Pre-eclampsia differential diagnosis: Difference between revisions

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{{Pre-eclampsia}}
{{Pre-eclampsia}}
{{CMG}}; {{AE}} {{Ochuko}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{Ochuko}}
 
==Overview==
All of the [[hypertensive disorders]] during [[pregnancy ]] including [[chronic hypertension]], [[white coat hypertension]], [[mask hypertension]], [[gestational hypertension]] increase the risk of [[preeclampsia]].


==Differentiating Pre-eclampsia from other Diseases==
==Differentiating Pre-eclampsia from other Diseases==


. Another condition that may
{| class="wikitable"
be confused with eclampsia or preeclampsia is reversible
|-
cerebral vasoconstriction syndrome (50). Reversible
! Differntiating diagnosis of [[hypertension]] in [[pregnancy]] !! [[Chronic hypertension]]<ref name="SeelyEcker2014">{{cite journal|last1=Seely|first1=Ellen W.|last2=Ecker|first2=Jeffrey|title=Chronic Hypertension in Pregnancy|journal=Circulation|volume=129|issue=11|year=2014|pages=1254–1261|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.113.003904}}</ref> !! [[White coat]]<ref name="pmid28197434">{{cite journal |vauthors=Shahbazian N, Shahbazian H, Mohammadjafari R, Mousavi M |title=Ambulatory monitoring of blood pressure and pregnancy outcome in pregnant women with white coat hypertension in the third trimester of pregnancy |journal=J Nephropharmacol |volume=2 |issue=1 |pages=5–9 |date=2013 |pmid=28197434 |pmc=5297468 |doi= |url=}}</ref> [[hypertension]] !! [[Mask hypertension]]<ref name="pmid27490952">{{cite journal |vauthors=Salazar MR, Espeche WG, Leiva Sisnieguez BC, Balbín E, Leiva Sisnieguez CE, Stavile RN, March CE, Grassi F, Santillan C, Cor S, Carbajal HA |title=Significance of masked and nocturnal hypertension in normotensive women coursing a high-risk pregnancy |journal=J Hypertens |volume=34 |issue=11 |pages=2248–52 |date=November 2016 |pmid=27490952 |doi=10.1097/HJH.0000000000001067 |url=}}</ref> !! [[Gestational ]] [[hypertension]]<ref name="pmid28437461">{{cite journal |vauthors=Shen M, Smith GN, Rodger M, White RR, Walker MC, Wen SW |title=Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia |journal=PLoS One |volume=12 |issue=4 |pages=e0175914 |date=2017 |pmid=28437461 |pmc=5402970 |doi=10.1371/journal.pone.0175914 |url=}}</ref> !! [[Preeclampsia]]
cerebral vasoconstriction syndrome is characterized by
|-
reversible multifocal narrowing of the arteries of the
| Onset || Before 20 weeks in [[pregnancy]] || [[Blood pressure]] ≥ 140/90 in office and clinic and [[BP]] < 135/85 at home || Normal [[blood pressure]] at office and elevation in other condition  || [[Hypertension]] after 20 weeks of [[pregnancy]] with out [[proteinuria]] or [[hematologic abnormality]]||  [[Hypertension]] after 20 weeks of [[pregnancy]] with [[proteinuria]] or maternal organ dysfunction
brain with signs and symptoms that typically include
|-
thunderclap headache and, less commonly, focal neurologic
| Management ||Tightly controlling of [[hypertension]] (110-140/85), Fetal growth monitoring || [[Blood pressure]] monitoring|| 24 hours ambulatory [[blood pressure]] monitoring  || Tightly controlling [[Blood pressure]] || Tightly controlling [[Blood pressure]]
deficits related to brain edema, stroke, or seizure.
|-
Treatment of women with PRES and reversible cerebral
| Prognosis || Increased risk of [[preeclampsia]] || Increased risk of [[preeclampsia]] || Increased risk of [[preeclampsia]] || Good prognosis,may 1/4 progress to [[ preeclampsia]]  || may progress to [[eclampsia]] or [[HELLP]] syndrome
vasoconstriction syndrome may include medical control
|}
of hypertension, antiepileptic medication and long-term
neurologic follow-up.
inaccurate.
Nervous system manifestations frequently encountered
in preeclampsia are headache, blurred vision,
scotomata, and hyperreflexia. Although uncommon,
temporary blindness (lasting a few hours to as long as
a week) also may accompany preeclampsia with severe
features and eclampsia (47). Posterior reversible encephalopathy
syndrome (PRES) is a constellation of a range
of clinical neurologic signs and symptoms such as vision
loss or deficit, seizure, headache, and altered sensorium
or confusion (48). Although suspicion for PRES is
increased in the setting of these clinical features, the
diagnosis of PRES is made by the presence of vasogenic
edema and hyperintensities in the posterior aspects of the
brain on magnetic resonance imaging. Women are particularly
at risk of PRES in the settings of eclampsia and
preeclampsia with headache, altered consciousness, or
visual abnormalities (49). Another condition that may
be confused with eclampsia or preeclampsia is reversible
cerebral vasoconstriction syndrome (50). Reversible
cerebral vasoconstriction syndrome is characterized by
reversible multifocal narrowing of the arteries of the
brain with signs and symptoms that typically include
thunderclap headache and, less commonly, focal neurologic
deficits related to brain edema, stroke, or seizure.
Treatment of women with PRES and reversible cerebral
vasoconstriction syndrome may include medical control
of hypertension, antiepileptic medication and long-term
 
 
 
 
 
 
 
Pre-eclampsia 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]], and [[hemolytic-uremic syndrome]]. It must always be considered a possibility in any pregnant woman beyond 20 weeks of [[gestation]]. It is particularly difficult to diagnose when preexisting disease such as [[hypertension]] is present.<ref name=AMN1>{{cite web | title =Preeclampsia-Eclampsia | publisher=Armenian Medical Network | work =Diagnosis and management of pre-eclampsia and eclampsia | url=http://www.health.am/gyneco/more/preeclampsia_eclampsia/ | year = 2003 | accessdate=2005-11-23}}</ref>


==References==
==References==
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Needs overview]]
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{{WS}}

Latest revision as of 13:40, 4 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Ogheneochuko Ajari, MB.BS, MS [3]

Overview

All of the hypertensive disorders during pregnancy including chronic hypertension, white coat hypertension, mask hypertension, gestational hypertension increase the risk of preeclampsia.

Differentiating Pre-eclampsia from other Diseases

Differntiating diagnosis of hypertension in pregnancy Chronic hypertension[1] White coat[2] hypertension Mask hypertension[3] Gestational hypertension[4] Preeclampsia
Onset Before 20 weeks in pregnancy Blood pressure ≥ 140/90 in office and clinic and BP < 135/85 at home Normal blood pressure at office and elevation in other condition Hypertension after 20 weeks of pregnancy with out proteinuria or hematologic abnormality Hypertension after 20 weeks of pregnancy with proteinuria or maternal organ dysfunction
Management Tightly controlling of hypertension (110-140/85), Fetal growth monitoring Blood pressure monitoring 24 hours ambulatory blood pressure monitoring Tightly controlling Blood pressure Tightly controlling Blood pressure
Prognosis Increased risk of preeclampsia Increased risk of preeclampsia Increased risk of preeclampsia Good prognosis,may 1/4 progress to preeclampsia may progress to eclampsia or HELLP syndrome

References

  1. Seely, Ellen W.; Ecker, Jeffrey (2014). "Chronic Hypertension in Pregnancy". Circulation. 129 (11): 1254–1261. doi:10.1161/CIRCULATIONAHA.113.003904. ISSN 0009-7322.
  2. Shahbazian N, Shahbazian H, Mohammadjafari R, Mousavi M (2013). "Ambulatory monitoring of blood pressure and pregnancy outcome in pregnant women with white coat hypertension in the third trimester of pregnancy". J Nephropharmacol. 2 (1): 5–9. PMC 5297468. PMID 28197434.
  3. Salazar MR, Espeche WG, Leiva Sisnieguez BC, Balbín E, Leiva Sisnieguez CE, Stavile RN, March CE, Grassi F, Santillan C, Cor S, Carbajal HA (November 2016). "Significance of masked and nocturnal hypertension in normotensive women coursing a high-risk pregnancy". J Hypertens. 34 (11): 2248–52. doi:10.1097/HJH.0000000000001067. PMID 27490952.
  4. Shen M, Smith GN, Rodger M, White RR, Walker MC, Wen SW (2017). "Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia". PLoS One. 12 (4): e0175914. doi:10.1371/journal.pone.0175914. PMC 5402970. PMID 28437461.