antiphospholipid syndrome, Acute fatty liver of pregnancy, Thrombotic thrombocytopenic purpura (TTP), Hemolytic uremic syndrome (HUS). […] The laboratory findings in these disorders overlap with those in preeclampsia with severe features.

• #55 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  A thorough medical history should be obtained to identify medical conditions that increase the risk for preeclampsia, including diabetes mellitus, hypertension, vascular and connective tissue disease, nephropathy, and antiphospholipid antibody syndrome. […] There currently is no single reliable, cost-effective screening test for preeclampsia. […] A baseline laboratory evaluation should be performed early in pregnancy in women who are at high risk for preeclampsia. […] Once the diagnosis of preeclampsia has been made, an expanded set of laboratory tests should be performed. […] The urinary protein-to-creatinine ratio is not sensitive enough to differentiate mild and severe preeclampsia if significant proteinuria exists. […] A baseline sonogram should be considered at 25 to 28 weeks of gestation to evaluate fetal growth in pregnant women at high risk for preeclampsia.

• #56 Screening for Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p117.html

  Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, which one of the following statements about the diagnosis of preeclampsia in this patient is accurate? […] The criteria for the diagnosis of preeclampsia include elevated blood pressure (140/90 mm Hg or greater on two occasions four hours apart, after 20 weeks’ gestation) and either proteinuria (300 mg per dL or greater on a 24-hour urine protein test, urine protein-to-creatinine ratio of 0.3 or greater, or urine protein dipstick reading greater than 1 if quantitative analysis is not available) or in the absence of proteinuria, findings of thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. […] Known clinical risk factors for preeclampsia include multifetal gestation, nulliparity, advanced maternal age, African American race, and obesity.

• #57 Screening for Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p117.html

  Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, which one of the following statements about the diagnosis of preeclampsia in this patient is accurate? […] The criteria for the diagnosis of preeclampsia include elevated blood pressure (140/90 mm Hg or greater on two occasions four hours apart, after 20 weeks’ gestation) and either proteinuria (300 mg per dL or greater on a 24-hour urine protein test, urine protein-to-creatinine ratio of 0.3 or greater, or urine protein dipstick reading greater than 1 if quantitative analysis is not available) or in the absence of proteinuria, findings of thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. […] Known clinical risk factors for preeclampsia include multifetal gestation, nulliparity, advanced maternal age, African American race, and obesity.

• #58 What doctors wish patients knew about preeclampsia | American Medical Association

  https://www.ama-assn.org/delivering-care/population-care/what-doctors-wish-patients-knew-about-preeclampsia

  That is why preeclampsia can be a complicated diagnosis, Dr. Peterson said, reiterating that diagnosis involves paying close attention to vital signs [mainly BP], lab values and patient symptoms. […] The American College of Obstetrics and Gynecologists recommends that women with severe high blood pressure BP of 160/110 during birth are evaluated again within 72 hours postpartum, Dr. Peterson said. […] While it is unclear why some women develop preeclampsia, there are some factors that may put you in the high-risk category. […] The treatment for preeclampsia is delivery, and the timing and route of delivery is based on the severity of disease and other obstetric factors, Dr. Peterson said. […] A lot of people think that theyre cured after they have their baby, Dr. Hoppe said. […] Women whove had a hypertension related diagnosis in a prior pregnancy are at risk of developing hypertension during a subsequent pregnancy, Dr. Hoppe said. […] I would suggest that prenatal care is set up to try to detect preeclampsia and other complications in pregnancy, Dr. Hoppe said. […] Once pregnant, we think aspirin can help lower ones risk of getting preeclampsia, said Dr. Hoppe.

• #59 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  A thorough medical history should be obtained to identify medical conditions that increase the risk for preeclampsia, including diabetes mellitus, hypertension, vascular and connective tissue disease, nephropathy, and antiphospholipid antibody syndrome. […] There currently is no single reliable, cost-effective screening test for preeclampsia. […] A baseline laboratory evaluation should be performed early in pregnancy in women who are at high risk for preeclampsia. […] Once the diagnosis of preeclampsia has been made, an expanded set of laboratory tests should be performed. […] The urinary protein-to-creatinine ratio is not sensitive enough to differentiate mild and severe preeclampsia if significant proteinuria exists. […] A baseline sonogram should be considered at 25 to 28 weeks of gestation to evaluate fetal growth in pregnant women at high risk for preeclampsia.

• #60 Biomarkers and point of care screening approaches for the management of preeclampsia | Communications Medicine

  https://www.nature.com/articles/s43856-024-00642-4

  The primary objective of PoC is to shift away from lengthy multi-step laboratory processes and, in doing so, deliver faster results. […] In this context, PoC tests for PE are better suited for screening or monitoring purposes. […] Here, the primary goal becomes the early detection and timely intervention, which can potentially mitigate the diseases severity, prevent its onset, or provide insights into its progression and the efficacy of the interventions utilized. […] Recognizing PE at its onset not only optimizes opportunities for surveillance and the application of therapeutic interventions, but also significantly improves maternal and neonatal outcomes. […] The effectiveness of this screening is improved by integrating multiple variables into predictive algorithms. […] The PRAECIS Study, whose findings have since undergone FDA clearance, is one example of this approach.

• #61

• #62 Preeclampsia Testing for Early Detection | Labcorp

  https://womenshealth.labcorp.com/providers/pregnancy/preeclampsia-screening

  Similar to common pregnancy symptoms, early signs of preeclampsia can include a rise in blood pressure, swelling, protein in the urine, changes in vision, nausea and headache. […] First trimester preeclampsia screening at 11-14 weeks gestation can help you avoid missing the window for early detection and intervention. […] When administered early, prophylactic aspirin treatment may help reduce the risk and severity of preeclampsia and allow for a decision to be made on whether a patient may need additional care including possible referral to a larger health center or tertiary care facility. […] Labcorps first-trimester preeclampsia screening test uses a combination of maternal factors plus two biochemical markers (PlGF and PAPPA) and two biophysical markers (MAP and UtAPI) delivering test sensitivity of up to 90%, compared to less than 50% sensitivity from using maternal history and demographics alone.

• #63 Screening for Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p117.html

  The USPSTF recommends the use of low-dose aspirin (81 mg per day) as preventive medication between 12 and 28 weeks’ gestation for women at high risk of preeclampsia, and the patient’s multifetal gestation qualifies as a significant risk factor. […] Evidence does not support the use of point-of-care urine testing alone to screen for preeclampsia because women may develop preeclampsia in the absence of proteinuria or may develop proteinuria in the absence of preeclampsia.

• #64 Preeclampsia Testing for Early Detection | Labcorp

  https://womenshealth.labcorp.com/providers/pregnancy/preeclampsia-screening

  Preeclampsia symptoms are similar to common pregnancy-related symptoms, which often leads to delayed preeclampsia diagnosis and intervention. […] Now with Labcorps preeclampsia screening during first, second and third trimesters, identifying those at risk and enhancing management of high-risk pregnancies can help lead to earlier detection and intervention and help reduce preeclampsia related complications and patient mortality. […] Up to 60% of preeclampsia-related deaths are preventable, making early detection critical. […] Labcorps first trimester blood test can help determine a pregnant patients risk for developing preeclampsia early in pregnancy before the patient typically becomes symptomatic (approximately 20 weeks gestation). […] To aid in the risk assessment of pregnant women hospitalized for hypertensive disorders of pregnancy for progression to preeclampsia with severe features within 2 weeks of presentation.

• #65 Preeclampsia Tests

  https://www.preeclampsia.org/preeclampsia-tests

  If protein is detected in your urine dipstick screening test, you may be asked to collect all of your urine in a jug for 12 or 24 hours to determine the amount of protein being lost. […] Any amount of protein in your urine over 300 mg in one day may indicate preeclampsia. […] Most providers will draw blood again to compare and look for changes in your liver and platelets if you have symptoms of severe preeclampsia. […] Preeclampsia symptoms can also appear for the first time after delivery, sometimes even without having symptoms before the birth of your baby. […] If your blood pressure is high three months after delivery, you should see a doctor who provides regular care for women who develop chronic hypertension. […] After pregnancy, you and your provider may decide to pursue additional tests to uncover underlying conditions that may have contributed to you developing preeclampsia. […] Women who have had preeclampsia in pregnancy may be at higher risk of heart disease, stroke, diabetes, renal failure, clot formation, and chronic high blood pressure later in life.

• #66 Postpartum Preeclampsia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17733-postpartum-preeclampsia

  Postpartum preeclampsia is a condition that can happen up to six weeks after your baby is born. This rare condition causes you to have high blood pressure and high levels of protein in your urine. This is a serious condition that can lead to brain damage, stroke and death if not treated. […] Postpartum preeclampsia is a rare but serious condition related to high blood pressure after you give birth. Its most common within 48 hours of delivery but can occur up to six weeks after your baby is born. Postpartum preeclampsia can lead to strokes, seizures and other complications if not promptly treated. […] If you have symptoms of postpartum preeclampsia, you need immediate medical attention. Once diagnosed and treated, the prognosis for a full recovery is very good. […] If your healthcare provider suspects you might have postpartum preeclampsia, they might perform the following tests: Blood pressure check. Blood tests to do a platelet count and check the function of your liver and kidneys. Urinalysis to check your urine for protein. Brain scan to look for possible brain damage if you have had a seizure.

• #67 Eclampsia: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/eclampsia

  Your doctor may order urine tests to check for the presence of protein and its excretion rate. […] Delivering your baby and placenta are the recommended treatment for preeclampsia and eclampsia. Your doctor will consider the severity of the disease and how mature your baby is when recommending timing of delivery. […] If your doctor diagnoses you with mild preeclampsia, they may monitor your condition and treat you with medication to prevent it from turning into eclampsia. Medications and monitoring will help keep your blood pressure within a safer range until the baby is mature enough to deliver. […] However, getting the proper medical care for preeclampsia may prevent progression of the disease into a more severe form such as eclampsia. Go to your prenatal visits as recommended by your doctor to have your blood pressure, blood, and urine monitored. Make sure to talk to your doctor about any symptoms you have, as well.

• #68 Evaluation of Preeclampsia at Term

  https://www.exxcellence.org/list-of-pearls/evaluation-of-preeclampsia-at-term/?categoryName=&searchTerms=&featured=False

  Rapid identification of preeclampsia with severe features allows initiation of magnesium sulfate for maternal seizure prevention. […] The diagnosis of superimposed preeclampsia is based on the new development of thrombocytopenia, liver dysfunction, renal insufficiency, severe or persistent RUQ or epigastric pain, pulmonary edema; or new-onset headache unresponsive to acetaminophen and not accounted for by alternative diagnoses or visual disturbances, as well as sudden difficulty in maintaining normal blood pressure ranges on previously effective medication. […] Initial evaluation for pre-eclampsia includes: Blood pressure, Clinical evaluation with review of symptoms, Laboratory tests for proteinuria, CBC, creatinine, AST, and ALT, Assessment of fetal wellbeing with antenatal testing. […] Initial management includes: Delivery with mode determined by fetal presentation, and usual maternal/fetal obstetric considerations, Anti-hypertensive therapy for severe hypertension, Magnesium for seizure prophylaxis for preeclampsia with severe features. […] BP monitoring should continue for at least 72 hours (about 3 days) postpartum, and again 7-10 days postpartum, or earlier if symptoms are present. Blood pressure monitoring should continue until the patient is confirmed to be normotensive or the diagnosis of chronic hypertension is confirmed.

• #69 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Management of preeclampsia begins with early diagnosis and intervention, focusing on adequate blood pressure control and seizure prevention. […] The first choice for seizure prophylaxis in patients with preeclampsia with severe features is IV magnesium sulfate therapy. […] Early diagnosis, timely medical intervention, and appropriate maternal and fetal surveillance significantly improve maternal and fetal outcomes. […] Delayed delivery of the fetus in preeclamptic patients in the late preterm period increases the risk of severe hypertension, with severe consequences such as eclampsia, HELLP syndrome, pulmonary edema, myocardial infarction, acute respiratory distress syndrome, stroke, renal and retinal injury, and fetal complications including fetal growth restrictions, placental abruption, or fetal or maternal death.

• #70 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Management of preeclampsia begins with early diagnosis and intervention, focusing on adequate blood pressure control and seizure prevention. […] The first choice for seizure prophylaxis in patients with preeclampsia with severe features is IV magnesium sulfate therapy. […] Early diagnosis, timely medical intervention, and appropriate maternal and fetal surveillance significantly improve maternal and fetal outcomes. […] Delayed delivery of the fetus in preeclamptic patients in the late preterm period increases the risk of severe hypertension, with severe consequences such as eclampsia, HELLP syndrome, pulmonary edema, myocardial infarction, acute respiratory distress syndrome, stroke, renal and retinal injury, and fetal complications including fetal growth restrictions, placental abruption, or fetal or maternal death.

• #71 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Management of preeclampsia begins with early diagnosis and intervention, focusing on adequate blood pressure control and seizure prevention. […] The first choice for seizure prophylaxis in patients with preeclampsia with severe features is IV magnesium sulfate therapy. […] Early diagnosis, timely medical intervention, and appropriate maternal and fetal surveillance significantly improve maternal and fetal outcomes. […] Delayed delivery of the fetus in preeclamptic patients in the late preterm period increases the risk of severe hypertension, with severe consequences such as eclampsia, HELLP syndrome, pulmonary edema, myocardial infarction, acute respiratory distress syndrome, stroke, renal and retinal injury, and fetal complications including fetal growth restrictions, placental abruption, or fetal or maternal death.

• #72 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  Delivery remains the ultimate treatment for preeclampsia. […] Women with preeclampsia should be counseled about future pregnancies. […] There currently are no well-established measures for preventing preeclampsia. […] Early detection, careful monitoring, and treatment of preeclampsia are crucial in preventing mortality related to this disorder.

• #73 Preeclampsia Tests

  https://www.preeclampsia.org/preeclampsia-tests

  If protein is detected in your urine dipstick screening test, you may be asked to collect all of your urine in a jug for 12 or 24 hours to determine the amount of protein being lost. […] Any amount of protein in your urine over 300 mg in one day may indicate preeclampsia. […] Most providers will draw blood again to compare and look for changes in your liver and platelets if you have symptoms of severe preeclampsia. […] Preeclampsia symptoms can also appear for the first time after delivery, sometimes even without having symptoms before the birth of your baby. […] If your blood pressure is high three months after delivery, you should see a doctor who provides regular care for women who develop chronic hypertension. […] After pregnancy, you and your provider may decide to pursue additional tests to uncover underlying conditions that may have contributed to you developing preeclampsia. […] Women who have had preeclampsia in pregnancy may be at higher risk of heart disease, stroke, diabetes, renal failure, clot formation, and chronic high blood pressure later in life.

• #74 Preeclampsia and High Blood Pressure During Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-pregnancy

  Preeclampsia is a serious disorder that can affect all the organs in your body. It usually develops after 20 weeks of pregnancy, often in the third trimester. When it develops before 34 weeks of pregnancy, it is called early-onset preeclampsia. It can also develop in the weeks after childbirth. […] A high blood pressure reading may be the first sign of preeclampsia. If your blood pressure reading is high, it may be checked again to confirm the results. You may have a urine test to check for protein. You may also have tests to check how your liver and kidneys are working and to measure the number of platelets in your blood. […] Women who have had preeclampsiaespecially those whose babies were born pretermhave an increased risk later in life of kidney disease, heart attack, stroke, and high blood pressure. Also, having preeclampsia once increases the risk of having it again in a future pregnancy.

• #75 Understand Preeclampsia Testing

  https://www.carnegieimaging.com/blog/understanding-preeclampsia-testing/

  Blood tests will be performed to check many different aspects of your health. Blood tests help test your creatinine levels, which may become elevated if your kidneys are impaired. Higher uric acid levels also can detect some negative changes in your kidneys. Additionally, for severe preeclampsia patients or patients with HELLP Syndrome, blood tests may be recommended to analyze your liver function tests, as well as a complete blood count (CBC) with platelet count, since these diagnoses can lead to red blood cells being destroyed, producing a type of anemia. […] After a preeclamptic pregnancy, preeclampsia symptoms may continue or disappear right after delivery. Because of this, your blood pressure should be monitored after giving birth during your follow-up appointments with your doctor. Additionally, women who have had preeclampsia are at a higher risk for other medical conditions later in life, such as hypertension and heart disease. It’s important to discuss your health with your doctor during your annual check-up about your preeclampsia risk and the potential impact on your heart health and kidney function.

• #76 Preeclampsia Tests

  https://www.preeclampsia.org/preeclampsia-tests

  If protein is detected in your urine dipstick screening test, you may be asked to collect all of your urine in a jug for 12 or 24 hours to determine the amount of protein being lost. […] Any amount of protein in your urine over 300 mg in one day may indicate preeclampsia. […] Most providers will draw blood again to compare and look for changes in your liver and platelets if you have symptoms of severe preeclampsia. […] Preeclampsia symptoms can also appear for the first time after delivery, sometimes even without having symptoms before the birth of your baby. […] If your blood pressure is high three months after delivery, you should see a doctor who provides regular care for women who develop chronic hypertension. […] After pregnancy, you and your provider may decide to pursue additional tests to uncover underlying conditions that may have contributed to you developing preeclampsia. […] Women who have had preeclampsia in pregnancy may be at higher risk of heart disease, stroke, diabetes, renal failure, clot formation, and chronic high blood pressure later in life.

• #77 Unitaid launches report on tools and interventions for diagnosis and management of pre-eclampsia, a major driver of maternal mortality – Unitaid

  https://unitaid.org/news-blog/unitaid-launches-report-on-tools-and-interventions-for-diagnosis-and-management-of-pre-eclampsia-a-major-driver-of-maternal-mortality/

  The best way to prevent pre-eclampsia and eclampsia is through timely and comprehensive antenatal care, said Kelsey Barrett, Unitaids technical manager for maternal and child health. What is provided in those antenatal care visits is critical and health workers need the diagnostics and therapeutic tools to provide care that is high quality and can mitigate the risks that lead to pre-eclampsia complications. […] Unitaids report highlights several new diagnostic tools that have the potential to identify a womans risk of developing pre-eclampsia or the conditions worsening. Two blood biomarker-based tests serum FMS-like tyrosine kinase 1 (sFlt-1) and placental growth factor have potential to be adapted for use in low-resource settings to better inform care for women at risk of pre-eclampsia/eclampsia.

• #78 Improving access to lifesaving tools for prevention, diagnosis, and management of pre-eclampsia and maternal anemia – Unitaid

  https://unitaid.org/call-for-proposal/improving-access-to-lifesaving-tools-for-prevention-diagnosis-and-management-of-pre-eclampsia-and-maternal-anemia/

  To improve PE outcomes, it is critical to reduce delays in identifying and managing pregnant women at risk. The primary clinical indicators of PE are proteinuria (protein in urine) and high blood pressure (BP). […] However, urine dipsticks for detecting proteinuria have demonstrated low accuracy and lab-based tests are costly, complex, and infrequently available. […] BP measurement is often inconsistent, with devices frequently broken, missing, or in use elsewhere in a health facility. […] Fortunately, there are new innovations with potential to make a difference, including semi-automated BP devices that incorporate clinical decision-support functions, or digital tools, such as those offering BP measurement by mobile phone. […] Other innovations for diagnosis and management include biomarker-based diagnostic tools.

• #79 Biomarkers and point of care screening approaches for the management of preeclampsia | Communications Medicine

  https://www.nature.com/articles/s43856-024-00642-4

  The primary objective of PoC is to shift away from lengthy multi-step laboratory processes and, in doing so, deliver faster results. […] In this context, PoC tests for PE are better suited for screening or monitoring purposes. […] Here, the primary goal becomes the early detection and timely intervention, which can potentially mitigate the diseases severity, prevent its onset, or provide insights into its progression and the efficacy of the interventions utilized. […] Recognizing PE at its onset not only optimizes opportunities for surveillance and the application of therapeutic interventions, but also significantly improves maternal and neonatal outcomes. […] The effectiveness of this screening is improved by integrating multiple variables into predictive algorithms. […] The PRAECIS Study, whose findings have since undergone FDA clearance, is one example of this approach.

• #80 Biomarkers and point of care screening approaches for the management of preeclampsia | Communications Medicine

  https://www.nature.com/articles/s43856-024-00642-4

  The emergence of medical tools capable of early PE detection before the third trimester offers a multitude of benefits. […] It sets the stage for enhanced screening, monitoring, and management, enabling timely detection and mitigation of potential complications for both pregnant people and their neonates. […] The ripple effect of early detection extends to better maternal and fetal outcomes by potentially curbing the progression of preeclampsia to its most severe forms and minimizing the risk of preterm birth and other adverse health outcomes. […] The development of portable medical devices that can be applied at the PoC has the potential to significantly enhance all of the positive features associated with the ability to detect individuals who will clinically develop PE from the earliest stages of pregnancy.

• #81 Biomarkers and point of care screening approaches for the management of preeclampsia | Communications Medicine

  https://www.nature.com/articles/s43856-024-00642-4

  Derived from Sub-Level I of categories A, B, and C from Table 1, this chart delineates the detection periods of various preeclampsia biomarkers throughout gestation. […] The sFlt-1 to PlGF ratio is specific and sensitive at ruling out PE development, so it is a good candidate for PoC PE screenings. […] Studies have shown that the cellular shear stress of the syncytiotrophoblast placental barrier, which occurs during the last 8-10 weeks of pregnancy, leads to biochemical changes in levels of sFlt-1 and PlGF in healthy pregnancies. […] The relationship between insulin resistance and PE has been explored in several studies, and the connection often centers on the broader metabolic changes that can occur during pregnancy. […] Some theories suggest that PE arises from a maladaptive immune response to the placenta.

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