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pre-eclampsia

For more details about the disease see the corresponding section in "obygyn".
Definition/Measurements/Treatment:

Management of ‎(severe)‎ pre-eclampsia

Behandlung der ‎‎(schweren)‎‎ Präeklampsie

Treatment:
  • Particular care should be taken to avoid precipitous falls in blood pressure, which may induce maternal or fetal complications, as a result of falling below critical perfusion thresholds. Elevated blood pressure should be lowered to levels of systolic 140-150 mmHg/diastolic 80-90 mmHg at a rate of 10-20 mmHg every 10-20 minutes (1).
  • Continous fetal heart rate monitoring should be employed until the blood pressure is stable (1).
  • Hydralazine is usually administered by intermittent bolus of 5 mg intravenously or intramuscularly. A continous infusion of 0.5-10 mg/h is also typically employed in more refractory cases. The use of hydralazine is often accompanied by maternal tachycardia and cautious administration of up to 500 ml crystalloid is recommended before or at the same time as the initial dose of intravenous hydralazine to reduce the chance of precipitous fall in blood pressure (3).
  • Acute pulmonary oedema is associated with positive fluid balances >5500 ml. In addition, evidence suggests that the use of intravenous fluids to increase plasma volume or treat oliguria in a woman with normal renal function and stable serum creatinine levels is not recommended (1).
  • For further information on magnesium sulfate see the corresponding section in "drugs".
  • For further information on labetalol see the corresponding section in "drugs".
  • For further information on corticosteroids see the corresponding section in "drugs".

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References:
  1. Management of pre-eclampsia. Anaesthesia 2012,67,1009-1020: full text | pdf
  2. Blaubuch Frauenklinik KSA: link (Nr. 59/2).
  3. The management of hypertensive disorders during pregnancy. National Institute for Health and Clinical Excellence Guideline (revised reprint January 2011): link.