Major changes in diagnosis and management of preeclampsia

Preeclampsia and eclampsia continue to be major contributors to maternal mortality and morbidity. Lack of appreciation for the multi-organ involvement of preeclampsia, combined with overly rigid criteria for diagnosis, may hinder early diagnosis and appropriate management. Recently, the American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy evaluated the evidence and formulated new recommendations for diagnosis and management. This article reviews some of these recommended changes, including the new classification of the hypertensive diseases of pregnancy. Systolic blood pressure has been shown to be as important as diastolic blood pressure in the diagnosis of preeclampsia. Changes in proteinuria are not predictive of disease severity or maternal or fetal complications; therefore, the magnitude of proteinuria or changes in the amount should not dictate diagnosis or management. Instead, symptoms of cerebral involvement, such as headache and visual changes or signs of end-organ involvement including abnormal laboratory tests (elevated serum creatinine or liver function tests, low platelet count), are evidence of preeclampsia with severe features. Immediate induction of labor is recommended for women with gestational hypertension or preeclampsia at 37 weeks' gestation or later. Pregnant and postpartum women need to know important warning signs and symptoms of preeclampsia. Prompt diagnosis of preeclampsia and appropriate management will improve the quality of care for women.