Pre/Eclampsia

Preeclampsia

• SBP ≥140mmHg OR

• DBP ≥90mmHg

  • 2 occasions, 4hrs apart

• AND after 20wks gestation

  • Think gestational trophoblastic if <20wks

• ± Proteinuria

  • ≥0.3 g in 24-hour urine OR

  • Protein/creatinine ratio ≥0.3 OR

  • Dipstick ≥2+

• In baby: can ➔ IUGR, pre-term

• In mom: can ➔ seizure, DIC, ARDS, renal failure, hemorrhagic stroke

Urgent BP control in pregnancy

Target BP: 130-150 / 80-100 (↓ MAP no more than 25% over 2hrs)

• Labetalol, 20mg, IV over 2mins, q10 min BPs

  • If BP remains above target

    • At 10 minutes, give 40mg

    • At 20 minutes, give 80mg

    • At 30 minutes, give 80mg

    • At 40 minutes, give 80mg

  • MAX DOSE: 300mg

• OR Hydralazine, 5 mg, IV over 1 to 2mins, q20 min BPs

  • • If BP remains above target

    • At 20 minutes, give 5 or 10mg

    • At 40 minutes, give 10mg

  • MAX DOSE: 30mg

• Other options: Dihydropyridine CCBs

  • Nifedipine XR, 30mg, PO

  • Nifedipine IR, 10mg, PO (↑ risk Mom’s BP tanking and FHR decelerations)

  • Nicardipine, 5mg/hr, IV infusion

Seizure (Eclampsia) PPX

• Magnesium sulfate

  • 6g, 10% solution IV over 15-20mins then infusion of 2g/h

  • Or 10g, 50% solution IM (5mg into each buttock) then 5g IM q4hrs

  • Maintain Mg > 2mmol/L

• Renal insufficiency (SrCr 1.0-1.5) or oliguria (< 30mL/hr for >4hrs)

  • 4-6g loading followed by 1g/hr

• Check Mg level if:

  • Seizures while receiving MgSO4

  • Renal insufficiency

  • SSX Mg toxicity (upper normal: 2.5)

    • Lost DTR - 7 to 10 mEq/L

    • Respiratory paralysis - 10 to 13 mEq/L

    • Altered cardiac conduction - >15 mEq/L

    • Cardiac arrest - >25 mEq/L

      • TX with 10 mL of 10% calcium gluconate IV (1g)