Preeclampsia

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Preeclampsia Treatment

The only known cure for preeclampsia is delivery. However, if that delivery would be preterm, the disease may be managed by bed rest and delivery as soon as the fetus has a good chance of surviving outside the womb. Patients are usually hospitalized, but occasionally they may be managed on an outpatient basis with careful monitoring of blood pressure, urine checks for protein, and weight.

Optimally, attempts are made to manage the condition until a delivery after 36 weeks of pregnancy can be achieved.

Labor may be induced if any of the following occur:

• Diastolic blood pressure greater than 100 mmHg consistently for a 24 hour period, or any confirmed reading over 110 mmHg
• Persistent or severe headache
• Abdominal pain
• Abnormal liver function tests
• Rising serum creatinine
• HELLP syndrome
• Pulmonary edema (fluid in lungs)
• Eclampsia
• Thrombocytopenia
• Non-reassuring fetal monitoring tracings
• Failure of fetal growth noted by ultrasound
• Abnormal biophysical profile

In severe cases of preeclampsia with the pregnancy beyond 28 weeks, delivery is the treatment of choice. For pregnancies less than 24 weeks, the induction of labor is recommended, although the likelihood of a viable fetus is minimal.

Prolonging such pregnancies has shown to result in maternal complications, as well as infant death in approximately 87% of cases. Pregnancies between 24 and 28 weeks gestation present a "gray zone," and conservative management may be attempted, with monitoring for the presentation of maternal and fetal complications.

During induction of labor and delivery, medications are given to prevent seizures and to keep blood pressure under good control. The decision for vaginal delivery versus Cesarean section is based on fetal tolerance of labor.