The need to redefine preeclampsia.

INTRODUCTION: The current definition of preeclampsia is based on convention and not on maternal and/or perinatal outcomes. This article reviews some of the limitations of the conventional definition of preeclampsia and recent evidence suggesting that there is a dose-response relationship between the magnitude of uteroplacental ischemia and the timing of onset of preeclampsia. AREAS COVERED: This clinical opinion reviews the limitations of the conventional cutoff for 24-h proteinuria during pregnancy, problems with blood pressure measurement in pregnant women and recent insights into the pathophysiology of preeclampsia including the role of angiogenic imbalances. EXPERT OPINION: New criteria to redefine preeclampsia has to rely on studies that compare the degree of proteinuria, the severity of hypertension and perhaps the magnitude of angiogenic imbalances in relation with maternal and/or perinatal outcomes. We propose a hypothetical sub-classification of preeclampsia according to whether there is evidence of absolute or relative uteroplacental ischemia in view of the lack of placental pathology support for the cutoff of 34 weeks to sub-classify preeclampsia.