About This Page
This is a clinician-written, evidence-based summary aligned to the USMLE Step 2 CK Content Outline. It is intended for medical students preparing for USMLE Step 2 CK. Management reflects current ACC/AHA, USPSTF, and APA guidelines. Always cross-reference with UpToDate, institutional protocols, and clinical judgment.
The Bottom Line
- Preeclampsia = BP >=140/90 after 20 weeks plus proteinuria or end-organ dysfunction
- Proteinuria is not required if severe features are present
- Severe features include BP >=160/110, thrombocytopenia, renal insufficiency, transaminitis/RUQ pain, pulmonary edema, headache, or visual symptoms
- Magnesium sulfate prevents and treats eclamptic seizures
- Definitive treatment is delivery: >=37 weeks without severe features; >=34 weeks with severe features after stabilization
Overview
Preeclampsia is a multisystem placental disorder with abnormal placentation, endothelial dysfunction, vasospasm, and end-organ injury. Eclampsia is a generalized seizure in this setting not explained by another cause.
Epidemiology
Risk factors include nulliparity, prior preeclampsia, multifetal gestation, chronic hypertension, diabetes, kidney disease, autoimmune disease, obesity, advanced maternal age, and assisted reproduction. Preeclampsia increases future cardiovascular risk.
Clinical Features
Symptoms
Often asymptomatic and detected by BP screening
Persistent severe headache
Visual symptoms such as scotomas or blurred vision
RUQ or epigastric pain
Dyspnea or chest discomfort from pulmonary edema
Seizure = eclampsia
Signs
BP >=140/90 on two occasions after 20 weeks
Severe BP >=160/110
Hyperreflexia or clonus
Edema is common and not diagnostic
Fetal growth restriction or abnormal fetal testing
Investigations
First-line
Blood pressure confirmationTwo elevated readings after 20 weeks; severe-range values require prompt treatment
Urine proteinProtein/creatinine ratio >=0.3, 24-hour protein >=300 mg, or dipstick 2+ if needed
Preeclampsia labsCBC/platelets, creatinine, AST/ALT, bilirubin if HELLP concern
Second-line
Fetal assessmentGrowth ultrasound, amniotic fluid, NST/BPP
Symptom evaluationHeadache, visual symptoms, RUQ pain, dyspnea, neurologic findings
Differential testingConsider TTP/HUS, acute fatty liver, lupus flare, renal disease, seizure disorder
Specialist
Maternal-fetal medicine consultationSevere features before 34 weeks, FGR, diagnostic uncertainty, or inpatient expectant management
NeuroimagingFocal deficits, prolonged coma, trauma, atypical seizure, or hemorrhage concern
1
Without severe features
- At >=37 0/7 weeks: delivery
- Before 37 weeks: expectant management with maternal and fetal surveillance
- Monitor BP, symptoms, platelets, creatinine, liver enzymes, and urine protein
- Fetal growth and antenatal testing as indicated
2
With severe features
- Hospitalize and give magnesium sulfate
- Treat severe BP with IV labetalol, IV hydralazine, or oral immediate-release nifedipine
- At >=34 weeks: delivery after stabilization
- Before 34 weeks: expectant management only in selected stable patients at appropriate centers
- Give corticosteroids if preterm delivery likely and time permits
3
Eclampsia
- Airway protection, left lateral positioning, oxygen, IV access, seizure precautions
- Magnesium sulfate first-line: loading dose then infusion
- Benzodiazepines only for seizures refractory to magnesium or magnesium unavailable
- Proceed to delivery after stabilization
4
Postpartum
- Preeclampsia can present or worsen postpartum
- Continue magnesium for 24 hours postpartum when indicated
- Treat severe postpartum BP and arrange early BP follow-up
Complications
- Eclampsia: Generalized seizure from CNS involvement
- Stroke: Severe hypertension can cause hemorrhagic or ischemic stroke
- HELLP syndrome: Hemolysis, elevated liver enzymes, and low platelets
- Placental abruption: Painful bleeding and fetal distress
- Pulmonary edema: Endothelial leak and cardiac/renal dysfunction
- Fetal growth restriction: Uteroplacental insufficiency
USMLE Step 2 CK Exam Tips
- 1Preeclampsia can be diagnosed without proteinuria if severe features are present
- 2Severe-range BP in pregnancy = >=160/110
- 3Magnesium sulfate prevents seizures; it is not an antihypertensive
- 4Magnesium toxicity: loss of reflexes → respiratory depression; antidote calcium gluconate
- 5No severe features deliver at 37 weeks; severe features deliver at 34 weeks
- 6Eclampsia seizure first-line = magnesium sulfate
- 7Edema is not diagnostic
- 8Definitive treatment is delivery of the placenta
practicetest your knowledge on preeclampsia & eclampsiaApply what you've learnt with USMLE Step 2 CK-style questions from the iatroX Q-Bank — obstetrics & gynecology and beyond.
open q-bank