Preeclampsia-eclampsiaMANAGEMENT

OBSTETRIC PRESENTATIONS · 12 SECTIONS

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542 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Chorioamnionitis Eclampsia Ectopic Pregnancy (Ruptured)Ectopic Pregnancy (Unruptured)HELLP Syndrome Hyperemesis gravidarum Peripartum cardiomyopathy Placenta previa Placental abruption Postpartum Endometritis Postpartum hemorrhage Postpartum infection Preeclampsia Preeclampsia-eclampsia Preterm labor Sepsis in pregnancy Septic abortion Shoulder dystocia Spontaneous Abortion (Incomplete)Spontaneous Abortion (Missed)Spontaneous Abortion (Threatened)Threatened-inevitable-incomplete abortion Umbilical cord prolapse

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp66

Immediate threats

›Immediate stabilization priorities

›Seizure activity

›If active seizure, lateral position and suction readiness

›If ongoing convulsions, airway protection and rapid sequence intubation

›Magnesium sulfate for seizure control and prevention

›Severe hypertension

›Systolic blood pressure 160 mmHg or higher

›Diastolic blood pressure 110 mmHg or higher

›Persistent 15 minutes or more

›IV or oral rapid acting antihypertensive within 60 minutes (Class I)

›Respiratory compromise

›Pulmonary edema concern

›Oxygen saturation trend

›Noninvasive ventilation vs intubation triggers

›Hemorrhage concern

›Placental abruption suspicion

›Postpartum hemorrhage risk with coagulopathy

›Stroke concern

›Focal neurologic deficit

›Altered mental status not explained by postictal state

Hemodynamic targets and monitoring

›Monitoring and targets

›Blood pressure measurement technique

›Correct cuff size

›Seated or left lateral position

›Repeat after rest

›Blood pressure goals during acute control

02History/hx67

Presentation and timelines

›Symptom pattern and timing

›Gestational age and onset after 20 weeks

›New hypertension timing

›Prior normal blood pressure documentation

›Neurologic symptoms

›Headache persistent or severe

›Visual disturbance

›Confusion

›Seizure events

›Cardiopulmonary symptoms

›Dyspnea

›Orthopnea

›Chest pain

›Abdominal symptoms

›Right upper quadrant pain

›Epigastric pain

›Nausea or vomiting

›Bleeding and abruption symptoms

›Vaginal bleeding

›Abdominal pain with uterine tenderness

›Decreased fetal movement

Risk factors

›Risk profile

›Prior preeclampsia

›Early onset history

›Severe features history

›Chronic hypertension

03Physical Exam/exam51

Vital signs and general

›Vital signs and overall status

›Blood pressure confirmation

›Repeat measurements

›Both arms if concern for error

›Heart rate and rhythm

›Bradycardia with magnesium concern

›Tachycardia with hemorrhage concern

›Respiratory status

›Respiratory rate

›Work of breathing

›Oxygen saturation

›Volume assessment

›Peripheral edema

›JVP if needed

›Lung crackles

Neurologic

›Neurologic findings

›Mental status

›Persistent confusion

›Postictal resolution

›Visual findings

›Blurred vision

›Scotoma

›Reflexes

›Hyperreflexia

›Clonus

›Focal deficits

04Differential Diagnosis/ddx58

Hypertensive disorders and mimics

›Related hypertensive conditions

›Chronic hypertension with superimposed preeclampsia

›Worsening blood pressure

›New end organ features

›Gestational hypertension

›Hypertension without proteinuria or severe features

›Preeclampsia

›Hypertension with proteinuria or end organ involvement

›Eclampsia

›New onset generalized seizure in pregnancy or postpartum

›HELLP syndrome

›Hemolysis

›Elevated liver enzymes

›Low platelets

Neurologic emergencies

›Neurologic differentials

›Intracranial hemorrhage

›Severe headache

›Focal deficit

›Ischemic stroke

›Focal deficit

›Persistent symptoms

›Cerebral venous thrombosis

›Headache postpartum

›Seizure

›Posterior reversible encephalopathy syndrome

›Headache

05Laboratory Tests/lt42

Core maternal labs

›Maternal laboratory evaluation

›Complete blood count

›Platelet count trend for severe features

›Hemoglobin for hemolysis and bleeding

›Comprehensive metabolic panel

›Creatinine for kidney involvement

›AST

›ALT

›Bilirubin

›Hemolysis markers

›LDH elevation support

›Peripheral smear schistocytes support

›Haptoglobin low support when available

›Urine protein assessment

›Protein creatinine ratio

›24 hour urine protein when needed for confirmation

Coagulation and complications

›Complication directed labs

›Coagulation studies when indicated

›PT

›INR

›aPTT

›Fibrinogen with abruption or DIC concern

›Type and screen

›Abruption concern

›Delivery planning

›Magnesium level

06Diagnostic Tests/dt43

Scoring Systems

›Risk stratification tools

›fullPIERS score

›Designed for adverse maternal outcomes in preeclampsia

›Inputs include symptoms and labs and oxygen saturation

›HELLP classification frameworks

›Tennessee criteria

›Hemolysis evidence

›AST or ALT elevated

›Platelets low

›Mississippi classes

›Class based on platelet nadir

›Lower platelets correlate with severity

MRI

›MRI indications and interpretation

›Brain MRI for suspected PRES

›Persistent headache

›Visual symptoms

›Persistent altered mental status

›MR venography for cerebral venous thrombosis concern

›Postpartum headache

›Seizure

›MRI safety considerations in pregnancy

›Noncontrast preferred when feasible

›CT indications and interpretation

›Head CT without contrast for acute neurologic emergency

›Focal deficit

07Disposition/dispo28

Level of care

›Disposition decisions

›ICU or high dependency criteria

›Eclampsia

›Refractory severe hypertension

›Pulmonary edema

›Stroke or intracranial hemorrhage

›DIC or massive hemorrhage

›Inpatient obstetric admission criteria

›Preeclampsia with severe features

›Worsening labs

›Persistent symptoms

›Need for magnesium infusion

›Transfer criteria

›Gestational age less than 34 weeks with severe features

›Need for tertiary maternal fetal medicine

›Need for tertiary neonatal care

Discharge and follow up

›Outpatient pathway

›Appropriate only for nonsevere disease and reliable follow up

›No severe features

›Stable labs

›Reassuring fetal testing plan

›Blood pressure follow up plan

›Home monitoring instructions

›Early postpartum check within 3 to 7 days

›Return precautions

›Neurologic symptoms

08Treatment/t90

Seizure prophylaxis and management

›Magnesium sulfate protocol

›Standard dosing

›Loading dose 4 g IV over 15 to 20 minutes

›Alternative loading dose 6 g IV for high risk or active seizure per local protocol

›Maintenance 1 g per hour IV infusion

›Alternative maintenance 2 g per hour IV infusion per local protocol

›Continue 24 hours postpartum for severe features or eclampsia typical practice

›Recurrent seizure on magnesium

›Additional bolus 2 g IV

›Repeat once if needed per local protocol

›Toxicity monitoring

›Respiratory rate below 12 per minute concern

›Stop infusion and urgent evaluation

›Loss of deep tendon reflexes concern

›Stop infusion and urgent evaluation

›Urine output below 25 to 30 mL per hour concern

›Dose adjustment or hold

›Antidote

›Calcium gluconate 1 g IV over 3 minutes

›10 percent solution 10 mL equals 1 g

Acute severe hypertension

›Rapid acting antihypertensive options

›Labetalol IV

›Initial 20 mg IV

›Repeat 40 mg IV after 10 minutes if still severe

›Repeat 80 mg IV after 10 minutes if still severe

›Maximum cumulative 220 mg

›Contraindications

›Asthma with active bronchospasm

›Bradycardia

›Heart block

›Decompensated heart failure

›Hydralazine IV

›Initial 5 mg IV

›Repeat 5 to 10 mg IV after 20 minutes if still severe

›Typical maximum 20 to 30 mg in acute episode per protocol

›Adverse effects

›Reflex tachycardia

›Headache

›Nifedipine immediate release oral

›Initial 10 mg oral

›Repeat 20 mg oral after 20 minutes if still severe

›Maximum 50 mg within 1 hour typical protocol

›Cautions

›Avoid sublingual use

›Monitor for hypotension with magnesium

Ongoing blood pressure control

›Maintenance antihypertensives

›Labetalol oral

›Typical starting 100 to 200 mg oral twice daily

›Titration based on blood pressure response

›Nifedipine extended release oral

›Typical starting 30 mg oral daily

›Titration based on blood pressure response

›Methyldopa oral

›Alternative option when needed

›Slower onset

Fluids and pulmonary edema

›Volume strategy

›Restrictive fluids

›Avoid routine bolus

›Maintenance only if needed

›Pulmonary edema management

›Oxygen support escalation

›Loop diuretic

›Furosemide 20 mg IV

›Repeat dosing based on response and renal function

Delivery and obstetric management

›Definitive management considerations

›Delivery as cure

›Maternal stabilization before delivery when possible

›Timing guidance commonly used

›Preeclampsia without severe features

›Delivery at 37 weeks gestation typical recommendation

›Preeclampsia with severe features

›Delivery at 34 weeks gestation or later typical recommendation

›Earlier delivery for maternal or fetal deterioration

›Expectant management before 34 weeks

›Tertiary center requirement

›Close maternal and fetal monitoring

›Antenatal corticosteroids

›Betamethasone 12 mg IM

›Repeat 12 mg IM in 24 hours

›Magnesium for fetal neuroprotection

›Preterm delivery anticipated before 32 weeks per many protocols

Postpartum considerations

›Postpartum management

›Continued risk window

›New onset hypertension and symptoms up to 6 weeks postpartum

›Blood pressure peak postpartum

›Commonly 3 to 6 days postpartum

›Medication compatibility with breastfeeding

›Labetalol generally compatible

›Nifedipine generally compatible

09Special Populations/sp43

Pregnancy

›Pregnancy specific considerations

›Diagnostic definitions

›New hypertension after 20 weeks

›Systolic blood pressure 140 mmHg or higher

›Diastolic blood pressure 90 mmHg or higher

›Two readings at least 4 hours apart

›Severe range hypertension

›Systolic blood pressure 160 mmHg or higher

›Diastolic blood pressure 110 mmHg or higher

›Preeclampsia criteria

›Hypertension plus proteinuria

›Hypertension plus severe feature without proteinuria

›Severe features list

›Thrombocytopenia

›Platelets below 100 x 10^9 per L

›Kidney injury

›Creatinine above 97 micromol per L

›Doubling of baseline creatinine

›Liver involvement

›AST or ALT at least twice normal

›Persistent RUQ or epigastric pain

›Pulmonary edema

›Clinical or imaging support

›Cerebral or visual symptoms

›Severe headache

›Visual disturbance

›Eclampsia definition

10Background/b27

Epidemiology

›Epidemiology essentials

›Incidence range commonly reported

›Preeclampsia affects roughly 2 to 8 percent of pregnancies in many populations

›Timing

›Most cases after 20 weeks gestation

›Postpartum onset possible up to 6 weeks

›Maternal outcomes

›Major contributor to maternal morbidity and mortality worldwide

Pathophysiology

›Core mechanisms

›Abnormal placentation

›Poor spiral artery remodeling

›Endothelial dysfunction

›Increased vascular permeability

›Vasoconstriction

›Multisystem involvement

›Brain

›Liver

›Kidney

›Hematologic system

Therapeutic Considerations

›Treatment rationale

›Severe hypertension treatment goal

›Prevent intracranial hemorrhage and stroke

›Magnesium sulfate mechanism

›Central anticonvulsant effect

›Reduces recurrent seizures better than many alternatives

11Patient Discharge Instructions/pdi21

copy discharge instructions

›Discharge instructions for nonsevere disease or postpartum follow up

›Home blood pressure monitoring plan

›Same arm and position

›Rest 5 minutes before reading

›Record readings with date and time

›Medication instructions

›Exact dose and schedule

›Missed dose guidance per prescriber

›Return immediately for emergency care

›Severe headache

›Vision changes

›Seizure

›Shortness of breath

›Chest pain

›New severe swelling with breathing difficulty

›Right upper quadrant or epigastric pain

›Heavy vaginal bleeding

›Decreased fetal movement during pregnancy

›Follow up timeline

›Blood pressure check within 72 hours to 7 days postpartum

›Earlier review if symptoms occur

12References/r6

Clinical guidelines and core sources

›Key references

›ACOG Practice Bulletin No 222 Gestational Hypertension and Preeclampsia 2020

›Society for Maternal Fetal Medicine consensus guidance on severe hypertension and preeclampsia management

›NICE guideline NG133 Hypertension in pregnancy diagnosis and management

›World Health Organization recommendations on prevention and treatment of preeclampsia and eclampsia

›Standard obstetric emergency treatment bundles for acute severe hypertension and eclampsia management

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.