Pre-eclampsia and related hypertensive disorders of pregnancy
THE CONTEXT
Pre-eclampsia is a progressive multisystem disorder involving new hypertension with proteinuria or other evidence of end-organ dysfunction.
Definition and timing
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Pre-eclampsia develops after 20 weeks of gestation in a previously normotensive woman, with new hypertension and either proteinuria or other signs of end-organ dysfunction.
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Features may rarely appear before 20 weeks in hydatidiform mole or multiple pregnancy.
Related clinical patterns
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Gestational hypertension develops after 20 weeks in a previously normotensive woman without proteinuria or signs of end-organ damage. It may be severe or nonsevere.
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Pre-eclampsia may also be severe or nonsevere.
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Eclampsia involves grand mal seizures and/or coma in a woman with pre-eclampsia.
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HELLP syndrome comprises hemolysis, elevated liver enzymes, and low platelets. It is described as a more severe form of pre-eclampsia, although it can occur without hypertension or proteinuria.
Chronic hypertension and superimposed disease
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Chronic hypertension is present before 20 weeks of gestation and persists longer than 12 weeks postpartum.
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New proteinuria or end-organ dysfunction in a woman with chronic hypertension indicates superimposed pre-eclampsia.
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Listed features of superimposed disease include worsening hypertension, development of HELLP syndrome, headache, scotoma, and epigastric pain.
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Listed causes of chronic hypertension include essential hypertension, chronic renal disease, coarctation of the aorta, endocrine disorders, and connective tissue diseases.