From the Guidelines
Management of preeclampsia requires prompt intervention with blood pressure control using antihypertensive medications such as labetalol, nicardipine, or nifedipine, and magnesium sulfate for seizure prophylaxis, as recommended by the most recent guidelines 1. The goal of treatment is to prevent maternal and fetal complications by maintaining systolic blood pressure between 140-160 mmHg and diastolic between 90-100 mmHg. Key aspects of management include:
- Blood pressure control with antihypertensive medications
- Magnesium sulfate administration for seizure prophylaxis
- Fluid management to prevent pulmonary edema
- Delivery as the definitive treatment for severe preeclampsia, with timing based on gestational age, maternal condition, and fetal status
- Antenatal corticosteroids for fetal lung maturity before 34 weeks
- Close monitoring of blood pressure, urine output, neurological status, and laboratory tests postpartum.
According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1,
- drug treatment with i.v. labetalol or nicardipine and magnesium is recommended for pre-eclampsia or eclampsia with hypertensive crisis
- nitroglycerin given as an i.v. infusion is recommended for pre-eclampsia or eclampsia associated with pulmonary oedema
- drug treatment with i.v. labetalol, oral methyldopa, or oral nifedipine is recommended for severe hypertension in pregnancy, with intravenous hydralazine as a second-line option.
These interventions are critical because preeclampsia involves systemic endothelial dysfunction and vasospasm, which can lead to multi-organ damage if not properly managed 2, 3, 4, 5.
From the Research
Management of Preeclampsia
The management of preeclampsia involves several key components, including:
- Identifying women at increased risk and detecting the condition early through repetitive searches for signs and symptoms in the 2nd half of pregnancy 6
- Providing adequate and proper prenatal care, which is the most important part of managing preeclampsia 6
- Maternal antenatal monitoring, including recognizing clinical signs and symptoms, and observing the progression of the condition to the severe state 6
Treatment Options
Treatment options for preeclampsia include:
- Delivering the infant and placenta, which is the only effective treatment for the condition 6, 7
- Ancillary therapy, which is predominantly symptomatic and not directed at underlying causes 6
- Pharmacologic control of severe hypertension prior to delivery, which is generally accepted as beneficial 6
- Expectant management, which may be suitable for women with severe preeclampsia between 24 0/7 and 32 6/7 weeks of gestation in a suitable hospital 6, 8
Expectant Management
Expectant management of severe preeclampsia may be characterized by progressive deterioration in both maternal and fetal conditions 6
- The decision to use expectant management depends on fetal gestational age, maternal and fetal status, presence of labor or rupture of fetal membranes, and level of available neonatal and maternal services 6
- Studies have shown that expectant management can be safe and improve neonatal outcome in select groups of women with severe preeclampsia 6, 8
- However, expectant management before 34 weeks may increase the risk of stillbirths 8
Medications
Medications used to treat preeclampsia include:
- Oral anti-hypertensive agents, such as labetalol, nifedipine, and methyldopa 9
- Intravenous anti-hypertensives, such as labetalol, hydralazine, and glyceryl trinitrate 9
- Magnesium sulphate, which should be considered early to prevent seizures 9
- Hydralazine with labetalol and magnesium sulfate, which are commonly used to slow disease progression and prevent maternal seizure 7