Severe preeclampsia

A. All women with severe preeclampsia should be delivered or hospitalized for the duration of pregnancy. Prolonged antepartum management may be considered in women under 32 to 34 weeks of gestation who have:

1. Severe proteinuria (greater than 5 g in 24 hours).

2. Mild intrauterine fetal growth restriction (fifth to tenth percentile), as long as antepartum fetal testing remains reassuring, oligohydramnios is not severe, umbilical artery diastolic flow is not reversed on Doppler velocimetry, and there is progressive fetal growth.

3. Severe hypertension with blood pressure reduction after hospitalization.

4. Asymptomatic laboratory abnormalities that quickly resolve after hospitalization.

B. Delivery should be initiated, after a course of antenatal corticosteroid therapy if possible, when there is poorly controlled, severe hypertension, eclampsia, thrombocytopenia (less than 100,000 platelets/microL), elevated liver function tests with epigastric or right upper quadrant pain, pulmonary edema, rise in serum creatinine concentration by 1 mg/dL over baseline, placental abruption, or persistent severe headache or visual changes. Fetal indications for delivery include nonreassuring fetal testing, severe oligohydramnios, or severe fetal growth restriction (less than the 5th percentile).

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