›10–20 mg PO every 20–30 minutes
›Maximum 50 mg per episode
›Do not use sublingual route — precipitous drop risk
›Target blood pressure
›SBP 130–155 mmHg
›Avoid dropping SBP below 130 mmHg to maintain uteroplacental perfusion
›ACOG target range per Practice Bulletin 222
›DBP 80–105 mmHg
›Reassess every 10–20 minutes after each antihypertensive dose
›Initiate continuous IV infusion if oral/IV bolus regimen fails
›Platelet transfusion thresholds
›Cesarean section
›Transfuse to >50,000/μL before operative delivery
›One apheresis unit expected to raise platelets ~30,000–50,000/μL
›Vaginal delivery
›Transfuse to >30,000/μL if hemorrhage risk
›No transfusion required for stable vaginal delivery with platelets >30,000
›Invasive procedures (central line, epidural)
›Target >40,000/μL for neuraxial analgesia
›Anesthesia consultation for epidural with platelets 80,000–100,000
›Avoid platelet transfusion triggers
›Routine prophylactic transfusion above thresholds not indicated
›DIC may consume transfused platelets rapidly
›Disseminated intravascular coagulation
›Fresh frozen plasma
›10–15 mL/kg for PT/INR >1.5 or aPTT >45 seconds with active bleeding
›Repeat coagulation labs 1 hour post-transfusion
›Cryoprecipitate
›10 units if fibrinogen <150 mg/dL with active bleeding
›Each unit raises fibrinogen approximately 10 mg/dL
›Packed red blood cells
›Transfuse for hemoglobin <70 g/L (or <80 g/L with symptoms)
›Hemolysis accelerates anemia in HELLP
Hepatic complication management
›Hepatic subcapsular hematoma
›Contained hematoma — expectant management
›Strict bed rest, serial imaging
›Avoid abdominal palpation or pressure
›Enlarging or ruptured hematoma
›Hepatic artery embolization — preferred if interventional radiology available
›Surgical packing and drainage if embolization unavailable or fails
›Massive transfusion protocol activation
›Progressive liver failure
›Supportive care including glucose maintenance, coagulopathy correction
›Lactulose if encephalopathy develops
›Avoid hepatotoxic medications (NSAIDs, aminoglycosides)
›Liver transplant evaluation if failure persists beyond 72 hours postpartum
›Transfer to transplant center early — bridge listing while evaluating
Corticosteroids for fetal maturity
›Antenatal corticosteroid therapy if <34 weeks
›Betamethasone
›12 mg IM every 24 hours for 2 doses
›Cochrane review: no maternal mortality benefit, only improved platelet count
›Do not delay delivery for steroid completion if maternal condition deteriorating
›Single dose provides partial benefit
›Delivery takes priority over complete steroid course