Management of Suspected Pre-eclampsia in Pregnant Women

Diagnosis and Assessment

The American College of Cardiology recommends that headache in the presence of any degree of hypertension should be considered pre-eclampsia until proven otherwise, given the combination of headache and dyspnea at 32 weeks, regardless of whether hypertension or proteinuria has been documented yet 1
The European Society of Cardiology states that dyspnea may indicate pulmonary edema from severe pre-eclampsia or HELLP syndrome 2
The American Heart Association recommends measuring blood pressure immediately, and if diastolic BP ≥90 mmHg with headache, refer for same-day hospital assessment 3

The American College of Obstetricians and Gynecologists recommends obtaining the following tests urgently to evaluate for maternal organ dysfunction and exclude pre-eclampsia: complete blood count with platelet count, liver transaminases, serum creatinine and uric acid, and urinalysis with protein:creatinine ratio or albumin:creatinine ratio 1, 4
The European Society of Cardiology recommends testing for hemolysis, including LDH, indirect bilirubin, and peripheral smear 2

The American College of Cardiology recommends that if hypertension is confirmed (BP ≥140/90 mmHg), initiate oral labetalol, nifedipine, or methyldopa for non-severe hypertension, and urgent treatment in a monitored setting for severe hypertension 2
The American Heart Association recommends administering magnesium sulfate if severe hypertension is present or if delivery before 32 weeks is anticipated, for both seizure prophylaxis and fetal neuroprotection 2
The European Society of Cardiology recommends giving betamethasone or dexamethasone immediately for 48 hours to accelerate fetal lung maturation if delivery is anticipated before 34 weeks 6, 2

The American College of Obstetricians and Gynecologists recommends investigating the cause of anemia, including iron deficiency, hemolysis, fetomaternal hemorrhage, or inherited disorders, and performing iron supplementation if iron deficiency is confirmed 7, 5

The American College of Obstetricians and Gynecologists recommends performing obstetrical ultrasound to assess fetal biometry, estimated fetal weight, amniotic fluid volume, umbilical artery Doppler, and confirm breech presentation 4
The European Society of Cardiology recommends continuous electronic fetal heart rate monitoring for a minimum of 4 hours for all pregnant trauma/high-risk patients ≥23 weeks 4

The American College of Obstetricians and Gynecologists recommends delivering urgently if any of the following develop: inability to control BP despite ≥3 antihypertensive classes, progressive thrombocytopenia, progressively abnormal liver or renal function tests, pulmonary edema, severe intractable headache or repeated visual scotomata, eclamptic seizure, placental abruption, or non-reassuring fetal status 4, 2, 5