Management of Preeclampsia at 38 Weeks

Evaluation and Diagnosis

The International Society for the Study of Hypertension in Pregnancy (ISSHP) recommends hospitalization for pregnant women with preeclampsia at 38 weeks of gestation for immediate preparation for delivery, as the condition can rapidly become an emergency 1, 2, 3
The ISSHP guidelines indicate that hospitalization is mandatory for all pregnant women with preeclampsia at the time of diagnosis, regardless of gestational age 1, 2, 3
Initial maternal monitoring should include blood pressure checks every 4 hours or more frequently if necessary, as well as clinical evaluation of clonus and deep tendon reflexes 1, 4
Laboratory tests, including hemoglobin, platelets, liver transaminases, creatinine, and uric acid, should be performed at least twice a week 1, 3, 4

The ISSHP recommends initiating oral anti-hypertensive treatment for pregnant women with preeclampsia and blood pressure ≥140/90 mmHg, with a target diastolic blood pressure of 85 mmHg and systolic blood pressure of 110-140 mmHg 1, 2, 3, 4
First-line agents for hypertension include methyldopa, labetalol, and oral nifedipine 1, 2, 4

The ISSHP recommends the use of magnesium sulfate for seizure prophylaxis in pregnant women with preeclampsia, particularly those with symptoms such as headache, even if mild 1, 2, 3, 4
Magnesium sulfate should be administered during labor and for the first 24 hours postpartum 1, 4

The ISSHP recommends immediate delivery for pregnant women with preeclampsia at ≥37 weeks of gestation, regardless of severity 1, 2, 3
Vaginal delivery should be attempted if there are no obstetric contraindications, and cesarean section should be reserved for usual obstetric indications 1

Continuous monitoring of blood pressure, cardiotocography, and magnesium sulfate administration should be performed during labor and for 24 hours postpartum 1
Signs of alarm, such as severe headache, visual disturbances, epigastric pain, and dyspnea, should be closely monitored 1, 3