The Guidelines Guys: Preeclampsia
Joe Weatherly DO, Andrew Buelt DO, and Vanessa Cardy MD
USPSTF Preeclampsia Screening Guideline 2017 JAMA
- Why this guideline is important
- Preeclampsia occurs in 4% of pregnancies
- Preeclampsia can lead to eclampsia which is the 2nd leading cause of maternal mortality worldwide
- USPSTF last updated their guidance in 1996
- Diagnostic criteria
- BP ≥ 140/90 x 2 after 20 weeks gestation and 1 of the following
- Proteinuria > 300mg/dL on 24-hour urinary protein test
- OR a protein to creatinine ratio ≥ to 0.3 mg/mmol
- OR a urine protein dipstick > 1 if quantitative analysis is not available
- Alternate diagnosis
- SBP ≥140 mmHg or DBP ≥90 mmHg and ≥ 1 of the following signs and symptoms of end-organ dysfunction
- Cytopenia
- Renal insufficiency
- Impaired liver function
- Pulmonary edema
- Cerebral or visual symptoms
- New recommendation
- 1996: Screen with blood pressure readings at first visit and periodically after
- 2017: Screen with blood pressure readings throughout pregnancy (GRADE B)
- Take home point
- Screen often with tests that are most reliable including BP and 24-hour urine protein if appropriate.
References:
The Guideline: https://jamanetwork.com/journals/jama/fullarticle/2620095
Bibbins-Domingo, Kirsten, et al. "Screening for preeclampsia: US preventive services task force recommendation statement." Jama 317.16 (2017): 1661-1667.
MAGPIE Trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08778-0/fulltext
Group, The Magpie Trial Collaborative. "Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial." The Lancet359.9321 (2002): 1877-1890.
