- Severe features: BP ≥160/110, thrombocytopenia (<100,000), elevated liver enzymes (double normal), renal insufficiency, pulmonary edema, cerebral symptoms
- Eclampsia: generalized tonic‑clonic seizures
- HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets
Preeclampsia
Must-Not-Miss / Red Flags
Patient Explanation
“You have developed high blood pressure during pregnancy that can affect your and your baby’s health. We’ll monitor you closely and deliver your baby when it’s safest.”
Board Fact
“The only definitive cure for preeclampsia is delivery of the placenta.”
ICD-10
O14.9
Definition & Core Concept
Preeclampsia is a multisystem hypertensive disorder of pregnancy, defined by new‑onset hypertension (≥140/90 mmHg) after 20 weeks of gestation with proteinuria or evidence of maternal organ dysfunction.
Epidemiology & Risk Factors
- Affects 5‑8% of pregnancies worldwide
- Leading cause of maternal and perinatal morbidity and mortality
- Risk factors: nulliparity, prior preeclampsia, chronic HTN, DM, multiple gestation, BMI >30, maternal age >35
Clinical Vignette
A 30‑year‑old primigravida at 32 weeks presents with headache, visual scotomata, and BP 170/105. Urine protein‑creatinine ratio is 1.2. Platelets are 130,000, and LFTs are mildly elevated.
Pearls & Pitfalls
- Magnesium sulfate is the gold standard for eclampsia prevention and treatment – always monitor deep tendon reflexes, respiratory rate, and urine output.
- Preeclampsia can present up to 6 weeks postpartum – consider it in any recently postpartum patient with hypertension or headache.
Discharge & Follow-Up
BP monitoring for 6 weeks postpartum. Switch to Enalapril if breastfeeding (safe). Discuss recurrence risk and pre‑conception counseling for future pregnancies.
Literature & Guidelines
ACOG Practice Bulletin #222: Gestational Hypertension and Preeclampsia (2024). PMID: 38450501.