Review Question - QID 103480

This patient has symptoms of severe preeclampsia. Seizure prophylaxis and blood pressure control are necessary prior to delivery.

Antihypertensive agents should be used to control diastolic blood pressures above 100 mmHg in patients with symptoms of severe preeclampsia, notably proteinuria, hypertension, headaches, changes in visual, and right upper quadrant pain. Acceptable antihypertensive agents for pregnant females include hydralazine, labetalol, and nifedipine. Seizure prophylaxis with magnesium should be used to prevent progression to eclampsia.

Wagner reviews the management of preeclampsia. A loading dose of 6g of magnesium sulfate followed by an hourly infusion of 2g per hour is used for seizure prophylaxis. Antihypertensive therapy is used to lower systolic blood pressure below 160 mmHg and diastolic blood pressure below 100 mmHg.

Lo et al. review hypertensive diseases of pregnancy. They report a preeclampsia incidence of approximately 3%. Widespread use of magnesium sulfate has decreased the incidence of eclampsia in industrialized countries.

Illustration A describes treatment options for severe preeclampsia from Leeman et al. "Hypertensive disorders of pregnancy."
Illustration B depicts the algorithm for differentiating between hypertensive disorders occuring during pregnancy from Wagner 2004.

Incorrect answers:
Answer 2: Seizure prophylaxis is necessary in all patients with severe preeclampsia. Blood pressure control alone is inadequate.
Answers 3 and 4: Delivery of the child is indicated only after blood pressure control and appropriate seizure prophylaxis.
Answer 5: Steroid administration is used to induce fetal lung maturity prior to delivery in pregnancies less than 34 weeks gestation and is not indicated here.