Lightning Learning: Pre-eclampsia

““Pre-eclampsia affects pregnant women from around Week 20 until soon after birth. If untreated it can progress to seizures (eclampsia) which can be life-threatening.””

— advice is based on local guidelines & procedures

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What?

Pre-eclampsia affects pregnant women from around Week 20 until soon after birth.

Early signs include…

High blood pressure:

• Systolic BP >160 mmHg, or

• MAP >120 mmHg

Proteinuria:

• 2+ or more on reagent strip

Other symptoms include…

• Facial swelling

• Peripheral oedema

• Visual disturbances

• Severe headache

• Chest pain

• Vomiting

• Low platelets (<100x109)

• Raised ALT (>70 iu/L)

If untreated it can progress to seizures (eclampsia) which can be life-threatening.

How?

Early recognition and appropriate treatment is key. Treatment is aimed at lowering blood pressure. Start with an oral antihypertensive, such as Nifedipine SR. Blood pressure should be checked every 5 mins until the MAP is below 120 mmHg.

Intravenous treatment is required if no improvement after 30 mins. Labetalol (or hydralazine if asthmatic) should be given, with an infusion if no improvement in blood pressure.

To treat eclampsia, give 4g intravenous magnesium over 10 mins followed by an infusion at 1g per hour.

Further Reading

• NICE Guidance Hypertension in Pregnancy – Diagnosis & Management
• Local Guidance (UHL): Severe Pre-eclampsia & Eclampsia – Guidelines for Management