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What is preeclampsia and How do you treat it?

Posted on behalf of D'Amico & Pettinicchi, LLC on Aug 15, 2015 in Medical Malpractice

Untreated or inappropriately treated preeclampsia can result in damage to both an unborn baby and the mother. Although some of the criteria for the diagnosis of preeclampsia are changing, the general thought is that the diagnosis of preeclampsia can generally be made in a previously normotensive woman with new onset hypertension and either proteinuria or end-organ dysfunction after 20 weeks. Hypertension was defined as a blood pressure reading greater than or equal to 140/90, taken serially (generally 4 hours apart). Proteinuria is diagnosed by both a dipstick into a urine sample, and then confirmed with a 24 hour urine test (urine measured and collected over 24 hour period and tested for protein). End organ dysfunction refers to issues like low platelet count, renal dysfunction, or increased serum creatinine.

Treatment for preeclampsia during pregnancy depends on the severity of the hypertension and the presence of other symptoms such as headaches or visual disturbances. In general, hypertensive medications are not prescribed for blood pressures consistently less than 150/100, unless there are signs of cardiac decompensation or cerebral symptoms (severe headache, visual disturbances, chest discomfort, shortness of breath, or confusion). For women with chronic non-severe hypertension with comorbid conditions, antihypertensive drug therapy should be used to keep systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg. The American College of Obstetricians and Gynecologists recommends using labetolol, nifedipine, or methyldopa as first line therapy.

Preeclampsia is defined as severe when hypertension is greater than or equal to 160/110 with end organ failure (thrombocytopenia, impaired liver function, progressive renal insufficiency, pulmonary edema, new onset cerebral or visual disturbances). Severe hypertension should be treated to protect the mother from serious complications such as stroke, heart failure, or renal failure. Health care providers should ask patients about persistent and/or severe headaches; visual abnormalities (scotomata, photophobia, blurred vision, or temporary blindness); upper abdominal or epigastric (just under rib cage and generally more to the right hand side) pain; nausea, vomiting; dyspnea; and altered mental status. Patients should undergo platelet counts, serum creatinine, AST, ALT, obstetrical ultrasounds and non-stress testing. Treatment for severe preeclampsia is the same as for preeclampsia, but ACOG recommends using the short acting preparation of oral nifedipine under these circumstances as well as hydralazine. The goal blood pressure in this context is to achieve a systolic pressure of 140-150 mmHg and a diastolic pressure of 90-100 mmHg. Magnesium sulfate is also used in a hospital setting intravenously for severe preeclampsia to control high blood pressure and as seizure prophylaxis due to eclampsia, or to control seizures due to eclampsia.

The only way to completely cure preeclampsia is to deliver the pregnancy. The decision to deliver is made on a case by case basis and depends on the severity of the preeclampsia and severity of complications. ACOG recommends delivery at 37-39 weeks 
for women with hypertension controlled by medications; and 36-37 weeks for women with severe hypertension that is difficult to control. 
Post-partum hypertension related to preeclampsia usually resolves within a few weeks; it can take 6 months. If blood pressures are borderline at delivery, blood pressures should be monitored closely, sometimes with home blood pressure monitoring equipment. Women should be instructed to seek medical attention if they develop severe headaches or if blood pressure increases to severe levels. The medications to manage post-partum hypertension are the same as for during pregnancy, plus other traditional blood pressure medications may be available depending on whether the patient is breastfeeding.