Preeclampsia Management Guidelines

Definition and Diagnosis

Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg) after 20 weeks of gestation with either proteinuria OR evidence of end-organ damage, according to the American College of Obstetricians and Gynecologists 1, 2
The American Academy of Family Physicians recommends a hypertension threshold of systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg 3
The British Medical Journal suggests proteinuria is defined as ≥300 mg/24 hours OR protein/creatinine ratio ≥30 mg/mmol (0.3 mg/mg) 4, 1

The American Academy of Family Physicians states that preeclampsia affects 3-7% of all pregnancies 3
The American College of Obstetricians and Gynecologists notes that preeclampsia is the second leading cause of maternal mortality worldwide 3

The American Academy of Family Physicians recommends that all pregnant women should undergo blood pressure screening at every prenatal visit throughout pregnancy 3
The British Medical Journal suggests that low-dose aspirin (75-162 mg/day) should be initiated before 16 weeks' gestation in women with strong clinical risk factors, as recommended by the American College of Obstetricians and Gynecologists 6, 2

The American College of Obstetricians and Gynecologists states that all cases of preeclampsia should be considered potentially severe as they can rapidly progress to emergencies 1, 2
The British Medical Journal notes that severe hypertension is defined as BP ≥160/110 mmHg 1, 6, 2

The American College of Obstetricians and Gynecologists recommends that severe hypertension requires urgent treatment in a monitored setting within minutes to prevent maternal stroke 1, 6, 2
The American Academy of Family Physicians suggests that the target BP is systolic 110-140 mmHg, diastolic 85 mmHg 1, 6, 2

The American College of Obstetricians and Gynecologists states that magnesium sulfate should be administered for seizure prophylaxis in women with preeclampsia who have severe hypertension or neurological symptoms 1, 6, 2

The American College of Obstetricians and Gynecologists recommends that total fluid intake should be strictly limited to 60-80 mL/hour to prevent pulmonary edema 6, 2

The American College of Obstetricians and Gynecologists states that delivery is the definitive treatment for preeclampsia 6, 2
The American Academy of Family Physicians notes that immediate delivery is indicated for all women with preeclampsia at ≥37 weeks' gestation 1, 6, 2

The American College of Obstetricians and Gynecologists recommends that close monitoring must continue for at least 3 days postpartum as eclampsia can still develop 6, 2

The American College of Obstetricians and Gynecologists states that women with a history of preeclampsia have significantly increased lifetime cardiovascular risk 2