Preeclampsia

Also known as: eclampsia · gestational hypertension · HELLP

Free to read — no account needed. Sign in only to bookmark this disease and track your study progress.

United StatesACOG

Current

Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222

American College of Obstetricians and Gynecologists (ACOG) · 2020 · Practice Bulletin No. 222

ACOG's practice bulletin on the classification, diagnosis and clinical management of gestational hypertension and preeclampsia, including risk assessment, prevention and decisions about timing of delivery. It remains ACOG's principal document on the topic, with later targeted clinical practice updates layered on top of it. Metadata record only.

Published in Obstetrics & Gynecology 2020;135(6):e237-e260. source
Addresses hypertensive disorders of pregnancy, which are among the leading contributors to maternal and perinatal morbidity and mortality worldwide. source

Verify against original ↗

EuropeESHRE/RCOG

Current

Hypertension in pregnancy: diagnosis and management

National Institute for Health and Care Excellence (NICE) · 2019 · NICE guideline NG133 (last updated April 2023)

The UK national guideline on diagnosing and managing high blood pressure in pregnancy, including pre-eclampsia, across the antenatal, intrapartum and postnatal periods. It also covers advice for women with pre-existing hypertension who are planning pregnancy and follow-up after a pregnancy affected by hypertension. Metadata record only.

Published 25 June 2019 and last updated 17 April 2023. source
Supersedes NICE clinical guideline CG107 (August 2010) on the same topic. source
Covers risk reduction, proteinuria assessment, fetal monitoring, intrapartum and critical-care management, and postnatal antihypertensive treatment. source

Verify against original ↗

US vs EU key differences

Aspirin prophylaxis differs in dose and duration: ACOG specifies 81 mg/day started between 12 and 28 weeks (optimally before 16 weeks), while NICE specifies 75-150 mg daily from 12 weeks until birth. source
Antihypertensive treatment thresholds diverge sharply: ACOG Practice Bulletin 222 reserves urgent treatment for severe-range blood pressure of 160/110 mm Hg or higher, whereas NICE treats sustained readings of 140/90 mm Hg or higher and sets a target of 135/85 mm Hg. source
Biomarker testing differs: NICE offers placental growth factor (PlGF)-based testing between 20 and 36+6 weeks to help rule out pre-eclampsia, while the 2020 ACOG bulletin concludes no single angiogenic marker reliably predicts pre-eclampsia and that clinical utility is not yet demonstrated. source
The two guidelines converge on delivery timing: ACOG favours expectant monitoring until 37 0/7 weeks in preeclampsia without severe features, and NICE likewise advises initiating birth within 24-48 hours once 37 weeks is reached. source
Both allow diagnosis without proteinuria: ACOG diagnoses preeclampsia in new-onset hypertension plus severe features such as thrombocytopenia below 100,000/L, creatinine above 1.1 mg/dL, or transaminases more than twice normal, even when proteinuria is absent. source

What changed recently

EUNICE guideline NG133 (June 2019) → NICE guideline NG133 (last updated April 2023)2023-04-17
The April 2023 update revised the recommendations on when clinicians should offer placental growth factor (PlGF)-based blood testing to help rule out pre-eclampsia, bringing the guideline into line with NICE's separate diagnostics guidance on PlGF testing. NG133 itself had earlier replaced the 2010 hypertension in pregnancy guideline CG107.
source ↗
USPractice Bulletin No. 202 (December 2018) → Practice Bulletin No. 2222020-06-01
Bulletin 222 formally replaced Practice Bulletin No. 202 from December 2018. Its interim update carried focused corrections to the platelet-count thresholds and to the boxed diagnostic criteria for preeclampsia and for preeclampsia with severe features.
source ↗

See the full update feed for changes across every system.