What is the treatment for preeclampsia?

From the Guidelines

The primary treatment for preeclampsia is delivery of the baby and placenta, which is the only definitive cure. For severe preeclampsia or eclampsia, immediate delivery is necessary regardless of gestational age. For mild preeclampsia at less than 37 weeks, management may include close monitoring with bed rest, blood pressure control, and corticosteroids to accelerate fetal lung maturity.

Key Management Points

• Antihypertensive medications commonly used include labetalol (starting at 200-400 mg orally twice daily), nifedipine (10-20 mg orally every 4-6 hours), or methyldopa (250-500 mg orally three times daily) 1.
• For severe hypertension (≥160/110 mmHg), intravenous labetalol, hydralazine, or oral nifedipine may be used 1.
• Magnesium sulfate is administered to prevent seizures, typically as a 4-6g IV loading dose followed by 1-2g/hour continuous infusion until 24 hours postpartum 1.
• Patients require close monitoring of blood pressure, urine output, reflexes, respiratory rate, and magnesium levels.
• Fluid management is crucial to avoid pulmonary edema.
• Preeclampsia can rapidly worsen, so vigilant monitoring for signs of organ dysfunction, including liver involvement, thrombocytopenia, and renal impairment is essential.
• The underlying cause involves placental dysfunction leading to systemic endothelial damage and inflammation.

Monitoring and Delivery

• Women with preeclampsia should be assessed in hospital when first diagnosed; thereafter, some may be managed as outpatients once it is established that their condition is stable and they can be relied on to report problems and monitor their BP 1.
• Women with preeclampsia should be delivered if they have reached 37 weeks’ (and zero days) gestation or if they develop any of the following: repeated episodes of severe hypertension, progressive thrombocytopenia, progressively abnormal renal or liver enzyme tests, pulmonary edema, abnormal neurological features, or nonreassuring fetal status 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. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end-plate by the motor nerve impulse.

The treatment for preeclampsia includes the use of magnesium sulfate (IV) to prevent and control seizures. The mechanism of action of magnesium sulfate in treating preeclampsia is by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end-plate by the motor nerve impulse, thereby preventing or controlling convulsions 2, 2.

• Key points:
  • Magnesium sulfate is used to prevent and control seizures in preeclampsia
  • The drug works by blocking neuromuscular transmission and decreasing acetylcholine release
  • Effective anticonvulsant serum levels range from 2.5 to 7.5 mEq/L

From the Research

Treatment Options for Preeclampsia

• The treatment for preeclampsia depends on several factors, including symptom severity, maternal or fetal compromise, and gestational period 3.
• For patients with severe preeclampsia, nifedipine, a calcium channel blocker, has been shown to be effective in controlling blood pressure 4, 5.
• Hydralazine, a vasodilator, is also commonly used to treat hypertensive emergencies associated with pregnancies, but it may cause unpredictable hypotension 3.
• Labetalol, a beta-blocker, may be preferred due to its lack of reflex tachycardia, hypotension, or increased intracranial pressure 3.
• Magnesium sulfate is the drug of choice for the prevention and control of maternal seizures in patients with severe preeclampsia or eclampsia during the peripartum period 3, 6.

Management of Preeclampsia

• Close monitoring of maternal and fetal status is essential in managing preeclampsia before the onset of labor 6.
• Delivery remains the ultimate treatment for preeclampsia, and access to prenatal care, early detection of the disorder, and appropriate management are crucial elements in preventing preeclampsia-related deaths 6.
• In cases of chronic or mild hypertension, oral methyldopa may be administered on an outpatient basis 3.
• For patients undergoing cesarean section, nifedipine may be used to attenuate the pressor response to intubation, and it has been shown to be effective in controlling blood pressure without causing significant maternal or fetal side effects 7.

Medications Used in Preeclampsia Treatment

• Nifedipine: effective in controlling blood pressure, convenient, and low-cost, with minimal side effects 4, 5, 7.
• Hydralazine: commonly used to treat hypertensive emergencies, but may cause unpredictable hypotension 3.
• Labetalol: preferred due to its lack of reflex tachycardia, hypotension, or increased intracranial pressure 3.
• Magnesium sulfate: drug of choice for the prevention and control of maternal seizures in patients with severe preeclampsia or eclampsia during the peripartum period 3, 6.