Which finding defines preeclampsia after 20 weeks gestation?

• A. Hypertension with edema only
• B. Hypertension with hyperglycemia
• C. Hypertension with new-onset proteinuria or end-organ dysfunction
• D. Hypotension with proteinuria

Answer: (C)

Preeclampsia is diagnosed after 20 weeks when there is new-onset hypertension along with either proteinuria or evidence of end-organ dysfunction. Hypertension with edema alone isn’t enough, since edema is common in pregnancy and doesn’t confirm the syndrome. Hypertension with hyperglycemia isn’t part of the criteria for preeclampsia, as hyperglycemia points to gestational diabetes. Hypotension with proteinuria contradicts the defining feature, which is high blood pressure. So the combination of high blood pressure after 20 weeks plus new proteinuria or signs of end-organ damage best defines preeclampsia. End-organ dysfunction can include elevated creatinine or liver enzymes, thrombocytopenia, pulmonary edema, or neurologic/cerebral symptoms.