Preeclampsia

From mdEBMwiki
Jump to: navigation, search


Contents

Initial Diagnosis

[ ] Pre-eclampsia w/o Severe Features (>140/90 with >300mg/24hr of proteinuria, >0.3 on spot urine protein:creatinine ratio, Asx. otherwise)

[ ] Preeclampsia w/ Severe Features (Any Systemic Sx=Headaches, IUGR, Pulm Edema, Renal Insuff, BP>160/90, dont wait for protein)

[ ] Superimposed Preeclampsia on Chronic Hypertension (Increase in BPs, Proteinuria, or Sx.)

[ ] Eclampsia / HELLP (Seizure, Plt<100k, Abnl AST, LDH>600 or Seizure, Abnl Smear)

GHTN / Pre-eclampsia w/o severe features Management Plan

[ ] Consider Inpt vs Outpt

[ ] Light activity is recommended, not strict bed rest.

[ ] Fetal Movement monitoring daily by mother

[ ] Serial measurements of BP (twice weekly)

[ ] Weekly platelet counts and liver enzymes in suggested (CBC & CMP)

[ ] Biweekly Antenatal Testing @ 28-32 weeks

[ ] U/S to assess fetal growth (q3-4 wks is reasonable)

[ ] Plan to deliver @ 37 weeks, Magnesium generally not suggested

Magnesium usually not suggested
Do not treat BPs <160/110 ACOG Severe HTN Protocol.
Postpartum Care

[ ] >150/105 persistent BPs treat

[ ] Inpatient Monitoring at least 72 hrs

[ ] Outpatient BP check / followup 7-10 days


Preeclampsia w/ Severe Features / HELLP Syndrome / Eclampsia Management Plan

Initial

[ ] Admission to hospital

[ ] Maternal stabilization w/ blood pressure control to <160/110. ACOG Severe HTN Protocol.

[ ] Magnesium Sulfate IV x 24 hrs (Don't rely on Magnesium to control blood pressure)


Delivery Decision
Eclampsia deliver after maternal stabilization
<34 weeks, BMZ 12mg IM q24 x2
HELLP Deliver @ 24-48hrs, steroids for moms platelets to come up.
Defer for 48 hrs if (PPROM, Labor, <100k Plt, >2x AST/ALT, IUGR <5%, AFI<5cm, Revere EDF on Umb. Art Dopp, Renal Dysfxn Cr>nl)
If stability reached, aim for 34 wks.
>34 weeks, deliver



Inpatient Management

[ ] CBC, CMP qday or every other day if stable

[ ] VS, IO, UOP, Sx Assessment q8hrs

[ ] NST / Kick count daily

[ ] BPP twice weekly

[ ] Fetal Growth US q2 wks


At delivery

[ ] Continue Magnesium sulfate intrapartum & 24hrs post-partum

[ ] >150/105 persistent BPs treat

[ ] Inpatient Monitoring at least 72 hrs

[ ] Outpatient BP check / followup 7-10 days (Consider re-admission if signs of post-partum Pre-eclampsia develop)

Personal tools