Step 1: New-Onset Hypertension (Required)

Systolic BP ≥ 140 mmHg OR Diastolic BP ≥ 90 mmHg on 2 occasions ≥ 4 hours apart (or ≥ 160/110 on 1 occasion if severe)After 20 weeks gestation or within 6 weeks post-partum, in a previously normotensive woman.

Step 2: Proteinuria OR Severe Features (≥ 1 required)

Significant Proteinuria: ≥ 300 mg/24h, protein:creatinine ratio ≥ 0.3, or dipstick 2+ on 2 occasions (if quantitative unavailable)New-onset proteinuria detected after 20 weeks.Thrombocytopenia: Platelet count < 100 × 10⁹/LSevere feature — new-onset thrombocytopenia.Renal Insufficiency: Serum creatinine > 97 mcmol/L (> 1.1 mg/dL) or doubling of baseline creatinine WITHOUT renal diseaseSevere feature indicating renal involvement.Impaired Liver Function: AST or ALT > 2× upper limit of normal (severe = with RUQ pain unresponsive to analgesics)Severe feature — hepatic dysfunction.Pulmonary Edema (new-onset)Severe feature — new pulmonary edema on exam or imaging.New-Onset Headache Unresponsive to Analgesics AND/OR Visual DisturbancesSevere feature — new neurological symptoms: severe persistent headache, visual scotomata, diplopia, cortical blindness, altered mentation.Severe-Range Blood Pressure: SBP ≥ 160 mmHg OR DBP ≥ 110 mmHg (severe feature designation even without other criteria)Severe-range hypertension — must be treated within 30–60 minutes of confirmation.

HELLP Syndrome Assessment (Subset of Severe Preeclampsia)

Hemolysis: LDH > 600 U/L, indirect bilirubin elevated, or schistocytes on peripheral smearMicroangiopathic hemolytic anemia.Elevated Liver Enzymes: AST or ALT ≥ 2× ULNHepatic dysfunction in HELLP.Low Platelets: < 100 × 10⁹/LThrombocytopenia in HELLP.

ACOG Preeclampsia Diagnostic Criteria 2020

ACOG Preeclampsia Diagnostic Criteria 2020