Hi everyone, Our Thursday POTD inspiration comes from a case mentioned to us today by Dr. Kay Odashima. We're talking preeclampsia! This is a can't-miss diagnosis in our pregnant and postpartum patients, so let's review.

Interesting fact: "eclampsia" has its roots in the Ancient Greek eklámpō, meaning to “burst forth violently” 😱

Preeclampsia is seen in women >20 weeks gestation or up to 4 weeks postpartum, and is subdivided into mild or severe, based on the absence/presence of end-organ dysfunction:


  • BP >140/90
  • 2+ on urine dipstick
  • Well appearing, mild leg swelling, otherwise asymptomatic, normal bloodwork


The diagnostic workup is similar to that done for hypertensive emergency: CBC, BMP, LFTs, coags (if the patient looks sick, to screen for DIC), uric acid, UA / urine dip looking for proteinuria.

Preeclampsia is associated with significant risk for morbidity and mortality, including:

  • DIC
  • Pulmonary edema
  • Intracranial hemorrhage
  • PRES (Posterior Reversible Encephalopathy Syndrome, dx on MRI brain)
  • Placental abruption (in a preeclamptic with vaginal bleeding, assume abruption until proven otherwise!)
  • HELLP syndrome
  • Progression to eclamptic seizuresSafe antihypertensive drugs for treatment: Goal BP: <160/110. Maximize one agent before moving on to a second agent. 

In addition, IV magnesium should be given to any preeclamptic with severe features: dosed at 4 grams IV load (over 5-10 minutes) followed by infusion at 1-2 gram/hr for 24 hr.

Disposition: ALWAYS consult with OB/GYN in any patient with preeclampsia. Even if these mild patients qualify for discharge home, they need extremely close OB follow-up. Patients with severe features need to be admitted to the OB floor and monitored until delivery (ideally at/after 34 weeks if possible). Remember, delivery is the definitive treatment for preeclampsia!

For me, the key takeaways are:

  • "High-normal" BP is NOT NORMAL in this population: >140/90 is considered mild preeclampsia!
  • Preeclampsia can manifest up to 4 weeks postpartum!
  • In a healthy woman presenting with new seizure and no obvious cause, think eclampsia and give mag!