Pregnancy topic

Preeclampsia

New hypertension and proteinuria after week 20 — warning signs and response

Preeclampsia is a pregnancy-specific syndrome that develops after 20 weeks. It features new high blood pressure (≥ 140/90) with proteinuria or other end-organ involvement. It affects 5–8% of pregnancies and is a leading cause of maternal and fetal morbidity. Early recognition saves lives.

Emergency warning signs — call now

Go to the emergency room or labor and delivery immediately if you have:

Severe headache that does not respond to acetaminophen.
Vision changes: blurring, flashing lights, spots.
Right upper quadrant or epigastric pain — liver involvement.
Sudden severe nausea/vomiting appearing after week 20.
Sudden swelling of hands, face, or feet (overnight).
Shortness of breath or chest tightness.
Reduced fetal movement.

Major risk factors

First pregnancy (especially age ≥ 35)
Prior preeclampsia
Twin or multiple pregnancy
Chronic hypertension, diabetes, kidney disease
Obesity (BMI ≥ 30)
Autoimmune disease (lupus, antiphospholipid syndrome)
IVF pregnancy
Family history (mother or sister)

Diagnostic criteria

After week 20 of pregnancy:

Blood pressure: ≥ 140/90 on two readings 4+ hours apart.
Proteinuria: 24-hour urine ≥ 300 mg, or protein/creatinine ratio ≥ 0.3.

Diagnosis without proteinuria

Preeclampsia can also be diagnosed with high blood pressure plus any of:

Platelets < 100,000/µL
Liver enzymes (AST/ALT) > 2× normal
Creatinine > 1.1 mg/dL
Pulmonary edema
Severe headache or visual symptoms with no other cause

Management

Mild and pre-term: close monitoring weekly — BP, urine, fetal surveillance.
Severe: hospitalization. Antihypertensives (labetalol, nifedipine, hydralazine). Magnesium sulfate to prevent seizures.
Delivery: the definitive treatment. Induction at term, earlier if maternal or fetal condition warrants.
Antenatal corticosteroids: if preterm delivery becomes likely before 34 weeks, for fetal lung maturation.

Prevention for at-risk pregnancies

Low-dose aspirin (81 mg/day): ACOG recommends starting at 12 weeks for high-risk patients.
Calcium supplementation: in low-calcium populations.
Home BP monitoring: late pregnancy for at-risk patients.
Weight management: enter pregnancy at BMI < 30 when possible.

Postpartum preeclampsia

Most cases resolve within 1–6 weeks postpartum, but 5–10% of preeclampsia develops or worsens after delivery. Watch for headaches, vision changes, and high BP after discharge.

Long-term risks

A history of preeclampsia raises lifelong risks of chronic hypertension (2–4×), cardiovascular disease (2×), stroke (1.7×), and kidney disease (5×). Annual cardiovascular check-ups are recommended.