Pregnancy, Preeclampsia
Follow-Up
Follow-up
Further Inpatient Care:
- Hospitalization is indicated for all women with preeclampsia in whom systolic blood pressure is above 140 mm Hg or diastolic blood pressure is above 90 mm Hg or manifestation of severe disease is present. The goals of hospitalization include the following:
- Daily weigh-ins
- Blood pressure readings every 4 hours
- Prophylactic anticonvulsive therapy
- Corticosteroids to enhance fetal lung maturity
Further Outpatient Care:
- Outpatient management of preeclampsia has a limited role. The decision to treat on an outpatient basis must be made in consultation with an obstetrician. Detailed instructions on signs and symptoms of progression of disease, including headache, visual changes, abdominal pain, vaginal bleeding, or decreased fetal movement, as well as strict bed rest is recommended.
- Outpatient therapy for hypertension is not generally recommended unless it is preexistent.
Transfer:
- Patients with severe preeclampsia must be stabilized in the ED as much as possible prior to transfer to a tertiary care facility.
Complications:
- Abruptio placentae with disseminated intravascular coagulopathy
- Renal insufficiency or failure
- Hemolysis, elevated liver enzyme levels, and low platelet count (or HELLP syndrome)
- Eclampsia
- Cerebral hemorrhage
- Death, either maternal and/or fetal
Prognosis:
- Early detection and frequent obstetric assessment markedly improves prognosis.
Patient Education:
- For excellent patient education resources, visit eMedicine's Pregnancy and Reproduction Center and Circulatory Problems Center. Also, see eMedicine's patient education articles Pregnancy and High Blood Pressure.
Miscellaneous
Medical/Legal Pitfalls:
- Immediate obstetric consultation is required for all patients presenting with preeclampsia.
- Maintain a high index of suspicion for preeclampsia when evaluating any complaint in a pregnant patient with abnormally elevated BP.
- Any pregnant patient, regardless of age, is at risk for preeclampsia.
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Bibliography
- Doan-Wiggins L: Hypertensive disorders of pregnancy. Emerg Med Clin North Am 1987 Aug; 5(3): 495-508[Medline].
- Frakes MA, Richardson LE: Magnesium sulfate therapy in certain emergency conditions. Am J Emerg Med 1997 Mar; 15(2): 182-7[Medline].
- Lew M, Klonis E: Emergency management of eclampsia and severe pre-eclampsia. Emerg Med (Fremantle) 2003 Aug; 15(4): 361-8[Medline].
- Lipstein H, Lee CC, Crupi RS: A current concept of eclampsia. Am J Emerg Med 2003 May; 21(3): 223-6[Medline].
- Ogle ME, Sanders AB: Preeclampsia. Ann Emerg Med 1984 May; 13(5): 368-70[Medline].
- Powers DR, Papadakos PJ, Wallin JD: Parenteral hydralazine revisited. J Emerg Med 1998 Mar-Apr; 16(2): 191-6[Medline].
- Probst BD: Hypertensive disorders of pregnancy. Emerg Med Clin North Am 1994 Feb; 12(1): 73-89[Medline].
- Sibai B, Dekker G, Kupferminc M: Pre-eclampsia. Lancet 2005 Feb 26-Mar 4; 365(9461): 785-99[Medline].
- Wagner LK: Diagnosis and management of preeclampsia. Am Fam Physician 2004 Dec 15; 70(12): 2317-24[Medline].
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Synonyms And Related Keywords
preeclampsia, HTN, hypertensive disease in pregnancy, pregnancy-induced hypertension, toxemia of pregnancy, hypertension, proteinuria, new-onset nondependent edema, seizure activity, eclampsia, seizure in pregnancy, microangiopathic hemolytic anemia, HELLP syndrome, hypertensive encephalopathy
