Preeclampsia Screening and Prevention

Screening and Risk Factors

All pregnant women should be screened for preeclampsia with blood pressure measurements at each prenatal visit, as recommended by the American Academy of Family Physicians 1
High-risk factors for preeclampsia include a history of preeclampsia, previous adverse pregnancy outcome, pre-existing conditions such as diabetes, chronic hypertension, and renal disease, multifetal gestation, nulliparity, obesity, African American race, low socioeconomic status, and advanced maternal age 1

Proper blood pressure measurement technique involves the patient being relaxed, seated for 5 minutes, with legs uncrossed and back supported, arm at heart level, and using a large blood pressure cuff if upper arm circumference is greater than or equal to 33 cm 1

Calcium supplementation of 1.2-2.5 g/day is recommended for women with low calcium intake, less than 600 mg/day, as supported by the American College of Obstetricians and Gynecologists 2
Regular exercise, following guidelines of at least 3 days/week for 50 minutes using aerobic exercise, strength, and flexibility training, is recommended 2
Low-dose aspirin (81 mg/day) should be initiated between 12-16 weeks of gestation and continued until delivery for high-risk women, as recommended by the USPSTF and ACOG, with a reduction in preeclampsia risk by 24% 3
Diets focusing on fruits, vegetables, whole grains, and limiting foods high in fat, sugar, and salt are associated with reduced hypertension in pregnancy risk, and excessive gestational weight gain is associated with hypertension in pregnancy risk 4

Preeclampsia is defined as gestational hypertension accompanied by ≥1 of the following new-onset conditions at or after 20 weeks' gestation, as supported by the American College of Cardiology 2
Proteinuria is present in approximately 75% of preeclampsia cases but is not required for diagnosis, and urinary protein assessment is recommended using protein/creatinine ratio, with ≥30 mg/mmol considered abnormal 2
HELLP syndrome occurs in 0.2%-0.6% of pregnancies and can develop with or without hypertension, which is present in 85% of cases 5

The definitive management of preeclampsia involves antihypertensive treatment for severe hypertension (SBP ≥160 mmHg and/or DBP ≥110 mmHg), magnesium sulfate for seizure prophylaxis in severe cases, and delivery timing based on disease severity and gestational age 6
Severe hypertension (SBP ≥160 mmHg and/or DBP ≥110 mmHg) requires immediate treatment to reduce maternal complications, with first-line IV medications including labetalol, hydralazine, and oral nifedipine, and a target BP of diastolic 85 mmHg, systolic 110-140 mmHg 6
Magnesium sulfate should be continued for at least 24 hours postpartum in patients with severe preeclampsia 6

Immediate delivery is the definitive treatment for HELLP syndrome regardless of gestational age, with the mode of delivery depending on maternal condition, fetal status, and gestational age, as recommended by the British Journal of Anaesthesia guidelines 7
Patients with partial HELLP syndrome should be delivered expeditiously after maternal stabilization, regardless of gestational age, as recommended by the American Association for the Study of Liver Diseases 5
Platelet transfusion is recommended if the platelet count is less than 50,000/mm³, especially prior to Caesarean section, and whole blood or packed red cells are recommended if hemoglobin is less than 10 g/dL 7

Blood pressure should be monitored at each antenatal visit, with minimum twice weekly blood tests for women with diagnosed preeclampsia, and laboratory monitoring should include complete blood count with platelets, liver function tests, renal function, and uric acid 2
Automated home blood pressure monitoring devices should be prescribed, and patients should be instructed on proper technique and appropriate cuff size, with elevated readings reported promptly for triage, as recommended by the American Academy of Family Physicians 8
Continuous fetal heart rate monitoring is essential in patients with preeclampsia, along with ultrasound for fetal growth assessment, amniotic fluid volume assessment, and Doppler studies if growth restriction is suspected, as recommended by the American College of Obstetricians and Gynecologists 9
Continue blood pressure monitoring every 4-6 hours for at least 3 days, taper antihypertensive medications slowly after days 3-6, and follow-up within 1 week if still on antihypertensives at discharge, as recommended by the ACOG guidelines 10, 2