One of the most sensitive tests for determining the severity of PIH involves collecting a 24-hour urine sample for protein. In PIH, the amount of protein spilled in the urine increases due to the changes in the kidneys that are a result of the disease. The amount of protein can be measured and certain thresholds used to determine severity of illness.
The amount of hyper-reflexia (just how jumpy the knee-jerk reflex is), is a rather subjective way to add to the alarm in severe PIH. Swelling is probably the least reliable, but when central swelling of the face shows up, there are usually enough other indicators to make it an incidental finding.
Chronic Hypertension Complicated by PIH
In most cases, the management of this condition is no different from the management of severe PIH. It may be particularly tricky to assign how much of the blood pressure comes from the chronic hypertension and how much from the PIH. But no matter how high a chronic hypertension patient's blood pressure was at the onset of pregnancy, the rule of +30 systolic (top number) and/or +15 diastolic (bottom number) is still meaningful in suspecting a PIH onset.
Management of PIH
Treatment with anti-hypertensives is not useful in PIH. Merely making the blood pressure go down does not stop the disease. The damage and danger will still rage in the background. In PIH, the high blood pressure is not the disease, but an effect of the disease, whereas in chronic hypertension, for the most part, high blood pressure really is the disease.
The cure for PIH is delivery. The trick is to get a baby to maturity before having to unload because of the PIH. If a patient has only mild PIH, it can be followed conservatively. Bed rest, a low salt diet, and peace and quiet are the treatment for mild preeclampsia, and this regimen hasn't changed in over a hundred years.
Of course close observation with frequent blood pressures and serial 24-hour urine collections go with this conservative treatment. As soon as the patient's cervix is inducible near term, induction for delivery is recommended.