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Preeclampsia Delivery Indications

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Preeclampsia Delivery Indications, Delivery Indications in PIH

  • See Also
  1. Pregnancy Induced Hypertension
  2. Gestational Hypertension Management
  3. Mild PIH Management
  4. Severe PIH Management
  5. PIH Blood Pressure Management
  6. PIH Seizure Prophylaxis
  • Management
  • Medications
  1. See Severe Preeclampsia
  2. Corticosteroids if Preterm delivery unavoidable and fetus Gestational age 24-34 weeks (consider up to 37 weeks)
    1. Betamethasone 12 mg IM every 24 hours for 2 doses or
    2. Dexamethasone 6 mg IM every 12 hours for 4 doses
  1. Mild Preeclampsia
    1. Delivery at 37 weeks is preferred (as of 2015)
  2. Severe Preeclampsia
    1. Delivery after 32 to 34 weeks
    2. Based on Fetal Lung Maturity and Preeclampsia severity (see below)
  3. Severe refractory Preeclampsia with signs maternal or fetal deterioration (see below)
    1. Delivery in <24 hours regardless of Gestational age or Fetal Lung Maturity
    2. Attempt Corticosteroids
  1. Gestational age >34 weeks and Severe Preeclampsia
  2. Refractory, Severe Hypertension (>160/110 mmHg) at any Gestational age
  3. Maternal or fetal deterioration
  4. Eclampsia
  5. Pulmonary Edema
  6. Placental Abruption
  7. HELLP Syndrome
  8. Disseminated Intravascular Coagulation
  9. Acute Renal Failure
  10. Acute cardiovascular events (e.g. Myocardial Infarction, Cerebrovascular Accident)
  11. Fetal death, lethal anomaly, extreme prematurity
  12. Reverse end-diastolic flow on umbilical artery doppler
  1. Thrombocytopenia (Platelet Count <100k)
  2. Serum transaminase levels >2x normal
  3. Intrauterine Growth Retardation (IUGR <5th percentile)
  4. Severe oligohydramnios
  5. Umbilical artery reversed end-diastolic flow (Uteroplacental insufficiency)
  6. New or worsening renal dysfunction
  7. Non-reassuring fetal testing
  8. Other symptoms which may prompt early delivery
    1. Persistant severe Headache or visual changes
    2. Persistant severe Epigastric Pain or Emesis
  • Management
  • Indications for cesarean delivery (Vaginal Delivery is otherwise preferred)
  1. Recurrent Seizures refractory to medical management
  2. Refractory, Severe Hypertension (>160/110 mmHg)
  3. Maternal or fetal deterioration without impending delivery
  4. Severe Preeclampsia with unfavorable Cervix <30 weeks gestation (expert opinion)
  • Precautions
  1. Avoid epidural or spinal Anesthetic if Platelet Count <70k, Coagulopathy, Anticoagulants or antiplatelet agents
  • References
  1. Fontaine (2000) in ALSO, B:1-36
  2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
  3. Leeman (2016) Am Fam Physician 93(2):121-7 [PubMed]
  4. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]