Diagnosis of preeclampsia

As mentioned previously, both proteinuria and hypertension after 20 weeks of gestation must be present for a diagnosis of preeclampsia to be made. The diagnostic criteria for preeclampsia are presented in Table 11.1. Blood pressures should be measured with an appropriately sized cuff, with the patient in an upright position [8]. Edema and blood pressure elevations above the patient's baseline are no longer included in diagnostic criteria [3, 7].

In severe preeclampsia, blood pressures may be higher and proteinuria more pronounced. The diagnostic criteria for severe preeclampsia are also presented in Table 11.1. Any signs or symptoms indicating end organ damage make the diagnosis of severe preeclampsia.

Although 24-h urine collections are the gold standard for measuring proteinuria, a random urinary protein-to-creatinine ratio can rule out significant proteinuria if the ratio is less than 0.19 [9]. The urine protein-to-creatinine ratio using the 0.19 cutoff has a sensitivity of 90%, specificity of 70%, and a negative predictive value of 87% [9].

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