How Is Pre-Eclampsia Managed?

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Prevention

Although there is no fixed way to prevent pre-eclampsia, there are some measures which can be taken to reducing the risk of this condition

This includes:

  • Being healthy prior to conceiving (this can also help minimise the risk of other pregnancy complications!
  • Managing pre-existing medical conditions if any
    • Do consult with your doctor in relation to this to best manage the conditions and have a healthy pregnancy
  • Work towards maintaining a healthy body weight, a BMI between 19-25 is quite safe for women looking to have children.
  • Avoid unnecessary stress
    • Unnecessary stress can lead to increased blood pressure
  • Having a healthy diet
    • This includes eating balanced meals, such as more fruits and vegetables, while avoiding foods high in saturated fats and sodium.
    • You may also consider increasing calcium intake if one has low calcium intake but at risk of pre-eclampsia
  • Avoid alcohol and cigarettes
    • Especially for pregnant women, consumption of alcohol and smoking can lead to many negative side effects, which include increased blood pressure.
  • Exercise regularly (150 minutes per week of moderate intensity exercise is good!)
  • Going for routine checkups with obstetrician
    • It would be good to go for routine checkups with your doctor, and perform health screenings for suspected conditions.
    • You can not only reduce the risk for developing such conditions, treatment may also be more successful.

Additionally, low dose aspirin is recommended for women at high risk (i.e. pre-existing hypertension, pre-eclampsia in previous pregnancies)

  • This can start after 1st trimester (14 weeks)
  • Lower risk of hypertension during pregnancy and development of pre-eclampsia

Routine Pregnancy Screening

What happens at the antenatal visits?

If you have been diagnosed with pre-eclampsia, it is important to go for antenatal visits 1-2x per week to follow up and monitor your condition! Your doctor may also perform some tests during these checkups, which can include:

  • Tests to see if the condition is progressing
    • Blood test: this can be used to assess kidney and liver function
    • Urine test: urinary protein levels can also reflect how pre-eclampsia is progressing
  • Tests to monitor growth of fetus
    • Ultrasound: an ultrasound can be used to check blood flow to the fetus, monitor its growth, and assess amniotic fluid[1].
    • Cardiotocography: this is a method to electronically monitor the heart rate of the fetus, and can be used to detect signs of distress.

What can I do at home?

In cases of less severe pre-eclampsia, it can be managed on an outpatient basis, so it would be good to take these measures by yourself at home!

  • Daily blood pressure monitoring
    • Using a blood pressure monitor, you can take your blood pressure to check for abnormal levels as this could mean the condition has worsened.
  • Keep track of baby’s kick count
    • Keeping track of your baby’s kick count can help you monitor its movement and health to some extent.

Treatment Options

How can pre-eclampsia be treated? The treatment for each patient depends greatly on the severity of pre-eclampsia, and the stage of pregnancy which one is at.

Lifestyle

For patients with pre-eclampsia that is mild,

  • More bedrest, less physical activity to reduce blood pressure
  • Close monitoring by doctor or midwife

Admission for inpatient monitoring will be considered if:

  • Severe pre-eclampsia
  • Persistent hypertension or proteinuria

Diet

While diet is not a sure way of treating pre-eclampsia, there are changes which can be made to one’s diet to avoid progression of the condition. This include:

  • Having a low – moderate sodium content in food
  • Increased protein consumption (pre-eclampsia involves proteinuria[2])
  • For severe cases,
    • Dietary changes during hospital stay can also include electrolyte and fluid replacements

Medications

Antihypertensive medication (to control blood pressure)

  • Recommended when diastolic blood pressure above 100mmHg, and proteinuric gestational hypertension 
  • First-line choices include: methyldopa, labetalol, nifedipine 

Steroid medications — corticosteroids

  • Considered if patient has severe pre-eclampsia
  • As baby may be delivered prematurely, this can help the baby’s lungs mature
  • Temporarily improves platelet and liver function of the mother

Magnesium sulfate — anticonvulsant (to prevent seizures)

  • Recommended for women with pre-eclampsia that are at risk of seizure
  • Also given if patient has a plan for delivery
  • Delivered to patient’s bloodstream intravenously (IV)

Delivery

Delivery is the only actual cure for pre-eclampsia.

  • If pre-eclampsia is discovered at 37 weeks or after, the patient will be asked to deliver immediately if possible. This is because the baby would be fully mature by that time.
    • This can be done through caesarean section or induced labour.
  • Delivery at 37 weeks would also be recommended for patients with mild pre-eclampsia that is discovered earlier.
    • If the baby is not doing well in the womb, it may also be advised to deliver earlier.
  • However, if the patient has severe pre-eclampsia, delivery would be carried out as soon as possible past the 34 week mark.
    • Usually delivered via caesarean section
    • Baby may need to stay in NICU

Other factors which contribute to consideration of delivery:

  • Evidence of fetal compromise (would be noticed from monitoring of baby)
  • Problems with controlling blood pressure
  • High risk of eclampsia, or eclampsia
  • Evidence of severe organ dysfunction or multi-organ dysfunction in mother
  • Clinician is confident of fetal maturity

Close follow-up (after giving birth)

After delivery of your child, pre-eclampsia will usually go away in a time span between a few hours to 6 months. However, follow-up is important as pre-eclampsia is a condition which can escalate quickly and have severe effects if not monitored.

  • Monitoring of blood pressure right after delivery
    • There is possibility that the mother’s condition deteriorates so must establish that blood pressure has stabilised
    • Must continue to check blood pressure regularly even after leaving the hospital, medication may also continue depending on the patient.
  • May be at higher risk of cardiovascular disease in the future

Postpartum Pre-Eclampsia

In some cases, patients may only experience pre-eclampsia after delivery, and it is important to get treatment as soon as possible. This condition usually occurs between 48 hours to 6 weeks after delivery.

  • Common symptoms of postpartum pre-eclampsia include:
    • Headaches and nausea
    • Vision changes
    • Abdominal pain

Pre-eclampsia can be a serious complication during pregnancy, but it is also one that can be managed with the help of a medical team. If you are pregnant or know someone who is, make sure to educate yourself on the signs and symptoms of pre-eclampsia so that you can seek treatment as soon as possible if necessary.

References:

https://www.healthxchange.sg/women/pregnancy/preeclampsia-risk-during-pregnancy-symptoms-complications

https://www.nicoleconsultancy.com/nursing-care-for-preeclampsia-singapore/

https://www.ams.edu.sg/view-pdf.aspx?file=media%5C759_fi_262.pdf&ofile=Management_of_Pre-Eclampsia.pdf

https://www.sog.com.sg/resource-center/preeclampsia-risk-factors-symptoms-and-treatment/

https://www.aafp.org/afp/2004/1215/p2317.html

https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751

https://www.huggies.com.sg/en-sg/parenting-center/pregnancy/preeclampsia

https://drpamelatan.com/preeclampsia-the-hidden-dangers-of-pregnancy/

https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/treatments

https://www.nhs.uk/conditions/pre-eclampsia/treatment/

https://www.healthline.com/health/preeclampsia#complications