Preeclampsia:eclampsiaMANAGEMENT

OBSTETRIC PRESENTATIONS · 12 SECTIONS

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542 items

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Eclampsia Ectopic Pregnancy (Ruptured)Ectopic Pregnancy (Unruptured)HELLP Syndrome Hyperemesis gravidarum Placenta previa Placental abruption Postpartum Endometritis Postpartum hemorrhage Postpartum infection Preeclampsia Preeclampsia:eclampsia Preterm labor Spontaneous Abortion (Incomplete)Spontaneous Abortion (Missed)Spontaneous Abortion (Threatened)Threatened:inevitable:incomplete abortion

Systemic and Miscellaneous Presentations15▾

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

›Systolic blood pressure 140 to 150 mmHg

›Diastolic blood pressure 90 to 100 mmHg

›Continuous monitoring

›Cardiac monitoring for IV antihypertensives

›Pulse oximetry

›Strict intake and output

›Magnesium toxicity surveillance

›Respiratory rate

›Deep tendon reflexes

›Urine output

Team activation and consults

›Escalation and consultation triggers

›Obstetrics and maternal fetal medicine

›Suspected severe features

›Eclampsia

›HELLP syndrome concern

›Anesthesia

›Anticipated operative delivery

›Thrombocytopenia and neuraxial planning

›Critical care

›Refractory severe hypertension

›Pulmonary edema

›Persistent neurologic abnormality

›Neonatology

›Preterm delivery planning

›Fetal compromise

Key decision points

›Time critical decisions

›Diagnosis category

›Gestational hypertension

›Preeclampsia without severe features

›Preeclampsia with severe features

›Eclampsia

›HELLP syndrome

›Delivery timing

›Maternal instability

›Fetal status

›Gestational age

›Transfer to higher level of care

›Need for ICU

›Need for tertiary neonatal care

›Need for expectant management before 34 weeks

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

›Baseline blood pressure before 20 weeks

›Antihypertensive use

›Diabetes mellitus

›Type 1

›Type 2

›Kidney disease

›Baseline creatinine

›Proteinuria baseline

›Autoimmune disease

›Antiphospholipid syndrome

›Systemic lupus erythematosus

›Multifetal gestation

›Twins or higher

›First pregnancy

›Nulliparity

›Assisted reproduction

›IVF

›Obesity

›Prepregnancy BMI risk

›Family history

›First degree relative preeclampsia

Medications and exposures

›Medication and substance history

›Antihypertensives

›Adherence

›Recent dose changes

›Seizure threshold modifiers

›Stimulants

›Illicit substances

›NSAID use postpartum

›Fluid retention concern

›Blood pressure effect concern

Obstetric and fetal context

›Pregnancy course details

›Prenatal care and prior blood pressures

›Trend of readings

›Home readings reliability

›Prior ultrasound growth assessment

›Fetal growth restriction history

›Abnormal Dopplers history

›Symptoms suggesting labor or rupture of membranes

›Contractions

›Fluid leakage

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

›Weakness

›Aphasia

Cardiopulmonary

›Cardiopulmonary findings

›Lung exam

›Pulmonary edema signs

›Aspiration after seizure

›Cardiac exam

›New murmur

›Signs of heart failure

Abdomen and obstetric

›Abdominal and obstetric findings

›Right upper quadrant tenderness

›Liver capsule stretch concern

›Uterine tenderness

›Abruption concern

›Fundal height and fetal position

›Gestational age correlation

›Vaginal bleeding

›Quantification

PITFALLS

›Common pitfalls

›Normal edema as sole indicator

›Low specificity

›Single elevated blood pressure without repeat

›Misclassification risk

›Assuming postpartum seizures are epilepsy

›Postpartum eclampsia risk up to 6 weeks

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

›Visual symptoms

›Seizure

›Meningitis or encephalitis

›Fever

›Neck stiffness

Abdominal and hematologic

›Abdominal and hematologic differentials

›Acute fatty liver of pregnancy

›Hypoglycemia

›Coagulopathy

›Encephalopathy

›Thrombotic thrombocytopenic purpura

›Hemolysis

›Neurologic symptoms

›Severe thrombocytopenia

›Hemolytic uremic syndrome

›Kidney failure

›Hemolysis

›Viral hepatitis

›Marked transaminitis

›Cholecystitis or pancreatitis

›RUQ pain

›Lipase elevation

Coding aligned terms

›ICD and SNOMED aligned labels

›Preeclampsia (ICD 10 O14)

›Mild to moderate (ICD 10 O14.0)

›Severe (ICD 10 O14.1)

›Unspecified (ICD 10 O14.9)

›Eclampsia (ICD 10 O15)

›In pregnancy (ICD 10 O15.0)

›In labor (ICD 10 O15.1)

›Puerperium (ICD 10 O15.2)

›HELLP syndrome (commonly coded under O14.2)

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

›Renal impairment

›Suspected toxicity

Thresholds supporting severity

›Diagnostic thresholds and interpretation

›Proteinuria definitions

›Protein creatinine ratio 0.3 or higher

›24 hour urine protein 300 mg or higher

›Thrombocytopenia severe feature

›Platelets below 100 x 10^9 per L

›Kidney severe feature

›Creatinine above 97 micromol per L

›Doubling of baseline creatinine

›Liver severe feature

›AST or ALT at least twice normal

›Hemolysis features for HELLP

›LDH elevation

›Indirect hyperbilirubinemia support

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

›Concern for hemorrhage

›Persistent decreased consciousness

›CT pulmonary angiography when pulmonary embolism concern

›Hypoxia not explained by edema

›Pleuritic chest pain

›Radiation counseling

›Maternal benefit prioritized in emergencies

Ultrasound (or US)

›Ultrasound evaluation

›Fetal growth ultrasound

›Estimated fetal weight trend

›Amniotic fluid assessment

›Umbilical artery Dopplers when fetal growth restriction

›Absent end diastolic flow concern

›Reversed end diastolic flow concern

›Placental assessment

›Abruption may be occult on ultrasound

›Point of care lung ultrasound

›B lines supporting pulmonary edema

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

›Dyspnea

›RUQ pain

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

›Generalized tonic clonic seizure

›No alternative cause identified

Geriatric

›Geriatric considerations

›Not applicable to typical obstetric population

›Rare pregnancy at advanced maternal age still follows same criteria

›Comorbidity burden

›Chronic hypertension more common

›Kidney disease more common

Pediatrics

›Pediatric and adolescent pregnancy considerations

›Same diagnostic thresholds

›Blood pressure criteria unchanged

›Weight based medication considerations

›Anesthesia and airway equipment sizing

›Safeguarding and support

›Social support assessment

›Follow up reliability planning

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

›Delivery as definitive therapy

›Placenta as driver of disease process

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 June 16, 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.