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Pregnancy, Preeclampsia (Treatment)

eMedicine Emergency Medicine, 2014

Treatment Prehospital Care Oxygen via facemask Intravenous access Cardiac monitoring Transportation of patient in left lateral decubitus position Seizure precautions Emergency Department Care In the emergency setting, control of BP and seizures should be priorities.
Definitive therapy is delivery of the fetus, although preeclampsia may paradoxically emerge in postpartum patients.
In general, the further the pregnancy is from term, the greater the impetus to manage the patient medically.
BP control   The goal is to lower BP to prevent cerebrovascular and cardiac complications while maintaining uteroplacental blood flow.
Control of mildly increased BP does not appear to improve perinatal morbidity or mortality, and, in fact, it may reduce birth weight.
Antihypertensive treatment is indicated for diastolic blood pressure above 105 mm Hg and systolic pressure above 160 mm Hg, though patients with chronic hypertension may tolerate higher values.
Patients with severe preeclampsia who have BP below 160/105 mm Hg may benefit from antihypertensives because of the possibility of unpredictable acceleration of the disease and sudden increases in hypertension.
The goal is to maintain diastolic blood pressure between 90 and 100 mm Hg and systolic pressure between 140 and 155 mm Hg.
Control of seizures   Active seizures should be treated with intravenous magnesium sulfate as a first-line agent.
Prophylactic treatment with magnesium sulfate is indicated for all patients with severe preeclampsia.
No consensus exists about whether patients with mild preeclampsia (elevated blood pressure without evidence of end-organ damage) need to be on magnesium seizure prophylaxis.