Testing for<unk>  is recommended throughout pregnancy via measuring a woman's blood pressure. Diagnostic criteria<unk>  is diagnosed when a pregnant woman develops: * Blood pressure ≥140 mmHg systolic or ≥90 mmHg diastolic on two separate readings taken at least four to six hours apart after 20 weeks' gestation in an individual with previously normal blood pressure. * In a woman with essential hypertension beginning before 20 weeks' gestational age, the diagnostic criteria are an increase in systolic blood pressure (SBP) of ≥30 mmHg or an increase in diastolic blood pressure (DBP) of ≥15 mmHg. * Proteinuria ≥ or more of protein in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio ≥0.3 or a urine dipstick reading of 1+ or greater (dipstick reading should only be used if other quantitative methods are not available). Suspicion for<unk>  should be maintained in any pregnancy complicated by elevated blood pressure, even in the absence of proteinuria. Ten<unk> rcent of individuals with other signs and symptoms of<unk>  and 20% of individuals diagnosed with eclampsia show no evidence of proteinuria. In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of<unk> : * Evidence of kidney dysfunction (oliguria, elevated creatinine levels) * Impaired liver function (noted by liver function tests) * Thrombocytopenia (platelet count 5g in a 24-hour<unk> riod is also indicative of severe<unk> . Clinically, individuals with severe<unk>  may also present epigastric/right upper quadrant abdominal pain, headaches, and vomiting. Severe<unk>  is a significant risk factor for intrauterine fetal death. A rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is important to note but is not considered diagnostic. Predictive tests There have been many assessments of tests aimed at predicting<unk> , though no single biomarker is likely to be sufficiently predictive of the disorder. Predictive tests that have been assessed include those related to placental<unk> rfusion, vascular resistance, kidney dysfunction, endothelial dysfunction, and oxidative stress. Examples of notable tests include: * Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental<unk> rfusion. This test has a high negative predictive value among those individuals with a history of prior<unk> . * Elevations in serum uric acid (hyperuricemia) is used by some to "define"<unk> , though it has been found to be a poor predictor of the disorder. Elevated levels in the blood (hyperuricemia) are likely due to reduced uric acid clearance secondary to impaired kidney function. * Angiogenic proteins such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1) have shown promise for potential clinical use in diagnosing<unk> , though evidence is unsufficient to recommend a clinical use for these markers. A recent study, ASPRE, known to be the largest multi-country prospective trial, has reported a significant<unk> rformance in identifying pregnant women at high risk of<unk>  yet during the first trimester of pregnancy. Utilizing a combination of maternal history, mean arterial blood pressure, intra-uterine Doppler and PlGF measurement, the study has shown a capacity to identify more than 75% of the women that will develop<unk> , allowing early intervention to prevent development of later symptoms. This approach is now officially recommended by the International Federation of Gynecologists & Obstetricians (FIGO) * Recent studies have shown that looking for podocytes (specialized cells of the kidney) in the urine has the potential to aid in the prediction of<unk> . Studies have demonstrated that finding podocytes in the urine may serve as an early marker of and diagnostic test for<unk> . Differential diagnosis<unk>  can mimic and be confused with many other diseases, including chronic hypertension, chronic renal disease, primary seizure disorders, gallbladder and pancreatic disease, immune or thrombotic thrombocytopenic purpura, antiphospholipid syndrome and hemolytic-uremic syndrome. It must be considered a possibility in any pregnant woman beyond 20 weeks of gestation. It is particularly difficult to diagnose when pre-existing conditions such as hypertension are present. Women with acute fatty liver of pregnancy may also present with elevated blood pressure and protein in the urine, but differ by the extent of liver damage. Other disorders that can cause high blood pressure include thyrotoxicosis, pheochromocytoma, and drug misuse.
Pre-eclampsia
Eclampsia
Early pregnancy bleeding
Hypertensive disease of pregnancy
Gestational hypertension
Gestational diabetes
Antepartum bleeding
Recurrent miscarriage