Placentas of women destined to develop preeclampsia overproduce
at least two antiangiogenic proteins that reach abnormally
high levels in the maternal circulation. One soluble
Fms-like tyrosine kinase 1 (sFlt-1) is a receptor for placental
growth (PIGF) and vascular endothelial growth (VEGF) facTable
1
Preeclampsia: judging severity*
Less Severe More Severe
Presentation Gestational
wk 34
Gestational
wk 35
Diastolic BP 100 mm Hg 110 mm Hg
Headache Absent Present
Visual disturbances Absent Present
Abdominal pain Absent Present
Oliguria Absent Present
SCreatinine (GFR) Normal Elevated
(decreasing)
LDH, AST Normal Elevated
Proteinuria Mild to
moderate
Nephrotic range
(3 g/24 h)†
Nonreassuring fetal
testing‡
Absent Present
AST, aspartate aminotransferase; BP, blood pressure; GFR, glomerular
filtration rate; LDH, lactic acid dehydrogenase.
* Presence of convulsions (eclampsia), congestive heart failure,
or pulmonary edema are always very ominous signs. † Degree of proteinuria alone may not indicate seriousness unless
accompanied by other ominous sign or symptom. ‡ Growth restriction, adverse signs during periodic fetal testing
including electronic monitoring and Doppler ultrasound.
The American College of Obstetrics and Gynecology bulletins
utilize the terms “mild” and “severe” for our preferred “less” and
“more” severe, so as to underscore diligence for any form of
preeclampsia.
M.D. Lindheimer et al. / Journal of the American Society of Hypertension 2(6) (2008) 484 – 494 487
tors