Generally, the diagnosis of PRE is established on the basis of hypertension and proteinuria. Fundoscopic exam will often demonstrate vasospasm of the retinal vessels. Neurologic examination is usually normal. An abdominal exam can detect the presence of uterine or liver tenderness.
#Preeclampsia blood pressure chart skin
Skin exam can show dependent, facial, or periorbital edema. Lung exam is usually normal, unless there is evidence of congestive heart failure. Heart rate could be normal or there may be tachycardia or bradycardia. Characteristic findings on physical examinationīlood pressure elevations can be mild or severe (≥ 160 mm Hg systolic and/or ≥ 110 mm Hg diastolic).
In some patients, other diagnoses such as renal disease, connective tissue disease (lupus), and vascular diabetes mellitus should be considered. The diagnosis should be suspected in patients with symptoms and in patients with mucosal bleeding. Patients with a diagnosis of GH, chronic hypertension, and previous preeclampsia are at increased risk to develop PRE. The patient will have new onset hypertension and proteinuria after 20 weeks gestation with or without headaches, visual changes, epigastric pain, or shortness of breath. Patients with PRE should have no history of chronic hypertension or renal disease prior to pregnancy and/or prior to 20 weeks gestation. Preeclampsia What you should be alert for in the history? This condition can overlap with undiagnosed chronic hypertension, particularly in women with no medical care prior to pregnancy and those who present for prenatal care after 20 weeks gestation. The diagnosis is confirmed when there is persistent elevation of blood pressure (in the mild range), with absent proteinuria, normal blood tests, absent maternal symptoms, and normal fetal testing. Diagnosis confirmation and differential diagnosis Generally, serum creatinine will be 5 cm (normal, 5-20 cm), and a reactive non-stress test (NST) during fetal heart rate monitoring. Characteristic findings on physical examinationīlood pressure is usually between 140-150/90-100 mm Hg with no abdominal or epigastric tenderness and no evidence of petechial hemorrhage or ecchymosis on skin examination. Pregnancy outcome is usually good when the diagnosis is made at ≥ 37 weeks gestation. The rate of the progression will depend on gestational age at diagnosis. They should have no headaches, visual changes, or respiratory or gastrointestinal symptoms.Approximately 30-50% of patients with GH will progress to preeclampsia or severe gestational hypertension, and 12-15% will ultimately develop fetal growth restriction (FGR). They are usually in their first pregnancy, and have an increased body mass index (BMI). Patients with GH have no prior history of chronic hypertension and typically have normal blood pressure recordings prior to 20 weeks gestation. Diagnosis and differential diagnosis Classical GH What you should be alert for in the history The estimated incidence of HELLP syndrome is 1 in 1,000 deliveries, and in 5-20% of patients with preeclampsia. HELLP syndrome (the three main features are hemolysis, elevated liver enzymes, and low platelet count) is characterized by either GH or PRE in association with all the laboratory findings listed in Table 3.
Signs and symptoms and laboratory tests consistent with preeclampsia
Preeclampsia is also diagnosed in absence of proteinuria in association with any of the symptoms or laboratory findings listed in Table II. Hypertension can develop during the antepartum period, labor, or within 48 hours postpartum. The major diagnostic criteria for mild GH include a systolic blood pressure (BP) of 140-159 mm Hg and/or a diastolic BP of 90-109 mm Hg at least 4 hours apart occurring after 20 weeks gestation. The clinical presentation varies from mild hypertension to severe hypertension with or without various organ dysfunctions that can include hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.Ĭlassical gestational hypertension (GH) is characterized by mild hypertension without the presence of maternal symptoms, normal laboratory findings, including absent proteinuria, and normal fetal growth. As a group, hypertensive disorders during pregnancy are clinically heterogeneous with an estimated incidence of 6-30%, depending on parity, number of fetuses, body mass index, and previous obstetric history. The term gestational hypertension-preeclampsia is used to describe a wide spectrum of disorders that are characterized by hypertension in pregnancy (Figure 1).
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