Pre-eclampsia medical therapy

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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.

Serum Magnesium Concentration (mg/dL)	Effect
5–9	Therapeutic range
>9	Loss of patellar reflexes
> 12	Respiratory paralysis
> 30	Cardiac arrest

Drug	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: 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 200 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