Advise adequate dietary calcium (at least 1 000 mg daily).
Bed rest, preferably in hospital.
Lifestyle adjustment and diet.
Monitor BP, urine output, renal and liver function tests, platelet count, proteinuria and fetal condition.
Consider delivery when risks to mother outweigh risks of prematurity to baby.
Medical Treatment: Prevention For women at high risk of pre-eclampsia, e.g. pre-eclampsia in a previous pregnancy, chronic hypertension, diabetes, antiphospholipid syndrome or SLE, from 16 weeks gestation onwards:
Aspirin, oral, 75-150 mg daily with food.
For high-risk patients: Calcium carbonate, oral, 500 mg 12 hourly (equivalent to 1 g elemental calcium daily).
Although the benefit is greatest in high-risk women, consider use of this agent in all pregnant women.
When using iron together with calcium supplementation, ensure that iron and calcium are taken at least 4 hours apart from one another.
Drug treatment will be dictated by blood pressure response.
Monitor progress until a stable result is achieved.
In general, diuretics are contra-indicated for hypertension in pregnant women.
When needed, combine drugs using lower doses of the three agents before increasing the doses to a maximum.
Methyldopa, oral, 250 mg 8 hourly as a starting dose.
Increase to 500 mg 6 hourly, according to response.
Maximum dose: 2 g/day.
Amlodipine, oral, 5 mg daily.
Increase to 10 mg daily.
Hydralazine, oral, 25 mg 8 hourly.
Titrate up to 50 mg 6 hourly
SBP equal to or greater than160 mmHg or DBP equal to or greater than 110 mmHg. Admit to a high-care setting for close monitoring.
Sodium chloride 0.9%, IV infusion, 200 mL.
Nifedipine, oral, 10 mg
Repeat after an hour if needed until systolic blood pressure <160 mmHg and diastolic blood pressure < 110 mmHg
Swallow whole. Do not chew, bite or give sublingually.
Hydralazine, oral, 25 mg
Repeat after an hour if needed until systolic blood pressure < 160 mmHg and diastolic blood pressure < 110 mmHg.
If unable to take oral or inadequate response:
Lasslol, IV infusion, 2 mg/minute to a total of 1-2 mg/kg.
Reconstitute solution as follows: Discard 40mL of sodium chloride 0.9% from a 200mL container. Add 2 vials (2 x 100 mg) of Lasslol (5 mg/mL) to the remaining 160 mL of sodium chloride 0.9% to create a solution of 1 mg/mL. Start at 40mL/hour to a maximum of 160 mL/hour. Titrate against BP - aim for BP of 140/100 mmHg.
Oxytocin, IV/IM, 10 units as a single bolus after delivery of the baby.
Ergot-containing drugs are contraindicated in hypertensive women, including pre-eclampsia, following delivery of the baby.
Pre-eclamptic and eclamptic women are hypovolaemic, particularly when the haematocrit exceeds 40%, but are also susceptible to pulmonary oedema. Consequently, hypotension is a risk during anaesthesia. Careful infusion of IV fluids is important. Limit blood-loss at Caesarean section.
Both epidural and spinal anaesthesia may be used for operative delivery in hypertensive women, including pre-eclampsia. This should be administered by an experienced person, with meticulous attention to IV fluid management and haemodynamic monitoring.
Epidural analgesia is ideal for labour and delivery, but should only be undertaken by experienced practitioners in a unit properly equipped for resuscitation and with facilities available for urgent operative delivery. Avoid excessive IV fluids as there is no need for IV fluid loading in labour.