New onset proteinuria hypertension and at least one of the following

Symptoms of central nervous system dysfunction: Blurred vision, scotomata, altered mental status, severe headache Symptoms of liver capsule distention: Right upper quadrant or epigastric pain

Hepatocellular injury: Serum transaminase concentration at least twice normal Severe blood pressure elevation: Systolic blood pressure >160 mm Hg or diastolic >110 mm Hg on two occasions at least six hours apart Thrombocytopenia: Less than 100,000 platelets per mm3

Proteinuria: Over 5 grams in 24 hours or 3+ or more on two random samples four hours apart

Oliguria <500 mL in 24 hours

Intrauterine fetal growth restriction

Pulmonary edema or cyanosis

Cerebrovascular accident

Coagulopathy

D. Maternal assessment of women with hypertension after midpregnancy. Mild preeclampsia includes those women who satisfy the criteria for preeclampsia but do not have any features of severe disease.

1. Hypertension should be confirmed by at least two measurements at least several six hours apart.

2. Laboratory evaluation consists of hematocrit (hemoconcentration suggests preeclampsia), platelet count, protein excretion, serum creatinine, serum uric acid, serum alanine and aspartate aminotransferase concentrations (ALT, AST), and lactic acid dehydrogenase concentration (LDH).

E. Eclampsia refers to the development of grand mal seizures in a woman with preeclampsia. Preeclampsia-eclampsia is caused by generalized vasospasm, activation of the coagulation system, and changes in autoregulatory systems related to blood pressure control.

F. Edema and intravascular volume. Most women with preeclampsia have edema. Although peripheral edema is common in normal pregnancy, sudden and rapid weight gain and facial edema often occur in women who develop preeclampsia.

G. Hematologic changes. Increased platelet turnover is a consistent feature of preeclampsia. The most common coagulation abnormality in preeclampsia is thrombocytopenia.

H. Liver involvement may present as right upper quadrant or epigastric pain, elevated liver enzymes and subcapsular hemorrhage or hepatic rupture.

I. Central nervous system. Headache, blurred vision, scotomata, and, rarely, cortical blindness are manifestations of preeclampsia; seizures in a preeclamptic woman are defined as eclampsia.

J. Fetus and placenta. The fetal consequences are fetal growth restriction and oligohydramnios. Severe or early onset preeclampsia result in the greatest decrements in birth weight.

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