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Preeclampsia: Management and prognosis

INTRODUCTION

Preeclampsia refers to the new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman (table 1). It is a multisystem, progressive disorder with a disease spectrum that ranges from mild to severe. Progression to severe disease (table 2) may be gradual or rapid. Delivery results in resolution of the disease.

GENERAL PRINCIPLES

A key aspect of routine prenatal care is monitoring pregnancies for signs and symptoms of preeclampsia. If the diagnosis is made, the definitive treatment is delivery to prevent development of maternal or fetal complications from disease progression. (See "Preeclampsia: Clinical features and diagnosis", section on 'Burden of disease'.) When to initiate delivery is based upon gestational age, the severity of the disease, and maternal and fetal condition. Patients with preeclampsia at ≥37 weeks of gestation are delivered; however, before term, the risks of serious sequelae from disease progression need to be balanced with the risks of preterm birth. Evidence of serious maternal end-organ dysfunction or nonreassuring tests of fetal well-being are indications for prompt delivery at any gestational age. On the other hand, when mother and fetus are stable and without findings of serious end-organ dysfunction, a conservative approach with close monitoring for evidence of progression to severe features of the disease (table 2) is reasonable in order to achieve further fetal growth and maturity.

APPROACH BASED ON DISEASE SEVERITY

Preeclampsia with features of severe disease — Preeclampsia with features of severe disease (also called severe preeclampsia) (table 2) is generally regarded as an indication for delivery in the following settings:

Before fetal viability

At ≥340/7ths weeks of gestation

                                    

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Literature review current through: Jun 2014. | This topic last updated: Jul 23, 2014.
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