What are the treatment options for preeclampsia due to chronic hypertension?

Updated: Jun 12, 2018
  • Author: Michael P Carson, MD; Chief Editor: Edward H Springel, MD, FACOG  more...
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Answer

Answer

Women with suspected, mild, or diagnosed preeclampsia remote from term or labile blood pressures due to chronic hypertension and/or gestational hypertension should be hospitalized for close observation, bed rest, and frequent fetal monitoring. The severity of any abnormalities on admission dictates the frequency of blood work. When diagnosed with preeclampsia, delivering the baby is always in the mother's best interest. Any delay in delivery should be due to uncertainty about the diagnosis or immaturity of the fetus.

Daily examination should include a funduscopic examination for retinal spasm or edema, lung examination for signs of volume overload, cardiac examination for gallop rhythms, abdominal examination for hepatic tenderness, extremities/sacrum examination for increasing edema, and neurologic examination for clonus.

Women with preeclampsia remote from term (ie, < 34-36 weeks' gestation) should be promptly transferred to a facility with adequate resources to care for premature newborn infants. This is essential because worsening preeclampsia disease activity may require urgent delivery at any time.

When preeclampsia develops remote from term (ie, < 34-36 weeks' gestation), attempts are often made to prolong the pregnancy to allow for further fetal growth and maturation. In this setting, both maternal and fetal status must be very closely monitored in a high-risk obstetric center. Fetal testing should be performed at least twice weekly, using a combination of biophysical profiles and nonstress testing supervised by an obstetrician (see Fetal Monitoring). Facilitated delivery should occur if either maternal or fetal deterioration is noted, with the mode of delivery decided by obstetric indications.

Treating hypertension secondary to preeclampsia with medications may reassure the clinician falsely but does not slow progression of the process; therefore, if treatment with antihypertensives is undertaken, clinicians must remain vigilant for all other symptoms, signs, and laboratory evidence of worsening preeclampsia. Other symptoms and signs of worsening preeclampsia must be sought routinely and delivery facilitated if the maternal or fetal condition worsens.


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