From the Guidelines
Pre-eclampsia without elevated blood pressure, also known as non-hypertensive pre-eclampsia or atypical pre-eclampsia, is a rare but serious condition that requires prompt medical attention, as stated in the 2021 study by the American Journal of Obstetrics and Gynecology 1. This condition is characterized by the presence of pre-eclampsia symptoms and signs such as proteinuria (protein in urine), liver dysfunction, thrombocytopenia (low platelet count), or neurological complications without the typical hypertension.
Key Characteristics
- Proteinuria (protein in urine)
- Liver dysfunction
- Thrombocytopenia (low platelet count)
- Neurological complications
Management and Treatment
Management includes close monitoring in a hospital setting with frequent blood pressure checks, urine protein assessment, and blood tests to monitor organ function. Treatment focuses on symptom management, preventing progression to eclampsia, and timely delivery if the condition worsens. Low-dose aspirin (150 mg daily) may be prescribed as prophylaxis in high-risk patients, as recommended by the 2023 study in the Journal of Hepatology 1. Magnesium sulfate may be administered intravenously (4-6g loading dose followed by 1-2g/hour maintenance) to prevent seizures in severe cases. The definitive treatment is delivery of the baby and placenta, with timing based on gestational age and maternal/fetal condition. This condition occurs because placental dysfunction triggers the release of anti-angiogenic factors that cause systemic endothelial damage, which can affect multiple organ systems even before blood pressure elevation becomes apparent, as discussed in the 2018 study by the American family physician 1. Regular prenatal care is essential for early detection and management of this condition. It is also important to note that the 2019 study by the European Heart Journal 1 emphasizes the importance of managing severe pre-eclampsia and eclampsia with BP-lowering therapy and intravenous magnesium sulfate. However, the most recent and highest quality study, the 2023 study in the Journal of Hepatology 1, provides the most up-to-date guidance on the management of liver diseases in pregnancy, including pre-eclampsia. Therefore, the most recent and highest quality evidence supports the use of low-dose aspirin and magnesium sulfate in the management of pre-eclampsia without elevated blood pressure, with the goal of preventing progression to eclampsia and improving maternal and fetal outcomes.
From the Research
Definition of Preeclampsia
- Preeclampsia is a multisystemic disorder characterized by new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman 2.
- However, the American College of Obstetricians and Gynecologists has stated that proteinuria is no longer required for the diagnosis of preeclampsia 2.
Preeclampsia Without Hypertension
- The studies provided do not directly address the concept of preeclampsia without hypertension, as hypertension is a key component of the traditional definition of preeclampsia 2, 3, 4.
- However, it is noted that the American College of Obstetricians and Gynecologists has updated the definition of preeclampsia to no longer require proteinuria, but there is no mention of preeclampsia without hypertension 2.
Related Concepts
- The studies discuss the importance of identifying women at risk for preeclampsia and preventing the onset of the disease, particularly through the use of low-dose aspirin 5, 6.
- The management of preeclampsia focuses on controlling high blood pressure and preventing complications, with delivery being the only curative treatment 2, 3, 4.