From the Guidelines
Management of superimposed preeclampsia requires prompt intervention with antihypertensive medications and close monitoring to reduce the risk of maternal and fetal complications, as recommended by the ISSHP classification, diagnosis, and management recommendations for international practice 1.
Key Management Points
- For acute blood pressure control, intravenous labetalol or hydralazine should be administered to maintain blood pressure below 160/110 mmHg, as stated in the ISSHP guidelines 1.
- For ongoing management, oral medications like labetalol, nifedipine, or methyldopa are recommended, with a target diastolic BP of 85 mmHg and systolic BP of 110-140 mmHg 1.
- Magnesium sulfate should be given for seizure prophylaxis in women with preeclampsia who have proteinuria and severe hypertension, or hypertension with neurological signs or symptoms, as recommended by the ISSHP guidelines 1.
- Patients require intensive monitoring, including frequent blood pressure checks, continuous fetal monitoring, daily laboratory assessment, and regular evaluation for symptoms like headache, visual disturbances, or epigastric pain, as outlined in the ISSHP guidelines 1.
Timing of Delivery
- Delivery should be considered if the patient has reached 37 weeks' gestation or develops any of the following: repeated episodes of severe hypertension, progressive thrombocytopenia, progressively abnormal renal or liver enzyme tests, pulmonary edema, abnormal neurological features, or nonreassuring fetal status, as recommended by the ISSHP guidelines 1.
- Corticosteroids should be administered if delivery is anticipated before 34 weeks to accelerate fetal lung maturity, as recommended by the ISSHP guidelines 1.
Importance of Close Monitoring
- Close monitoring is crucial in managing superimposed preeclampsia, as it allows for early detection of complications and prompt intervention to reduce the risk of maternal and fetal morbidity and mortality, as emphasized by the ISSHP guidelines 1.
From the Research
Definition and Diagnosis of Superimposed Preeclampsia
- Superimposed preeclampsia refers to the development of preeclampsia in women with chronic arterial hypertension 2.
- The diagnosis of preeclampsia is based on the new onset of hypertension and proteinuria after 20 weeks of gestation, although proteinuria is no longer required for the diagnosis 3.
Management of Superimposed Preeclampsia
- The management of superimposed preeclampsia involves the assessment of disease severity and the use of antihypertensive medications to prevent complications 3.
- The decision to terminate pregnancy and perform delivery is based on gestational age, maternal and fetal conditions, and severity of preeclampsia 3.
- Antenatal corticosteroids may be administered to promote fetal lung maturity in women with severe preeclampsia 3.
Treatment Options for Severe Hypertension in Preeclampsia
- Nifedipine, labetalol, and hydralazine are commonly used as first-line therapies for severe hypertension in preeclampsia [(4,5)].
- A randomized controlled trial found that nifedipine was the most effective drug in reducing blood pressure when a single dose was administered, while hydralazine was the most effective when the drug administration was maximized up to three doses 4.
- Another study found that oral antihypertensive regimens, including nifedipine retard, labetalol, and methyldopa, were effective in managing severe hypertension in pregnancy 5.