Preeclampsia Flashcards
Generally, the treatment of gestational hypertension or preeclampsia without severe features is. . .
Delivery at 37 weeks
Or, if at or past 37 weeks, delivery now
The management of preeclampsia without severe features in a preterm pregnancy is. . .
. . . observation until either
- severe features are noted
- term gestation is reached
Management of preeclampsia with severe features
If < 34 weeks, begin corticosteroids and magnesium, admit to tertiary care unit for close observation
If at or > 34 weeks, induce labor and begin magnesium
First sign of magnesium toxicity
Loss of deep tendon reflexes
Therapeutic range for magnesium in the treatment of preeclampsia/eclampsia
4-8 mg/dL magnesium
Two ways to receive a diagnosis of chronic hypertension in association with pregnancy
- Hypertension develops prior to 20 weeks gestation
- Hypertension that develops after 20 weeks gestation persists beyond 12 weeks postpartum
Acute onset severe hypertension in pregnancy
Defined as >160 mmHg systolic OR 110 mmHg diastolic persisting beyond 15 minutes
A hypertensive emergency. High risk for PRES.
Requires IV labetalol, IV hydralazine, or oral nifedipine
PRES in the peripartum period
A not uncommon complication of preeclampsia / eclampsia
Will persent as visual disturbance or cerebellar signs +/- headache.
Diagnose with MRI.
Formal diagnosis of preeclampsia
Two elevated BPs measured at least 6 hours apart
One of:
- 24 hour urinary protein > 300 mg OR P/Cr ratio > 0.3 OR dipstick >= 1+ protein
- Plt < 100,000
- LFT elevation (2x normal)
- Renal insufficiency (Cr > 1.1 mg/dL)
- Pulmonary edema
- New onset cerebral disturbance or visual impairment
“Severe features” that make a dx of preeclampsia with severe features
- SBP > 160 or DBP > 110 on two occasions 4 hours apart
- Plt < 100,000
- Impaired LFTs (2x normal) OR severe persistent epigastric or RUQ pain
- Progressive renal insufficiency (Cr > 1.1 mg/dL)
- Pulmonary edema
- New onset cerebral or visual disturbance
Management of superimposed preeclampsia
If < 34 weeks, begin corticosteroids and magnesium, admit to tertiary care unit for close observation
If at or > 34 weeks, induce labor and begin magnesium
Note: The same as preeclampsia with severe features.
Management of pregnancies of chronic hypertension patients who are well controlled
Observation with delivery at 38-39 weeks
How long does it take to treat a premature patient with corticosteroids?
48 hours
So, there is a balance between prolonging a risky pregnancy and allowing time for fetal lungs to mature.
Generally speaking, a stable patient with preeclampsia with severe features or superimposed preeclampsia can tolerate waiting 48 hours.
However, if the patient is unstable or if the patient is full-on eclamptic, has HELLP, or has PRES, you probably need to deliver now.
What medications should a preeclamptic patient NOT receive?
(on top of the regular pregnancy no-no’s)
NSAIDs
NSAIDs may result in elevated post-partum blood pressures in preeclamptic patients, which may in turn precipitate postpartum preeclampsia complications (AKI, PRES, cerebral hemorrhage, etc).
Therefore, we avoid these in preeclamptic patients.
This includes the tocolytic indomethacin.
When do you start magnesium for a preeclamptic patient?
When do you stop magnesium for a preeclamptic patient?
Start: During labor or labor induction
Stop: 24 hours postpartum
When is it appropriate to control the blood pressure in a preeclamptic patient?
When the HTN is in the severe range. In other words, SBP > 160, DBP > 100.
More mild HTN we will simply observe.
