Sibai BM. Diagnosis and management of gestational hypertension and pre-eclampsia. Expectant Management. Antenatal testing in women who have preeclampsia with severe features may include daily nonstress tests, amniotic fluid assessment, and periodic ultrasonography to assess fetal growth. Between 24 and 34 weeks' gestation, fetal lung maturity may be accelerated by the use of betamethasone two mg intramuscular doses given 24 hours apart or dexamethasone four 6-mg intramuscular doses given 12 hours apart.
Delivery route and timing are based on maternal factors e. However, many women are not candidates for expectant management and require urgent delivery. If maternal and fetal conditions allow, corticosteroids should be administered to women with preeclampsia and preterm labor or rupture of membranes before 34 weeks' estimated gestational age. Attempted vaginal delivery is recommended in women who have preeclampsia with severe features if it is not otherwise contraindicated.
Some experts recommend cesarean delivery in preeclamptic patients with severe features and an unfavorable cervix who require delivery before 30 weeks' gestation.
Peripheral blood smear shows evidence of damaged erythrocytes e. Information from American College of Obstetricians and Gynecologists. Corticosteroids increase platelet counts in women with HELLP syndrome, 44 , 45 but they have not been shown to improve fetal or maternal outcomes except for the proven benefit on fetal lung maturation before 34 weeks' gestation.
Postictal confusion, agitation, or combativeness may follow. During an eclamptic seizure, the fetus often manifests hypoxia-related bradycardia, but usually recovers. Table 4 presents principles for management of eclamptic seizures. Maintain situational awareness. An eclamptic seizure is dramatic and disturbing. The attending clinician is challenged to maintain a purposeful calm and to avoid unnecessary interventions that can result in iatrogenic complications. Avoid polypharmacy. Do not attempt to shorten or abolish the initial convulsion by using drugs such as diazepam Valium or phenytoin Dilantin.
Magnesium sulfate is the drug of choice for initial and recurrent convulsions. Polypharmacy can lead to maternal or neonatal respiratory depression, aspiration, or other adverse effects. Protect the airway, and minimize the risk of aspiration. Place the patient on her left side and suction her mouth. Call for someone skilled in intubation to be immediately available. Prevent maternal injury. Falls from the bed can result in contusions or fractures, and head injury may result from violent seizure activity.
Close observation and use of soft padding and side rails on the bed may help prevent injuries. Administer magnesium sulfate to control convulsions. If the patient has already received a prophylactic loading dose and is receiving a continuous infusion when the seizure occurs, an additional 2 g should be given intravenously.
Otherwise, a 4- to 6-g loading dose should be given intravenously over 15 to 20 minutes, followed by a continuous infusion of 2 g per hour. The loading dose and subsequent bolus should not total more than 8 g for a recurrent seizure.
Follow delivery plan. Avoid the temptation to perform immediate cesarean delivery for a self-limited seizure episode. Information from reference After delivery, most women with preeclampsia experience diuresis, a decrease in BP, and general improvement. The greatest risk of post-partum eclampsia is in the first 48 hours 33 ; hypertension may worsen after delivery as third space fluid returns to the vasculature.
MgSO 4 should be continued for 12 to 24 hours after delivery. Women with a systolic BP of mm Hg or greater or diastolic BP of mm Hg or greater should be rechecked within 15 minutes, and antihypertensive treatment should be started within 60 minutes if BP is still elevated. Women with hypertension that persists for more than 24 hours after delivery should not take nonsteroidal anti-inflammatory drugs because they may worsen BP.
Preeclampsia is a risk factor for future cardiovascular disease, especially if it occurs in multiple pregnancies or is associated with intrauterine growth restriction or required delivery before 37 weeks' gestation.
Preventive Services Task Force USPSTF expands the recommendation to include women with multifetal pregnancies, chronic hypertension, type 1 or 2 diabetes mellitus, renal disease, autoimmune diseases, or several moderate risk factors. Data Sources : A PubMed search was completed in Clinical Queries using key terms including preeclampsia, eclampsia, and gestational hypertension.
The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Search date: November 15, , and November 15, This review updates a previous article on this topic by Leeman and Fontaine.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the authors. American College of Obstetricians and Gynecologists. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. Risk of adverse pregnancy outcomes in women with mild chronic hypertension before 20 weeks of gestation.
Magee LA, Duley L. Oral beta-blockers for mild to moderate hypertension during pregnancy. Fall in mean arterial pressure and fetal growth restriction in pregnancy hypertension: a meta-analysis. Diuretics for preventing preeclampsia. Oral nifedipine or intravenous labetalol for hypertensive emergency in pregnancy: a randomized controlled trial. Mild gestational hypertension remote from term: progression and outcome. New aspects in the pathophysiology of preeclampsia. J Am Soc Nephrol. Abnormal placentation and the syndrome of preeclampsia.
Semin Nephrol. Preeclampsia: the role of angiogenic factors in its pathogenesis. Physiology Bethesda. Lin J, August P. Genetic thrombophilias and preeclampsia: a meta-analysis.
How does variability of immune system genes affect placentation? Endothelin: key mediator of hypertension in preeclampsia. Am J Hypertens. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Early pregnancy prediction of pre-eclampsia in nulliparous women, combining clinical risk and biomarkers: the Screening for Pregnancy Endpoints SCOPE international cohort study.
February — Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. Magnesium sulfate prophylaxis in preeclampsia: evidence from randomized trials.
Clin Obstet Gynecol. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a ran-domised placebo-controlled trial. Timing of indicated late-preterm and early-term birth. Immediate delivery versus expectant monitoring for hypertensive disorders or pregnancy between 34 and 37 weeks of gestation HYPITAT-II : an open-label, randomised controlled trial.
Dildy GA. Share on: Facebook Twitter. Show references American College of Obstetricians and Gynecologists. Practice Bulletin No. Bokslag A, et al. Preeclampsia; short and long-term consequences for mother and neonate.
Early Human Development. August P, et al. Preeclampsia: Clinical features and diagnosis. Accessed March 17, Karumanchi SA, et al. Preeclampsia: Pathogenesis. Accessed Dec. Hofmeyr R, et al. Preeclampsia in Obstetric and anaesthesia management. Best Practice and Research Clinical Anaesthesiology.
In press. Norwitz ER, et al. Early pregnancy prediction of preeclampsia. Meher S, et al. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database of Systematic Reviews. Accessed Jan. Norwitz ER. Preeclampsia: Management and prognosis. Preeclampsia: Prevention. De Regil LM, et al. Vitamin D supplementation for women during pregnancy.
Wei SQ. Vitamin D and pregnancy outcomes. Current Opinion in Obstetrics and Gynecology. Butler Tobah YS expert opinion. Mayo Clinic, Rochester, Minn. LeFevre ML, et al. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta.
Medscape; Hypertension and Pregnancy. Mayo Clinic. Most cases occur… Pregnancy Complications Gestational Diabetes Gestational diabetes is diabetes diagnosed for the first time during pregnancy. Preeclampsia Causes, Treatment and Prevention Who is at risk for preeclampsia? A first-time mom Previous experience with gestational hypertension or preeclampsia Women whose sisters and mothers had preeclampsia Women carrying multiple babies Women younger than 20 years and older than age 40 Women who had high blood pressure or kidney disease prior to pregnancy Women who are obese or have a BMI of 30 or greater What are the symptoms?
How do I know if I have preeclampsia? What is the treatment? If you have a mild case and your baby has not reached full development, your doctor will probably recommend you do the following: Rest, lying on your left side to take the weight of the baby off your major blood vessels. Increase prenatal checkups. Consume less salt Drink at least 8 glasses of water a day Change your diet to include more protein If you have a severe case, your doctor may try to treat you with blood pressure medication until you are far enough along to deliver safely, along with possibly bed rest, dietary changes, and supplements.
How can preeclampsia affect the mother? It may also lead to the following life-threatening conditions: Eclampsia — This is a severe form of preeclampsia that leads to seizures in the mother. HELLP Syndrome hemolysis, elevated liver enzymes, and low platelet count - This is a condition usually occurring late in pregnancy that affects the breakdown of red blood cells, how the blood clots, and liver function for the pregnant woman.
How does preeclampsia affect my baby? How can I prevent preeclampsia: The exact cause of preeclampsia is not known. Use little or no added salt in your meals Drink glasses of water a day Avoid fried foods and junk food Get enough rest Exercise regularly Elevate your feet several times during the day Avoid drinking alcohol Avoid beverages containing caffeine Your doctor may suggest you take the prescribed medicine and additional supplements What are the Causes of Preeclampsia?
Causes of this abnormal development may include: Insufficient blood flow to the uterus Damage to the blood vessels A problem with the immune system Certain genes Want to Know More?
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