Management and Treatment of Preeclampsia

Introduction to Preeclampsia Management

The American College of Cardiology and other guideline societies recommend that the definitive treatment for preeclampsia is delivery of the placenta and fetus, with timing based on gestational age, maternal condition, and fetal status 1, 2

Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg) after 20 weeks of gestation with proteinuria or evidence of end-organ damage, according to the American Heart Association 4
The European Society of Cardiology suggests that all women with preeclampsia should be hospitalized initially to confirm diagnosis, assess severity, and monitor progression 3
Maternal monitoring should include blood pressure measurements every 4 hours (more frequently if severe) and at least twice weekly blood tests for hemoglobin, platelet count, liver enzymes, and renal function, as recommended by the American College of Obstetricians and Gynecologists 1, 3

The American Heart Association recommends that severe hypertension (≥160/110 mmHg) requires urgent treatment in a monitored setting using oral nifedipine, IV labetalol, or IV hydralazine 1, 3
For non-severe hypertension (≥140/90 mmHg), the European Society of Cardiology suggests treating with oral antihypertensives aiming for a target diastolic BP of 85 mmHg and systolic BP between 110-140 mmHg 1, 5

The American College of Obstetricians and Gynecologists recommends that all women with preeclampsia should receive magnesium sulfate for convulsion prophylaxis, especially those with severe hypertension or neurological symptoms 1, 3
The dosing regimen for magnesium sulfate includes a loading dose of 4 g IV or 10 g IM, maintenance of 5 g IM every 4 hours or IV infusion of 1 g/hour, and continuation until delivery and for at least 24 hours postpartum, as suggested by the American Heart Association 1, 5

The European Society of Cardiology recommends limiting total fluid intake to 60-80 mL/hour to avoid pulmonary edema 3
The American College of Cardiology suggests that plasma volume expansion is not recommended routinely 1

The American College of Obstetricians and Gynecologists recommends that initial assessment should confirm fetal well-being and serial ultrasound surveillance including fetal biometry, amniotic fluid assessment, and umbilical artery Doppler 1, 3, 4

The American Heart Association suggests delivering at 37 weeks' gestation or earlier if any of the following develop: repeated episodes of severe hypertension, progressive thrombocytopenia, progressively abnormal renal or liver enzyme tests, pulmonary edema, abnormal neurological features, or non-reassuring fetal status 1, 3, 5
Women with onset of preeclampsia at ≥37 weeks' gestation should be delivered, according to the European Society of Cardiology 1

The American College of Obstetricians and Gynecologists recommends continuing close monitoring for at least 3 days postpartum as eclampsia can still develop and monitoring BP at least every 4-6 hours 3, 5
Antihypertensives should be continued and tapered slowly after days 3-6 postpartum, as suggested by the American Heart Association 5

The European Society of Cardiology recommends that women still requiring antihypertensives at discharge should be reviewed within 1 week and all women with preeclampsia should be reviewed at 3 months postpartum 5
By 3 months, blood pressure, urinalysis, and all laboratory tests should have normalized; persistent abnormalities require further investigation, according to the American College of Cardiology 5
Women with a history of preeclampsia have increased lifetime risks of cardiovascular disease, stroke, diabetes mellitus, venous thromboembolic disease, and chronic kidney disease, as reported by the American Heart Association 3, 4, 5

The American College of Obstetricians and Gynecologists recommends low-dose aspirin (75-162 mg/day) before 16 weeks' gestation for women with strong clinical risk factors and supplemental calcium if dietary intake is likely low 3

The American Heart Association suggests that there should be no attempt to diagnose mild versus severe preeclampsia clinically as all cases may become emergencies, often rapidly 1
Neither serum uric acid nor the level of proteinuria should be used as an indication for delivery, according to the European Society of Cardiology 1