Definition

Pre-eclampsia is defined as:

  • New onset hypertension after 20 weeks of gestation (systolic blood pressure > 140 and/or diastolic blood pressure > 90)

And either

  • Proteinuria (urine protein:creatinine ratio ≥30mg/mmol)

Or

  • Other features of pre-eclampsia1:
    • AKI (creatinine ≥ 90)
    • Liver dysfunction (ALT>40)/epigastric/RUQ pain
    • New severe persistent headache without an alternative diagnosis
    • Persistent visual disturbance 
    • Haematological complications (platelets <150/DIC/haemolysis)
    • Neurological complications (clonus/stroke/seizures(eclampsia))
    • Pulmonary oedema
    • Uteroplacental dysfunction (fetal growth restriction/placental abruption/intrauterine death)

Onset is usually after 20 weeks of gestation, but it can also occur up to a few weeks postpartum. 

Eclampsia:

  • This is pre-eclampsia that has progressed to cause seizure(s)

Learning bite

If new onset hypertension is associated with other features of pre-eclampsia, proteinuria does not necessarily need to be present. 

Classification of Hypertensive Disorders of Pregnancy

Hypertension known before pregnancy or present in the first 20 weeks Hypertension arising at or after 20 weeks (systolic ≥140 and/or diastolic ≥90)
 Chronic hypertension – essential  Chronic hypertension – secondary  White coat hypertension   Pre-eclampsia (de novo or superimposed on chronic hypertension) Gestational hypertension  

Gestational hypertension:

This is new onset hypertension in pregnancy but where there is an absence of significant proteinuria and any other features of pre-eclampsia.   Patients with gestational hypertension are at risk of going on to develop pre-eclampsia.

Chronic hypertension:

This may be previously diagnosed or recognised at the patient’s booking appointment.  These patients are also at risk of going on to develop pre-eclampsia.  

Learning bite 

Both chronic hypertension and gestational hypertension increase the risk of pre-eclampsia. 

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