Pre-eclampsia and its management

Pre-eclampsia is diagnosed when blood pressure is ≥140/90 mmHg after 20 weeks of pregnancy plus proteinuria ≥300 mg in 24 hours or ≥2+ on urine dipstick. It may also be diagnosed in a pregnant woman with elevated blood pressure and features of end-organ damage such as pulmonary oedema, renal impairment, or liver dysfunction.

Diagnostic criteria

Most patients are asymptomatic, but symptoms may include:

• Headache

• Dizziness

• Blurred vision

• Epigastric pain

Clinical findings include:

• Blood pressure ≥140/90 mmHg

• Proteinuria ≥300 mg in 24 hours

• Generalized oedema may be present (not required for diagnosis)

Investigations

• Urine protein assessment (qualitative or quantitative 24-hour urine collection)

• Obstetric ultrasound and biophysical profile

• Urea, creatinine, electrolytes, liver function tests and uric acid

• Full blood picture (FBP) and clotting profile

• Fundoscopy

Non-Pharmacological management

Pregnancy <37 Weeks Gestation

• Hospitalization and close monitoring

• Bed rest

• Daily monitoring of:

  • Blood pressure

  • Urine output

  • Proteinuria

  • Fetal movements

  • Fetal heart rate

Pregnancy >37 weeks gestation

• Admit and deliver accordingly

Pre-eclampsia with severe features

This is diagnosed when:

• Blood pressure ≥160/110 mmHg (especially diastolic BP ≥110 mmHg)

OR

• Blood pressure ≥140/90 mmHg with evidence of end-organ damage such as:

  • Severe headache

  • Epigastric pain

  • Blurred vision with or without vomiting

  • Pulmonary oedema

  • Renal impairment

  • Liver dysfunction

  • Haemolysis

  • Thrombocytopenia

Pharmacological treatment

Blood Pressure Control

Hydralazine

• 5 mg IV diluted in 10 mL sterile water administered over 4 minutes as an initial dose

• Follow with 5–10 mg IV every 20 minutes as required until diastolic BP is less than 110 mmHg AND

Methyldopa

• 500 mg orally every 8 hours AND

Nifedipine

• 20 mg orally every 8 hours until blood pressure is stabilized

Refractory Hypertension

Labetalol

• 10–20 mg IV bolus stat

• Repeat every 10–20 minutes as needed

• Doses may be doubled gradually

• Do not exceed 80 mg in a single dose

• Maximum cumulative dose: 300 mg

Antenatal Corticosteroids

Dexamethasone Injection

• 6 mg every 12 hours for 48 hours if pregnancy is less than 34 weeks gestation

Seizure Prophylaxis

Magnesium Sulfate is the anticonvulsant of choice.

• 1 g IV hourly in 250 mL Ringer's Lactate

OR

• 5 g of 50% magnesium sulfate IM every 4 hours in alternating buttocks

Continue treatment:

• For 24 hours if gestational age is ≤34 weeks

• Until 24 hours after delivery if gestational age is ≥34 weeks

(Refer to Eclampsia section)

Obstetrical Management

• If the pregnancy is at term, stabilize the mother and proceed with delivery.

• Vaginal delivery is preferred whenever feasible.