The Diversity of Diagnoses of Preeclampsia

OBJECTIVE: To document the diversity of definitions and diagnoses of the hypertensive disorders of pregnancy reported in major medical journals as a preliminary step from which future documents may be developed concerning the classification and diagnosis of the hypertensive disorders of pregnancy. METHODS: A systematic review was undertaken of articles published between 1997 and 1998 researching "preeclampsia" in nine internationally recognized journals. Each article was assessed to establish the features used by the authors to define preeclampsia and its major defining variables (i.e., proteinuria and hypertension). Documentation of aspects of the blood pressure measurement technique was also noted. RESULTS: One hundred thirty-five articles were studied, demonstrating a wide variety in the authors' definitions of preeclampsia, "significant" proteinuria, and hypertension. In up to 13% of articles, one or more of these terms was not defined and documentation of the blood pressure measurement technique was generally poor. The diversity of reporting was of such magnitude that the groups of women in these studies could rarely be considered truly comparable. CONCLUSION: Scientific and clinical research groups are studying different preeclamptic groups as a result of using different definitions of this condition. As comparison of results among studies is fundamental to the correct elucidation of knowledge about preeclampsia, standardization of the classification and diagnostic criteria of the hypertensive disorders of pregnancy should be a major priority of societies devoted to the study of these disorders.