Differential Diagnosis. Chronic hypertension should always be ruled out.
Diagnosis is made with the diagnostic dyad, as there are no pathognomic tests:
Risk Factors. Preeclampsia is found 8 times more frequently in primiparas.
Other risk factors are multiple gestation, hydatidiform mole, diabetes mellitus,
age extremes, chronic hypertension, and chronic renal disease.
Lab abnormalities include the following: Evidence of hemoconcentration is
shown by elevation of hemoglobin, hematocrit, blood urea nitrogen (BUN),
serum creatinine, and serum uric acid. Proteinuria is present (described under
diagnostic criteria). Evidence of disseminated intravascular coagulation (DIC) or
liver enzyme elevation would move the diagnosis from preeclampsia without
severe features to preeclampsia with severe features.
Management. The only definitive cure is delivery and removal of all fetal-
placental tissue. However, delivery may be deferred in preeclampsia without
severe features to minimize neonatal complications of prematurity. Management
is based on gestational age.
Sustained BP elevation of ≥140/90 mm Hg
Proteinuria of ≥300 mg on a 24 h urine collection or protein/creatinine ratio
of ≥0.3Conservative management. Before 37 weeks’ gestation as long as mother
and fetus are stable, mild preeclampsia is managed in the hospital or as
outpatient, watching for possible progression to severe preeclampsia. No
antihypertensive agents or MgSO 4 are used.
Delivery. At ≥37 weeks’ gestation, delivery is indicated with dilute IV