Clinical Review

Preeclampsia and eclampsia: 7 management challenges (and zero shortcuts)

OBG Manag. 2009 April;21(4):44-55

References

1. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183:S1-S22.

2. ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002;99:159-167.

3. Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105:402-410.

4. Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007;196:514-519.

5. Altman D, Carroli G, Duley L, et al:. Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359:1877-1890.

6. Fonseca JE, Méndez F, Cataño C, Arias F. Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial. Am J Obstet Gynecol. 2005;193:1591-1598.

Atypical eclampsia has been defined as eclampsia that occurs before 20 weeks’ gestation or from 48 hours to 14 days after delivery. Its management is similar to the management of eclampsia, with BP control and magnesium sulfate being the mainstays of therapy.

Because of the relative rarity of atypical eclampsia, we recommend neurologic consultation in these cases to evaluate for other possible causes of seizure.

TABLE 4

HELLP syndrome—Sibai criteria

Hemolysis: Abnormal peripheral blood smear; total bilirubin >1.2 mg/dL Elevated liver enzymes: AST and ALT more than twice the upper limit of normal for the lab Low platelets: 3/μL

CASE RESOLVED

After initial hospitalization, the patient is monitored as an outpatient until 35 weeks’ gestation, when more labile BP and increased proteinuria necessitate hospitalization. However, her preeclampsia remains mild by definition and, after continued reassuring fetal testing, she undergoes labor induction at 37 weeks.

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Preeclampsia and eclampsia: 7 management challenges (and zero shortcuts)

References

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