Management of Pre-eclampsia
| Hypertension | Severe Hypertension | |
|---|---|---|
| BP | 140/90 TO 159/109 mmHg | 160/ 110 mmHg or more |
| Admit | If any clinical concerns | Admit, but if BP falls below 160/110 mmHg then manage as for hypertension |
| Pharmacological Treatment | If BP REMAINS > 140/90 | Offer to ALL women |
| BP Target after starting antihypertensive | 135/85 | 135/85 |
| BP Measurement | At least every 48 hours. -More frequently if the woman is admitted to hospital | Every 15–30 minutes until BP is less than 160/110 mmHg, – then at least 4 times daily while the woman is an inpatient, depending on clinical circumstances |
| Urine dipstick for proteinuria ( Remember- patient has already been diagnosed as pre-eclampsia) | Only repeat if clinically indicated | Only repeat if clinically indicated |
| Labs( FBC, LFT, RFT) | Twice a week | Thrice a week |
| Fetal assessment 1. Fetal heart auscultation | Offer at every antenatal appointment. | Offer at every antenatal appointment. |
| CTG | At diagnosis and then only if clinically indicated | At diagnosis and then only if clinically indicated |
| Ultrasound | At diagnosis and, – if normal, repeat every 2 weeks | At diagnosis and, – if normal, repeat every 2 weeks |
- TIMING OF BIRTH- Thresholds for considering planned early birth before 37 weeks may be ( There may be other indications also) –
- inability to control maternal blood pressure despite using 3 or more classes of antihypertensives in appropriate doses
- maternal pulse oximetry less than 90%
- progressive deterioration in liver function, renal function, haemolysis, or platelet count
- ongoing neurological features, such as severe intractable headache, repeated visual scotomata, or eclampsia
- reversed end-diastolic flow in the umbilical artery doppler velocimetry, a non-reassuring cardiotocograph, or stillbirth.
- placental abruption
- Birth before 34 weeks- Deliver if there are indications. Give steroids +_ Magensium sulphate. Neonatology review. Senior Obstetrician Involvement.
- Birth from 34 +0 to 36 + 6 weeks- Deliver if there are indications. Consider steroids. Neonatology review. Senior Obstetrician Involvement.
- 37 weeks onwards- Initiate birth within 24 to 48 hours