Pre-eclampsia medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 13: Line 13:
*The mainstay  of therapy for [[ preeclampsia]], who have [[proteinuria]] with severe hypertension]] or [[hypertension ]] with [[neurologic]] signs and symptoms, is [[magnesium sulfate]] ([[MgSO4]]) for [[convulsion]] prophylaxis.
*The mainstay  of therapy for [[ preeclampsia]], who have [[proteinuria]] with severe hypertension]] or [[hypertension ]] with [[neurologic]] signs and symptoms, 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]].
*
{{MedCondContrAbs
|MedCond = Pre-eclampsia |Warfarin|
}}
===Other investigated treatments===
====Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia.<!--
  --><ref name="JCEM-preeclampsia-vitamin-D">{{cite journal | author=Lisa M. Bodnar, Janet M. Catov, Hyagriv N. Simhan, Michael F. Holick, Robert W. Powers, James M. Roberts |title=Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia. | journal= | year=2007
url=http://jcem.endojournals.org/cgi/content/abstract/92/9/3517}}</ref>====
Studies into supplementation with [[antioxidant]] vitamins C and E found no change in preeclampsia rates.<!--
  --><ref name="NEJM2006-Rumbold">{{cite journal | author=Rumbold A, Crowther C, Haslam R, Dekker G, Robinson J | title=Vitamins C and E and the risks of preeclampsia and perinatal complications. | journal=N Engl J Med | volume=354 | issue=17 | pages=1796-806 | year=2006 | id=PMID 16641396}}</ref>
Doctors Padayatty and Levine with NIH in a "Letter to the Editor" stated that the studies and another "Letter to the Editor" overlooked a key reason for the lack of vitamin C on the prevention of preeclampsia. Because plasma ascorbate concentrations were not reported, we estimated them from known data, the placebo and treatment groups in the study  probably had similar plasma and tissue ascorbate concentrations. Doses of 1 g per day have little effect on plasma or intracellular ascorbate concentrations.<!--
  --><ref name="Padayatta">{{cite journal | author= Padayatty SJ, Levine M. |  title=Vitamin C and E and the Prevention of Preeclampsia - Letter | journal=NEJM | volume=355 |issue=10 | pages=1065-1066 | year=2006 | url=http://www.health.adelaide.edu.au/og/research/ACTS%20Published%20letter1065.pdf | format=PDF}}</ref>
Calcium supplementation in women with low-calcium diets found no change in preeclampsia rates but did find a decrease in the rate of severe preeclamptic complications.<!--
  --><ref name="AmJObstetGynecol2006-Villar">{{cite journal | author=Villar J, Abdel-Aleem H, Merialdi M, Mathai M, Ali M, Zavaleta N, Purwar M, Hofmeyr J, Nguyen T, Campódonico L, Landoulsi S, Carroli G, Lindheimer M | title=World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. |journal=Am J Obstet Gynecol | volume=194 | issue=3 | pages=639-49 | year=2006 | id=PMID 16522392}}</ref>
Aspirin supplementation is still being evaluated as to dosage, timing, and population and may provide a slight preventative benefit in some women, however significant research has been done on aspirin and the results thus far are unimpressive.<!--
  --><ref name="Cochrane2004-Duley">{{cite journal | author=Duley L, Henderson-Smart D, Knight M, King J | title=Antiplatelet agents for preventing pre-eclampsia and its complications. | journal=Cochrane Database Syst Rev | year=2004 | issue=1 | pages=CD004659 | id=PMID 14974075}}</ref>
There is insufficient evidence to recommend either exercise<!--
  --><ref name="Cochrane2006-Meher-exercise">{{cite journal | author=Meher S, Duley L | title=Exercise or other physical activity for preventing pre-eclampsia and its complications. | journal=Cochrane Database Syst Rev | month=Apr 19 | year=2006 | issue=2 | pages=CD005942 | id=PMID 16625645}}</ref><!--
--> or bedrest<!--
  --><ref name="Cochrane2006-Meher-rest">{{cite journal | author=Meher S, Duley L | title=Rest during pregnancy for preventing pre-eclampsia and its complications in women with normal blood pressure. | journal=Cochrane Database Syst Rev | month=Apr 19 | year=2006 | issue=2 | pages=CD005939 | id=PMID 16625644}}</ref><!--
--> as preventative measures.  Studies of protein/calorie supplementation have found no effect on preeclampsia rates, and dietary protein restriction does not appear to increase preeclampsia rates.<!--
  --><ref name="Cochrane2003-Kramer">{{cite journal | author=Kramer M, Kakuma R | title=Energy and protein intake in pregnancy. | journal=Cochrane Database Syst Rev | year=2003| issue=4 | pages=CD000032 | id=PMID 14583907}}</ref>
====Sexual Health====
It has been suggested that fellatio may, through "immune modulation", have a beneficial role in preventing dangerous complications during pregnancy. Specifically, a research group reported that pre-eclampsia, a life threatening complication that sometimes arises in pregnancy, is much less frequent in couples who have practiced oral sex, and even more rare in couples where fellatio ended with the semen swallowed. Both results were statistically significant. This is consistent with other evidence that semen contains an agent that prevents preeclampsia, and with the theory that preeclampsia is an immunological condition. According to that view, preeclampsia is caused by a failure of the mother organism to accept the fetus and placenta, which both contain "foreign" proteins from the father's genes. Regular exposure to the father's semen might cause her immune system to gradually "grow accustomed" to their proteins. Other studies also found that, while any exposure to the partner's sperm during sex appears to decrease the chances of various disorders, women in couples who have practiced "other sex acts" than intercourse are half as likely to suffer pre-eclampsia. It is not known whether this represents a protective effect of "other sex acts" including oral sex, or a correlation between these sexual practices and some other protective factor: for example, greater overall frequency of sex. The standard way to resolve such questions (confounding) in medical science would be through a randomized trial, but there are unique challenges to research in sexual health.
When reporting the findings of the first research group mentioned above, New Scientist magazine thought it worth mentioning that some of the research team were women (including the lead author). Candidates for a protective agent in semen may include serum hormone leutinizing agent and transforming growth factor beta.


==References==
==References==

Revision as of 13:05, 8 October 2020

Pre-eclampsia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pre-eclampsia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pre-eclampsia medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Pre-eclampsia medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pre-eclampsia medical therapy

CDC on Pre-eclampsia medical therapy

Pre-eclampsia medical therapy in the news

Blogs on Pre-eclampsia medical therapy

Directions to Hospitals Treating Pre-eclampsia

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: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

The only known treatment for eclampsia or advancing preeclampsia is delivery, either by induction or Caesarean section. However, post-partum pre-eclampsia may occur up to 6 weeks following delivery even if symptoms were not present during the pregnancy. Post-partum pre-eclampsia is dangerous to the health of the mother since she may ignore or dismiss symptoms as simple post-delivery headaches and edema. Hypertension can sometimes be controlled with anti-hypertensive medication, but any effect this might have on the progress of the underlying disease is unknown. Studies have suggested that the father's semen when introduced into the mother, most effectively orally but also through intercourse,[1] prior to pregnancy reduces chances of preeclampsia, as it exposes the mother to foreign proteins of her partner.==Treatment==

Treatment

Medical Therapy

References

  1. PMID 10706945

Template:WH Template:WS