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Mild PIH Management

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Mild PIH Management, Mild Preeclampsia, PIH Management, Preeclampsia Management

  • See Also
  1. Hypertensive Disorders of Pregnancy
  2. Chronic Hypertension in Pregnancy
  3. PIH Prophylaxis
  4. PIH Blood Pressure Management
  5. Severe PIH Management
  6. Delivery Indications in PIH
  • Criteria
  1. Blood Pressure >140/90 on 2 Blood Pressure readings 4-6 hours apart
    1. Assumes normal Blood Pressure before pregnancy (and before 20 weeks gestation)
    2. See Chronic Hypertension in Pregnancy
    3. Blood Pressure >160/110 on 2 occasions meets criteria for Severe Preeclampsia
      1. Start Antihypertensives if systolic Blood Pressure >160 or diastolic Blood Pressure >110 for >15 minutes
      2. See Severe Hypertension Management in Pregnancy
  2. Other findings in Preeclampsia (not required for diagnosis)
    1. Evaluate for features consistent with Severe Preeclampsia (e.g. Headache, abnormal labs such as Thrombocytopenia)
      1. See Severe PIH Management (includes IV Magnesium and delivery at >=34 weeks)
    2. Urine Protein 24 Hour: >300 mg
    3. Generalized Edema (affecting hands and face)
      1. Not reliable due to high False Positive and False Negative Rate in pregnancy
  • Findings
  1. Symptoms are typically absent in Mild Preeclampsia (consider Severe Preeclampsia if present)
    1. Typically, no Headache, visual changes or Epigastric Pain
  2. Signs are typically mild (contrast with Severe Preeclampsia)
    1. Urine Output maintained >500 ml/24h
    2. Urinalysis with no more than 1 to 2+ Protein
  • Evaluation
  • Maternal
  1. Monitor Blood Pressure 1-2 times weekly
  2. Obtain Preeclampsia labs weekly
    1. Complete Blood Count with Platelets
    2. Aspartate transaminase (AST)
    3. Alanine transaminase (ALT)
    4. Lactate Dehydrogenase (LDH)
    5. Serum Creatinine
    6. Urine Protein to Creatinine Ratio
      1. Consider quantifying abnormal values with Urine Protein 24 Hour collection
  • Evaluation
  • Fetal (starting at 26-28 weeks)
  1. Fetal Safety Assessment: Abnormal results prompt intervention, possible delivery
    1. Option 1
      1. Non-Stress Test weekly and
      2. Amniotic fluid index weekly and
      3. Biophysical Profile weekly
    2. Option 2
      1. Non-Stress Test twice weekly and
      2. Amniotic fluid index twice weekly
    3. Additional Measures
      1. Monitor fetal movevement with kick counts
    4. Interpretation
      1. Non-reassuring Non-Stress Test prompts repeat Biophysical Profile, anmniotic fluid index
      2. Consider intervention for Biophysical Profile <6/8 or amniotic fluid index <5 cm
  2. Fetal Growth Assessment
    1. Ultrasound for Fetal Growth every 3-4 weeks
    2. Consider concurrent Doppler Ultrasound of umbilical artery systolic/diastolic ratios
    3. Consider intervention if estimated fetal weight <10th percentile, or decreased ratio
  • Management
  • Mild Preeclampsia
  1. See Severe PIH Management
  2. See Delivery Indications in PIH
  3. Co-management with obstetrics
  4. Term Gestation: Delivery at 37 weeks is preferred
  5. Preterm gestation
    1. Maternal and Fetal Monitoring as above until Gestational age >37-38 weeks
    2. Consider earlier delivery when Fetal Lung Maturity adequate or clinical worsening
  • References
  1. Fontaine (2000) in ALSO, B:1-36
  2. Marlow (2021) Crit Dec Emerg Med 35(2): 19-23
  3. Sibai in Gabbe (2002) Obstetrics, p. 945-74
  4. Farahi (2024) Am Fam Physician 109(3): 251-60 [PubMed]
  5. Leeman (2008) Am Fam Physician 78:93-100 [PubMed]
  6. Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
  7. (2000) Am J Obstet Gynecol 183(1):S1-22 [PubMed]
  8. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]