diagnostic criteria, these elevations in BP must be noted on
two occasions at least 4 hours apart (ACOG). Although
proteinuria ≥300 mg in a 24-hour urine collection remains
part of the diagnostic criteria, it is important to note that
some women with preeclampsia may not present with proteinuria
(ACOG). Women who meet the BP parameters of
the disease in the absence of proteinuria can still be diagnosed
when any one of the following criteria exist: including
platelet count >100,000 per microliter, serum creatinine
>1.1 or doubling of serum creatinine in absence of renal
disease, elevated concentrations of blood liver transaminases
to twice normal levels, pulmonary edema, or new
onset of cerebral or visual disturbances (ACOG). Typically
as the disease increases in severity, there is an increase in the
severity of maternal symptoms and sequelae. Preeclampsia
is no longer classifi ed as mild or severe, but rather “preeclampsia
without severe features” or “preeclampsia with
severe features” (ACOG, p. 18). This modifi cation in
nomenclature came after recognition that preeclampsia
severity can change rapidly and the classifi cation spectrum
should remain fl uid, as women with preeclampsia require
frequent evaluation by healthcare providers for worsening
signs and symptoms (ACOG).