Definition

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• Preeclampsia: new-onset gestational hypertension with proteinuria or end-organ dysfunction
  • Superimposed preeclampsia: preeclampsia that occurs in a patient with chronic hypertension
  • HELLP syndrome
    • A life-threatening form of preeclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets
    • May occur without hypertension or proteinuria
  • Occurrence of new-onset hypertension, proteinuria, or end-organ dysfunction at < 20 weeks’ gestation is suggestive of gestational trophoblastic disease.
• Eclampsia: new-onset seizures (tonic-clonic, focal, or multifocal) in the absence of other causes ; a convulsive manifestation of hypertensive pregnancy disorders

Epidemiology

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Etiology

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Pathophysiology

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Clinical features

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Diagnostics

Urine studies

In the kidneys, vasospasm causes decreased renal blood flow and glomerular filtration rate, leading to minimal, concentrated urine (ie, high specific gravity) and increased serum creatinine levels.

• 24-hour urine collection (gold standard): proteinuria (urinary protein excretion ≥ 300 mg/day)
• Urine protein:creatinine ratio: ≥ 0.3
• Urine dipstick: > 2+ protein

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Treatment

Antihypertensives in pregnancy

Antihypertensives for urgent blood pressure control in pregnancy

• Parenteral labetalol (avoid in patients with contraindications to β-blockers)
• Nifedipine (immediate release)
• Parenteral hydralazine

Common oral antihypertensives in pregnancy

• Labetalol
• Nifedipine (extended release)
• Methyldopa

Magnesium sulfate for seizure prophylaxis

• Indications
  • Eclampsia
  • HELLP syndrome
  • Preeclampsia with severe features
• Administration: magnesium sulfate (IV or IM)
  • Contraindicated in patients with myasthenia gravis
  • Should be administered with care in patients with renal insufficiency
• Monitoring
  • Monitor all patients for signs of hypermagnesemia (e.g., decreased deep tendon reflexes, respiratory depression).
  • Signs of hypermagnesemia: Administer calcium gluconate (see “Hypermagnesemia” for clinical features and more information on management of hypermagnesemia).

Aspirin for preeclampsia prophylaxis

• Indications
  • ≥ 1 high-risk feature or ≥ 2 moderate-risk factors for preeclampsia.
• Regimen
  • Initiate low-dose aspirin between 12–20 weeks’ gestation (optimally before 16 weeks)

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