Preeclampsia Delivery Indications

1. See Also
   1. Pregnancy Induced Hypertension
   2. Gestational Hypertension Management
   3. Mild PIH Management
   4. Severe PIH Management
   5. PIH Blood Pressure Management
   6. PIH Seizure Prophylaxis
2. Management: Medications
   1. Preterm delivery unavoidable if fetus 24-34 weeks
      1. Betamethasone 12 mg IM q24 hours x2 doses or
      2. Dexamethasone 6 mg IM q12 hours x4 doses
3. Management: Delivery gestational age goals
   1. Mild Preeclampsia
      1. Delivery by 40 weeks if unfavorable Cervix
      2. Delivery at 37-38 weeks if favorable Cervix
   2. Severe Preeclampsia
      1. Delivery after 32 to 34 weeks
      2. Based on Fetal Lung Maturity
   3. Severe refractory Preeclampsia with signs maternal or fetal deterioration
      1. Delivery in <24 hours regardless of gestational age or Fetal Lung Maturity
      2. Attempt Corticosteroids
4. Indications: Maternal Indications for delivery
   1. Platelet Count under 100,000
   2. Progressive liver function deterioration
   3. Progressive Renal Function deterioration
   4. Suspected Abruptio Placentae
   5. Refractory Severe Hypertension (>160/110)
   6. Persistant severe Headache or visual changes
   7. Persistant severe Epigastric Pain or Emesis
5. Indications: Fetal Indications for Delivery
   1. Severe fetal Intrauterine Growth Retardation
   2. Low umbilical artery systolic/diastolic ratio by doppler ultrasound (Uteroplacental insufficiency)
   3. Non-reassuring fetal testing
   4. Oligohydramnios
6. References
   1. Fontaine (2000) in ALSO, B:1-36
   2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
   3. Zamorski (2001) Clin Fam Pract 3:329-47