| PreE with severe features34,35 |
| PreE with severe features is diagnosed when a patient with PreE (gestational hypertension with proteinuria) or gestational hypertension alone has ≥1 of the following: |
| Severe blood pressure elevation: systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg on 2 occasions, at least 4 hours apart while the patient is on bedrest (antihypertensive therapy may be initiated upon confirmation of severe hypertension, in which case severe blood pressure elevation criteria can be satisfied without waiting until 4 hours have elapsed) |
| Central nervous system dysfunction: new-onset cerebral or visual disturbance including photopsia, scotomata, cortical blindness, retinal vasospasm, severe headache, or headache that persists and progresses despite analgesic therapy, and altered mental status |
| Abdominal pain, hepatic abnormality: severe persistent right upper quadrant or epigastric pain unresponsive to medication and/or serum transaminase of ≥2-times upper-limit-of-normal range |
| Thrombocytopenia: <100 × 109/L |
| Renal dysfunction: progressive renal insufficiency (serum creatinine >1.1 mg/dL] or a doubling of the serum creatinine level in the absence of other causes of renal impairment) |
| Pulmonary edema |
| Placental insufficiency with severe features |
| Intrauterine fetal growth restriction defined as ultrasound fetal biometry–estimated fetal weight of <10th percentile for gestational age OR small-for-gestational-age postnatal birth weight defined as <10th percentile for gestational age in the absence of fetal-neonatal syndromes or genetic conditions associated with growth restriction AND ≥1 of the following: |
| Abnormal or nonreassuring fetal surveillance test(s) suggestive of fetal hypoxemia, for example, a nonreactive nonstress test |
| Abnormal doppler flow velocimetry waveform analysis suggestive of fetal hypoxemia, for example, absent end-diastolic flow in the umbilical artery |
| Severe intrauterine fetal growth restriction suggested by fetal biometry indicating an estimated fetal or postnatal birth weight of <3rd percentile for gestational age |
| Oligohydramnios, for example, an amniotic fluid index of ≤5 cm, or deepest vertical pocket of <2 cm |
| Maternal vascular malperfusion on placental histology, suggested by placental infarction, decidual vasculopathy, and/or thrombosis |
| PreE with severe features34,35 |
| PreE with severe features is diagnosed when a patient with PreE (gestational hypertension with proteinuria) or gestational hypertension alone has ≥1 of the following: |
| Severe blood pressure elevation: systolic blood pressure of ≥160 mm Hg or diastolic blood pressure of ≥110 mm Hg on 2 occasions, at least 4 hours apart while the patient is on bedrest (antihypertensive therapy may be initiated upon confirmation of severe hypertension, in which case severe blood pressure elevation criteria can be satisfied without waiting until 4 hours have elapsed) |
| Central nervous system dysfunction: new-onset cerebral or visual disturbance including photopsia, scotomata, cortical blindness, retinal vasospasm, severe headache, or headache that persists and progresses despite analgesic therapy, and altered mental status |
| Abdominal pain, hepatic abnormality: severe persistent right upper quadrant or epigastric pain unresponsive to medication and/or serum transaminase of ≥2-times upper-limit-of-normal range |
| Thrombocytopenia: <100 × 109/L |
| Renal dysfunction: progressive renal insufficiency (serum creatinine >1.1 mg/dL] or a doubling of the serum creatinine level in the absence of other causes of renal impairment) |
| Pulmonary edema |
| Placental insufficiency with severe features |
| Intrauterine fetal growth restriction defined as ultrasound fetal biometry–estimated fetal weight of <10th percentile for gestational age OR small-for-gestational-age postnatal birth weight defined as <10th percentile for gestational age in the absence of fetal-neonatal syndromes or genetic conditions associated with growth restriction AND ≥1 of the following: |
| Abnormal or nonreassuring fetal surveillance test(s) suggestive of fetal hypoxemia, for example, a nonreactive nonstress test |
| Abnormal doppler flow velocimetry waveform analysis suggestive of fetal hypoxemia, for example, absent end-diastolic flow in the umbilical artery |
| Severe intrauterine fetal growth restriction suggested by fetal biometry indicating an estimated fetal or postnatal birth weight of <3rd percentile for gestational age |
| Oligohydramnios, for example, an amniotic fluid index of ≤5 cm, or deepest vertical pocket of <2 cm |
| Maternal vascular malperfusion on placental histology, suggested by placental infarction, decidual vasculopathy, and/or thrombosis |
ACR/EULAR APS classification criteria definitions of PreE with severe features and PI with severe features as modified from Barbhaiya et al.1