Management of preeclampsia

A. The definitive treatment of preeclampsia is delivery. Delivery is recommended for women with mild preeclampsia at or near term and for most women with severe preeclampsia or severe gestational hypertension regardless of gestational age. Exceptions may be made for women remote from term (less than 32 to 34 weeks of gestation) who improve after hospitalization and do not have significant end-organ dysfunction or fetal deterioration.

B. Fetal assessment consists of daily fetal movement counts and nonstress testing and/or biophysical profiles at periodic intervals. A sonographic estimation of fetal weight should be performed to look for growth restriction and oligohydramnios, and it should be repeated serially.

Fetal Assessment in Preeclampsia

Mild preeclampsia

Daily fetal movement counting Ultrasound examination for estimation of fetal weight and amniotic fluid determination at diagnosis. Repeat in three weeks if the initial examination is normal, twice weekly if there is evidence of fetal growth restriction or oligohydramnios. Nonstress test and/or biophysical profile once or twice weekly. Testing should be repeated immediately if there is an abrupt change in maternal condition.

Severe preeclampsia

Daily nonstress testing and/or biophysical profile

C. Antenatal corticosteroids to promote fetal lung maturation should be administered to women less than 34 weeks of gestation who are at high risk for delivery within the next seven days. Betamethasone (two doses of 12 mg given intramuscularly 24 hours apart) or dexamethasone (four doses of 6 mg given intramuscularly 12 hours apart) may be used.

D. Maternal monitoring. Laboratory evaluation (eg, hematocrit, platelet count, creatinine, urine protein, LDH, AST, ALT, uric acid) should be repeated once or twice weekly in women with mild stable preeclampsia.

E. Symptoms. Patients should call immediately if they develop severe or persistent headache, visual changes, right upper quadrant or epigastric pain, nausea or vomiting, shortness of breath, or decreased urine output. Decreased fetal movement, vaginal bleeding, abdominal pain, rupture of membranes, or uterine contractions should be reported immediately.

F. Women with severe preeclampsia should be delivered or hospitalized for the duration of pregnancy. Prolonged antepartum management may be considered in selected women under 32 weeks of gestation, such as those whose condition improves after hospitalization and who have no evidence of end-organ dysfunction or fetal deterioration.

G. Timing and indications for delivery. Delivery at or by 40 weeks of gestation should be considered for all women with preeclampsia. Women with mild disease and a favorable cervix may benefit from induction as early as 38 weeks, while those with stable severe disease should be delivered after 32 to 34 weeks if possible (with demonstration of fetal pulmonary maturity).

0 0

Post a comment