Pre-eclampsia definition (ISSHP 2021)
Obstetrics
Also known as: Hypertensive disorders of pregnancy (ISSHP) · Präeklampsie: Definition nach ISSHP · Hypertensive Schwangerschaftserkrankungen (ISSHP) · Preeklampsi tanı kriterleri (ISSHP) · Gebelikte hipertansif bozukluklar (ISSHP) · Pre-eclampsia and hypertensive disorders of pregnancy (ISSHP 2021 definitions)
What it is for
International Society for the Study of Hypertension in Pregnancy (ISSHP) 2021 definitions. Hypertension in pregnancy is a systolic blood pressure (BP) of 140 mmHg or more and/or a diastolic BP of 90 mmHg or more on repeated measurement.
Classification
| Category | Description |
|---|---|
| Chronic hypertension | hypertension present before pregnancy or diagnosed before 20 weeks' gestation. |
| Gestational hypertension | new hypertension at or after 20 weeks without the features of pre-eclampsia. |
| Pre-eclampsia (de novo) | gestational hypertension with at least one new-onset feature at 20 weeks or later: (1) proteinuria, (2) other maternal organ dysfunction, or (3) uteroplacental dysfunction. Proteinuria is not required. |
| Proteinuria | urine protein/creatinine ratio of 30 mg/mmol (0.3 mg/mg) or more, or 0.3 g or more in 24 hours. |
| Maternal organ dysfunction | neurological (eclampsia, altered mental status, blindness, stroke, clonus, severe headache, persistent visual scotomata); haematological (platelets below 150 × 10⁹/l, disseminated intravascular coagulation, haemolysis); acute kidney injury (e.g. creatinine 90 µmol/l (1 mg/dl) or more); liver involvement (e.g. alanine or aspartate aminotransferase (ALT/AST) above 40 IU/l), with or without right upper quadrant or epigastric pain. |
| Uteroplacental dysfunction | placental abruption, angiogenic imbalance (e.g. low placental growth factor (PlGF) or raised sFlt-1/PlGF ratio), fetal growth restriction, abnormal umbilical artery Doppler waveform, or intrauterine fetal death. |
| Superimposed pre-eclampsia | chronic hypertension with new proteinuria, maternal organ dysfunction or uteroplacental dysfunction. |
| Change from older definitions | the classical definition required hypertension plus proteinuria; ISSHP (2018, 2021) also accepts organ or uteroplacental dysfunction without proteinuria, and 2021 counts angiogenic imbalance as uteroplacental dysfunction. |
Source
The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice
ISSHP · Pregnancy Hypertens 2022;27:148–169 (Magee LA, Brown MA, Hall DR, et al.)
DOI: 10.1016/j.preghy.2021.09.008
PMID: 35066406
- Edition
- ISSHP 2021 classification (published 2022), updating ISSHP 2018
- Checked on
Summary of the published classification in our own words. Not a substitute for the original publication.
A question about this classification?
Medelix answers clinical questions from guidelines and studies – every statement with its source.