gynecology and obstetrics
Preeclampsia and Eclampsia
Key Points
Preeclampsia is new-onset hypertension with proteinuria after 20 weeks gestation, and eclampsia is unexplained generalized seizures in patients with preeclampsia; preeclampsia develops postpartum in 25% of cases. Preeclampsia is differentiated from chronic hypertension and gestational hypertension by the presence of new-onset proteinuria and/or end-organ damage. Preeclampsia is severe if it causes significant organ dysfunction (eg, renal insufficiency, impaired liver function, pulmonary edema, visual symptoms), even in the absence of proteinuria. HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a related disorder that occurs in 10 to 20% of women who have preeclampsia with severe features or eclampsia. Evaluate and closely monitor the mother and fetus, usually in a hospital maternal special care unit, but sometimes outpatient monitoring is possible. Delivery is usually indicated when the pregnancy is ≥ 37 weeks, but if preeclampsia with severe features is diagnosed, deliver by 34 weeks; if HELLP syndrome or eclampsia is diagnosed, deliver immediately. Treat eclampsia immediately with magnesium sulfate to prevent seizures from recurring; consider magnesium sulfate for seizure prophylaxis in women who have preeclampsia with severe features, but usually not in those with mild preeclampsia. If magnesium sulfate is given for seizure prophylaxis, continue for 12 to 24 hours after delivery. Give women with certain risk factors low-doseaspirinstarting at 12 to 28 weeks to reduce risk of preeclampsia, ideally before 16 weeks. 