What is the best approach to cure preeclampsia once diagnosed?

Management of Preeclampsia: Definitive Treatment

Delivery of the fetus and placenta is the only definitive cure for preeclampsia. 1, 2, 3, 4, 5, 6

Rationale for Delivery as Definitive Treatment

Preeclampsia is a pregnancy-specific condition characterized by hypertension and often proteinuria after 20 weeks gestation. The International Society for the Study of Hypertension in Pregnancy (ISSHP) and American College of Obstetricians and Gynecologists (ACOG) guidelines clearly state that delivery is the only cure for preeclampsia 2. This is because:

• The pathophysiology of preeclampsia is directly related to the presence of the placenta
• Once the placenta is delivered, the disease process begins to resolve
• No other intervention can completely reverse the underlying pathophysiological changes

Timing of Delivery

The decision about when to deliver depends on several factors:

• ≥37 weeks gestation: Immediate delivery is recommended for all women with preeclampsia 1, 2
• 34-37 weeks gestation: Expectant management with close monitoring may be appropriate 1
• <34 weeks gestation: Conservative management at a center with maternal-fetal medicine expertise is recommended, balancing maternal risks against fetal prematurity 1

Other Management Approaches (Not Curative)

While the following interventions are important in managing preeclampsia, none of them constitute a cure:

1. Antihypertensive Medications

• Used to control blood pressure and prevent complications
• Target diastolic BP of 85 mmHg and systolic BP of 110-140 mmHg 1
• First-line agents include methyldopa, labetalol, oxprenolol, and nifedipine 1
• These medications manage symptoms but do not address the underlying pathology

2. Magnesium Sulfate

• Used for seizure prophylaxis in severe preeclampsia 1, 7
• Typically administered as:
  • Initial dose: 4-5g IV over 15-20 minutes
  • Maintenance: 1-2g/hour continuous infusion
  • Continue for at least 24 hours postpartum 2, 7
• While essential for preventing eclampsia, it does not cure preeclampsia

3. Quiet and Calm Environment

• May help reduce seizure risk as an adjunctive measure
• Cannot address the underlying pathophysiology
• Not a substitute for definitive treatment

Common Pitfalls and Caveats

• Misunderstanding the role of MgSO₄: Magnesium sulfate is critical for preventing seizures but does not cure preeclampsia itself 7
• Overreliance on antihypertensives: While controlling blood pressure is important to prevent maternal complications, it does not resolve the underlying disease process 1
• Delaying delivery inappropriately: When maternal or fetal indications for delivery are present, prolonging pregnancy can increase risks 1
• Failure to recognize progression: Preeclampsia can rapidly progress to severe features requiring immediate intervention 1

Prevention Strategies (Not Relevant to Cure Once Diagnosed)

• Low-dose aspirin (100-150 mg daily) from week 12 to weeks 36-37 for high-risk women 2
• Calcium supplementation (≥1 g/day) for women with low calcium intake 2

In conclusion, while various management strategies are important in controlling symptoms and preventing complications of preeclampsia, only delivery of the fetus and placenta constitutes a definitive cure for this condition. All other interventions should be viewed as temporizing measures until delivery can be safely accomplished.