II. Management: Medications
- See Severe Preeclampsia
-
Corticosteroids if Preterm delivery unavoidable and fetus Gestational age 24-34 weeks (consider up to 37 weeks)
- Betamethasone 12 mg IM every 24 hours for 2 doses or
- Dexamethasone 6 mg IM every 12 hours for 4 doses
III. Management: Delivery Gestational age goals
-
Mild Preeclampsia
- Delivery at 37 weeks is preferred (as of 2015)
-
Severe Preeclampsia
- Delivery after 32 to 34 weeks
- Based on Fetal Lung Maturity and Preeclampsia severity (see below)
- Severe refractory Preeclampsia with signs maternal or fetal deterioration (see below)
- Delivery in <24 hours regardless of Gestational age or Fetal Lung Maturity
- Attempt Corticosteroids
IV. Management: Indications for emergent delivery now regardless of Gestational age in Severe Preeclampsia
- Gestational age >34 weeks and Severe Preeclampsia
- Refractory, Severe Hypertension (>160/110 mmHg) at any Gestational age
- Maternal or fetal deterioration
- Eclampsia
- Pulmonary Edema
- Placental Abruption
- HELLP Syndrome
- Disseminated Intravascular Coagulation
- Acute Renal Failure
- Acute cardiovascular events (e.g. Myocardial Infarction, Cerebrovascular Accident)
- Fetal death, lethal anomaly, extreme prematurity
- Reverse end-diastolic flow on umbilical artery doppler
V. Management: Indications for delivery after 48 hours of Corticosteroids (Gestational age 24-34 weeks) in Severe Preeclampsia
- Thrombocytopenia (Platelet Count <100k)
- Serum transaminase levels >2x normal
- Intrauterine Growth Retardation (IUGR <5th percentile)
- Severe oligohydramnios
- Umbilical artery reversed end-diastolic flow (Uteroplacental insufficiency)
- New or worsening renal dysfunction
- Non-reassuring fetal testing
- Other symptoms which may prompt early delivery
- Persistant severe Headache or visual changes
- Persistant severe Epigastric Pain or Emesis
VI. Management: Indications for cesarean delivery (Vaginal Delivery is otherwise preferred)
- Recurrent Seizures refractory to medical management
- Refractory, Severe Hypertension (>160/110 mmHg)
- Maternal or fetal deterioration without impending delivery
- Severe Preeclampsia with unfavorable Cervix <30 weeks gestation (expert opinion)
VII. Precautions
- Avoid epidural or spinal Anesthetic if Platelet Count <70k, Coagulopathy, Anticoagulants or antiplatelet agents
VIII. References
- Fontaine (2000) in ALSO, B:1-36
- Sibai in Gabbe (2002) Obstetrics, p. 945-74
- Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
- Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]