1. Clinical features
Abnormal vasculogenesis and angiogenesis and releasing of anti-angiogenic factors results in
Vasospasm
Endothelial dysfunction
Etiology of various clinical signs and symptoms

3. So, Preeclampsia usually develops in third trimester
Abnormal placentation
Endothelial dysfunction

4. Clinical diagnosis of Preeclampsia
ACOG Task Force on
Hypertension in Pregnancy 2013

5. Classification of Preeclampsia
Preeclampsia-eclampsia
Chronic hypertension
Chronic hypertension with superimposed preeclampsia
Gestational hypertension

6. Preeclampsia-eclampsia 2013
PROTEINURIA
Not always necessary
HYPERTENSION OR
SEVERE FEATURES
**edema, IUGR, oligohydramnios, 24 hour proteinuria > 5 gms/day
NOT include in diagnostic criteria

7. Systolic BP
Diastolic BP
(4 hours apart)
HYPERTENSION

8. 24 hours ≥ 300 mg
Urine dipstick ≥ 1+
PROTEINURIA

9. SEVERE FEATURES Severe hypertension (≥ 160/110 mmHg)
Low platelet count (< 100,000/cu.mm.)
Abnormal liver function
(Increase AST/ALT 2 folds or RUQ pain)
Abnormal renal function
(Cr > 1.1 mg/dl or 2 folds of baseline level)
Pulmonary edema
Symptoms of nervous system and vision
CBC with platelet, AST, ALT, LDH,
Creatinine, Bilirubin, Uric acid

10. Mild preeclampsia Severe preeclampsia
Preeclampsia without severe features
Severe preeclampsia
Preeclampsia with severe features

11. ECLAMPSIA

12. fit
during pregnancy
38-55%

13. fit
18-36%
during labor

14. fit
11-44%
postpartum
Mostly within
48 hours

15. Can Preeclampsia-eclampsia
be prevented?

16. ASPIRIN Low dose aspirin (60-80 mg) for high risk group
beginning in the late first trimester

17. ASPIRIN High risk group
Previous preeclampsia, diabetes, hypertension, renal disease, autoimmune disease, multiple pregnancy

18. Preeclampsia-eclampsia
Principle of management

19. Preeclampsia-eclampsia
Controlling or prevention of eclampsia
Lowering blood pressure
Adequate hydration
Termination of pregnancy

20. MgSO4 1
Preeclampsia with severe features
Eclampsia

21. MgSO4 1 Dosage : Therapeutic level : 4.8-8.4 mg/dL Monitor :
20% MgSO4 2-6 gram IV loading dose in min, then
50% MgSO4 40 gram + 5%DW 920 mL IV drip 2 gram (50 mL)/hr
Therapeutic level : mg/dL
Monitor :
urine output, reflex,
respiratory rate, blood pressure
Antidote : 10% Calcium gluconate 10 mL (1gram) IV

22. Antihypertensive 2
BP ≥ 160/110 mmHg
Labetalol
Hydralazine
Nifedipine

23. Antihypertensive 2 Labetalol 20 mg IV over 2 minutes 10 minutes
BP ≥ 160/110 mmHg and viable fetus
Labetalol 20 mg IV over 2 minutes
Hydralazine 10 mg IV over 2 minutes
Labetalol 40 mg IV over 2 minutes
10 minutes
Labetalol 80 mg IV over 2 minutes
Consult or
Surveillance
ACOG Committee opinion; FEB 2015

24. Antihypertensive 2 20 minutes Hydralazine 10 mg IV over 2 minutes
BP ≥ 160/110 mmHg and viable fetus
Hydralazine 5-10 mg IV over 2 minutes
Labetelol 40 mg IV over 2 minutes
Hydralazine 10 mg IV over 2 minutes
20 minutes
Labetelol 20 mg IV over 2 minutes
10 minutes
Consult or
Surveillance
ACOG Committee opinion; FEB 2015

25. Labetelol 40 mg IV over 2 minutes
Antihypertensive 2
BP ≥ 160/110 mmHg and viable fetus
Nifedipine 10 mg PO
Labetelol 40 mg IV over 2 minutes
Nifedipine 20 mg PO
20 minutes
Consult or
Surveillance
ACOG Committee opinion; FEB 2015

26. 2
Special precaution
Do not prescribe diazepam (valium®) in case of preeclampsia-eclampsia
Unless status epilepticus was observed

27. 3
Limited IV access

28. 4 Termination as soon as possible 37 weeks gestation
Preeclampsia without severe features
37 weeks gestation
Preeclampsia with severe features
at least 34 weeks gestation

29. 4 Termination as soon as possible
Expectant management should be considered
If GA >24 to < 34 weeks gestation and available NICU
Corticosteroids are recommended
if GA < 34 weeks gestation

30. 4 Termination as soon as possible
Delivery after completion of 4 doses of corticosteroids
PPROM
Labour
Platelet < 100,000
Abnormal LFT
Renal dysfunction
Fetal growth restriction
Severe oligohydramnios
Abnormal doppler study
reversed end diastolic flow (umbilical a)

31. 4 Termination as soon as possible
Prompt delivery after maternal stabilization regardless of GA if
uncontrolled BP
eclampsia
pulmonary edema
abruptio placentae
disseminated intravascular coagulation
evidence of nonreassuring fetal status
intrapartum fetal demise

32. Postpartum surveillance
Treatment if BP ≥ 150/100 mmHg (4-6 hrs apart)
Prompt treatment if BP ≥ 160/110 mmHg

33. Postpartum surveillance
BP monitoring for 72 hrs
BP follow up 7-10 days postpartum