Pre-eclampsia medical therapy: Difference between revisions
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==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]]. | *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]]. | ||
*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. | ||
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! Serum [[Magnesium]] Concentration (mg/dL) !! Effect | ! align="center" style="background: #4479BA; color: #FFFFFF |Serum [[Magnesium]] Concentration (mg/dL) !! align="center" style="background: #4479BA; color: #FFFFFF |Effect | ||
|- | |- | ||
|5–9 || Therapeutic range | |5–9 || Therapeutic range | ||
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! 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 |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: | | [[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: | ||
Revision as of 03:04, 28 January 2021
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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.
- 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.[1]
| 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[2] | 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 200 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". Obstetrics & Gynecology. 135 (6): e237–e260. 2020. doi:10.1097/AOG.0000000000003891. ISSN 0029-7844.