Preeclampsia

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Preeclampsia

Toxemia; Pregnancy-induced hypertension

Currently, the only way to cure preeclampsia is to deliver the baby. However, if that delivery would be very premature, the disease may be managed by bed rest, close monitoring, and delivery as soon as the fetus has a good chance of surviving outside the womb.

Patients are usually hospitalized, but occasionally they may be managed on an outpatient basis with careful monitoring of blood pressure, urine checks for protein, and weight.

Optimally, attempts are made to manage the condition until a delivery after 36 weeks of pregnancy can be achieved.

Labor may be induced if any of the following occur:

• Diastolic blood pressure greater than 100 mmHg consistently for a 24 hour period, or any confirmed reading over 110 mmHg
• Persistent or severe headache
• Abdominal pain
• Abnormal liver function tests
• Rising serum creatinine
• HELLP syndrome
• Pulmonary edema (fluid in lungs)
• Eclampsia
• Thrombocytopenia (low platelet count)
• Non-reassuring fetal monitoring tracings
• Failure of fetal growth noted by ultrasound
• Abnormal biophysical profile (a test to monitor the health of the fetus)

In cases of severe preeclampsia when the pregnancy is between 32 and 34 weeks, delivery is the treatment of choice. For pregnancies less than 24 weeks, the induction of labor is recommended, although the likelihood that the fetus will survive is very small.

Prolonging pregnancies has been shown to result in maternal complications, as well as infant death in approximately 87% of cases. Pregnancies between 24 and 34 weeks gestation present a "gray zone," and the medical team and the parents may decide to attempt to delay delivery in order to allow the fetus to mature.

During this time, the mother is treated with steroid injections which help speed the maturity of some fetal organs including the lungs. The mother and baby are closely monitored for complications.

During induction of labor and delivery, medications are given to prevent seizures and to keep blood pressure under good control. The decision for vaginal delivery versus Cesarean section is based on how well the fetus is able to tolerate labor.