Mild PIH Management


Mild PIH Management, Mild Preeclampsia, PIH Management, Preeclampsia Management

  • Criteria
  1. Blood Pressure >140/90 on 2 Blood Pressure readings 6 hours apart
    1. Assumes normal Blood Pressure before pregnancy (and before 20 weeks gestation)
    2. See Chronic Hypertension in Pregnancy
    3. Blood Pressure >160/110 on 2 occasions meets criteria for Severe Preeclampsia
  2. Other findings in Preeclampsia (not required for diagnosis)
    1. Urine Protein 24 Hour: >300 mg
    2. Generalized Edema (affecting hands and face)
      1. Not reliable due to high False Positive and False Negative Rate in pregnancy
  • Monitoring
  • Maternal
  1. Monitor Blood Pressure twice weekly
  2. Obtain Preeclampsia labs weekly
    1. Complete Blood Count with platelets
    2. Aspartate transaminase (AST)
    3. Alanine transaminase (ALT)
    4. Lactate Dehydrogenase (LDH)
    5. Uric Acid
    6. Serum Creatinine
    7. Urine with dipstick protein or random protein to Creatinine ratio
      1. Quantify abnormal values with Urine Protein 24 Hour collection
  • Monitoring
  • Fetal (starting at 26-28 weeks)
  1. Fetal Safety Assessment: Abnormal results prompt intervention, possible delivery
    1. Option 1
      1. Non-Stress Test weekly and
      2. Amniotic fluid index weekly and
      3. Biophysical Profile weekly
    2. Option 2
      1. Non-Stress Test twice weekly and
      2. Amniotic fluid index twice weekly
    3. Additional Measures
      1. Monitor fetal movevement with kick counts
    4. Interpretation
      1. Non-reassuring Non-Stress Test prompts repeat Biophysical Profile, anmniotic fluid index
      2. Consider intervention for Biophysical Profile <6/8 or amniotic fluid index <5 cm
  2. Fetal Growth Assessment
    1. Ultrasound for Fetal Growth every 3-4 weeks
    2. Consider concurrent Doppler Ultrasound of umbilical artery systolic/diastolic ratios
    3. Consider intervention if estimated fetal weight <10th percentile, or decreased ratio
  • Management
  • Mild Preeclampsia
  1. See Severe PIH Management
  2. See Delivery Indications in PIH
  3. Term Gestation: Delivery by 38-40 weeks (37 weeks is preferred)
  4. Preterm gestation
    1. Maternal and Fetal Monitoring as above until Gestational age >37-38 weeks
    2. Consider earlier delivery when Fetal Lung Maturity adequate or clinical worsening