[Preeclampsia in pregnancy. Importance of reclassification]

It is difficult to determine the etiology of hypertension during pregnancy on the basis of clinical criteria alone. The purpose of the present study is to emphasize the impact of the postpartum reclassification of the hypertensive disorders in gestation. One hundred and fifty eight patients with an initial diagnosis of preeclampsia were prospectively studied. The follow-up included a reclassification of their hypertensive disorder at 4, 8 and 12 weeks postpartum. Such reclassification was based on renal function test and values of blood pressure. Among 158 patients, 118 had an initial diagnosis of preeclampsia during pregnancy, and only in 39 cases (33%) such diagnosis was confirmed postpartum. At the time of reclassification the rest of the patients belonged to the following conditions: gestational hypertension without proteinuria 35%, chronic hypertension 16%, nephropathy (7 with renal biopsy) 11%, and 4% with chronic hypertension and superimposed preeclampsia. There was no significative difference in perinatal morbidity between patients with chronic and gestational hypertension. A total of 10% of perinatal mortality rate was found. We concluded that the reclassification postpartum of the hypertensive disorders in pregnancy is essential to avoid errors in diagnosis and to establish adequate maternal and perinatal outcomes in future pregnancies.