Snapshot A 20-year-old woman at 30 weeks gestation presents to the emergency room with malaise, headache, and nausea. On physical exam, she is alert and oriented. She is noted to have bilateral lower extremity edema. A urine dipstick shows 2+ proteinuria and her blood pressure is 150/96 mmHg. Her other laboratory values are within normal limits. She is discharged home. The next day, she returns with a worsening headache and found with elevated blood pressure again at 163/100 mmHg. She is admitted and started on magnesium sulfate for seizure prophylaxis. Introduction Overview login to view 2 more bullets Diagnosis of preeclampsia login to view 8 more bullets Spectrum of Hypertensive Disorders in PregnancyChronic HypertensionGestational HypertensionPreeclampsiaEclampsiaHELLP SyndromeHistory of hypertension(> 140/90 mmgHg) before pregnancy or before 20 weeks of gestationHypertension persists after deliveryHypertension after 20 weeks of gestationHypertension returns to baseline by 6 weeks post-partumCommon in multiple gestationsHypertension (> 140/90 mmHg on 2 separate occasions, or >160/110 mmHg) plusproteinuriaPreeclampsia plus seizuresHemolysisElevatedLiver enzymesLowPlatelets Epidemiology Incidence login to view 1 more bullet Risk factors login to view 6 more bullets Etiology Pathogenesis login to view 4 more bullets Presentation Symptoms login to view 8 more bullets Physical exam login to view 6 more bullets Studies Serum labs login to view 7 more bullets Differential Acute fatty liver of pregnancy login to view 2 more bullets HELLP syndrome login to view 2 more bullets Treatment Medical login to view 15 more bullets Surgical login to view 6 more bullets Complications Maternal cerebral hemorrhage Disseminated intravascular coagulopathy Acute respiratory distress syndrome Abruptio placentae Recurrence of preeclampsia Prognosis Maternal mortality 14% Most resolve after delivery