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Severe PIH ManagementAka: Preeclampsia Management of Severe Cases, Severe Preeclampsia

See Also
Management: General measures
1. Hospitalize
2. Supplemental Oxygen
3. Strict bedrest
4. Maternal assessment every 15-60 minutes until stable
  1. Vital signs
  2. Deep Tendon Reflexes
  3. Neurologic checks
5. Fetal Assessment
  1. External fetal monitor
  2. Nonstress Test
  3. Ocytocin Challenge Test (OCT)
  4. Biophsical profile (BPP)
  5. Consider Fetal Lung Maturity if premature
6. Foley Catheter
  1. Urine output
  2. Urine Dipstick for protein hourly
7. Careful fluid management
  1. Daily weight
  2. Strict Intake and output
  3. Careful Intravenous fluids
    1. D5LR 50 to 125 cc/hour to keep urine out 30-40 cc/h
    2. Fluid volume should not be greater than 150 cc/h
  4. Lung Exam (assess for Pulmonary Edema)
  5. Consider fluid restriction
8. Lab monitoring every 4-6 hours
  1. Complete Blood Count
    1. Thrombocytopenia: Check platelets q4 hours in labor
  2. Blood Urea Nitrogen
  3. Serum Creatinine
  4. Uric Acid
  5. Serum electrolytes
  6. Liver transaminases (AST, ALT)
  7. Lactate Dehydrogenase (LDH)
Management: Specific
1. See Delivery Indications in PIH
2. Seizure Precautions
  1. PIH Seizure Prophylaxis with Magnesium Sulfate
  2. See Magnesium Sulfate for dosing and monitoring
  3. PIH Seizure Management as needed
3. Blood Pressure management
  1. PIH Blood Pressure Management
4. Administer Corticosteroids if fetus 24-34 weeks
  1. Preparation for anticipated preterm delivery
  2. Betamethasone 12 mg IM q24 hours x2 doses or
  3. Dexamethasone 6 mg IM q12 hours x4 doses
References
1. Fontaine (2000) in ALSO, B:1-36
2. Sibai in Gabbe (2002) Obstetrics, p. 945-74
3. (2000) Am J Obstet Gynecol 183(1):S1
4. Zamorski (2001) Clin Fam Pract 3:329

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.