What is the summary of the National Institute for Health and Care Excellence (NICE) guideline on preeclampsia?

From the Guidelines

The management of preeclampsia should prioritize urgent treatment of blood pressure ≥ 160/110 mm Hg in a monitored setting, with acceptable agents including oral nifedipine or intravenous labetalol or hydralazine, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1.

Key Management Points

• Blood pressure should be treated aiming for a target diastolic BP of 85 mm Hg (and systolic BP at least < 160 mm Hg) to reduce the likelihood of developing severe maternal hypertension and possibly other complications, such as low platelets and elevated liver enzymes with symptoms 1.
• Antihypertensive drugs should be reduced or ceased if diastolic BP falls < 80 mm Hg, with acceptable agents including oral methyldopa, labetalol, oxprenolol, nifedipine, and second or third line agents hydralazine and prazosin 1.
• Women with preeclampsia should all be assessed in hospital when first diagnosed, and 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.

Severe Preeclampsia Management

• Women with preeclampsia who have proteinuria and severe hypertension, or hypertension with neurological signs or symptoms, should receive MgSO4 for convulsion prophylaxis 1.
• Delivery should be considered if the woman has reached 37 weeks’ gestation or develops 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; or nonreassuring fetal status 1.

Fetal and Maternal 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 1.
• 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 1.

From the Research

Summary of NICE Guideline on Preeclampsia

The National Institute for Health and Care Excellence (NICE) guideline on preeclampsia is not directly mentioned in the provided studies. However, based on the available evidence, the following points can be summarized:

• Preeclampsia is a multisystem disease associated with eclampsia, HELLP syndrome, acute kidney injury, pulmonary edema, placental abruption, and intrauterine fetal death 2.
• Management of severe preeclampsia includes identification of high-risk patients, optimization of antenatal care, early intervention, and identification and early management of complications 2.
• The primary objective of management of preeclampsia must always be the safety of the mother, and delivery is the definitive management of severe preeclampsia 3.
• The decision between delivery and expectant management depends on fetal gestational age, maternal and fetal status at the time of initial evaluation, presence of labor or rupture of fetal membranes, and level of available neonatal and maternal services 3.

Key Points in Preeclampsia Management

• Hypertensive disorders of pregnancy are one of the leading causes of peripartum morbidity and mortality globally 2.
• Oral anti-hypertensive agents, including labetalol, nifedipine, and methyldopa, should be tried first, and if they fail to adequately control blood pressure, intravenous anti-hypertensives should be considered 2.
• Magnesium sulphate should be considered early to prevent seizures 2.
• Expectant management of severe preeclampsia may be considered in select cases, but the decision should be made based on fetal gestational age, maternal and fetal status, and availability of neonatal and maternal services 3.
• Labetalol is currently recommended as first-line treatment by national UK guidance, and intravenous labetalol provides proper reduction of blood pressure in Han Chinese women with preeclampsia, but has the risk of undesirable maternal and neonatal adverse effects 4.

Preeclampsia Diagnosis and Prevention

• Pre-eclampsia is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation 5.
• Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage 5.
• Risk factors for preeclampsia include a prior history of preeclampsia, diabetes, kidney disease, obesity, and high maternal age at pregnancy 6.
• Current treatment and management guidelines focus on the management of high blood pressure and any potential complications, but lack adequate prediction markers and are unable to prevent maternal and fetal mortality 6.