Cardiovascular Medicine Book

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Preeclampsia Prevention

Aka: Preeclampsia Prevention, Preeclampsia Prophylaxis, PIH Prophylaxis
  1. Indications: Preeclampsia risk factors
    1. Preeclampsia in prior pregnancy
    2. Chronic Hypertension
    3. Diabetes Mellitus
    4. Renal disease
    5. Advanced maternal age
  2. Management: Aspirin 81 mg/day
    1. Indications (to start in first trimester)
      1. ACOG recommendations
        1. Prior Preeclampsia requiring delivery before 37 weeks OR
        2. More than one pregnancy with Preeclampsia
      2. USPTF recommendations (in addition to ACOG)
        1. Prior Severe Preeclampsia
        2. Diabetes Mellitus
        3. Chronic Hypertension
        4. Renal disease
        5. Autoimmune disease
    2. Efficacy: Benefits
      1. Prevents Pregnancy Induced Hypertension
      2. Prevents Intrauterine Growth Retardation
    3. Efficacy: Number Needed to Treat (NNT) to prevent one case of Preeclampsia
      1. NNT: 69 (overall)
      2. NNT: 18 (if highest risk factors present)
    4. References
      1. Coomarasamy (2003) Obstet Gynecol 101:1319-32 [PubMed]
  3. Management: Calcium Supplementation
    1. Dose
      1. Calcium 1-2 g orally daily
    2. Indications
      1. Dietary Calcium <600 mg/day
    3. Efficacy: Benefits
      1. Lowers Preeclampsia risk
      2. Lowers Blood Pressure
        1. Systolic lowered 5.4 mmHg
        2. Diastolic lowered 3.4 mmhg
    4. Reference
      1. Bucher HC (1996) JAMA 275:1113-7 [PubMed]
  4. Management: Agents to avoid due to low efficacy
    1. Avoid routine Magnesium Supplementation
    2. Avoid routine Omega-3 Fatty Acid Supplementation
    3. Avoid antioxidant Vitamin Supplementation
  5. 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):S1-22 [PubMed]
    4. Zamorski (2001) Clin Fam Pract 3:329-47 [PubMed]

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