Preeclampsia Diagnosis

Preeclampsia Diagnosis

• Proteinuria of ≥ 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of ≥ 0.3, or a urine dipstick protein of 1+ is required to diagnose preeclampsia.
• Preeclampsia with severe features is defined as the presence of one of the following symptoms or signs in the presence of preeclampsia.

Severe Features of Preeclampsia

• SBP of ≥ 160 mm Hg or DBP of ≥ 110 mm Hg on two occasions at least 4 hours apart while the patient is on bed rest.
• Impaired hepatic function, indicated by abnormally elevated blood concentrations of liver enzymes (to double the normal concentration).
• Severe, persistent upper quadrant or epigastric pain that does not respond to pharmacotherapy and is not accounted for by alternative diagnoses.
• Progressive renal insufficiency (serum creatinine concentration > 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease).
• New-onset cerebral or visual disturbances.

Laboratory Tests for Preeclampsia

• Elevated levels of uric acid in the blood may be present, indicating reduced blood flow to the kidneys.
• Abnormalities in coagulation studies, such as elevated D-dimer levels, may be observed, indicating a heightened risk of blood clot formation.
• Thrombocytopenia, a decrease in platelet count, may be indicative of preeclampsia.

Additional Tests for Preeclampsia

• Blood tests to check for other signs of preeclampsia.
• Vitamin D level testing to assess parathyroid function.
• Urinary calcium testing to measure calcium excretion.
• Bone density testing to assess bone density and risk of osteoporosis.
• Imaging studies, such as ultrasound, CT, or scintigraphy, to locate and assess the size of parathyroid glands.
• Genetic testing for suspected hereditary conditions affecting the parathyroid glands.
• Fine Needle Aspiration (FNA) to collect a tissue sample for examination.

PTH Function and Regulation

• PTH helps to increase calcium concentration in the blood by promoting calcium release from bones and increasing calcium reabsorption in the kidneys.
• PTH decreases phosphorus reabsorption in the kidneys, leading to increased excretion in the urine.

Gestational Trophoblastic Disease (GTD)

• Lab findings may include:
  • Elevated hCG levels, often to a much higher extent than in a normal pregnancy.
  • Persistent or rapidly rising hCG levels as a key indicator of GTD.
  • Anemia may be present due to uterine bleeding associated with GTD.
  • Abnormal liver function tests and elevated serum LDH levels.
  • Thyroid function tests may be affected in some cases of GTD.
  • Blood type and Rh factor should be determined to assess for ABO blood group incompatibility or Rh sensitization.

Eclampsia

• Eclampsia is seizures that occur in pregnant people with preeclampsia.
• Symptoms of eclampsia include high blood pressure, headaches, blurry vision, and convulsions.
• Eclampsia is a rare but serious condition that occurs in the second half of pregnancy.
• Eclampsia typically develops from preeclampsia.
• Lab findings may include:
  • Elevated liver enzymes, such as AST and ALT.
  • Elevated serum creatinine levels, indicating impaired kidney function.
  • Hematological abnormalities, such as thrombocytopenia and hemolysis, which may be seen in HELLP syndrome.

This quiz covers the criteria for diagnosing preeclampsia, including blood pressure and proteinuria levels.