Pre-eclampsia medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pre-eclampsia}} | {{Pre-eclampsia}} | ||
{{CMG}}; {{AE}} {{Ochuko}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{Ochuko}} | ||
==Overview== | ==Overview== | ||
*The aim of therapy is starting treatment in [[blood pressure]]≥ 140/90 mmHg in office or clinic and [[blood pressure]] ≥ 135/85 mmHg at home and reaching the target [[systolic blood pressure]] 110-140 mmHg and [[diastolic blood pressure]] less than 85 mmHg regardless the type of [[hypertension]] in [[pregnancy]]. | |||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
* The mainstay of therapy for [[hypertension]] in [[preeclampsia]] is [[oral methyldopa]], [[labetalol]], [[oxprenolol]], and [[nifedipine]], and second or third line agents include [[hydralazine]] and [[prazosin]]. | * The mainstay of therapy for [[hypertension]] in [[preeclampsia]] is [[oral methyldopa]], [[labetalol]], [[oxprenolol]], and [[nifedipine]], and second or third line agents include [[hydralazine]] and [[prazosin]]. | ||
* | *For patients who have [[proteinuria]] with [[severe hypertension]] or [[hypertension ]] with [[neurologic]] signs and symptoms, treatment is [[magnesium sulfate]] ([[MgSO4]]) for [[convulsion]] prophylaxis. | ||
* Urgent therapy for [[severe hypertension]]( [[blood pressure]] >160/110) is oral [[nifedipine]] or intravenous [[labetalol]] or [[hydralazine]] or oral [[labetalol]]. | * Urgent therapy for [[severe hypertension]]( [[blood pressure]] >160/110) is oral [[nifedipine]] or intravenous [[labetalol]] or [[hydralazine]] or oral [[labetalol]].<ref>{{cite journal|doi=10.1161/HYP.0000000000000065Hypertension.}}</ref><ref name="pmid32443079">{{cite journal |vauthors= |title=Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 |journal=Obstet Gynecol |volume=135 |issue=6 |pages=e237–e260 |date=June 2020 |pmid=32443079 |doi=10.1097/AOG.0000000000003891 |url=}}</ref> | ||
{| class="wikitable" | |||
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! align="center" style="background: #4479BA; color: #FFFFFF |Serum [[Magnesium]] Concentration (mg/dL) !! align="center" style="background: #4479BA; color: #FFFFFF |Effect | |||
|- | |||
|5–9 || Therapeutic range | |||
|- | |||
| >9|| Loss of [[patellar reflexes]] | |||
|- | |||
| > 12 || Respiratory paralysis | |||
|- | |||
| > 30 || [[Cardiac arrest]] | |||
|- | |||
|} | |||
{| class="wikitable" | |||
|- | |||
! align="center" style="background: #4479BA; color: #FFFFFF |Drugs for urgent controlling of [[hypertension]] in [[preeclampsia]]<ref>{{cite journal|title=Gestational Hypertension and Preeclampsia|journal=Obstetrics & Gynecology|volume=135|issue=6|year=2020|pages=e237–e260|issn=0029-7844|doi=10.1097/AOG.0000000000003891}}</ref> | |||
! align="center" style="background: #4479BA; color: #FFFFFF |Dose !! align="center" style="background: #4479BA; color: #FFFFFF |Specific considration !! align="center" style="background: #4479BA; color: #FFFFFF |Onset of action | |||
|- | |||
| [[Labetalol]]|| 10–20 mg IV, then 20–80 mg every 10–30 minutes upto a maximum dosage of 300 mg; or infusion 1–2 mg/min IV || Contraindications: | |||
*[[Asthma]] | |||
* [[Decompensated heart failure]], | |||
* [[ Heart block]] | |||
* [[Bradycardia]] | |||
|| 1-2 minutes | |||
|- | |||
| [[Hydralazine]] || 5 mg IV or IM, then 5–10 mg IV every 20–40 minutes upto a maximum dosage of 20 mg or keeping infusion of 0.5–10 mg/hr || Side effects in higher dosage: | |||
* maternal [[hypotension]] | |||
* [[Headaches]] | |||
*Abnormal [[fetal heart rate]] tracings | |||
|| 10-20 minutes | |||
|- | |||
| [[Nifedipine]] ||10–20 mg orally, repeat in 20 minutes if needed; then 10–20 mg every 2–6 hours, maximum daily dose is 180 mg|| Side effect: | |||
* Reflex [[tachycardia]] | |||
* [[Headache]] | |||
|| 5-10 minutes | |||
|- | |||
|} | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 06:38, 11 March 2022
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Pre-eclampsia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pre-eclampsia medical therapy On the Web |
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American Roentgen Ray Society Images of Pre-eclampsia medical therapy |
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Risk calculators and risk factors for Pre-eclampsia medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Ogheneochuko Ajari, MB.BS, MS [3]
Overview
- The aim of therapy is starting treatment in blood pressure≥ 140/90 mmHg in office or clinic and blood pressure ≥ 135/85 mmHg at home and reaching the target systolic blood pressure 110-140 mmHg and diastolic blood pressure less than 85 mmHg regardless the type of hypertension in pregnancy.
Treatment
Medical Therapy
- The mainstay of therapy for hypertension in preeclampsia is oral methyldopa, labetalol, oxprenolol, and nifedipine, and second or third line agents include hydralazine and prazosin.
- For patients who have proteinuria with severe hypertension or hypertension with neurologic signs and symptoms, treatment is magnesium sulfate (MgSO4) for convulsion prophylaxis.
- Urgent therapy for severe hypertension( blood pressure >160/110) is oral nifedipine or intravenous labetalol or hydralazine or oral labetalol.[1][2]
| Serum Magnesium Concentration (mg/dL) | Effect |
|---|---|
| 5–9 | Therapeutic range |
| >9 | Loss of patellar reflexes |
| > 12 | Respiratory paralysis |
| > 30 | Cardiac arrest |
| Drugs for urgent controlling of hypertension in preeclampsia[3] | Dose | Specific considration | Onset of action |
|---|---|---|---|
| Labetalol | 10–20 mg IV, then 20–80 mg every 10–30 minutes upto a maximum dosage of 300 mg; or infusion 1–2 mg/min IV | Contraindications: | 1-2 minutes |
| Hydralazine | 5 mg IV or IM, then 5–10 mg IV every 20–40 minutes upto a maximum dosage of 20 mg or keeping infusion of 0.5–10 mg/hr | Side effects in higher dosage:
|
10-20 minutes |
| Nifedipine | 10–20 mg orally, repeat in 20 minutes if needed; then 10–20 mg every 2–6 hours, maximum daily dose is 180 mg | Side effect:
|
5-10 minutes |
References
- ↑ . doi:10.1161/HYP.0000000000000065Hypertension. Check
|doi=value (help). Missing or empty|title=(help) - ↑ "Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222". Obstet Gynecol. 135 (6): e237–e260. June 2020. doi:10.1097/AOG.0000000000003891. PMID 32443079 Check
|pmid=value (help). - ↑ "Gestational Hypertension and Preeclampsia". Obstetrics & Gynecology. 135 (6): e237–e260. 2020. doi:10.1097/AOG.0000000000003891. ISSN 0029-7844.