Management Of Pre Eclampsia

By Author: Ibrahim Machiwala
Total Articles: 463
Comment this article

The definitive treatment of pre eclampsia is delivery to prevent development of maternal or fetal complications from disease progression.
Mild pre-eclampsia — At term, women are induced if there are no contraindications to vaginal birth. This minimizes the risk of progression to severe disease and its complications -- There is no reason to delay induction of women who are at least 37 weeks of gestation and have a favorable cervix (Bishop score greater than 6).
Hospital Admission -- Close maternal monitoring upon diagnosis is important for disease severity and the rate of progression. Hospitalization is useful for making these assessments & facilitates rapid intervention in the event of fulminant progression to eclampsia, hypertensive crisis, abruptio placenta, or HELLP syndrome.
Lab Follow up -- platelet count, serum creatinine, serum ALT and AST should be repeated once or twice weekly.
Assessment of fetal well-being & fetal growth - Ultrasound Doppler and Biophysical profile.
Antenatal corticosteroids -- to promote fetal lung maturity should be administered to women less than ...
... 34 weeks of gestation.

Expectant Management of Pre Eclampsia:

In women with severe preeclampsia remote from term, the decision to continue pregnancy beyond that interval required for the administration of corticosteroids depends upon daily maternal and fetal assessment with continual review of the ongoing risks of conservative management versus the benefit of further fetal maturation. Such women should be cared for in a hospitalized setting and by, or in consultation with, a maternal-fetal medicine specialist.

Hospitalize until delivery.
Keep the patient at bed rest, except for bathroom privileges.
Monitor blood pressure every 2 to 4 hours while awake.
Assess maternal symptoms every 2 to 4 hours while awake.
Strict recording of fluid intake and urine output.
Complete blood count, electrolytes, and liver and renal function tests twice weekly.
Antenatal corticosteroids if not previously given.
Regular assessment of fetal wellbeing.
Elective delivery after 34 weeks.

Management of Pre Eclampsia:

Sodium restriction and diuretics have no role in routine therapy.
L-arginine supplementation lowered blood pressure or improved kidney function in pre eclamptic women. Effect of L-arginine therapy on the glomerular injury of preeclampsia:
--- a randomized controlled trial Hladunewich MA; Derby GC; Lafayette RA; Blouch KL; Druzin ML; Myers BD Obstet Gynecol. 2006 Apr;107(4):886-95
Anti Hypertensive Treatment -- initiating antihypertensive therapy in pre-eclamptic/eclamptic women when the systolic blood pressure is >150 mm Hg & diastolic >100 mm Hg.
Acute Therapy:
Labetalol - Intermittent or continuous infusion fall in blood pressure begins within 5 to 10 minutes and lasts from 3 to 6 hours.
Hydralazine -- The fall in blood pressure begins within 10 to 30 minutes and lasts from 2 to 4 hours.
Calcium channel blockers - Nifedipine & Nicardipine.
Diazoxide - used when BP control is not archived with Labetalol & Hydralazine

Drugs contraindicated in pregnancy:
Sodium Nitroprusside
ACE Inhibitors
ARB's

Target blood pressures:
Systolic b/w 130 to 150 mmHg
Diastolic b/w 80 to 100 mm Hg

Breastfeeding mothers:
Beta-adrenergic blockers & calcium channel blockers enter breast milk; but considered "compatible" with breastfeeding by the American Academy of Pediatrics.
ACEi & ARB's are generally avoided during lactation in the neonatal period. Diuretics reduces milk volume.

Effects of BP Control on Fetus:
A 10 mmHg fall in mean arterial pressure was associated with a 176 g decrease in birth weight. This effect was unrelated to the type of hypertension or choice of medication.
Most experts agree that severe hypertension should be treated to prevent maternal vascular complications. However, there is no consensus as to the optimal blood pressure threshold for initiating therapy. We initiate antihypertensive therapy in adult women at systolic pressures between 150 and 160 mm Hg and diastolic blood pressures between 100 and 105 mm Hg.

Complications of Pre-eclampsia:

Outcome measure Normal blood pressure, (percent) Mild preeclampsia (percent) Severe preeclampsia (percent)
Maternal
Outcome measure, Normal blood pressure, (percent), Mild preeclampsia (percent), Severe preeclampsia (percent)
Maternal
Liver dysfunction, 0.2, 3.2, 20.2
Kidney dysfunction, 0.3, 5.1, 12.8
Placental abruption, 0.7, 0.5, 3.7
Induced labor, 12.1, 41.5, 58.7
Cesarean delivery, 13.3, 30.9, 34.9
Delivery