Preeclampsia

Definition: New onset of hypertension and proteinuria, [or new onset of hypertension and significant end-organ dysfunction with or without proteinuria] after 20 weeks of gestation.

HTN in preeclampsia is defined as SBP ≥140 mmHg or DBP ≥90 mmHg on two occasions at least 4 hours apart.
Proteinuria in preeclampsia is defined as:
≥0.3 g protein in a 24-hour urine specimen
Random protein:creatinine ratio ≥0.3 mg protein/mg creatinine
Protein ≥1+ (30 mg/dL) on a urine dipstick.

Diagnostic studies:
–CBC (Hgb, Hct, Plt); CMP (Cr, Liver enzymes, Albumin); Urinary protein (spot protein to creatinine ratio OR 24-hour urine protein).
-Consider LDH, uric acid, coagulation studies, and peripheral smear.
BP monitoring
Antepartum fetal testing, such as a nonstress test to assess fetal well-being.
Ultrasonography to assess for fetal intrauterine growth restriction.

Treatment
Delivery is the definitive treatment of preeclampsia.
The timing of delivery is based on the gestational age, the severity of preeclampsia, and maternal and fetal condition.
Preeclampsia with severe features: This is usually an indication to deliver immediately, regardless of the gestational age. Consult maternal-fetal medicine as needed.
-Magnesium sulfate(1st-line) for seizure prophylaxis in preeclampsia with severe features. Monitor for toxicity q1-2hrs.
Preeclampsia without severe features: Manage conservatively and deliver at 37 weeks of gestation.
If <34 weeks of gestation, give antenatal steroids.
Treat severe HTN (SBP ≥160 mmHg and DBP ≥110 mmHg) to decrease stroke. Don’t treat mild HTN.
Vaginal delivery is preferred over C/S, if possible, in patients with preeclampsia.
Low-dose Aspirin for the Prevention of Preeclampsia.

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