Materiały źródłowe

• #1 Pre-eclampsia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/326

  Pre-eclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks’ gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. […] All pregnant women presenting with hypertension and either proteinuria or evidence of systemic involvement require close assessment and monitoring for pre-eclampsia and its complications. […] Delivery is the definitive treatment; the decision about when and how to deliver should only be made after a thorough assessment of the risk and benefits to the mother and baby. […] Other mainstays of management include antihypertensive therapy, seizure control, and fluid restriction. […] Maternal mortality is highest after delivery, so vigilance should be maintained in the postnatal period. […] Pre-eclampsia can occur in subsequent pregnancies; therefore, women should be counselled about the risk.

• #2 Pre-eclampsia | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-023-00417-6

  Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. […] Available treatments target maternal hypertension and seizures, but the only cure for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. […] Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. […] By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. […] Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.

• #3 Pre-eclampsia – Wikipedia

  https://en.wikipedia.org/wiki/Pre-eclampsia

  The definitive treatment for pre-eclampsia is the delivery of the baby and placenta, but the danger to the mother persists after delivery and full recovery can take days or weeks. The timing of delivery should balance the desire for optimal outcomes for the baby while reducing risks for the mother. The severity of the disease and the maturity of the baby are primary considerations. These considerations are situation-specific, and management will vary with situation, location, and institution. Treatment can range from expectant management to expedited delivery by induction of labor or caesarean section. In the case of preterm delivery additional treatments, including corticosteroid injection to accelerate fetal pulmonary maturation and magnesium sulfate for prevention of cerebral palsy, should be considered. Important in management is the assessment of the mother’s organ systems, management of severe hypertension, and prevention and treatment of eclamptic seizures. Separate interventions directed at the baby may also be necessary. Bed rest is not useful and is thus not routinely recommended.

• #4 Preeclampsia – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751

  The primary treatment for preeclampsia is either to deliver the baby or manage the condition until the best time to deliver the baby. This decision with your health care provider will depend on the severity of preeclampsia, the gestational age of your baby, and the overall health of you and your baby. […] Severe preeclampsia requires that you be in the hospital to monitor your blood pressure and possible complications. Your health care provider will frequently monitor the growth and well-being of your baby. […] Medications to treat severe preeclampsia usually include: Antihypertensive drugs to lower blood pressure, Anticonvulsant medication, such as magnesium sulfate, to prevent seizures, Corticosteroids to promote development of your baby’s lungs before delivery. […] If you have preeclampsia that isn’t severe, your health care provider may recommend preterm delivery after 37 weeks. If you have severe preeclampsia, your health care provider will likely recommend delivery before 37 weeks, depending on the severity of complications and the health and readiness of the baby. […] You need to be closely monitored for high blood pressure and other signs of preeclampsia after delivery. Before you go home, you’ll be instructed when to seek medical care if you have signs of postpartum preeclampsia, such as severe headaches, vision changes, severe belly pain, nausea and vomiting.

• #5 Preeclampsia > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/preeclampsia

  Treatment includes monitoring, early delivery, medication. […] Treatments are available to help manage preeclampsia with the goal of preventing complications and, if possible, reaching term. However, the condition typically resolves only after delivery. […] For mild preeclampsia, one or more of the following treatments may be recommended: Blood pressure readings weekly or twice weekly, Frequent urine tests to check for protein, Monitoring kick counts, or fetal movement, Weekly blood tests to look at blood platelets, liver enzymes, and kidney function, Ultrasounds every 2 to 4 weeks to monitor fetal growth to ensure the baby is growing at the expected rate, Delivery at 37 weeks of pregnancy (delivery is considered the best treatment as symptoms resolve within a few days/weeks afterwards).

• #6 Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal

  https://www.mdpi.com/2308-3425/5/1/3

  The most recent studies failed to prove the benefits of an antihypertensive therapy in pregnant women with mild pre-eclampsia in which the blood pressure is between 140/90 mmHg–150/100 mmHg: in these cases, medical surveillance is the only recommended measure. Most guidelines, including some used in Portugal, follow this advice, suggesting that an antihypertensive therapy should be initiated only if SBP > 150–160 mmHg or if DBP > 100–110 mmHg. […] The recommended first-line therapy, which is agreed by the several national and international guidelines analyzed, is intravenous labetalol. […] The recommended drug to use is intravenous magnesium sulfate. The infusion should start with a bolus of 4–6 g in 20 min, followed by a maintenance dose of 2–3 g. […] The use of corticosteroids has great importance in the successful outcome of pregnancy, since it helps the correct development of fetal lungs and is neuroprotective for preterm fetuses. […] Apart from low-dose aspirin, there is still no effective preventive measure for all forms of pre-eclampsia, and the pharmacological management of the disease is the most important factor for the patient’s and the fetus’s well-being.

• #7 Preeclampsia > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/preeclampsia

  Blood pressure medication is not recommended for patients with non-severe preeclampsia, but may be for those with severe preeclampsia based on their blood pressure levels. The most common medications used for blood pressure control are labetalol, nifedipine, and methyldopa. […] For severe preeclampsia, one or more of the following treatments may be recommended: Hospitalization for close monitoring and treatment, Medications to treat hypertension, such as labetalol, hydralazine, nifedipine, Magnesium sulfate to prevent seizures (this is only used when a decision to deliver is made), Early delivery (at 34 weeks of pregnancy); oxytocin may be used to induce labor, Corticosteroids to help the baby’s lungs mature more quickly if delivery is scheduled at 34 weeks or before. […] Preeclampsia sometimes occurs after delivery (postpartum). Health care providers will closely monitor a patient’s blood pressure readings for three days after delivery, particularly if they had high blood pressure during pregnancy or labor, or if they experience headaches and vision problems after delivery.

• #8 Preeclampsia and Eclampsia – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/preeclampsia-and-eclampsia

  Usually hospitalization […] Delivery, depending on factors such as gestational age, fetal status, and severity of preeclampsia […] Magnesium sulfate to prevent or treat new seizures or to prevent seizures from recurring […] Sometimes antihypertensive treatment, if patient meets criteria for severe hypertension. […] Definitive treatment for preeclampsia is delivery. […] Patients with preeclampsia with severe features or eclampsia are often admitted to a maternal special care unit or an intensive care unit (ICU). […] If patients have preeclampsia with severe features, magnesium sulfate is given to prevent seizures. […] As soon as eclampsia is diagnosed, magnesium sulfate must be given to prevent seizures from recurring. […] Magnesium sulfate 4 g IV over 20 minutes is given, followed by a constant IV infusion of 2 g/hour.

• #9 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Ultimately, the definitive treatment of preeclampsia is the delivery of the fetus. […] It is also recommended that patients diagnosed with preeclampsia with severe features at or beyond 34 0/7 weeks gestation undergo delivery after maternal stabilization and should not be delayed to accommodate steroid administration. […] While neonatal and maternal outcomes may benefit from delivery or expectant management, informed decision-making regarding benefits and risks must be discussed with the patient.

• #9 Preeclampsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK570611/

  Management of preeclampsia begins with early diagnosis and intervention, focusing on adequate blood pressure control and seizure prevention. […] Blood pressure control includes both immediate antihypertensive management in cases of severe hypertension (ie, 160 mm Hg systolic and/or 110 mm Hg diastolic) as well as maintenance antihypertensive management either in the antepartum or postpartum periods depending on the particular diagnosis of preeclampsia. […] Antihypertensive medications, which are efficacious and without adverse effects on the fetus, include the following medications: Beta-blockers, such as labetalol; Calcium-channel blockers, such as nifedipine; Alpha-2 agonists, such as clonidine; Vasodilators, such as hydralazine. […] The first choice for seizure prophylaxis in patients with preeclampsia with severe features is IV magnesium sulfate therapy.

• #10 Pre-eclampsia – Wikipedia

  https://en.wikipedia.org/wiki/Pre-eclampsia

  The World Health Organization recommends that women with severe hypertension during pregnancy should receive treatment with anti-hypertensive agents. Severe hypertension is generally considered systolic BP of at least 160 or diastolic BP of at least 110. Evidence does not support the use of one anti-hypertensive over another. The choice of which agent to use should be based on the prescribing clinician’s experience with a particular agent, its cost, and its availability. Diuretics are not recommended for prevention of pre-eclampsia and its complications. Labetalol, hydralazine and nifedipine are commonly used antihypertensive agents for hypertension in pregnancy. ACE inhibitors and angiotensin receptor blockers are contraindicated as they affect fetal development. […] The intrapartum and postpartum administration of magnesium sulfate is recommended in severe pre-eclampsia for the prevention of eclampsia. Further, magnesium sulfate is recommended for the treatment of eclampsia over other anticonvulsants. Magnesium sulfate acts by interacting with NMDA receptors.

• #11

  https://www.nhs.uk/conditions/pre-eclampsia/treatment/

  Pre-eclampsia can only be cured by delivering the baby. If you have pre-eclampsia, you’ll be closely monitored until it’s possible to deliver the baby. […] Once diagnosed, you’ll be referred to a hospital specialist for further assessment and any necessary treatment. […] Medicine is recommended to help lower your blood pressure. These medicines reduce the likelihood of serious complications, such as stroke. […] Some of the medicines used regularly in the UK include labetalol, nifedipine or methyldopa. […] Your doctors may recommend one of them if they think it’s the most suitable medicine for you. […] Anticonvulsant medicine may be prescribed to prevent fits if you have severe pre-eclampsia and your baby is due within 24 hours, or if you have had convulsions (fits). […] In most cases of pre-eclampsia, having your baby at about the 37th to 38th week of pregnancy is recommended.

• #12 5 Medications for Preeclampsia

  https://www.healthline.com/health/pre-eclampsia-medication

  Preeclampsia is a serious pregnancy condition that requires early medical intervention. Medications like labetalol and magnesium sulfate can help reduce the risk of complications by managing blood pressure and preventing seizures. […] The only cure for preeclampsia is giving birth. Some medications, like antihypertensives, can help lower blood pressure and reduce the risk of complications until you give birth. […] Research found that labetalol is a first-line treatment for preeclampsia because it is both effective and safe during pregnancy. It helps lower blood pressure quickly, reducing the risk of stroke while maintaining healthy blood flow to the placenta. […] A 2023 clinical trial found that nifedipine is highly effective for controlling blood pressure in preeclampsia and has fewer side effects than other blood pressure medications.

• #13 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  The treatment goal is to lower systolic pressure to 140 to 155 mm Hg and diastolic pressure to 90 to 105 mm Hg. […] In women with preeclampsia, blood pressure usually normalizes within a few hours after delivery but may remain elevated for two to four weeks. […] Women with preeclampsia should be counseled about future pregnancies.

• #13 Diagnosis and Management of Preeclampsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html

  Delivery remains the ultimate treatment for preeclampsia. […] Although maternal and fetal risks must be weighed in determining the timing of delivery, clear indications for delivery exist. […] When possible, vaginal delivery is preferable to avoid the added physiologic stressors of cesarean delivery. […] If cesarean delivery must be used, regional anesthesia is preferred because it carries less maternal risk. […] During labor, the management goals are to prevent seizures and control hypertension. Magnesium sulfate is the medication of choice for the prevention of eclamptic seizures in women with severe preeclampsia and for the treatment of women with eclamptic seizures. […] Antihypertensive drug therapy is recommended for pregnant women with systolic blood pressures of 160 to 180 mm Hg or higher and diastolic blood pressures of 105 to 110 mm Hg or higher.

• #14 Preeclampsia, Eclampsia & HELLP – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/preeclampsia-eclampsia-hellp-treatment/

  Second line […] Clonidine, hydralazine and thiazides. […] DO NOT use ACE Inhibitors and Angiotensin RB in pregnancy or first few weeks post-partum or preterm babies if breastfeeding. […] Aim for <85mmHg diastolic, especially if comorbidities or postpartum. [...] Avoid dropping MAP >25 percent in 2 hours to avoid myocardial, cerebral or uteroplacental hypoperfusion. […] Usual seizure management/precautions. […] First Line – Magnesium sulfate (MgSO4) […] MgSO4 Intravenous (PREFERRED): […] Loading dose: 4-6 GRAMS IV over 15 minutes […] Maintenance: 1-2 GRAMS/hr IV […] OR […] MgSO4 Intramuscular […] Loading dose: 10 GRAMS IM (5 grams into each buttock) […] Maintenance dose: 5 GRAMS IM q4h […] Renal Insufficiency: Same loading dose. Reduce or withhold maintenance dosing.

• #15

  https://www.who.int/news-room/fact-sheets/detail/pre-eclampsia

  Magnesium sulfate reduces the risk of eclampsia by more than half. Despite the availability of magnesium sulfate, its use is still limited in many low-resource settings. […] The primary treatment for pre-eclampsia is the administration of magnesium sulfate to prevent seizures. […] The treatment and management of pre-eclampsia depend on the severity of the condition and the gestational age of the pregnancy. The goal is to prevent complications and have the best possible outcomes for the mother and the pregnancy. […] Other management strategies include: antihypertensive medications to control blood pressure, corticosteroids to accelerate fetal lung maturity if preterm delivery is anticipated, close monitoring of maternal and fetal health. […] Key WHO recommendations include: calcium supplementation during pregnancy in areas with low dietary calcium intake, low-dose aspirin during pregnancy for women at high risk of pre-eclampsia, use of magnesium sulfate for the prevention of eclampsia, training health-care providers in the early detection and management of pre-eclampsia, strengthening health systems to ensure timely and effective care for pregnant women.

• #16 Eclampsia in the ED: Presentation, Differential Diagnosis, and Treatment – emDocs

  https://www.emdocs.net/eclampsia-in-the-ed-presentation-differential-diagnosis-and-treatment/

  Eclampsia is defined as the occurrence of one or more generalized tonic-clonic convulsions unrelated to other medical conditions in pregnant or postpartum patients with hypertensive disorders of pregnancy. Hypertensive disorders of pregnancy are a spectrum of clinical conditions including chronic hypertension, gestational hypertension, preeclampsia, preeclampsia superimposed on chronic hypertension, and Hemolysis, Elevated liver enzymes and Low platelets (HELLP) syndrome. Defining characteristics of the hypertensive disorders of pregnancy can be observed in Table 1. As convulsions may be the presenting symptom of preeclampsia, seizures in pregnant or postpartum patients should be considered eclampsia until proven otherwise. […] The mainstay of treatment for eclampsia is magnesium sulfate, both as seizure prophylaxis in patients with preeclampsia and as a first line antiepileptic when seizures occur. A 2010 Cochrane review evaluating the evidence supporting magnesium sulfate vs. diazepam in the treatment of eclampsia demonstrated fewer maternal deaths and recurrence of seizures in patients receiving magnesium. There was no difference in neonatal outcomes. The largest trials included in this review demonstrated a 52% lower risk of recurrent convulsions in patients receiving magnesium sulfate when compared with diazepam and a 67% lower risk when compared with phenytoin. The American College of Obstetrics and Gynecology (ACOG) currently maintains a level A recommendation for the use of magnesium sulfate in the prevention and treatment of eclampsia. A summary of the following recommendations can be seen in Table 2.

• #17 Eclampsia in the ED: Presentation, Differential Diagnosis, and Treatment – emDocs

  https://www.emdocs.net/eclampsia-in-the-ed-presentation-differential-diagnosis-and-treatment/

  Mechanistically, magnesium has many sites of action, but exerts its main therapeutic effect by stabilizing cell membrane potentials and inducing smooth muscle relaxation. Therapeutic plasma levels of magnesium necessary to reduce and prevent seizures (3.5-7mEq/L) are much greater than those used in treatment of other conditions. The most recent ACOG guidelines recommend initial dosing in any patient suspected to have eclampsia includes a loading dose of 4 or 6 grams over 15-20 minutes, followed by maintenance with continuous infusion at a rate of 2 g/hr. If IV magnesium sulfate is not available or IV access cannot be established, administer a 10g loading dose IM (5g IM in each buttock) followed by 5g IM every 4 hours. […] There are few absolute contraindications to magnesium sulfate therapy, including myasthenia gravis, severe hypocalcemia, complete heart block, and myocarditis. Renal failure is a relative contraindication. Magnesium is fully excreted by the kidneys and therefore dosing should be adjusted in patients with potential for reduced clearance. Patients with serum creatinine > 1.2mg/dL should receive a standard loading dose of 4 to 6 grams, but a maintenance infusion at a lower rate of 1g/hr. Caution is advised in patients taking labetalol and nifedipine; administration of magnesium sulfate may produce a synergistic effect leading to bradycardia and/or hypotension. Monitoring of magnesium levels is not universally recommended, except in patients with renal dysfunction or those showing signs of toxicity, such as loss of deep tendon reflexes, respiratory depression, or cardiac arrest. Attention should be taken to limit total IV fluid administration to an average of <125 mL/hr to avoid pulmonary edema, a common complication of severe preeclampsia.

• #18 Preeclampsia, Eclampsia & HELLP – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/preeclampsia-eclampsia-hellp-treatment/

  Monitor for magnesium toxicity (eg. loss of reflexes, respiratory depression), if suspected check serum levels and stop maintenance dose – antidote is calcium gluconate. […] May also give additional MgSO4 2-4 GRAMS IV over five minutes. […] Second Line […] Lorazepam 2-4 mg IV over 2 minutes or diazepam 5-10 mg IV […] Phenytoin […] Barbiturates […] When to start: […] Intrapartum and postpartum for women with preeclampsia. […] Any patient with preeclampsia with severe features, HELLP or eclampsia. […] Follow same dosing of magnesium sulfate as outlined above. […] Prophylactic platelet transfusion indications – Consult obstetrics. […] <50 × 10^9/L prior to delivery (caesarian or vaginal). [...] Consult obstetrics, antenatal corticosteroids can be considered for all premature cases.

• #19 Postpartum Preeclampsia

  https://www.preeclampsia.org/postpartum-preeclampsia

  Delivery is not the cure for preeclampsia. […] Once the baby is delivered, mom still needs to receive care if she is experiencing high blood pressure and related preeclampsia symptoms. […] It’s important to know that delivery is not the cure for preeclampsia. […] Early diagnosis through recognition and proper response to symptoms is key. Prompt treatment saves lives. […] The early postpartum period (up to seven days after delivery) is when women who experience preeclampsia are at highest risk — much of this risk can be lessened with effective blood pressure control. […] Magnesium sulfate is started prior to delivery to reduce the risks of maternal seizures, eclampsia. Most protocols recommend continuation for 24 hours postpartum when the risk for seizures remains high. […] Treatment of high blood pressure while breastfeeding requires agreement among the mother, obstetrician, and pediatrician. It’s critically important that the mother’s blood pressure be controlled, and the benefits of early breastfeeding are recognized and prioritized. […] If a seizure occurs after delivery, it is referred to as postpartum eclampsia.

• #20 What are the treatments for preeclampsia, eclampsia, & HELLP syndrome? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/treatments

  When a woman has severe preeclampsia and is at 34 weeks of pregnancy or later, the American College of Obstetricians and Gynecologists recommends delivery as soon as medically possible. […] If the pregnancy is at less than 34 weeks, healthcare providers will probably prescribe corticosteroids to help speed up the maturation of the fetal lungs before attempting delivery. […] Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications. […] The symptoms of preeclampsia usually go away within 6 weeks of delivery. […] Eclampsia, the onset of seizures in a woman with preeclampsia, is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother’s seizures, treat blood pressure levels that are too high, and deliver the fetus.

• #21

  https://www.nhs.uk/conditions/pre-eclampsia/treatment/

  Delivering the baby early can also reduce the risk of complications from pre-eclampsia. […] Although pre-eclampsia usually improves soon after your baby is born, complications can sometimes develop a few days later. […] You’ll usually need to have your blood pressure checked regularly after leaving hospital, and you may need to continue taking medicine to lower your blood pressure for several weeks.

• #22 Pre-eclampsia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/326

  Pre-eclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks’ gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. […] All pregnant women presenting with hypertension and either proteinuria or evidence of systemic involvement require close assessment and monitoring for pre-eclampsia and its complications. […] Delivery is the definitive treatment; the decision about when and how to deliver should only be made after a thorough assessment of the risk and benefits to the mother and baby. […] Other mainstays of management include antihypertensive therapy, seizure control, and fluid restriction. […] Maternal mortality is highest after delivery, so vigilance should be maintained in the postnatal period. […] Pre-eclampsia can occur in subsequent pregnancies; therefore, women should be counselled about the risk.

• #23 Preeclampsia Treatment & Management: Approach Considerations, Prehospital Treatment, Care in Preeclampsia Without Severe Features

  https://emedicine.medscape.com/article/1476919-treatment

  When preeclampsia with severe features is diagnosed after 34 weeks gestation, delivery is most appropriate. […] Women with preeclampsia with severe features who have nonreassuring fetal status, ruptured membranes, labor, or maternal distress should be delivered regardless of gestational age. […] If a patient presents with preeclampsia with severe features before 34 weeks’ gestation but appears to be stable, and if the fetal condition is reassuring, expectant management may be considered, provided that the patient meets the strict criteria set by Sibai et al. […] The basic principles of airway, breathing, and circulation (ABC) should always be followed as a general principle of seizure management. […] Magnesium sulfate is the first-line treatment for the prevention of primary and recurrent eclamptic seizures.

• #24 Preeclampsia Treatment

  https://blog.thesullivangroup.com/preeclampsia-treatment

  Standardized preeclampsia treatment has shown to improve maternal outcomes. Treatment takes into consideration maternal-fetal status; it becomes a balancing act regarding management and timing of delivery. Treatment considerations include: fetal status and gestational age, maternal status, labor status, severity of the disease, and availability of resources. Any patient experiencing blood pressure issues should have close monitoring and comprehensive maternal-fetal management. Antepartum testing should be initiated. […] Newer recommendations suggest delivery at 37 weeks, which improves both maternal and fetal outcomes. Less favorable outcomes result from waiting for a favorable cervix and/or approaching 39 weeks and beyond. Diagnosis of preeclampsia does not require cesarean section for delivery; if mother and baby are stable, a trial of labor is appropriate. Induction of labor is attempted if there are no contraindications. Regional anesthesia is recommended at the time of delivery, as general anesthesia can be a risk for the patient with severe hypertension and preeclampsia. It is recommended to place the epidural early in the patient in the intrapartum setting so it will be ready and functional in case platelets continue to drop.

• #25 Preeclampsia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000898.htm

  Preeclampsia usually resolves within 6 weeks after the baby is born and the placenta is delivered. However, it may persist longer or even begin after delivery. […] As a result, your provider will likely want your baby to be delivered so the preeclampsia does not get worse. You may get medicines to help trigger labor, or you may need a C-section. […] If your baby is not fully developed and you have mild preeclampsia, the disease can often be managed at home until your baby has matured. The provider will recommend: Frequent provider visits to make sure you and your baby are doing well. Medicines to lower your blood pressure (sometimes). The severity of preeclampsia may change quickly, so you’ll need very careful follow-up. […] Sometimes, a pregnant woman with preeclampsia is admitted to the hospital. This allows the health care team to monitor the baby and mother more closely.

• #26 What are the treatments for preeclampsia, eclampsia, & HELLP syndrome? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/treatments

  Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. […] HELLP syndrome, a severe complication of preeclampsia and eclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. […] The healthcare provider may consider the following treatments after a diagnosis of HELLP syndrome: Delivery of the fetus, Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus’s lungs. […] As mentioned earlier, some women develop preeclampsia or eclampsia after they deliver their babies. […] The American College of Obstetricians and Gynecologists recommends that healthcare providers closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery, either at home or in the hospital.

• #27 Preeclampsia | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/preeclampsia

  Most pregnant people who have preeclampsia have healthy babies. If you’re at risk for preeclampsia, your provider may want you to take low-dose aspirin during your pregnancy to help prevent it. […] Yes, low-dose aspirin (also known as baby aspirin) can reduce the risk of preeclampsia. […] If you have preeclampsia before 37 weeks, your provider: Will check your blood pressure and urine regularly. […] If you have preeclampsia with severe features (this includes very high blood pressure), you will most likely stay in the hospital so your provider can closely monitor you and your baby. Your provider may treat you with medicines called antenatal corticosteroids. […] If you have preeclampsia, a vaginal birth may be better than a Cesarean birth (also called c-section). […] Postpartum preeclampsia is a rare condition. Its when you have preeclampsia after youve given birth. It most often happens within a few days after giving birth, but it can develop up to 6 weeks after delivery. Its just as dangerous as preeclampsia that happens during pregnancy and needs immediate treatment.

• #28 How Is Postpartum Preeclampsia Treated?

  https://www.medicinenet.com/how_is_postpartum_preeclampsia_treated/article.htm

  Postpartum preeclampsia is treated with medications to lower your blood pressure as well as medicine, such as magnesium sulfate, to prevent seizures. Medication to reduce headache pain may also be given. […] If the doctor diagnoses postpartum preeclampsia, theyll want to lower your blood pressure with medication. Theyll also give you medicine, such as magnesium sulfate, to prevent seizures. You might receive medication to reduce the pain from your headaches. […] There are many different types of medication to treat blood pressure. Depending on your body chemistry and what the doctor thinks will help, they might give you any of the following: Beta-blockers, Diuretics, ACE inhibitors, Alpha blockers, Vasodilators, Calcium channel blockers, Alpha-2 receptor agonists, Blood thinners, such as Apixaban.

• #29 Preeclampsia Treatment & Management: Approach Considerations, Prehospital Treatment, Care in Preeclampsia Without Severe Features

  https://emedicine.medscape.com/article/1476919-treatment

  Little clinical evidence exists in the published literature on which to base decisions regarding the management of fluids during preeclampsia. […] Preeclampsia resolves after delivery. However, patients may still have an elevated BP postpartum. […] Efforts to prevent preeclampsia have been disappointing. […] A systematic review of 14 trials using low-dose aspirin (60-150 mg/d) in women with risk factors for preeclampsia concluded that aspirin reduced the risk of preeclampsia and perinatal death. […] Low-dose aspirin (81 mg/d) prophylaxis is recommended for pregnant individuals at high risk of preeclampsia with one or more of the following risk factors: History of preeclampsia, multifetal gestation, chronic hypertension, pregestational type 1 or 2 diabetes, kidney disease, autoimmune disease.

• #30 Pre-eclampsia | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pre-eclampsia/

  Pre-eclampsia is a complication of pregnancy that causes you to have high blood pressure and protein in your urine. […] You may be offered medication to lower your high blood pressure but pre-eclampsia will not get better until after you have given birth. […] If you develop severe pre-eclampsia, you will be admitted to hospital and cared for by a specialist team. Treatment may include medication (either tablets or via a drip) to lower and control your blood pressure. You may also be given a medication called magnesium sulfate to reduce the chance of you having an eclamptic fit. This medication can also be used to treat eclampsia if you have already had a fit. […] The only way to cure pre-eclampsia is for your baby to be born. […] If you have had pre-eclampsia in one pregnancy you are advised to take aspirin tablets (75-100 mg) from 12 weeks in any future pregnancy to reduce the risk of it happening again.

• #31 Preeclampsia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745

  Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range. […] Left untreated, preeclampsia can lead to serious even fatal complications for both the mother and baby. […] Early delivery of the baby is often recommended. The timing of delivery depends on how severe the preeclampsia is and how many weeks pregnant you are. Before delivery, preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications. […] The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your primary care provider may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor. […] It’s important that you talk with your provider before taking any medications, vitamins or supplements to make sure it’s safe for you.

• #32 Pre-eclampsia | Healthify

  https://healthify.nz/health-a-z/p/pre-eclampsia

  Sometimes you will be given medication to lower your blood pressure, but the aim will be to not lower the blood pressure too much or too suddenly as this can cause distress to your baby. […] Aspirin has been shown to decrease the chances of a pregnant woman developing pre-eclampsia by about 10%. […] If you think you might benefit from aspirin treatment, talk to your doctor. Aspirin needs to be started before 20 weeks and ideally at 12 weeks to have the best effect. […] If delivery is planned and your baby is premature (particularly before 32 weeks), you will usually be given 2 steroid injections, 12 to 24 hours apart, which help to mature your baby’s lungs. […] You may also be given magnesium sulphate through a vein (intravenously) to prevent seizures. […] If you’re diagnosed with pre-eclampsia near the end of your pregnancy, your doctor may recommend inducing labour right away. […] If you’re still more than a month away from your due date, or if there are signs that your baby may not cope well with a labour, a caesarean section will be recommended as the safest way to deliver your baby.

• #33 Preeclampsia Treatment & Management: Approach Considerations, Prehospital Treatment, Care in Preeclampsia Without Severe Features

  https://emedicine.medscape.com/article/1476919-treatment

  On the basis of limited evidence from a systematic review and meta-analysis, the addition of low-molecular weight heparin or unfractionated heparin to low-dose aspirin has the potential to reduce the prevalence of preeclampsia and birth of small-for-gestational-age neonates in women with a history of preeclampsia. […] Research into the use of calcium and vitamin C and E supplementations in low-risk populations did not find a reduction in the incidence of preeclampsia. […] Preeclampsia is an appropriate disease to screen, as it is common, important, and increases maternal and perinatal mortality.

• #34 New therapeutic prospect for preeclampsia | Institut Pasteur

  https://www.pasteur.fr/en/press-area/press-documents/new-therapeutic-prospect-preeclampsia

  Preeclampsia is a condition that affects the placenta during pregnancy and is dangerous for both the fetus and the mother. Scientists from the Institut Pasteur, Inserm and the CNRS have proposed a new therapy, tested in two rodent models, that corrects the defects identified in placental cells, and restores placental and fetal weight. The treatment successfully lowers blood pressure in the mother and resolves the characteristic preeclampsia symptoms of excess protein in urine and cardiovascular abnormalities. […] The current first-line treatment for preeclampsia is limited and involves the preventive use of aspirin for at-risk patients. This treatment reduces the procoagulant state in the placenta and partly relieves pressure on the vascular network. […] Finding a way of restoring NO production in the placenta via NOSs could represent an effective new therapy to treat preeclampsia.

• #35 New therapeutic prospect for preeclampsia | Institut Pasteur

  https://www.pasteur.fr/en/press-area/press-documents/new-therapeutic-prospect-preeclampsia

  Treating trophoblasts with BH4 (or tetrahydrobiopterin, a cofactor that stabilizes the NOS enzyme producing NO) corrected the defects identified in these cells, restoring production of NO rather than potentially toxic molecules. More importantly, administering BH4 to the two preclinical rodent models restored placental and fetal weight. Finally, in the early-onset STOX1 preclinical model with significant arterial hypertension and proteinuria, the BH4 treatment corrected blood pressure, excess protein in urine, and cardiovascular abnormalities in the mother. […] In conclusion, the scientists propose that a treatment combining BH4 and aspirin could be the ultimate therapeutic solution for many cases of preeclampsia. This hypothesis needs to be validated in clinical trials.

• #36 Therapy developed at Boston Children’s stops preeclampsia before it starts – Boston Children’s Answers

  https://answers.childrenshospital.org/preeclampsia/

  New research shows that mesenchymal stromal cells exosomes (MEx) can prevent preeclampsia in pre-clinical mouse models, likely through changing the intrauterine environment. […] Preeclampsia occurs in about 3 to 5 percent of all pregnancies. Characterized by very high maternal blood pressure, it can lead to serious, sometimes fatal, complications in both mother and baby. In severe cases, early delivery is often the only effective treatment, usually before the baby’s lungs are fully developed. […] “While there are some therapies to help reduce maternal blood pressure in preeclampsia, we don’t have a treatment for prevention and no current therapies to prevent the long-lasting problems in the babies, like overall small birth weight and lung disease,” says Elizabeth Taglauer, MD, PhD, first-author of a preclinical study in mice that tested a new treatment to prevent preeclampsia onset.

• #37 Therapy developed at Boston Children’s stops preeclampsia before it starts – Boston Children’s Answers

  https://answers.childrenshospital.org/preeclampsia/

  “The exciting promise here is being able to intervene at the prenatal stage and prevent preeclampsia in the mother, as well as the complications of prematurity in the baby,” says senior author Stella Kourembanas, MD, the division’s chief. […] The team led by Kourembanas and Mitsialis discovered that the therapeutic benefits of MSC therapy are due to the MEx they release. […] This study showed that MEx prevented maternal symptoms of preeclampsia and fetal growth restriction when given early. […] “We were excited that our study also showed improvement in the fetus,” says Taglauer. […] “We hope that in the future, once this remedy has been tested in the clinic, we will be able to treat the moms who exhibit early signs of preeclampsia,” adds Kourembanas. […] Next, Taglauer plans to study whether MEx treatment can stop preeclampsia if it is given later in pregnancy.

• #38 Preeclampsia Treatment

  https://blog.thesullivangroup.com/preeclampsia-treatment

  Intrapartum treatment goals are to prevent seizures and control hypertension. Magnesium sulfate is given to control seizures, not to control blood pressure, and is used for both preeclampsia and eclampsia. Anti-hypertensive therapy is aggressive and swift. […] While controlling the blood pressure is important, it does not halt the disease progression; the disease continues to evolve even with blood pressure correction. Risk reduction and safe outcomes require prompt hypertensive management with the use of standardized treatment. Severe hypertension needs to be treated within 30-60 minutes of diagnosis of severe hypertension. […] In April 2017, ACOG released standardized treatment guidelines for treatment of severe hypertension. Institutions should have protocols in place that address the importance of fast, standardized emergency intervention to decrease blood pressure in a hypertensive crisis. Treatment with a first-line drug agent should occur within 30-60 minutes of confirmed severe hypertension to reduce the chance of stroke.

• #39 Preeclampsia Treatment

  https://blog.thesullivangroup.com/preeclampsia-treatment

  The goal of treatment is not to normalize BP, but rather to get it into an acceptable range of 140-150/90-100 or lower in order to prevent prolonged exposure to elevated levels that cause loss of cerebral vasculature autoregulation. […] In the rare instance that one of these three agents fails to decrease the BP when given in successive appropriate doses, then emergency consultation of an MFM specialist, anesthesiologist or critical care subspecialist should be considered to address emergency second-line recommendations.

• #40 Preeclampsia Treatment

  https://blog.thesullivangroup.com/preeclampsia-treatment

  Preeclampsia without severe features may be managed at home when the patient is reliable. Ongoing outpatient testing of maternal-fetal status is acceptable. Women with barriers to follow-up and ongoing care should be hospitalized for observation. (Reminder: anti-hypertensives do not prevent evolution of the disease.) […] The patient with severe features who is preterm is best managed in a tertiary care facility. MFM experts and a high-risk perinatal team will provide oversight of fetal surveillance and appropriate timing for delivery. Administration of antenatal corticosteroids should be given to all women with severe preeclampsia because of the strong possibility of preterm birth. […] Once preeclampsia is diagnosed, antepartum testing is essential until 37 weeks; then delivery is indicated. Delivery is always best for maternal health.

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