Management of Preeclampsia with Severe Features at 37 Weeks Gestation

Diagnosis and Assessment

The American College of Cardiology recommends confirming preeclampsia diagnosis by documenting blood pressure measurements on at least two occasions 15 minutes apart, proteinuria assessment using urine protein/creatinine ratio, complete blood count focusing on hemoglobin and platelet count, and liver transaminases, creatinine, and uric acid levels 1, 2, 3, 4
The European Society of Cardiology suggests that proteinuria assessment using urine protein/creatinine ratio (≥30 mg/mmol is abnormal) is essential for diagnosing preeclampsia 3, 4

The American Heart Association recommends initiating oral antihypertensive therapy targeting diastolic BP of 85 mmHg and systolic BP 110-140 mmHg if blood pressure ≥140/90 mmHg but <160/110 mmHg, with first-line agents being oral nifedipine, labetalol, or methyldopa 1, 4, 5
The European Society of Cardiology advises against using ACE inhibitors, ARBs, or direct renin inhibitors due to severe fetotoxicity causing renal dysgenesis 9, 10

The American College of Obstetricians and Gynecologists recommends administering magnesium sulfate for seizure prophylaxis if proteinuria is present with severe hypertension (≥160/110 mmHg) or if any neurological signs or symptoms exist 1, 2, 6

The Society for Maternal-Fetal Medicine suggests performing a biophysical profile, including fetal biometry, amniotic fluid volume, fetal breathing movements, body movements, and tone, and continuous electronic fetal heart rate monitoring to assess for non-reassuring fetal status 5
The American College of Obstetricians and Gynecologists recommends proceeding with delivery after maternal stabilization because all women with preeclampsia at ≥37 weeks gestation should be delivered 1, 2, 6, 5

The European Society of Cardiology advises continuing blood pressure monitoring after delivery as 10% of maternal deaths from hypertensive disorders occur postpartum, and monitoring for postpartum complications including stroke and eclampsia 7