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Mild PIH Management
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Mild PIH Management
, Mild Preeclampsia, PIH Management, Preeclampsia Management
See Also
Hypertensive Disorders of Pregnancy
Chronic Hypertension in Pregnancy
PIH Prophylaxis
PIH Blood Pressure Management
Severe PIH Management
Delivery Indications in PIH
Criteria
Blood Pressure
>140/90 on 2
Blood Pressure
readings 4-6 hours apart
Assumes normal
Blood Pressure
before pregnancy (and before 20 weeks gestation)
See
Chronic Hypertension in Pregnancy
Blood Pressure
>160/110 on 2 occasions meets criteria for
Severe Preeclampsia
Start antihypertensives if systolic
Blood Pressure
>160 or diastolic
Blood Pressure
>110 for >15 minutes
See
Severe Hypertension Management in Pregnancy
Other findings in
Preeclampsia
(not required for diagnosis)
Urine Protein 24 Hour
: >300 mg
Generalized Edema
(affecting hands and face)
Not reliable due to high
False Positive
and
False Negative Rate
in pregnancy
Findings
Symptoms are typically absent in Mild Preeclampsia (consider
Severe Preeclampsia
if present)
Typically, no
Headache
, visual changes or
Epigastric Pain
Signs are typically mild (contrast with
Severe Preeclampsia
)
Urine Output
maintained >500 ml/24h
Urinalysis
with no more than 1 to 2+
Protein
Evaluation
Maternal
Monitor
Blood Pressure
twice weekly
Obtain
Preeclampsia
labs weekly
Complete Blood Count
with
Platelet
s
Aspartate
transaminase (AST)
Alanine
transaminase (ALT)
Lactate Dehydrogenase
(LDH)
Uric Acid
Serum Creatinine
Urine with dipstick
Protein
or random
Protein
to
Creatinine
ratio
Quantify abnormal values with
Urine Protein 24 Hour
collection
Evaluation
Fetal (starting at 26-28 weeks)
Fetal Safety Assessment: Abnormal results prompt intervention, possible delivery
Option 1
Non-Stress Test
weekly and
Amniotic fluid index weekly and
Biophysical Profile
weekly
Option 2
Non-Stress Test
twice weekly and
Amniotic fluid index twice weekly
Additional Measures
Monitor fetal movevement with kick counts
Interpretation
Non-reassuring
Non-Stress Test
prompts repeat
Biophysical Profile
, anmniotic fluid index
Consider intervention for
Biophysical Profile
<6/8 or amniotic fluid index <5 cm
Fetal
Growth Assessment
Ultrasound
for
Fetal Growth
every 3-4 weeks
Consider concurrent
Doppler Ultrasound
of umbilical artery systolic/diastolic ratios
Consider intervention if estimated fetal weight <10th percentile, or decreased ratio
Management
Mild Preeclampsia
See
Severe PIH Management
See
Delivery Indications in PIH
Co-management with obstetrics
Term Gestation: Delivery by 38-40 weeks (37 weeks is preferred)
Preterm gestation
Maternal and
Fetal Monitoring
as above until
Gestational age
>37-38 weeks
Consider earlier delivery when
Fetal Lung Maturity
adequate or clinical worsening
References
Fontaine (2000) in ALSO, B:1-36
Marlow (2021) Crit Dec Emerg Med 35(2): 19-23
Sibai in Gabbe (2002) Obstetrics, p. 945-74
Leeman (2008) Am Fam Physician 78:93-100 [PubMed]
Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
(2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]
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