Pre-eclampsia describes the emergence of high blood pressure during pregnancy that may be a precursor to a woman developing eclampsia and other complications. It is classically a triad of 3 things:

• new-onset hypertension
• proteinuria
• oedema

Definition

The current formal definition is as follows

• new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:
  • proteinuria
  • other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

Features

Potential consequences of pre-eclampsia

• eclampsia
  • other neurological complications include altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata
• fetal complications
  • intrauterine growth retardation
  • prematurity
• liver involvement (elevated transaminases)
• haemorrhage: placental abruption, intra-abdominal, intra-cerebral
• cardiac failure

Features of severe pre-eclampsia

• hypertension: typically > 160/110 mmHg and proteinuria as above
• proteinuria: dipstick ++/+++
• headache
• visual disturbance
• papilloedema