From the Guidelines
Preeclampsia is a serious pregnancy complication that requires immediate medical attention, and the definitive treatment is delivery of the baby and placenta, with management including hospitalization, blood pressure control, and administration of corticosteroids to accelerate fetal lung maturity, as recommended by the most recent guidelines 1.
Diagnosis and Treatment
The diagnosis of preeclampsia is based on the presence of high blood pressure and organ damage, typically affecting the liver and kidneys, that usually begins after 20 weeks of pregnancy. The treatment of preeclampsia involves controlling blood pressure with medications like labetalol, nifedipine, or hydralazine, and administering magnesium sulfate to prevent seizures.
Blood Pressure Management
The goal of blood pressure management in preeclampsia is to maintain systolic pressure between 110-140 mmHg and diastolic between 85 mmHg, as recommended by the ISSHP guidelines 1. Medications like methyldopa and nifedipine are commonly used to control blood pressure.
Seizure Prophylaxis
Magnesium sulfate is the medication of choice to prevent seizures in women with preeclampsia, typically given as a 4-6g IV loading dose followed by 1-2g/hour continuous infusion until 24 hours postpartum, as recommended by the ISSHP guidelines 1.
Fetal Monitoring
Fetal monitoring in preeclampsia should include assessment of fetal biometry, amniotic fluid, and UA Doppler with ultrasound at first diagnosis and thereafter at 2 weekly intervals if the initial assessment was normal, as recommended by the ISSHP guidelines 1.
Maternal Monitoring
Maternal monitoring in preeclampsia should include BP monitoring, repeated assessments for proteinuria if not already present, clinical assessment including clonus, and twice weekly blood tests for Hb, platelet count, liver transaminases, creatinine, and uric acid, as recommended by the ISSHP guidelines 1.
Delivery
Women with preeclampsia should be delivered if they have reached 37 weeks’ gestation or they develop any of the following: repeated episodes of severe hypertension despite maintenance treatment with 3 classes of antihypertensive agents; progressive thrombocytopenia; progressively abnormal renal or liver enzyme tests; pulmonary edema; abnormal neurological features, such as severe intractable headache, repeated visual scotomata, or convulsions; or nonreassuring fetal status, as recommended by the ISSHP guidelines 1.
From the Research
Diagnosis of Preeclampsia
- Preeclampsia is characterized by blood pressure greater than 140/90 mmHg in the second half of pregnancy 2
- The disease is a major contributor to preterm and low birth weight babies 2
- Preeclampsia is a systemic disorder that may affect many organ systems 3
Treatment of Preeclampsia
- The current clinical management of preeclampsia includes hydralazine with labetalol and magnesium sulfate to slow disease progression and prevent maternal seizure 2
- Initiate antihypertensive drug treatment immediately if systolic blood pressure (sBP) >160 mmHg or diastolic blood pressure (dBP) >110 mmHg, or if sBP 140-159 mmHg and/or dBP 85-109 mmHg (prepregnancy renal disease or diabetes) 3
- The treatment of nonsevere pregnancy hypertension should include a treatment goal of dBP 80-105 mmHg, with one of the following agents: Methyldopa, Labetalol, Nifedipine, or, with special indications (renal or cardiac diseases), diuretics 3
- Drugs to avoid: angiotensin-converting enzyme inhibitors; angiotensin II receptor antagonists; and atenolol 3
Management of Severe Preeclampsia
- Management of severe preeclampsia includes identification of high-risk patients, optimization of antenatal care, early intervention, and the identification and early management of complications 4
- For the acute management of severe hypertension, initially reduce dBP by 10 mmHg and maintain the blood pressure at or below that level with either Nifedipine or Labetalol 3
- Magnesium sulphate should be considered early to prevent seizures 4
- Delivery of the baby is the definitive management of severe preeclampsia 4, 5, 6
Expectant Management of Preeclampsia
- Expectant management of preeclampsia may be considered for women with severe preeclampsia before 34 weeks' gestation where maternal condition is stable and fetal condition is reassuring 5
- The results of studies suggest that expectant treatment in a select group of women with severe preeclampsia between 24 0/7 and 32 6/7 weeks of gestation in a suitable hospital is safe and improves neonatal outcome 5