A rise in systolic blood pressure of 30 mm Hg or diastolic blood pressure increase of 15 mm Hg is diagnostic in a woman with preexisting hypertension.

Urine dipstick values greater than 2+ suggest significant proteinuria but are not reliable and should be followed with a 24-hour urine collection. Proteinuria is also present with greater than 300 mg of protein in a 24-hour urine.

Edema is also a symptom commonly associated with preeclampsia, although difficult to assess given that normal pregnancy also commonly has dependent edema.

Severe preeclampsia is diagnosed by a systolic blood pressure greater than 160 mm Hg or diastolic blood pressure greater than 110 mm Hg, excess proteinuria, severe oliguria, cerebral or visual disturbances, pulmonary edema, impaired liver function, epigastric or right upper quadrant pain, thrombocytopenia, or fetal growth retardation.

Additional studies include serum creatinine, platelet count, serum alanine and aspartate aminotransferase concentrations (ALT and AST), serum lactate dehydrogenase (LDH), and serum uric acid.¹

The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a sign of severe preeclampsia.

Every patient should have fetal heart sounds checked to confirm viability as part of the patient’s vital signs. Sonographic evaluation of the fetus is necessary to confirm gestational age if prenatal care is not well documented.

Gestational age is important in determining optimal management if the severity of symptoms progresses. A nonstress test or biophysical profile is used to evaluate fetal well being.

Visual disturbances, severe headaches, lateralizing neurologic signs, and liver tenderness in patients with severe preeclampsia should be treated aggressively to prevent progression to seizures and maternal organ damage.

CT scanning of the head is necessary in the case of lateralizing neurologic signs to rule out the possibility of intracranial hemorrhage.

Treatment

Delivery is the definitive treatment for preeclampsia and should be considered after 34 weeks gestation in the case of severe preeclampsia and 37 weeks gestation in mild preeclampsia.

A conservative approach, rather than preterm delivery, may be the better option depending on gestational age, maternal and fetal condition, and severity of disease.

Limitation of physical activity, including bed rest, has been proven to decrease blood pressure and is a common initial treatment of mild preeclampsia.

Mild preeclampsia may be monitored on an outpatient basis, but patients with moderate to severe preeclampsia should be admitted and closely followed.