---
title: Preeclampsia Monitoring
description: A clinical reference guide for the diagnosis, management, and monitoring of preeclampsia in pregnant patients.
keywords: [preeclampsia, hypertension, proteinuria, eclampsia, pregnancy, monitoring]
category: clinical
---

## Introduction to Preeclampsia

Preeclampsia is a pregnancy-specific condition characterized by the new onset of hypertension and proteinuria or end-organ dysfunction after 20 weeks of gestation. It is a leading cause of maternal and perinatal morbidity and mortality worldwide. Timely diagnosis and management of preeclampsia is crucial to prevent progression to life-threatening complications such as eclampsia, stroke, and multi-organ failure.

## Diagnostic Criteria

According to the American College of Obstetricians and Gynecologists (ACOG), the diagnostic criteria for preeclampsia include:

1. Blood pressure ≥ 140 mmHg systolic or ≥ 90 mmHg diastolic on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with previously normal blood pressure.
2. Proteinuria defined as ≥ 300 mg per 24-hour urine collection or a protein/creatinine ratio ≥ 0.3 mg/dL.

In the absence of proteinuria, preeclampsia can be diagnosed if hypertension is accompanied by the new onset of any of the following:

- Thrombocytopenia (platelet count < 100,000/μL)
- Renal insufficiency (serum creatinine > 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)
- Impaired liver function (elevated transaminases to twice normal concentration)
- Pulmonary edema
- Cerebral or visual disturbances

## Monitoring and Risk Assessment

Patients diagnosed with preeclampsia require close maternal and fetal monitoring. This includes:

- Daily maternal blood pressure monitoring
- Twice-weekly fetal non-stress tests and biophysical profiles
- Weekly maternal laboratory tests: complete blood count, liver enzymes, renal function, and proteinuria
- Fetal growth ultrasounds every 3-4 weeks

The severity of preeclampsia can be further classified based on the presence of severe features, which include:

- Systolic BP ≥ 160 mmHg or diastolic BP ≥ 110 mmHg
- Platelet count < 100,000/μL
- Elevated liver enzymes (to twice normal concentration)
- Serum creatinine > 1.1 mg/dL or doubling of baseline
- Pulmonary edema
- New-onset cerebral or visual disturbances

Patients with severe preeclampsia require more intensive monitoring and management.

## Treatment Principles

The definitive treatment for preeclampsia is delivery of the fetus and placenta. However, the timing of delivery depends on the gestational age, severity of maternal disease, and fetal well-being. In general:

- For preterm preeclampsia (< 34 weeks), corticosteroids are administered for fetal lung maturation, and delivery is considered when maternal and/or fetal conditions worsen.
- For term preeclampsia (≥ 34 weeks), delivery is recommended regardless of disease severity.
- Antihypertensive medications are used to control severe hypertension, aiming for a blood pressure goal of 140-150/90-100 mmHg. Common agents include labetalol, hydralazine, and immediate-release nifedipine.
- Magnesium sulfate is the anticonvulsant of choice for the prevention and treatment of eclampsia.
- Strict input/output monitoring, avoidance of fluid overload, and treatment of pulmonary edema are important supportive measures.

## Postpartum Monitoring

Postpartum, patients with preeclampsia require continued close monitoring, as the disease can worsen or new complications can arise. Recommended postpartum monitoring includes:

- Blood pressure monitoring at least daily for the first 72 hours, then every 2-3 days until 7-10 days postpartum
- Laboratory testing (CBC, liver enzymes, renal function) at 48-72 hours postpartum and as clinically indicated
- Evaluation for postpartum preeclampsia, which can occur up to 6 weeks after delivery
- Screening for postpartum depression and anxiety, which are more common in preeclampsia patients

Patients should be counseled about the increased risk of recurrent preeclampsia in future pregnancies and the need for close monitoring and early treatment.

## Complications and Contraindications

Severe preeclampsia can progress to life-threatening complications, including:

- Eclampsia: New-onset seizures in a preeclamptic patient
- Cerebrovascular accident (stroke)
- Liver dysfunction and hematoma/rupture
- Acute kidney injury
- Disseminated intravascular coagulation (DIC)
- Pulmonary edema

Absolute contraindications to continuing pregnancy include:
- Uncontrolled severe hypertension
- Eclampsia
- Kidney failure
- Pulmonary edema
- Suspected placental abruption

In these cases, immediate delivery is indicated regardless of gestational age.

## Conclusion

Preeclampsia is a serious pregnancy-related condition that requires vigilant monitoring and timely intervention to prevent maternal and fetal complications. Healthcare providers should be familiar with the diagnostic criteria, risk assessment, treatment principles, and potential complications of preeclampsia to ensure optimal patient outcomes.