-Case-
A 30-year-old woman at 34 weeks gestation arrives at the ED complaining of a pounding headache, blurry vision, and swelling in her hands and face over the past few days. Her blood pressure reads 168/102 mmHg, has bilateral 2+ pitting edema of the lower extremities, and she has 3+ proteinuria on urine dipstick.
-Evaluation-
Preeclampsia is a hypertensive disorder of pregnancy, typically occurring after 20 weeks gestation. It is a leading cause of maternal morbidity and mortality.
- Diagnostic Criteria: BP ≥140/90 mmHg on two occasions at least 4 hours apart, proteinuria, or end-organ dysfunction in the absence of proteinuria (think thrombocytopenia, renal dysfunction, elevated LFTs, pulmonary edema, new-onset headache or visual disturbances)
- Severe Features:
- BP ≥160/110 mmHg
- Persistent CNS symptoms (headache, vision changes, altered mental status)
- RUQ pain (suggesting hepatic involvement)
- Pulmonary edema
- Severe thrombocytopenia or worsening renal function
-Management-
Let’s follow a step-wise approach to limit sequela of this disease!
- Lower BP to reduce stroke risk: IV labetalol (first-line) or Hydralazine for acute BP control, with a goal SBP of 140-155 (not too low, to maintain uteroplacental perfusion!)
- Seizure prophylaxis: magnesium sulfate IV is needed for patients with severe features! Additionally, for those that have seizures, give IV magnesium immediately!
- Definitive treatment is delivery, especially if at or later than 37 week gestation!
-Fast Facts-
- Think preeclampsia in any pregnant patient with hypertension + systemic symptoms!
- Severe HTN = increased stroke risk → lower BP (but not too low)
- Seizure prophylaxis = magnesium sulfate
- The only definitive cure is delivery!
Want to learn more? Read our in-depth study guide about preeclampsia!
Cheers,
Tamir Zitelny, MD
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