Management of preeclampsia

Childbirth is the cure for preeclampsia as the disease process usually resolves within days of delivery. Delivery is always preferable from the perspective of maternal health. However, decisions on induction of labor or cesarean delivery must include a consideration of prematurity-related neonatal risks and the severity of the preeclampsia. Women with mild preeclampsia should be carefully followed until they are close to term and delivered at 37-39 weeks [30]. Women with severe preeclampsia may be expectantly managed until 32-34 weeks, or delivered sooner based on maternal and fetal status [31]. Women with preeclampsia need to have regular surveillance of the fetus with nonstress testing and amniotic fluid volume assessment. Blood work should be checked periodically to detect renal or hepatic involvement, hemolysis, or thrombocytopenia.

The hypertension of preeclampsia only warrants treatment if the systolic blood pressure is above 160 mmHg or the diastolic blood pressure is above 110 mmHg [3]. If these pressures occur near term, then the blood pressure may be managed with intravenous hydralazine or labetalol until delivery [32]. Women with severe preeclampsia undergoing expectant management may have their blood pressure controlled with oral labetalol, methyldopa, or nifedipine [3]. Magnesium sulfate is the drug of choice for the prevention and treatment of eclamptic seizures [33]. All women with severe preeclampsia need intravenous magnesium in labor and for 24 h postpartum [34]. The use of magnesium sulfate in women with mild preeclampsia remains controversial, as 400 women may need to be treated to prevent one eclamptic seizure [35].

Neonatal morbidity and mortality is due to the risk of prematurity, uteroplacental insufficiency, or placental abruption. An ultrasound for estimated fetal weight should be done at the time of diagnosis to evaluate for possible intrauterine growth restriction secondary to uteroplacental insufficiency [3]. If delivery is required prior to term, then the birth should occur at an institution with a neonatal intensive care unit capable of caring for infants at the anticipated gestational age. Placental abruption is an unpredictable event, which can lead to fetal death or morbidity.

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