From the Guidelines
Preeclampsia should be managed with delivery if the patient has reached 37 weeks' gestation or develops severe hypertension, progressive thrombocytopenia, or abnormal renal or liver enzyme tests, as this approach prioritizes reducing morbidity, mortality, and improving quality of life. The management of preeclampsia depends on the severity of the condition and the gestational age of the fetus. According to the International Society for the Study of Hypertension in Pregnancy (ISSHP) recommendations 1, women with preeclampsia should be assessed in hospital when first diagnosed, and those with severe hypertension or proteinuria should receive magnesium sulfate for convulsion prophylaxis.
Key Management Points
- Blood pressure monitoring and treatment with antihypertensive medications such as labetalol, nifedipine, or hydralazine to maintain blood pressure below 160/110 mmHg 1
- Fetal monitoring with ultrasound to assess fetal biometry, amniotic fluid, and umbilical artery Doppler 1
- Maternal monitoring with twice-weekly blood tests to evaluate liver and kidney function, as well as clinical assessment for signs of complications such as clonus or neurological symptoms 1
- Delivery should be considered if the patient develops severe hypertension, progressive thrombocytopenia, or abnormal renal or liver enzyme tests, regardless of gestational age 1
Treatment Options
- Antihypertensive medications: labetalol, nifedipine, hydralazine, or methyldopa 1
- Magnesium sulfate for convulsion prophylaxis in women with severe preeclampsia or proteinuria 1
- Corticosteroids to accelerate fetal lung maturity if preeclampsia develops before 34 weeks' gestation 1
Prevention Strategies
- Low-dose aspirin (81-150mg daily) starting at 12-16 weeks' gestation for high-risk women 1
From the FDA Drug Label
Magnesium sulfate injection is also indicated for the prevention and control of seizures in a pre-eclampsia and eclampsia, respectively. In severe pre-eclampsia or eclampsia, the total initial dose is 10 to 14 g of magnesium sulfate. The primary use of magnesium sulfate in pre-eclampsia is for the prevention and control of seizures. The recommended initial dose for severe pre-eclampsia is 10 to 14 g.
- Key considerations:
From the Research
Definition and Treatment of Pre-eclampsia
- Pre-eclampsia is a challenging disease of pregnancy, characterized by high blood pressure and often accompanied by significant amounts of protein in the urine [ 3 ].
- The treatment of pre-eclampsia involves the use of various antihypertensive agents, such as nifedipine, labetalol, and hydralazine, to reduce blood pressure and prevent complications [ 4 ].
Comparison of Antihypertensive Agents
- A study comparing oral nifedipine and intravenous labetalol for the treatment of severe pre-eclampsia found that both agents were effective in reducing blood pressure, with no significant difference in time to achieve target blood pressure [ 3 ].
- Another study compared the effectiveness of nifedipine, labetalol, and hydralazine in reducing blood pressure in patients with severe pre-eclampsia, and found that nifedipine was the most effective agent when a single dose was used, while hydralazine was the most effective when multiple doses were used [ 5 ].
Role of Magnesium Sulfate in Pre-eclampsia
- Magnesium sulfate is commonly used to prevent and treat eclampsia, a severe complication of pre-eclampsia characterized by seizures [ 4 ].
- A review of randomized trials found that magnesium sulfate reduced the risk of eclampsia by more than half, and probably reduced maternal death, although it had no clear effect on outcome after discharge from hospital [ 6 ].
Combination Therapy for Pre-eclampsia
- A study investigated the regulatory effect of magnesium sulfate combined with nifedipine and labetalol on disease-related molecules in serum and placenta in patients with pre-eclampsia, and found that this combination therapy had good efficacy in reducing blood pressure and promoting the expression of endogenous kallikrein [ 7 ].