Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Preeclampsia

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In one line

·New high blood pressure after 20 weeks of pregnancy, plus protein spilling into the urine or signs of organ damage.

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Normal physiology

·In a healthy pregnancy, the placenta burrows deep into the uterus wall and releases chemicals that keep the mother's blood vessels relaxed and wide, so blood pressure stays normal and plenty of oxygen and nutrients flow to the baby.

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What goes wrong

·The placenta does not dig in deep enough, so it sits shallow and starved for blood, then releases toxic proteins that poison the mother's blood vessels everywhere.

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Hallmark signs

·High blood pressure (140/90 or higher)
·Protein in the urine (proteinuria)
·Swelling of the hands and face (edema)
·Severe headache that does not go away
·Vision changes (blurred vision, seeing spots or flashing lights)
·Pain in the right upper belly (under the ribs)
·Sudden weight gain (more than 2 pounds in a week)
·Nausea or vomiting (especially later in pregnancy)

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Red flags · escalate now

·Blood pressure 160/110 or higher (severe range)
·Severe headache or vision changes (blurry, spots, flashing lights)
·Right upper belly pain or tenderness under the ribs
·Trouble breathing or chest pain
·Seizure (eclampsia) or confusion

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Workup

·Complete blood count (CBC) with platelet count
·Comprehensive metabolic panel (CMP): creatinine, BUN, electrolytes
·Liver function tests: AST, ALT, LDH, bilirubin
·Urine protein measurement: 24-hour urine collection or spot urine protein-to-creatinine ratio
·Fetal ultrasound with Doppler of umbilical artery and middle cerebral artery, plus amniotic fluid index
·Serum uric acid

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Treatment

·Magnesium sulfate: 4–6 g IV loading dose over 15–20 minutes, then 1–2 g/hr continuous infusion during labor and for 24 hours after delivery
·Immediate blood pressure control with IV labetalol (10–20 mg IV push, repeat every 10 minutes), IV hydralazine (5–10 mg IV push, repeat every 20 minutes), or oral nifedipine immediate-release (10 mg, repeat every 20 minutes) when systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg
·Delivery of the baby and placenta: at ≥37 weeks for preeclampsia without severe features; at ≥34 weeks for preeclampsia with severe features if stable; immediately if eclampsia, HELLP syndrome, placental abruption, severe fetal distress, or pulmonary edema (fluid flooding the lungs) occurs
·Corticosteroids (betamethasone 12 mg IM, 2 doses 24 hours apart, or dexamethasone 6 mg IM every 12 hours for 4 doses) if delivery is expected before 34 weeks
·Continue or start antihypertensive medication (labetalol, nifedipine extended-release, or methyldopa) after delivery, and monitor blood pressure closely for at least 6 weeks postpartum
·Fluid management: careful IV fluids during labor and the first 24 hours postpartum, avoiding overload
·Aspirin 81 mg daily starting at 12–16 weeks in the next pregnancy if the woman had preeclampsia before, especially severe or early-onset

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NCLEX trap

·Always check for protein in the urine and signs of organ damage right away. High blood pressure alone after 20 weeks is not preeclampsia—you need protein in the urine OR signs that organs are struggling (low platelets, kidney trouble, liver trouble, brain symptoms, or lung fluid). Preeclampsia is a whole-body problem, not just one high number.
·Never use ACE inhibitors or ARBs during pregnancy—they can hurt the baby's kidneys and heart. Use IV labetalol (a blocker that slows the heart and opens vessels), IV hydralazine (a vessel relaxer), or nifedipine pills (a calcium blocker that relaxes vessel walls) instead. These drugs lower blood pressure without harming the baby.
·Preeclampsia without severe features still needs delivery at 37 weeks. Waiting longer risks sudden HELLP syndrome (liver and blood damage), seizures (eclampsia), or the placenta tearing away (abruption). The placenta keeps making harmful proteins—you cannot reverse that, only end the pregnancy.
·Preeclampsia can happen to anyone, but it is more common in women with diabetes, chronic high blood pressure, obesity, autoimmune diseases like lupus, kidney disease, or a past pregnancy with preeclampsia. Having risk factors does not mean it will happen, and having no risks does not rule it out.
·Preeclampsia can show up with high blood pressure plus swelling even without heavy protein if signs of organ damage are present—new severe headache, vision changes (spots or blurring), right upper belly pain, low platelets (under 100,000), high liver enzymes, or creatinine rising above 1.1. Protein is common but not required for the diagnosis.
·Keep checking blood pressure closely for at least 6 weeks after birth. Preeclampsia can get worse or even start for the first time after delivery (postpartum preeclampsia). Blood pressure medicines—like labetalol, nifedipine, or methyldopa—may be needed for weeks to prevent stroke, seizure, or heart failure. The placenta is gone, but the blood vessels and organs take time to heal.

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