Mild Pre-eclampsia

Criteria

  • SBP ≥ 140 to < 160, DBP ≥ 90 to < 110 (two readings, 4 hours apart)
  • Significant proteinuria (≥ 300mg in 24 hrs)
  • No evidence of organ dysfunction

Management

Admission

Quantification of Proteinuria (24 hrs urinary total protein)

Monitoring of Maternal Condition

  • BP - 4 times a day
  • CBC, S. creatinine, S. electrolytes, ALT, S. bilirubin - twice a week
  • Examination of the retina

Monitoring of the Fetal Condition

  • Kick count - daily
  • USG to determine fetal growth - every 3 weeks

Control of BP

  • BP < 150/100 - no antihypertensive
  • BP ≥ 150/100 - oral labetalol 100 mg BD/TDS

Deliver if

  • At term
  • Signs of fetal growth restriction
  • Worsening fetal or maternal condition
  • Labor or rupture of membranes

Severe Pre-eclampsia

Criteria

  • SBP ≥ 160, DBP ≥ 110 (two separate readings, 4 hours apart)
  • Significant proteinuria (≥ 300 mg in 24 hours) or any evidence of organ dysfunction, e.g., low platelet count, elevated liver enzymes, pulmonary edema, creatinine ≥ 1.1 mg/dl, headache, blurring of vision.

Management

Admission

If ≥ 34 weeks or < 34 weeks with complications

Deliver after stabilization of maternal condition.

If < 34 weeks without any complications

  • Quantification of proteinuria
  • Monitoring of fetal & maternal condition
  • Control of BP by oral labetalol
  • Prophylactic dose of MgSO4 (10gm)

Plan of Delivery in Both Cases

  • Assess cervical status
  • If favorable, induce labor with ARM or oxytocin
  • If unfavorable:
    • Ripen the cervix with misoprostol or Foley’s catheter and then induce labor
    • Cesarean section