pre-eclampsia
Enable an agent to recognise possible pre-eclampsia, represent diagnostic uncertainty and maternal-fetal deterioration, and support clinician-directed assessment and follow-up.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an agent to recognise possible pre-eclampsia, represent diagnostic uncertainty and maternal-fetal deterioration, and support clinician-directed assessment and follow-up.
Pre-eclampsia is a pregnancy-associated multisystem disorder characterised by new-onset hypertension usually after 20 weeks of gestation, together with proteinuria, maternal organ dysfunction or, under some diagnostic frameworks, uteroplacental dysfunction, and it may first present postpartum.
It can be Assemble evidence for and against pre-eclampsia under an explicitly selected diagnostic framework; Identify missing, outdated or conflicting measurements requiring clinical review; Track maternal and fetal trajectories and flag configured escalation criteria; Prepare an episode summary for obstetric assessment, transfer or delivery planning; Record clinician decisions, their supporting evidence and subsequent responses; Coordinate postpartum reassessment and transfer unresolved abnormalities to appropriate neighbouring models.
Distinguishing features
Distinguish pre-eclampsia from gestational hypertension by recording qualifying proteinuria, maternal organ dysfunction or uteroplacental dysfunction under the selected definition; proteinuria is not universally required. [NICE NG133](https://www.nice.org.uk/guidance/ng133/chapter/recommendations)
For a typical antenatal presentation, establish new hypertension after 20 weeks together with qualifying additional findings, rather than inferring the condition from swelling or a single symptom. [NICE NG133](https://www.nice.org.uk/guidance/ng133/chapter/recommendations)
For chronic hypertension, require evidence supporting superimposed pre-eclampsia; a blood-pressure rise alone is insufficient under ISSHP recommendations. [ISSHP recommendations](https://isshp.org/wp-content/uploads/2023/09/ISSHP-2021-guidelines.pdf)
Record seizures as a possible eclampsia complication requiring separate attribution, rather than making seizures a prerequisite for recognising pre-eclampsia. [ISSHP recommendations](https://isshp.org/wp-content/uploads/2023/09/ISSHP-2021-guidelines.pdf)
Scope
+ Suspected and confirmed episodes, with the diagnostic framework and supporting evidence recorded
+ Antepartum and postpartum presentation, including superimposition on chronic hypertension
+ Maternal organ involvement and uteroplacental findings associated with the episode
+ Time-dependent assessment, escalation and delivery decisions
+ Episode resolution, persistent abnormalities and implications for subsequent pregnancies
- Routine pregnancy care unrelated to pre-eclampsia
- Chronic hypertension and chronic kidney disease as independent conditions
- Standalone models of eclampsia, HELLP syndrome and alternative thrombotic microangiopathies
- Detailed drug pharmacology, prescribing protocols and obstetric procedures
- Independent neonatal care and long-term cardiovascular disease management
Characteristics
- Episode classification
- suspected | confirmed | diagnosis reconsidered | resolving | resolved; timestamp and assessor Separates provisional recognition from an established diagnosis and preserves subsequent revision.
- Pregnancy-relative timing
- gestational weeks and days; hours or days since birth Anchors onset, interpretation and management decisions to the pregnancy timeline.
- Diagnostic framework
- issuing organisation, guideline version, jurisdiction and applied criteria Makes differing diagnostic and severity classifications traceable.
- Blood-pressure trajectory
- systolic and diastolic mmHg; timestamps, technique, repeat readings and treatment context Supports confirmation and recognition of sustained or worsening hypertension.
- Urinary protein assessment
- protein:creatinine or albumin:creatinine ratio with units; timed protein excretion; dipstick category Preserves assay differences, baseline abnormalities and the evidence used in diagnosis.
- Maternal organ findings
- renal, hepatic, haematological, neurological and respiratory findings; absent | present | unknown, with underlying observations Represents the pattern and progression of maternal involvement.
- Laboratory trajectory
- platelets in ×10^9/L, creatinine in µmol/L or mg/dL, transaminases in U/L; laboratory reference ranges and timestamps Allows comparison with baseline and distinguishes trends from isolated results.
- Uteroplacental assessment
- growth, Doppler, fetal surveillance and placental complication findings, each with date and interpretation Keeps fetal and placental evidence visible alongside maternal findings.
- Angiogenic test evidence
- PlGF concentration or sFlt-1/PlGF ratio; assay platform, units, sampling time and applicable interpretation Prevents an assay result from being interpreted without its intended clinical context.
- Baseline and previous-episode context
- linked pregnancy, chronic hypertension, kidney disease, baseline proteinuria and prior pre-eclampsia records Supports attribution of new findings and assessment of superimposed disease.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 19 findings · 29 questions.
Diagnostic boundaries Represent what qualifies as an episode and what remains uncertain.
Recognition requires an explicit definition and attribution of findings to the pregnancy-associated condition.
Criteria and evidence
Connect the diagnostic judgement to a named framework and observed findings.
Episode qualification
Record the criteria assessed, supporting observations and unresolved requirements.
- Which guideline version defines this episode, and which hypertension and additional-feature criteria are met? definition
- Which observations support the diagnostic judgement, who assessed them and when? provenance
Baseline and alternatives
Compare the episode with pre-existing disease and plausible competing explanations.
New finding attribution
Separate baseline hypertension or proteinuria from evidence attributed to pre-eclampsia.
- What blood-pressure, renal and proteinuria findings preceded pregnancy or the suspected onset? measurement
- What evidence distinguishes this episode from gestational hypertension, kidney disease exacerbation, lupus activity or another thrombotic microangiopathy? boundary
Maternal manifestations Represent measured hypertension and the distribution of maternal organ involvement.
A diagnostic label alone does not communicate the patient's current condition or direction of change.
Pressure and protein
Preserve measurement quality and serial blood-pressure and urinary findings.
Measurement interpretability
Capture repeat readings, collection methods and treatment timing needed to interpret results.
- Were blood-pressure readings obtained with an appropriate cuff and validated device, and how were abnormal readings confirmed? measurement
- Which urinary protein method, units and collection conditions were used, and how does the result compare with baseline? measurement
Organ involvement and trends
Record symptoms, laboratory changes and clinically attributed complications.
Maternal deterioration evidence
Maintain a time-stamped account of neurological, respiratory, renal, hepatic and haematological findings.
- Which symptoms, examination findings and laboratory trends indicate new or worsening organ involvement? measurement
- Which findings meet the adopted protocol's urgent review criteria, and has escalation occurred? action
Pregnancy and placental context Connect the episode to gestational timing and evidence concerning each fetus and the placenta.
Maternal findings, fetal condition and pregnancy timing must remain separately visible in a shared episode.
Onset and pregnancy linkage
Locate the first evidence and diagnosis within a specific pregnancy.
Episode timeline
Distinguish biological onset estimates, first observed abnormalities and diagnostic recognition.
- What are the gestational ages or postpartum intervals at first abnormal finding, diagnosis and birth? measurement
- How was pregnancy dating established, and how uncertain is the estimated onset? provenance
Uteroplacental evidence
Record fetal surveillance, placental findings and contextualised angiogenic testing.
Placental and fetal assessment
Keep raw results, clinical interpretations and their diagnostic or management roles distinct.
- What do serial growth assessments, Doppler studies and fetal surveillance show for each fetus? measurement
- If PlGF or sFlt-1/PlGF testing was used, which assay, gestational window and intended interpretation apply? boundary
Clinical decisions and response Represent clinician-led escalation, surveillance, treatment and birth planning.
An agent needs a traceable connection between episode evidence and the actions authorised by the care team.
Escalation and stabilisation
Capture urgency, care setting and response to selected interventions.
Immediate care plan
Record the responsible clinician, applicable protocol, monitoring requirements and reassessment.
- Which observed findings triggered urgent obstetric assessment, admission or transfer, and when was that action completed? action
- What indications, contraindications and responses were recorded for antihypertensive treatment, magnesium sulphate or fluid management? action
Surveillance and birth planning
Make continued surveillance and planned birth decisions reviewable.
Delivery decision record
Capture the evidence, patient preferences and reassessment conditions underlying birth timing.
- Which maternal findings, fetal findings and gestational considerations support the current birth-timing decision? action
- If surveillance continues, what monitoring schedule, review deadline and changes would trigger a revised decision? action
Postpartum course and future risk Follow the episode beyond birth and preserve information needed for later care.
The model needs explicit follow-up and closure criteria rather than treating birth as automatic episode closure.
Postpartum reassessment
Track postpartum presentation, persistent abnormalities and clinical recovery.
Resolution and persistence
Record follow-up observations and the rationale for resolving or retaining the episode.
- Which blood-pressure, symptom, proteinuria and organ-function findings persist or newly appear after birth? measurement
- What reassessment supports episode closure, and which persistent abnormalities require evaluation under another condition model? boundary
Subsequent care linkage
Carry the episode history into future pregnancy planning and preventive care.
History-informed follow-up
Preserve episode timing, complications and clinician recommendations without converting risk into a new diagnosis.
- Which episode features should be available for counselling and risk assessment before or during a subsequent pregnancy? provenance
- What cardiovascular, renal or pregnancy-prevention follow-up has been recommended, by whom and with what review date? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This is recall-based content; the named guidance and coding category have not been checked against current editions.
- Proteinuria is not mandatory when qualifying organ dysfunction is present; precise criteria and inclusion of placental findings differ between guidelines.
- Measurement values are diagnostic thresholds, not typical patient ranges; timing, repeat measurements and clinical context matter.
- Which of these check these first hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Early-onset pre-eclampsia, presenting before 34 weeks
- Late-onset pre-eclampsia, presenting at or after 34 weeks
- Pre-eclampsia with severe features
- Pre-eclampsia without severe features
- Pre-eclampsia superimposed on chronic hypertension
- Postpartum pre-eclampsia
- Which of these kinds and varieties hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 - O14 - Pre-eclampsia category; superimposed pre-eclampsia and eclampsia have separate categories, and national modifications affect coding detail.
- Which of these identifiers and schemes hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- American College of Obstetricians and Gynecologists: Practice Bulletin on Gestational Hypertension and Preeclampsia
- International Society for the Study of Hypertension in Pregnancy: recommendations for classification, diagnosis and management of hypertensive disorders of pregnancy
- National Institute for Health and Care Excellence: NG133, Hypertension in pregnancy: diagnosis and management
- World Health Organization: recommendations for prevention and treatment of pre-eclampsia and eclampsia
- Which of these standards and regulation hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Antenatal and postpartum assessment using blood pressure, symptoms, urine protein and laboratory evidence of organ dysfunction
- Risk assessment to identify pregnancies eligible for preventive interventions
- Maternal and fetal surveillance to inform treatment, referral and timing of birth
- Obstetric coding, epidemiological surveillance and maternal mortality review
- Long-term cardiovascular risk assessment after an affected pregnancy
- Which of these real-world use hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Blood pressure indicating hypertension - Systolic ≥140 or diastolic ≥90; confirmation requirements depend on severity and guideline - mmHg
- Blood pressure indicating severe hypertension - Systolic ≥160 or diastolic ≥110 - mmHg
- Urinary protein excretion - ≥300 over 24 hours is a commonly used threshold for significant proteinuria - mg/24 h
- Spot urine protein-to-creatinine ratio - ≥30 is a commonly used guideline threshold for significant proteinuria - mg/mmol
- Which of these typical measurements hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Progression to eclampsia with seizures
- Stroke and other serious neurological complications
- HELLP syndrome, hepatic injury and coagulation abnormalities
- Acute kidney injury or pulmonary oedema
- Placental abruption, fetal growth restriction, stillbirth and medically indicated preterm birth
- Which of these failure modes and hazards hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Diagnostic frameworks differ in their inclusion of uteroplacental dysfunction and their terminology for disease severity.
- Access to antenatal surveillance, laboratory testing, emergency obstetric care and neonatal support affects detection and outcomes.
- Urine protein measurement conventions and diagnostic coding vary between health systems.
- Which of these regional variation hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Gestational hypertension - New-onset hypertension after 20 weeks without the additional findings required for pre-eclampsia under the applicable diagnostic framework.
- Chronic hypertension in pregnancy - Hypertension predating pregnancy or identified before 20 weeks generally supports chronic hypertension; pre-eclampsia can subsequently develop on top of it.
- Eclampsia - New-onset seizures associated with the pre-eclampsia disease spectrum and not attributable to another cause.
- HELLP syndrome - Defined by haemolysis, elevated liver enzymes and low platelets; it overlaps with pre-eclampsia but may occur without its usual hypertension or proteinuria.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of pre-eclampsia this model covers, and on what evidence? provenance
What the second pass must settle
- Which diagnostic frameworks must the publication support, and how should differences in uteroplacental criteria and severity terminology be represented without implying equivalence?
- What evidence and time boundaries should govern de novo postpartum and atypical presentations?
- Which criteria most reliably distinguish superimposed pre-eclampsia from progression of chronic kidney disease when baseline proteinuria is present?
- Which angiogenic assays and interpretation windows are validated for the intended populations, including multifetal pregnancies and renal disease?
- What evidence should define episode resolution and trigger transfer of persistent abnormalities to chronic hypertension or kidney disease models?