Initial Management of Pre-eclampsia

Overview of Management

The American College of Cardiology recommends urgent blood pressure control when severe hypertension is present, administration of magnesium sulfate for seizure prophylaxis in severe cases, comprehensive maternal and fetal monitoring, and preparation for possible delivery depending on gestational age and clinical severity 1, 2, 3

The American Heart Association suggests urgent treatment of severe hypertension in a monitored setting using oral nifedipine, intravenous labetalol, or intravenous hydralazine 2, 3
Target diastolic BP of 85 mmHg and systolic BP between 110-140 mmHg to reduce the risk of developing severe maternal complications 2, 3

Administer magnesium sulfate for seizure prophylaxis in women with pre-eclampsia who have proteinuria with severe hypertension or any hypertension with neurological signs/symptoms 3, 4

Complete blood count with focus on hemoglobin and platelet count, and comprehensive metabolic panel including liver enzymes, creatinine, and uric acid 1, 3
Urinalysis and urine protein/creatinine ratio (≥30 mg/mmol or 0.3 mg/mg is abnormal) 5

Continuous blood pressure monitoring, assessment for proteinuria, clinical assessment including deep tendon reflexes and clonus, and evaluation for signs of end-organ damage 1, 3
Pulse oximetry monitoring 3

Initial ultrasound to assess fetal biometry, amniotic fluid volume, and umbilical artery Doppler 1, 3
Electronic fetal monitoring to assess fetal heart rate and variability 1, 6

Immediate delivery is indicated for women with pre-eclampsia at ≥37 weeks' gestation 1, 3, 6
For women between 34-37 weeks, expectant management with close monitoring is appropriate in the absence of severe features 6
Delivery is necessary for uncontrolled severe hypertension, oxygen saturation <90%, progressive deterioration in liver function, renal function, hemolysis, or platelet count, neurological complications, pulmonary edema or placental abruption, or non-reassuring fetal status 1, 3, 6

All cases of pre-eclampsia should be considered potentially severe as they can rapidly progress to emergencies 1, 3, 6
Blood pressure alone is not a reliable indicator of disease severity as serious organ dysfunction can develop at relatively mild levels of hypertension 3, 6
Neither serum uric acid nor the level of proteinuria should be used as an indication for delivery 1, 3
Plasma volume expansion is not recommended routinely 1, 3