Management of Preeclampsia at Term

Diagnosis and Classification

The American College of Obstetricians and Gynecologists recommends delivery at 37 weeks for preeclampsia without severe features, as stated by the International Society for the Study of Hypertension in Pregnancy 1
A protein-creatinine ratio of 245 mg/mmol is considered diagnostic for preeclampsia, according to the Hypertension guidelines 1
The presence of significant proteinuria at term warrants delivery, regardless of the degree of proteinuria, as per the Hypertension guidelines 1

The International Society for the Study of Hypertension in Pregnancy recommends delivery if preeclampsia is diagnosed at 37 weeks and zero days gestation, as stated in the Hypertension journal 1
The American College of Obstetricians and Gynecologists guidance indicates that delivery at 37 weeks is recommended for preeclampsia without severe features, as reported in the Praxis Medical Insights journal, but the same information is available from the Hypertension journal 1

The Hypertension guidelines recommend measuring current blood pressure immediately and initiating antihypertensive therapy if ≥140/90 mmHg, targeting diastolic BP of 85 mmHg and systolic BP 110-140 mmHg 1
For non-severe hypertension, the Hypertension guidelines suggest using oral methyldopa, labetalol, or nifedipine 1
For severe hypertension, the Hypertension guidelines recommend initiating urgent treatment with oral nifedipine or IV labetalol/hydralazine in a monitored setting 1

The Hypertension guidelines recommend administering magnesium sulfate for seizure prophylaxis if severe hypertension, neurological signs or symptoms, or other severe features are present 1

The Hypertension guidelines recommend obtaining a complete blood count, comprehensive metabolic panel, and other tests to assess for progression to severe features 1
The Hepatology journal suggests that thrombocytopenia <100,000 may indicate HELLP syndrome 3

The Praxis Medical Insights journal recommends performing a biophysical profile and continuous electronic fetal monitoring, but the same information is available from the Hypertension journal, which suggests that delivery should not be delayed based solely on non-reactive fetal testing 1

The Hypertension guidelines recommend that vaginal delivery is preferred unless cesarean is indicated for standard obstetric reasons 1
The Hypertension guidelines suggest that induction of labor is appropriate and should be initiated after maternal stabilization if severe features are present, and delivery should occur within 24-48 hours of diagnosis once maternal stabilization is achieved 1

The Hypertension guidelines recommend expediting delivery immediately if severe hypertension, progressive thrombocytopenia, or other severe features develop 1

The Hepatology journal recommends continuing close monitoring for 48-72 hours postpartum, as 20% of HELLP syndrome cases occur within 48 hours of delivery 3