Mild and Severe Preeclampsia: Differences and Diagnostic Criteria

When you compare the two forms of preeclampsia, mild and severe, you will find that the signs and symptoms are similar. The differences lie in the magnitude of the preeclampsia symptoms and the pathological findings.

According to the criteria laid down by the American Congress of Obstetricians and Gynecologists (ACOG), the guidelines for the diagnosis of mild and severe preeclampsia are explained below.

You can compare and find the differences in the magnitude of the signs and the results of the pathological tests. Symptoms remain the same except that the severe form exhibits symptoms that are more intense in nature.

Similarly, the complications that result in the mother and those in the fetus are more likely to onset with the severe form of preeclampsia.

Mild preeclampsia

  • New onset blood pressure is 140 to 159 mm Hg systolic and/or 90 to 109 mm Hg diastolic
  • Proteinuria is 300 mg/24 hours; or ≥1+ on 2 random urine samples, collected at least 4 hours apart or
  • Protein: creatinine ratio is ≥0.3 mg/dL.

In the absence of proteinuria, the following factors should be present:

  • Thrombocytopenia with platelets count <100,000/uL
  • Serum creatinine ≥1.1 mg/L or a doubling of the serum creatinine concentration in the absence of another renal disease
  • Impaired liver function with elevated blood concentrations of liver transaminases to twice normal concentration.
  • Pulmonary oedema
  • Cerebral or visual disturbances

Severe preeclampsia

  • BP is ≥160 mmHg systolic and/or ≥110 mm Hg diastolic on two occasions and taken at least six hours apart
  • Proteinuria is 300 mg/24 hours; or ≥1+ on 2 random urine samples, collected at least 4 hours apart
  • Protein: creatinine ratio is ≥0.3 mg/dL

In the absence of proteinuria, the following factors should be present:

  • Thrombocytopenia with platelets count <100,000/uL
  • Serum creatinine ≥1.1 mg/L or a doubling of the serum creatinine levels in the absence of another renal disease
  • Impaired liver function as indicated by elevated blood levels of liver transaminases to twice the normal concentration
  • Pulmonary oedema
  • Cerebral or visual disturbances.

Complications such as eclampsia and HELLP syndrome are seen in severe forms of preeclampsia.

Postpartum depression after mild and severe preeclampsia

In a study conducted by the U.S. Library of Medicine National Institute of health, among the cases of mild preeclampsia, 23% of the women reported postpartum depressive symptoms at some time up to 26 weeks after delivery while 44% of the women suffered from it after having suffered from severe preeclampsia.

The study further concluded that it is not the magnitude of the condition but the consequences that seem to cause the depression symptoms. Such consequences include admission to the Neonatal Intensive Care Unit (NICU) and perinatal death

Women whose baby has died after admission to the NICU or for whatever the reason are particularly at high risk of suffering from postpartum depression.

How do you classify early and late onset preeclampsia?

The National Institute for Health and Care Excellence (NICE) has laid down certain criteria classifying preeclampsia according to the timing of its onset.

  • Preeclampsia of early onset is that which comes on prior to 34 weeks. Earlier the onset, more are the risks of the complications.
  • Mid-onset preeclampsia comes on after 34 weeks and prior to 37 weeks.
  • Late-onset preeclampsia is that which develops after 37 weeks.
  • Postpartum preeclampsia develops after delivery.
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