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: Clinical features and diagnosis – UpToDate

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

  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. […] This topic will discuss the clinical features, diagnosis, and differential diagnosis of preeclampsia. […] 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.

• #3 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  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. […] This topic will discuss the clinical features, diagnosis, and differential diagnosis of preeclampsia. […] 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.

• #4 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 likely recommend close monitoring of your baby’s growth, typically through ultrasound. […] If you have preeclampsia that isn’t severe, your health care provider may recommend preterm delivery after 37 weeks. […] You need to be closely monitored for high blood pressure and other signs of preeclampsia after delivery.

• #5 Preeclampsia: Signs, Causes, Risk Factors, Complications, Diagnosis, and Treatment

  https://www.webmd.com/baby/what-is-preeclampsia

  Preeclampsia Diagnosis […] You have preeclampsia if you have high blood pressure and at least one of these other signs: […] Too much protein in your urine […] Not enough platelets in your blood […] High levels of kidney-related chemicals in your blood […] High levels of liver-related chemicals in your blood […] Fluid in your lungs […] A new headache that doesnt go away when you take medication […] To confirm a diagnosis, your doctor might give you tests including: […] Blood tests to check your platelets and to look for kidney or liver chemicals […] Urine tests to measure proteins […] Ultrasounds, nonstress tests, or biophysical profiles to see how your baby is growing […] […] […] If not treated, preeclampsia can lead to serious complications, such as eclampsia, which can be deadly for you and your baby. […] It’s important to get immediate medical care if you have preeclampsia symptoms. […] Early delivery is often recommended when you have preeclampsia. […] The only cure for preeclampsia is giving birth.

• #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 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.

• #8 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).

• #9 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. […] Signs or symptoms of end-organ damage may include one or more of the following: Thrombocytopenia (platelets 9 L), impaired liver function (aminotransferases 2 times normal) not accounted for by alternative diagnoses, severe persistent right upper quadrant or epigastric pain unresponsive to medications, renal insufficiency (serum creatinine 1.1 mg/dL or doubling of serum creatinine in the absence of renal disease), pulmonary edema, new-onset headache unresponsive to medication and not accounted for by alternative diagnoses, visual disturbances. […] 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).

• #10 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).

• #11 Preeclampsia: Signs, Causes, Risk Factors, Complications, Diagnosis, and Treatment

  https://www.webmd.com/baby/what-is-preeclampsia

  Preeclampsia Diagnosis […] You have preeclampsia if you have high blood pressure and at least one of these other signs: […] Too much protein in your urine […] Not enough platelets in your blood […] High levels of kidney-related chemicals in your blood […] High levels of liver-related chemicals in your blood […] Fluid in your lungs […] A new headache that doesnt go away when you take medication […] To confirm a diagnosis, your doctor might give you tests including: […] Blood tests to check your platelets and to look for kidney or liver chemicals […] Urine tests to measure proteins […] Ultrasounds, nonstress tests, or biophysical profiles to see how your baby is growing […] […] […] If not treated, preeclampsia can lead to serious complications, such as eclampsia, which can be deadly for you and your baby. […] It’s important to get immediate medical care if you have preeclampsia symptoms. […] Early delivery is often recommended when you have preeclampsia. […] The only cure for preeclampsia is giving birth.

• #12 Preeclampsia: Toxemia, Causes, Symptoms & Risk Factors

  https://my.clevelandclinic.org/health/diseases/17952-preeclampsia

  Preeclampsia is a serious blood pressure condition that develops during pregnancy. People with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria). Preeclampsia usually develops after the 20th week of pregnancy. […] Because of these risks, your healthcare provider will need to monitor your pregnancy closely and recommend treatment right away. […] When you have preeclampsia, your blood pressure is (higher than 140/90 mmHg), and you may have high levels of protein in your pee (a sign of kidney damage). Preeclampsia puts stress on your heart and other organs and can cause serious complications. […] You often dont know you have preeclampsia until your healthcare provider checks your blood pressure and urine (pee) at a prenatal appointment.

• #13 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.

• #14 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.

• #15 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.

• #16 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.

• #17 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.

• #18 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.

• #19

  https://www.nhs.uk/conditions/pre-eclampsia/diagnosis/

  Pre-eclampsia is easily diagnosed during the routine checks you have while you’re pregnant. […] A urine sample is usually requested at every antenatal appointment. This can easily be tested for protein using a dipstick. […] If you’re between 20 weeks and 36 weeks and 6 days pregnant, and your doctors think you may have pre-eclampsia, they may offer you a blood test to help rule out pre-eclampsia. […] If you’re diagnosed with pre-eclampsia, you should be referred to a specialist in hospital for further tests and more frequent monitoring.

• #20 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.

• #21 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.

• #22 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.

• #23 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.

• #24 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The specific criteria for diagnosis are listed in the table. […] Preeclampsia with severe features (formerly severe preeclampsia) is the subset of patients with preeclampsia who have severe hypertension and/or specific signs or symptoms of significant end-organ dysfunction that signify the severe end of the preeclampsia spectrum. […] 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.

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

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

  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. […] Investigations to consider include coagulation screen.

• #26 Pre-eclampsia laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Pre-eclampsia_laboratory_findings

  Laboratory findings consistent with the diagnosis of preeclampsia include: elevated liver enzyme tests, thrombocytopenia, elevated serum creatinine, and elevated serum uric acid. […] An elevated concentration of liver enzymes, low platelets, and hemolysis are diagnostic of HELLP syndrome.

• #27 Pre-eclampsia laboratory findings – wikidoc

  https://www.wikidoc.org/index.php/Pre-eclampsia_laboratory_findings

  Laboratory findings consistent with the diagnosis of preeclampsia include: elevated liver enzyme tests, thrombocytopenia, elevated serum creatinine, and elevated serum uric acid. […] An elevated concentration of liver enzymes, low platelets, and hemolysis are diagnostic of HELLP syndrome.

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

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

  Elevated Liver Enzymes – AST or ALT > 2X upper limit of normal […] Low Platelets – Platelet count <100,000/μL. [...] 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.

• #29 Developing Accurate Preeclampsia Tests

  https://www.preeclampsia.org/biomarkers

  Rapid, reliable and clinically useful biomarkers for preeclampsia are urgently needed as decision aids to improve pregnancy outcomes. […] Clinically relevant biomarkers of preeclampsia can be divided into placental, inflammatory, endothelial and metabolic categories. […] A few promising biomarkers include Placental Growth Factor (PlGF) which is involved in the modulation of the placental and maternal vascular system, soluble FMS-like tyrosine kinase-1 receptor (sFlt-1) which antagonizes blood vessel formation and promotes endothelial dysfunction, asymmetric dimethylarginine (ADMA), which interferes with nitric oxide production and leads to abnormal vascular function, Congo Red, a test of protein-folding abnormalities in the urine of preeclamptic women, and others. […] The status quo is inadequate. It is time to move to the molecular era. Biomarker studies and clinical adoption must be prioritized and accelerated if we are going to save the lives and improve health outcomes of preeclamptic mothers and their babies.

• #30 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.

• #31 Developing Accurate Preeclampsia Tests

  https://www.preeclampsia.org/biomarkers

  Combined with usual clinical and ultrasound surveillance during pregnancy, these biomarkers have been shown to diagnose preeclampsia and predict adverse outcomes with an even greater accuracy than traditional tests, and some have even been shown to reduce medical costs associated with evaluations of suspected preeclampsia. […] The FDA recognized some tests may provide substantial improvement over currently available clinical and diagnostic testing to diagnose preeclampsia and, hence, made an expedited review and approval process available to manufacturers pursuing commercial development. […] In 2023, the first-ever FDA-approved test for preeclampsia was approved, which measured Placental Growth Factor (PlGF) plus and soluble FMS-like tyrosine kinase-1 receptor (sFlt-1) via a blood serum test to aid in clinical management of preeclampsia.

• #32 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 (84.297%) and sensitive (8595%) 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 810 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.

• #33 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.

• #34 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The specific criteria for diagnosis are listed in the table. […] Preeclampsia with severe features (formerly severe preeclampsia) is the subset of patients with preeclampsia who have severe hypertension and/or specific signs or symptoms of significant end-organ dysfunction that signify the severe end of the preeclampsia spectrum. […] 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 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.

• #35 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).

• #36 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. […] Eclampsia occurs when women with preeclampsia develop seizures. The seizures can happen before or during labor or after the baby is delivered.

• #37 Preeclampsia in the ED — Taming the SRU

  https://www.tamingthesru.com/blog/diagnostics/preeclampsia

  Preeclampsia is a syndrome which has been recognized for centuries but remains poorly understood. The diagnostic criteria of preeclampsia and eclampsia are defined primarily by consensus statements from the American College of Obstetrics and Gynecology. Preeclampsia has classically been defined as gestational hypertension with proteinuria. However, since preeclampsia is recognized as a syndrome, some women may present with preeclampsia without proteinuria but with other signs of the disorder. Thus, preeclampsia is now diagnosed when a patient is 20 weeks pregnant presents with the following: […] Severe preeclampsia is diagnosed when the patient has SBP 160 mmHg or DBP 110 mmHg, or when she has thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral/visual symptoms. The quantity of proteinuria does not correlate well with the severity of the disease and so higher amounts of proteinuria no longer contribute to the diagnosis of severe preeclampsia.

• #38 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 likely recommend close monitoring of your baby’s growth, typically through ultrasound. […] If you have preeclampsia that isn’t severe, your health care provider may recommend preterm delivery after 37 weeks. […] You need to be closely monitored for high blood pressure and other signs of preeclampsia after delivery.

• #39 Preeclampsia: Signs, Causes, Risk Factors, Complications, Diagnosis, and Treatment

  https://www.webmd.com/baby/what-is-preeclampsia

  Preeclampsia Diagnosis […] You have preeclampsia if you have high blood pressure and at least one of these other signs: […] Too much protein in your urine […] Not enough platelets in your blood […] High levels of kidney-related chemicals in your blood […] High levels of liver-related chemicals in your blood […] Fluid in your lungs […] A new headache that doesnt go away when you take medication […] To confirm a diagnosis, your doctor might give you tests including: […] Blood tests to check your platelets and to look for kidney or liver chemicals […] Urine tests to measure proteins […] Ultrasounds, nonstress tests, or biophysical profiles to see how your baby is growing […] […] […] If not treated, preeclampsia can lead to serious complications, such as eclampsia, which can be deadly for you and your baby. […] It’s important to get immediate medical care if you have preeclampsia symptoms. […] Early delivery is often recommended when you have preeclampsia. […] The only cure for preeclampsia is giving birth.

• #40 Preeclampsia: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/252025

  Fetal ultrasound: Doctors will closely monitor the babys progress to make sure they are growing properly. […] Non-stress test: The doctor checks how the babys heartbeat reacts when they move. If the heartbeat increases 15 beats or more a minute for at least 15 seconds twice every 20 minutes, it is an indication that everything is normal.

• #41

  https://www.nhs.uk/conditions/pre-eclampsia/diagnosis/

  Pre-eclampsia is easily diagnosed during the routine checks you have while you’re pregnant. […] A urine sample is usually requested at every antenatal appointment. This can easily be tested for protein using a dipstick. […] If you’re between 20 weeks and 36 weeks and 6 days pregnant, and your doctors think you may have pre-eclampsia, they may offer you a blood test to help rule out pre-eclampsia. […] If you’re diagnosed with pre-eclampsia, you should be referred to a specialist in hospital for further tests and more frequent monitoring.

• #42 Recommendations | Hypertension in pregnancy: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng133/chapter/recommendations

  Advise pregnant women to see a healthcare professional immediately if they experience symptoms of pre-eclampsia. Symptoms include: […] Interpret proteinuria measurements for pregnant women in the context of a full clinical review of symptoms, signs and other investigations for pre-eclampsia. […] Assessment of women with pre-eclampsia should be performed by a healthcare professional trained in the management of hypertensive disorders of pregnancy. […] Carry out a full clinical assessment at each antenatal appointment for women with pre-eclampsia, and offer admission to hospital for surveillance and any interventions needed if there are concerns for the wellbeing of the woman or baby. Concerns could include any of the following: […] Consider using either the fullPIERS or PREP-S validated risk prediction models to help guide decisions about the most appropriate place of care (such as the need for in utero transfer) and thresholds for intervention.

• #43 Preeclampsia Testing | Choose the Right Test

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

  Following a diagnosis of preeclampsia, serum creatinine, liver enzymes, and platelet count should be retested at least twice weekly. […] Although data and expert consensus are lacking with respect to postpartum monitoring, it is recognized that preeclampsia, including preeclampsia with severe features (eg, HELLP syndrome), can develop postpartum and that vigilance is warranted.

• #44 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.

• #45 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The specific criteria for diagnosis are listed in the table. […] Preeclampsia with severe features (formerly severe preeclampsia) is the subset of patients with preeclampsia who have severe hypertension and/or specific signs or symptoms of significant end-organ dysfunction that signify the severe end of the preeclampsia spectrum. […] 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 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.

• #46 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  The specific criteria for diagnosis are listed in the table. […] Preeclampsia with severe features (formerly severe preeclampsia) is the subset of patients with preeclampsia who have severe hypertension and/or specific signs or symptoms of significant end-organ dysfunction that signify the severe end of the preeclampsia spectrum. […] 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 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.

• #47 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 report highlights new blood biomarker-based testing tools with potential to identify pre-eclampsia and eclampsia risk, alongside new evidence for improving existing prevention and management tools like blood pressure devices, low-dose aspirin, calcium supplements and ultrasounds. […] Improving the timing, quality, and continuity of antenatal care is one of the best ways to lower pre-eclampsia risk and prevent and manage this condition. Interventions that are women-centered, like group-based approaches and expanded routine and accurate blood pressure measurement, show positive results. […] The report underscores that key priorities are to make diagnostic tools and therapeutic interventions affordable and accessible in low-resource settings and to ensure that interventions are high-quality and consistently available for pregnant women.

• #48 Preeclampsia: Clinical features and diagnosis – UpToDate

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

  A calculator that combines maternal characteristics with mean arterial blood pressure, mean uterine artery resistance, and serum PlGF and PAPP-A levels was developed by the Fetal Medicine Foundation for screening patients in early pregnancy to stratify risk of developing preeclampsia later in pregnancy, primarily preterm preeclampsia. […] The clinical findings of preeclampsia result from the underlying pathophysiology of the disease: placental insufficiency, vasoconstriction, increased capillary permeability, and endothelial dysfunction. […] The pathogenesis of preeclampsia likely involves both placental and maternal factors. Abnormal development of the placental vasculature early in pregnancy is a key event that results in relative placental underperfusion, hypoxia, ischemia, and oxidative stress, leading to release of antiangiogenic factors into the maternal circulation.

• #49 Diagnosis and screening for pre-eclampsia – GPnotebook

  https://gpnotebook.com/pages/obstetrics/diagnosis-staging-and-screening/diagnosis-and-screening-for-pre-eclampsia

  Severe pre-eclampsia: pre-eclampsia with severe hypertension that does not respond to treatment or is associated with ongoing or recurring severe headaches, visual scotomata, nausea or vomiting, epigastric pain, oliguria and severe hypertension, as well as progressive deterioration in laboratory blood tests such as rising creatinine or liver transaminases or falling platelet count, or failure of fetal growth or abnormal doppler findings […] Assessment of women with pre-eclampsia should be performed by a healthcare professional trained in the management of hypertensive disorders of pregnancy. Carry out a full clinical assessment at each antenatal appointment for women with pre-eclampsia, and offer admission to hospital for surveillance and any interventions needed if there are concerns for the wellbeing of the woman or baby. Concerns could include any of the following: sustained systolic blood pressure of 160 mmHg or higher or any maternal biochemical or haematological investigations that cause concern, for example, a new and persistent: rise in creatinine (90micromol/litre or more, 1mg/100ml or more) or rise in alanine transaminase (over 70 IU/litre, or twice upper limit of normal range) or fall in platelet count (under 150,000/microlitre) or signs of impending eclampsia – convulsive condition associated with pre-eclampsia or signs of impending pulmonary oedema or other signs of severe pre-eclampsia or pre-eclampsia with severe hypertension that does not respond to treatment or is associated with ongoing or recurring severe headaches, visual scotomata, nausea or vomiting, epigastric pain, oliguria and severe hypertension, as well as progressive deterioration in laboratory blood tests such as rising creatinine or liver transaminases or falling platelet count, or failure of fetal growth or abnormal doppler findings or suspected fetal compromise or any other clinical signs that cause concern. Consider using either the fullPIERS or PREP-S validated risk prediction models to help guide decisions about the most appropriate place of care (such as the need for in utero transfer) and thresholds for intervention.

• #50 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 fullPIERS model has been validated and was successful in predicting adverse outcomes in advance; therefore, it is potentially able to influence treatment choices before complications arise.

• #51 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.

• #52 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.

• #53 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.

• #54 Preeclampsia – StatPearls – NCBI Bookshelf

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

  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. […] An essential part of providing adequate patient care is patient education and identifying patient-specific barriers to receiving care.

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