Preeclampsia - Revision history

Danbot: Strip excess bold

2026-03-22T09:28:18Z

Strip excess bold

← Revisión anterior		Revisión del 09:28 22 mar 2026
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	==Background==		==Background==
	*Hypertensive disorder of pregnancy characterized by '''new-onset hypertension + proteinuria or end-organ dysfunction''' after '''20 weeks gestation'''		*Hypertensive disorder of pregnancy characterized by '''new-onset hypertension + proteinuria or end-organ dysfunction''' after '''20 weeks gestation'''
	*Affects ~~'''~~2-8% of pregnancies~~'''~~ worldwide		*Affects 2-8% of pregnancies worldwide
	*Leading cause of maternal and fetal morbidity and mortality		*Leading cause of maternal and fetal morbidity and mortality
	*Risk factors:		*Risk factors:
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	===Diagnostic Criteria (ACOG)===		===Diagnostic Criteria (ACOG)===
	*~~'''~~Blood pressure ≥140/90 mmHg~~'''~~ on two occasions at least 4 hours apart (or ≥160/110 once) after 20 weeks in previously normotensive patient		*Blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart (or ≥160/110 once) after 20 weeks in previously normotensive patient
	*PLUS one or more:		*PLUS one or more:
	**~~'''~~Proteinuria~~'''~~ (≥300 mg/24h, protein/creatinine ratio ≥0.3, or dipstick ≥2+)		**Proteinuria (≥300 mg/24h, protein/creatinine ratio ≥0.3, or dipstick ≥2+)
	**~~'''~~OR end-organ dysfunction~~'''~~ (even without proteinuria):		**OR end-organ dysfunction (even without proteinuria):
	***Platelets <100,000		***Platelets <100,000
	***Creatinine >1.1 mg/dL (or doubling of baseline)		***Creatinine >1.1 mg/dL (or doubling of baseline)
Línea 27:		Línea 27:
	*BP 140-159/90-109 mmHg		*BP 140-159/90-109 mmHg
	*Proteinuria		*Proteinuria
	*May be ~~'''~~asymptomatic~~'''~~ or have mild edema		*May be asymptomatic or have mild edema

	===Preeclampsia With Severe Features (Any One)===		===Preeclampsia With Severe Features (Any One)===
	*~~'''~~BP ≥160/110 mmHg~~'''~~ (confirmed within minutes to facilitate timely treatment)		*BP ≥160/110 mmHg (confirmed within minutes to facilitate timely treatment)
	*~~'''~~Thrombocytopenia~~'''~~ (<100,000)		*Thrombocytopenia (<100,000)
	*~~'''~~Impaired liver function~~'''~~ (transaminases >2x normal, severe RUQ/epigastric pain)		*Impaired liver function (transaminases >2x normal, severe RUQ/epigastric pain)
	*~~'''~~Renal insufficiency~~'''~~ (creatinine >1.1 mg/dL)		*Renal insufficiency (creatinine >1.1 mg/dL)
	*~~'''~~Pulmonary edema~~'''~~		*Pulmonary edema
	*~~'''~~New-onset headache~~'''~~ unresponsive to medication		*New-onset headache unresponsive to medication
	*~~'''~~Visual disturbances~~'''~~ (scotomata, blurred vision, photopsia)		*Visual disturbances (scotomata, blurred vision, photopsia)

	===HELLP Syndrome===		===HELLP Syndrome===
	*~~'''H'''emolysis~~, ~~'''E'''levated '''L'''iver~~ enzymes, ~~'''L'''ow '''P'''latelets~~		*Hemolysis, Elevated Liver enzymes, Low Platelets
	*Variant of severe preeclampsia; may occur without significant hypertension		*Variant of severe preeclampsia; may occur without significant hypertension
	*Risk of hepatic rupture, [[DIC]], [[placental abruption]]		*Risk of hepatic rupture, [[DIC]], [[placental abruption]]
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	==Evaluation==		==Evaluation==
	*~~'''~~Blood pressure~~'''~~: manual measurement, correct cuff size, patient seated		*Blood pressure: manual measurement, correct cuff size, patient seated
	*~~'''~~CBC with platelet count~~'''~~		*CBC with platelet count
	*~~'''~~BMP~~'''~~: creatinine, uric acid (elevated in preeclampsia)		*BMP: creatinine, uric acid (elevated in preeclampsia)
	*~~'''~~LFTs~~'''~~: AST/ALT (hepatic involvement)		*LFTs: AST/ALT (hepatic involvement)
	*~~'''~~LDH, haptoglobin, peripheral smear~~'''~~ (evaluate for hemolysis / HELLP)		*LDH, haptoglobin, peripheral smear (evaluate for hemolysis / HELLP)
	*~~'''~~Coagulation studies~~'''~~: PT/INR, fibrinogen, D-dimer (if concern for DIC)		*Coagulation studies: PT/INR, fibrinogen, D-dimer (if concern for DIC)
	*~~'''~~Urinalysis and urine protein/creatinine ratio~~'''~~		*Urinalysis and urine protein/creatinine ratio
	*~~'''~~Fetal monitoring~~'''~~: continuous fetal heart rate monitoring, BPP/NST		*Fetal monitoring: continuous fetal heart rate monitoring, BPP/NST
	*~~'''~~Bedside US~~'''~~: fetal assessment, amniotic fluid index		*Bedside US: fetal assessment, amniotic fluid index

	==Management==		==Management==
	===Severe Hypertension (BP ≥160/110) — Treat Within 30-60 Minutes===		===Severe Hypertension (BP ≥160/110) — Treat Within 30-60 Minutes===
	*~~'''~~First-line~~'''~~:		*First-line:
	**~~'''~~IV labetalol~~'''~~: 20 mg IV bolus, then 40 mg, then 80 mg q10min (max 300 mg)		**IV labetalol: 20 mg IV bolus, then 40 mg, then 80 mg q10min (max 300 mg)
	**~~'''~~IV hydralazine~~'''~~: 5-10 mg IV q20min (max 30 mg)		**IV hydralazine: 5-10 mg IV q20min (max 30 mg)
	**~~'''~~PO nifedipine (immediate release)~~'''~~: 10-20 mg PO q20-30min (max 50 mg)		**PO nifedipine (immediate release): 10-20 mg PO q20-30min (max 50 mg)
	*~~'''~~Goal: BP 140-150/90-100 mmHg~~'''~~ (avoid precipitous drops — risk of fetal distress)		*Goal: BP 140-150/90-100 mmHg (avoid precipitous drops — risk of fetal distress)
	*~~'''~~Avoid~~'''~~: ACE inhibitors, ARBs (teratogenic), nitroprusside (cyanide risk to fetus)		*Avoid: ACE inhibitors, ARBs (teratogenic), nitroprusside (cyanide risk to fetus)

	===Seizure Prophylaxis===		===Seizure Prophylaxis===
	*~~'''~~Magnesium sulfate~~'''~~ for ALL patients with ~~'''~~severe features~~'''~~<ref>Altman D, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. ''Lancet''. 2002;359(9321):1877-1890. PMID 12057549</ref>		*Magnesium sulfate for ALL patients with severe features<ref>Altman D, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. ''Lancet''. 2002;359(9321):1877-1890. PMID 12057549</ref>
	**~~'''~~Loading dose: 4-6g IV over 15-20 minutes~~'''~~		**Loading dose: 4-6g IV over 15-20 minutes
	**~~'''~~Maintenance: 1-2g/hr IV continuous infusion~~'''~~		**Maintenance: 1-2g/hr IV continuous infusion
	**Continue for ~~'''~~24-48 hours postpartum~~'''~~		**Continue for 24-48 hours postpartum
	*~~'''~~Monitor for Mg toxicity~~'''~~:		*Monitor for Mg toxicity:
	**Loss of DTRs (first sign — check q1-2h)		**Loss of DTRs (first sign — check q1-2h)
	**Respiratory depression (hold if RR <12)		**Respiratory depression (hold if RR <12)
	**Therapeutic level: 4-7 mg/dL		**Therapeutic level: 4-7 mg/dL
	**~~'''~~Antidote: calcium gluconate 1g IV over 3 minutes~~'''~~		**Antidote: calcium gluconate 1g IV over 3 minutes

	===Definitive Treatment===		===Definitive Treatment===
	*~~'''~~Delivery is the only cure~~'''~~		*Delivery is the only cure
	*~~'''~~≥37 weeks~~'''~~: delivery recommended regardless of severity		*≥37 weeks: delivery recommended regardless of severity
	*~~'''~~<37 weeks without severe features~~'''~~: expectant management with close monitoring		*<37 weeks without severe features: expectant management with close monitoring
	*~~'''~~<37 weeks with severe features~~'''~~: delivery after stabilization (give antenatal corticosteroids if 24-34 weeks)		*<37 weeks with severe features: delivery after stabilization (give antenatal corticosteroids if 24-34 weeks)
	*Mode of delivery: vaginal preferred unless obstetric indication for cesarean		*Mode of delivery: vaginal preferred unless obstetric indication for cesarean

	===Postpartum Preeclampsia===		===Postpartum Preeclampsia===
	*Can occur ~~'''~~up to 6 weeks postpartum~~'''~~ (even without antepartum diagnosis)		*Can occur up to 6 weeks postpartum (even without antepartum diagnosis)
	*Same treatment principles: antihypertensives, magnesium if severe		*Same treatment principles: antihypertensives, magnesium if severe
	*Common cause of postpartum [[headache]] and [[seizures]]		*Common cause of postpartum [[headache]] and [[seizures]]

	==Disposition==		==Disposition==
	*~~'''~~Preeclampsia without severe features~~'''~~: admit to L&D for monitoring; may manage expectantly if <37 weeks		*Preeclampsia without severe features: admit to L&D for monitoring; may manage expectantly if <37 weeks
	*~~'''~~Preeclampsia with severe features~~'''~~: admit to L&D; plan for delivery after maternal stabilization		*Preeclampsia with severe features: admit to L&D; plan for delivery after maternal stabilization
	*~~'''~~OB consultation~~'''~~ for all suspected cases		*OB consultation for all suspected cases
	*Postpartum: close BP monitoring for 72 hours minimum		*Postpartum: close BP monitoring for 72 hours minimum

Danbot: Major update: ACOG diagnostic criteria, severe features definition, labetalol/hydralazine/nifedipine dosing, Mg monitoring, HELLP, postpartum preeclampsia, Magpie Trial, references with PMIDs

2026-03-21T19:49:21Z

Major update: ACOG diagnostic criteria, severe features definition, labetalol/hydralazine/nifedipine dosing, Mg monitoring, HELLP, postpartum preeclampsia, Magpie Trial, references with PMIDs

Show changes

Danbot: Add MedicationDose SMW entries for labetalol, hydralazine, nifedipine, magnesium sulfate; doses verified against ACOG guidelines

2026-03-20T17:41:04Z

Add MedicationDose SMW entries for labetalol, hydralazine, nifedipine, magnesium sulfate; doses verified against ACOG guidelines

@@ Línea 138: / Línea 138: @@
 ***Close follow up and return precautions is key
 ***Repeat lab tests 1-2x per week (platelet count, creatinine, AST)
 ==See Also==

Patricklin at 04:44, 5 December 2023

2023-12-05T04:44:24Z

← Revisión anterior		Revisión del 04:44 5 dic 2023
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	==Background==		==Background==
			*New-onset hypertensive disorder related to pregnancy, resulting in significant maternal morbidity and mortality worldwide
	*Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum		*Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
	**May occur sooner with gestational trophoblastic disease		**May occur sooner with gestational trophoblastic disease
	*~~Defined as [[hypertension\|SBP>140]] or DBP>90 in previously normotensive patient AND [[proteinuria]] >0.3gm in 24h or persistent proteinuria > 1+ on dipstick~~		**Only 10% of cases occur prior to 34wk
	*Only 10% of cases occur prior to 34wk		*Pathogenesis: Abnormalities in placental arterial vasculature, including spiral arteries, in early pregnancy can lead to relative hypoperfusion of placenta; subsequent release of growth factors lead to maternal endothelial dysfunction causing systemic hypertension

	===Risk Factors===		===Risk Factors===
	*Past history of preeclampsia		*Past history of preeclampsia
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	==Clinical Features==		==Clinical Features==
			*[[Headache]], new-onset
	*Edema		*Edema
			*RUQ or epigastric pain
	*[[Elevated BP]]		*[[Elevated BP]]
	*With increasing severity; [[pulmonary edema]], [[visual changes]], and [[altered mental status]] can develop		*With increasing severity; [[pulmonary edema]], [[visual changes]], and [[altered mental status]] can develop
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	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
			Note that all lab findings must not be explained by an pre-existing condition in order to be relevant for diagnosis of preeclampsia
	*CBC		*CBC
	**[[Thrombocytopenia]] suggests severe disease		**[[Thrombocytopenia]] suggests severe disease
	*Chemistry		*Chemistry
	**Elevated creatinine suggests severe disease		**Elevated creatinine suggests severe disease
	*Baseline Mg level
	*[[LFTs]]		*[[LFTs]]
	**AST/ALT elevation suggests severe disease		**AST/ALT elevation suggests severe disease
			*[[Urinalysis]]
			**[[Proteinuria]] (see diagnostic criteria)
			*Baseline Mg level
	*LDH		*LDH
	**Elevation suggests microangiopathic hemolysis		**Elevation suggests microangiopathic hemolysis
	*Uric acid level		*Uric acid level
	**Often elevated in preeclampsia		**Often elevated in preeclampsia but is not counted as a severe feature
	*[[Urinalysis]]
	**[[Proteinuria]]

	==ACOG Diagnostic Criteria==		==ACOG Diagnostic Criteria==
	*''In 2013, ACOG has decided to remove proteinuria from the definition of severity of preeclampsia but it is still part of the diagnosis''<ref>Hypertension in pregnancy: Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.</ref>		*''In 2013, ACOG has decided to remove proteinuria from the definition of severity of preeclampsia but it is still part of the diagnosis''<ref>Hypertension in pregnancy: Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.</ref>
	*'''Diagnosis is ~~either~~ based on blood pressure ~~AND~~ proteinuria ~~or the~~ presence of ~~Severe Symptoms'''~~		*See ACOG practice bulletin 222, Gestational Hypertension and Preeclampsia, for recommendations on diagnosis<ref>Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics & Gynecology 135(6):p e237-e260, June 2020. \| DOI:10.1097/AOG.0000000000003891</ref>
			*'''Diagnosis is based on blood pressure and proteinuria, OR based on blood pressure and presence of end-organ dysfunction (severe features) without proteinuria
			**Although most patients will have proteinuria, lack of it does not preclude diagnosis
			**Presence of "severe features" (see below) signify end organ dysfunction
			*Preeclampsia superimposed upon chronic hypertension: Similar criteria to preeclampsia, with acutely worsening blood pressure superimposed upon baseline, along with proteinuria and/or end-organ dysfunction

	===[[hypertension\|Blood Pressure]]===		===[[hypertension\|Blood Pressure]]===
	*Systolic ≥140 mmHg or diastolic ≥90 mmHg on 2 occasions at least 4 hours apart, after 20 weeks gestation with previously normal BPs		*Hypertension: Systolic ≥140 mmHg or diastolic ≥90 mmHg on 2 occasions at least 4 hours apart, after 20 weeks gestation with previously normal BPs
	*Systolic ≥160 mmHg or diastolic ≥110 mmHg acutely requiring emergent blood pressure decreases		*Severe range hypertension: Systolic ≥160 mmHg or diastolic ≥110 mmHg acutely requiring emergent blood pressure decreases

	===[[Proteinuria]]===		===[[Proteinuria]]===
	*Proteinuria ≥300mg in a 24-hour urine collection		*Proteinuria ≥300mg in a 24-hour urine collection
	*Spot protein(mg/dL)/creatinine(mg/dL) ratio ≥0.3		*Spot (one-time) protein(mg/dL)/creatinine(mg/dL) ratio ≥0.3
	*1+ on urine dipstick (if no quantitative measurement is unavailable)		*2+ on urine dipstick (not preferred; use if no quantitative measurement is unavailable)

	===Severe ~~Symptoms~~===		===Severe Features===
	~~In the absence of proteinuria, new onset hypertension with any severe features:~~
	*Systolic BP ≥160 or diastolic BP ≥110, 2 occasions, 4 hours apart, while on bed rest (unless antihypertension meds were started before this time)		*Systolic BP ≥160 or diastolic BP ≥110, 2 occasions, 4 hours apart, while on bed rest (unless antihypertension meds were started before this time)
	*[[Thrombocytopenia]] platelets <100,000/mL		*[[Thrombocytopenia]] platelets <100,000/mL
	*Elevated [[LFTS]] (2x normal concentration), severe persistent [[RUQ pain\|RUQ]]/[[epigastric pain]] unresponsive to medications and no alternative diagnosis
	*Progressive renal insufficiency (creatinine >1.1mg/dL or doubling of creatinine concentration in absence of renal disease)		*Progressive renal insufficiency (creatinine >1.1mg/dL or doubling of creatinine concentration in absence of renal disease)
	**Reduced urine output < 30 cc/hr may indicate severe disease		**Reduced urine output < 30 cc/hr may indicate severe disease
			*Elevated [[Liver function tests]] (2x normal concentration), severe persistent [[RUQ pain\|RUQ]]/[[epigastric pain]] unresponsive to medications and no alternative diagnosis
	*[[Pulmonary edema]]		*[[Pulmonary edema]]
	*New onset ~~cerebral~~ or [[visual disturbance]] (scotomata, blurry vision, loss of vision)		*New onset headache resistant to medications, or [[visual disturbance]] (scotomata, blurry vision, loss of vision)
			*Note that massive proteinuria is not currently a criteria for severe feature

	==Management==		==Management==

Josgood: /* Oral Antihypertension */

2020-10-09T14:11:11Z

Oral Antihypertension

← Revisión anterior		Revisión del 14:11 9 oct 2020
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	*[[Nifedipine\|Nifedipine ER]]		*[[Nifedipine\|Nifedipine ER]]
	**Option 1: 30-120mg/d		**Option 1: 30-120mg/d
	*[[~~Methydopa~~]]		*[[Methyldopa]]
	**Option 1: 0.5-3 g/d in two to three divided doses		**Option 1: 0.5-3 g/d in two to three divided doses
	*Thiazide diuretics - used as second line agent		*Thiazide diuretics - used as second line agent

ClaireLewis at 17:39, 16 October 2019

2019-10-16T17:39:46Z

← Revisión anterior		Revisión del 17:39 16 oct 2019
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	*Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum		*Preeclampsia and eclampsia are diagnosed after 20wks gestation and <4wk post-partum
	**May occur sooner with gestational trophoblastic disease		**May occur sooner with gestational trophoblastic disease
	*Defined as SBP>140 or DBP>90 in previously normotensive patient AND proteinuria >0.3gm in 24h or persistent proteinuria > 1+ on dipstick		*Defined as [[hypertension\|SBP>140]] or DBP>90 in previously normotensive patient AND [[proteinuria]] >0.3gm in 24h or persistent proteinuria > 1+ on dipstick
	*Only 10% of cases occur prior to 34wk		*Only 10% of cases occur prior to 34wk
	===Risk Factors===		===Risk Factors===
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	**Often elevated in preeclampsia		**Often elevated in preeclampsia
	*[[Urinalysis]]		*[[Urinalysis]]
	**Proteinuria		**[[Proteinuria]]

	==ACOG Diagnostic Criteria==		==ACOG Diagnostic Criteria==
	*''In 2013, ACOG has decided to remove proteinuria from the definition of severity of preeclampsia but it is still part of the diagnosis''<ref>Hypertension in pregnancy: Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.</ref>		*''In 2013, ACOG has decided to remove proteinuria from the definition of severity of preeclampsia but it is still part of the diagnosis''<ref>Hypertension in pregnancy: Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122:1122.</ref>
	*'''Diagnosis is either based on blood pressure AND proteinuria or the presence of Severe Symptoms'''		*'''Diagnosis is either based on blood pressure AND proteinuria or the presence of Severe Symptoms'''
	===Blood Pressure===		===[[hypertension\|Blood Pressure]]===
	*Systolic ≥140 mmHg or diastolic ≥90 mmHg on 2 occasions at least 4 hours apart, after 20 weeks gestation with previously normal BPs		*Systolic ≥140 mmHg or diastolic ≥90 mmHg on 2 occasions at least 4 hours apart, after 20 weeks gestation with previously normal BPs
	*Systolic ≥160 mmHg or diastolic ≥110 mmHg acutely requiring emergent blood pressure decreases		*Systolic ≥160 mmHg or diastolic ≥110 mmHg acutely requiring emergent blood pressure decreases

	===Proteinuria===		===[[Proteinuria]]===
	*Proteinuria ≥300mg in a 24-hour urine collection		*Proteinuria ≥300mg in a 24-hour urine collection
	*Spot protein(mg/dL)/creatinine(mg/dL) ratio ≥0.3		*Spot protein(mg/dL)/creatinine(mg/dL) ratio ≥0.3

ClaireLewis at 02:16, 4 October 2019

2019-10-04T02:16:44Z

← Revisión anterior		Revisión del 02:16 4 oct 2019
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	*Edema		*Edema
	*[[Elevated BP]]		*[[Elevated BP]]
	*With increasing severity pulmonary edema, visual changes, and [[altered mental status]] can develop		*With increasing severity; [[pulmonary edema]], [[visual changes]], and [[altered mental status]] can develop

	==Differential Diagnosis==		==Differential Diagnosis==
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	In the absence of proteinuria, new onset hypertension with any severe features:		In the absence of proteinuria, new onset hypertension with any severe features:
	*Systolic BP ≥160 or diastolic BP ≥110, 2 occasions, 4 hours apart, while on bed rest (unless antihypertension meds were started before this time)		*Systolic BP ≥160 or diastolic BP ≥110, 2 occasions, 4 hours apart, while on bed rest (unless antihypertension meds were started before this time)
	*Thrombocytopenia platelets <100,000/mL		*[[Thrombocytopenia]] platelets <100,000/mL
	*Elevated LFTS (2x normal concentration), severe persistent RUQ/epigastric pain unresponsive to medications and no alternative diagnosis		*Elevated [[LFTS]] (2x normal concentration), severe persistent [[RUQ pain\|RUQ]]/[[epigastric pain]] unresponsive to medications and no alternative diagnosis
	*Progressive renal insufficiency (creatinine >1.1mg/dL or doubling of creatinine concentration in absence of renal disease)		*Progressive renal insufficiency (creatinine >1.1mg/dL or doubling of creatinine concentration in absence of renal disease)
	**Reduced urine output < 30 cc/hr may indicate severe disease		**Reduced urine output < 30 cc/hr may indicate severe disease
	*Pulmonary edema		*[[Pulmonary edema]]
	*New onset cerebral or visual disturbance (scotomata, blurry vision, loss of vision)		*New onset cerebral or [[visual disturbance]] (scotomata, blurry vision, loss of vision)

	==Management==		==Management==
	===BP Control===		===BP Control===
	*For pregnant women with chronic hypertension, BP should be maintained between systolic 120-160mmHg and diastolic 80-105mmHg		*For pregnant women with chronic hypertension, BP should be maintained between systolic 120-160mmHg and diastolic 80-105mmHg
	*Either ~~labetol~~ or hydralazine can be used for initial control. Maximize the dose of each drug before adding on additional therapy.		*Either labetalol or hydralazine can be used for initial control. Maximize the dose of each drug before adding on additional therapy.
	===Urgent BP Control===		===Urgent BP Control===
	*[[Labetalol]]		*[[Labetalol]]
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	===Delivery Timing===		===Delivery Timing===
	*~~Pre Eclampsia~~ without severe features, delivery at 37 weeks		*Preeclampsia without severe features, delivery at 37 weeks
	*~~Pre Eclampsia~~ with severe features		*Preeclampsia with severe features
	**Before fetal viability, delivery after maternal stabilization, expectant management is not recommended		**Before fetal viability, delivery after maternal stabilization, expectant management is not recommended
	**Viable fetus at 33 6/7 weeks or less may delay delivery for 48 hours of corticosteroids if maternal and fetal conditions remain stable with any of the following:		**Viable fetus at 33 6/7 weeks or less may delay delivery for 48 hours of corticosteroids if maternal and fetal conditions remain stable with any of the following:
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	*Do not delay delivery after initial maternal stabilization regardless of gestational age for women with PreE with severe features complicated by any of the following:		*Do not delay delivery after initial maternal stabilization regardless of gestational age for women with PreE with severe features complicated by any of the following:
	**Uncontrollable severe hypertension		**Uncontrollable severe hypertension
	**Eclampsia		**[[Eclampsia]]
	**Pulmonary edema		**[[Pulmonary edema]]
	**~~Abruption placentae~~		**[[Placental abruption]]
	**Disseminated intravascular coagulation		**Disseminated intravascular coagulation
	**Evidence of nonreassuring fetal status		**Evidence of nonreassuring fetal status
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	==[[Seizure]] Prophylaxis==		==[[Seizure]] Prophylaxis==
	*Magnesium		*[[Magnesium]]
	**Option 1: Load 4-6 grams 10% magnesium sulfate in 100ml solution IV over 20 minutes, then continuous infusion of Magnesium sulfate maintenance 1-2 grams/hour		**Option 1: Load 4-6 grams 10% magnesium sulfate in 100ml solution IV over 20 minutes, then continuous infusion of Magnesium sulfate maintenance 1-2 grams/hour
	**Option 2: Magnesium sulfate 10 grams of 50% solution IM (5 grams in each buttock) if no IV accessMagnesium sulfate on infusion pump		**Option 2: Magnesium sulfate 10 grams of 50% solution IM (5 grams in each buttock) if no IV accessMagnesium sulfate on infusion pump
	Contraindications: pulmonary edema, renal failure, myasthenia gravis		*Despite [[pregnancy risk drug\|category D]] label, can be safely used for <48h to allow administration of betamethasone prior to preterm delivery
			*Contraindications: [[pulmonary edema]], [[renal failure]], [[myasthenia gravis]]
	Observe for loss of reflexes, respiratory depression		*Observe for loss of reflexes, respiratory depression

	==Disposition==		==Disposition==

ClaireLewis: /* Evaluation */

2019-08-23T19:18:23Z

Evaluation

← Revisión anterior		Revisión del 19:18 23 ago 2019
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	**Elevated creatinine suggests severe disease		**Elevated creatinine suggests severe disease
	*Baseline Mg level		*Baseline Mg level
	*~~LFT~~		*[[LFTs]]
	**AST/ALT elevation suggests severe disease		**AST/ALT elevation suggests severe disease
	*LDH		*LDH

Jonwarren: /* Prevention */

2019-03-06T06:04:30Z

Prevention

← Revisión anterior		Revisión del 06:04 6 mar 2019
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	*The USPSTF recommends the use of low-dose aspirin (81mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. ([[Evidence Based Recommendation Levels\| B recommendation]])<ref>http://annals.org/article.aspx?articleid=1902275</ref>		*The USPSTF recommends the use of low-dose aspirin (81mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. ([[Evidence Based Recommendation Levels\| B recommendation]])<ref>http://annals.org/article.aspx?articleid=1902275</ref>

	Per ACOG Task Force: For women with prior preeclampsia that led to delivery before 34 weeks of gestation or occurring in more than one pregnancy, offer daily low-dose aspirin (81mg or less) late in the first trimester.		*Per ACOG Task Force: For women with prior preeclampsia that led to delivery before 34 weeks of gestation or occurring in more than one pregnancy, offer daily low-dose aspirin (81mg or less) late in the first trimester.

	==[[Seizure]] Prophylaxis==		==[[Seizure]] Prophylaxis==

Jonwarren: /* Severe Symptoms */

2019-03-06T06:03:03Z

Severe Symptoms

← Revisión anterior		Revisión del 06:03 6 mar 2019
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	*Elevated LFTS (2x normal concentration), severe persistent RUQ/epigastric pain unresponsive to medications and no alternative diagnosis		*Elevated LFTS (2x normal concentration), severe persistent RUQ/epigastric pain unresponsive to medications and no alternative diagnosis
	*Progressive renal insufficiency (creatinine >1.1mg/dL or doubling of creatinine concentration in absence of renal disease)		*Progressive renal insufficiency (creatinine >1.1mg/dL or doubling of creatinine concentration in absence of renal disease)
			**Reduced urine output < 30 cc/hr may indicate severe disease
	*Pulmonary edema		*Pulmonary edema
	*New onset cerebral or visual disturbance		*New onset cerebral or visual disturbance (scotomata, blurry vision, loss of vision)

	==Management==		==Management==