• Evaluation of pregnant patients ≥20 weeks gestation with new-onset hypertension.
• Assessment of postpartum patients (up to 6 weeks) presenting with hypertension or headache.
• Differentiating gestational hypertension from preeclampsia.
• Identifying preeclampsia with severe features requiring immediate hospitalization.

• New-onset HTN (≥140/90) AFTER 20 weeks gestation PLUS:
• Proteinuria (≥300 mg/24h, P:C ratio ≥0.3, or 2+ dipstick)
• OR (in the absence of proteinuria) new-onset systemic dysfunction:
• Platelets < 100,000/μL
• Serum creatinine > 1.1 mg/dL (or doubling in absence of renal disease)
• Liver transaminases 2x upper limit of normal
• Pulmonary edema
• New-onset cerebral or visual disturbances

• Proteinuria is NO LONGER required for diagnosis if other systemic features are present.
• "Mild" preeclampsia is an obsolete term; the condition is now categorized as "Preeclampsia without Severe Features" or "Preeclampsia with Severe Features."
• Postpartum preeclampsia: Up to 30% of eclamptic seizures occur postpartum, often in patients who were normotensive at discharge.
• Epigastric pain is often misdiagnosed as GERD; in a hypertensive gravid patient, it is a marker of hepatic capsular stretch and a severe feature.

• Serial labs (CBC, LFTs, Cr) and BP monitoring 1–2x weekly.
• Fetal surveillance (NST/BPP) and serial growth scans.
• Delivery indicated at 37 0/7 weeks gestation.

• Hospitalization for the duration of pregnancy.
• Magnesium Sulfate for seizure prophylaxis.
• Antihypertensives (Labetalol, Hydralazine, or Nifedipine) for SBP ≥160 or DBP ≥110.
• Delivery indicated at 34 0/7 weeks (or earlier if maternal/fetal condition destabilizes).
• Administer corticosteroids for fetal lung maturity if <34 weeks.

Historically known as "toxemia," preeclampsia was long thought to be caused by a circulating toxin. We now recognize it as a complex multisystem syndrome driven by placental malperfusion and systemic endothelial dysfunction.

In 2013, the ACOG Task Force on Hypertension in Pregnancy fundamentally changed the diagnostic landscape by removing the absolute requirement for proteinuria, recognizing that women can progress to eclamptic seizures or HELLP syndrome without significant renal protein excretion.