Preeclampsia Delivery Indications

1. See Also
   1. Pregnancy Induced Hypertension
   2. Gestational Hypertension Management
   3. Mild PIH Management
   4. Severe PIH Management
   5. PIH Blood Pressure Management
   6. PIH Seizure Prophylaxis
2. Management: Medications
   1. See Severe Preeclampsia
   2. Preterm delivery unavoidable if fetus 24-34 weeks
      1. Betamethasone 12 mg IM q24 hours x2 doses or
      2. Dexamethasone 6 mg IM q12 hours x4 doses
3. Management: Delivery Gestational age goals
   1. Mild Preeclampsia
      1. Delivery at 37 weeks is preferred (as of 2015)
   2. Severe Preeclampsia
      1. Delivery after 32 to 34 weeks
      2. Based on Fetal Lung Maturity and Preeclampsia severity (see below)
   3. Severe refractory Preeclampsia with signs maternal or fetal deterioration (see below)
      1. Delivery in <24 hours regardless of Gestational age or Fetal Lung Maturity
      2. Attempt Corticosteroids
4. Management: Indications for emergent delivery now regardless of Gestational age in Severe Preeclampsia
   1. Gestational age >34 weeks and Severe Preeclampsia
   2. Refractory, Severe Hypertension (>160/110 mmHg) at any Gestational age
   3. Maternal or fetal deterioration
   4. Eclampsia
   5. Pulmonary Edema
   6. Placental Abruption
5. Management: Indications for delivery after 48 hours of Corticosteroids (Gestational age 24-34 weeks) in Severe Preeclampsia
   1. Thrombocytopenia (Platelet Count <100k)
   2. Serum transaminase levels >2x normal
   3. Intrauterine Growth Retardation (IUGR <5th percentile)
   4. Severe oligohydramnios
   5. Umbilical artery reversed end-diastolic flow (Uteroplacental insufficiency)
   6. New or worsening renal dysfunction
   7. Non-reassuring fetal testing
   8. Other symptoms which may prompt early delivery
      1. Persistant severe Headache or visual changes
      2. Persistant severe Epigastric Pain or Emesis
6. Management: Indications for cesarean delivery (Vaginal Delivery is otherwise preferred)
   1. Recurrent Seizures refractory to medical management
   2. Refractory, Severe Hypertension (>160/110 mmHg)
   3. Maternal or fetal deterioration without impending delivery
   4. Severe Preeclampsia with unfavorable Cervix <30 weeks gestation (expert opinion)
7. Precautions
   1. Avoid epidural or spinal Anesthetic if Platelet Count <70k, Coagulopathy, Anticoagulants or antiplatelet agents
8. References
   1. Fontaine (2000) in ALSO, B:1-36
   2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
   3. Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
   4. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]