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Pre-Eclampsia and Eclampsia - #PHARMFAX

Updated: Aug 20, 2023

Pre-eclampsia is defined by hypertension after 20 weeks of gestation with new-onset proteinuria or coaglupathies.

 


Hypertension after 20 weeks of gestation with new-onset proteinuria or coaglupathies sounds like pre-eclampsia. Eclampsia is the progression into seizures. The mechanism is unclear but believed to be multifactorial from pregnancy sequelae on vasoactive mediators and angiogenic factors. Pre-eclampsia and eclampsia are hypertensive emergencies during pregnancy that can be life-threatening to the mother and fetus.


Persistent severe hypertension above 160 systolic and/or 110 diastolic warrants aggressive anti-hypertensive therapy. Delivery of the baby for those near-term would be preferable. Call the labor and delivery specialists early since this can rapidly turn from one into two rapidly decompensating patients.


The American Congress of Obstetricians and Gynecologists recommend use of intravenous labetolol and hydralazine, in addition to oral nifedipine immediate release for pre-eclampsia given their efficacy and safety profile. Additionally, patients also receive seizure prophylaxis with magnesium sulfate bolus, and continuous infusion, is indicated for severe pre-eclampsia. Magnesium has been shown to be more effective than placebo, phenytoin, and other antihypertensives in seizure prophylaxis. Blood pressure goals are less than around SBP 130 and/or DBP around 90. Avoid overshooting to prevent hypoperfusion; let's keep the it safe with mom and baby.


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References

  1. Fox et al. Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med. 2019 Oct 4;8(10):1625. doi: 10.3390/jcm8101625.

  2. ACOG. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260.

  3. Nirupama et al. Preeclampsia: Pathophysiology and management. J Gynecol Obstet Hum Reprod. 2021 Feb;50(2):101975.

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