How is Preeclampsia Treated?

Question: How is Preeclampsia Treated?

Answer: The only definitive "cure" for preeclampsia is delivery, either vaginal or cesarean (c-section). Inducing labor is the treatment of choice for women who have reached a gestational age of at least 37 weeks. In all cases, the consensus is that all women with preeclampsia should be delivered by 40 weeks, and the use of induction drugs and cervical ripening agents is common.

For women who have not reached 37 weeks, treatment focuses on allowing the baby to mature as much as possible before inducing labor. The goal of preeclampsia treatment is to avoid progression of the disease and/or complications. A number of studies have shown that close outpatient monitoring is as effective as hospitalization for the majority of women, though women with severe disease usually require careful monitoring that is best accomplished in a hospital setting. In general, outpatient preeclampsia treatment means:

• Visiting the doctor every one to three days for a checkup
• Having weekly or twice weekly lab tests to check liver enzymes and kidney function
• Limiting difficult physical activity

High blood pressure medications are generally not given to women who are being treated on an outpatient basis, though certain medications are sometimes used during hospital-based treatment for severe preeclampsia. Similarly, there is currently no indication for either restricting salt intake or using diuretics in cases of preeclampsia, though both of these are commonly used for the initial treatment of high blood pressure not related to pregnancy. Bed rest is a well-known treatment measure, but, like salt restriction and diuretics, it has not been proven to improve ultimate outcomes.

The guiding factor in the treatment of preeclampsia is the health of the mother and the baby. In situations where the health of the mother or the baby appears to be in jeopardy, labor is usually induced. Specifically, signs that indicate labor induction should be started include:

• Maternal platelet count less than 100,000
• Worsening maternal liver function as observed on blood tests
• Worsening maternal kidney function as observed on blood tests (Creatinine >2)
• Persistent headaches or vision disturbances (blurry vision)
• Persistent abdominal pain
• Signs of severe fetal growth delay/restriction
• Signs of impaired fetal well-being

When delivery must be induced at a gestational age of less than 34 weeks, a course of steroids (usually betamethasone or dexamethasone) is given. This is done to help the baby's lungs develop, since babies born before 34 weeks almost always have some difficulty breathing because their lungs are still immature.

In cases of mild to severe preeclampsia, magnesium is usually given intravenously to prevent seizures and other serious potential complications. Numerous studies have shown that magnesium is vastly superior to other drugs for this purpose.

Learn More About Preeclampsia:
What is Preeclampsia?
What are the Symptoms of Preeclampsia?
Are there Different Kinds of Preeclampsia?
Is Preeclampsia Dangerous?
How is Preeclampsia Treated?

<sub>Sources:
1. Lucas, MJ., et al. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. New England Journal of Medicine, 333(4):201-5.
2. Goldenberg, RL., et al. Bed rest in pregnancy. Obstetrics and Gynecology, 84(1):131-6.
3. Barton, JR, et al. Monitored outpatient management of mild gestational hypertension remote from term. American Journal of Obstetrics and Gynecology, 170(3):765-9.
4. Sibai, BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics and Gynecology, 102(1):181-92.
5. Nicholson, JM, et al. The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: Evidence of a varying optimal time of delivery. Journal of Perinatology, 26(7):392-402.</sub>

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