Usually hospitalization and sometimes antihypertensive treatment
Delivery, depending on factors such as fetal maturity and severity of preeclampsia
Mg sulfate for prevention or treatment of seizures
General approach: Definitive treatment is delivery. However, risk of early delivery is balanced against severity of preeclampsia and response to other treatments. Usually, immediate delivery after maternal stabilization (eg, controlling seizures, beginning to control BP) is indicated for the following:

Pregnancy of ≥ 37 wk
Eclampsia
Severe preeclampsia if pregnancy is > 34 wk or if fetal lung maturity is documented
Deteriorating renal or hepatic function
Nonreassuring results of fetal monitoring
Other treatments aim to optimize maternal health, which usually optimizes fetal health. If delivery can be delayed in pregnancies of about 32 to 34 wk, corticosteroids are given for 48 h to accelerate fetal lung maturity.

Most patients are hospitalized. Patients with eclampsia or severe preeclampsia are often admitted to an ICU.

Mild preeclampsia: If preeclampsia is mild, outpatient treatment is possible; it includes strict bed rest, lying on the left side whenever possible, BP evaluation and physician visits 2 to 3 times/wk, a normal salt intake, and increased fluid intake.

However, most patients with mild eclampsia require hospitalization; some also need drug treatment for a few hours to stabilize them and to lower systolic BP to 140 to 155 mm Hg and diastolic BP to 90 to 105 mm Hg. Delivery follows unless preeclampsia does not progress and the fetus is very premature.

Monitoring: Outpatients are usually evaluated once every 2 or 3 days for seizures, symptoms of severe preeclampsia, and vaginal bleeding. BP, reflexes, and fetal heart status (with nonstress testing or a biophysical profile) are also checked. Platelet count, serum creatinine, and serum liver enzymes are measured at least weekly. All hospitalized patients are followed by an obstetrician and evaluated as described above but more frequently, particularly patients that are in an ICU.

Mg sulfate: As soon as eclampsia or severe preeclampsia is diagnosed, Mg sulfate must be given to stop or prevent seizures and reduce reflex reactivity. Whether patients with mild preeclampsia always require Mg sulfate before delivery is controversial.

Mg sulfate 4 g IV over 20 min is given, followed by a constant IV infusion of about 1 to 3 g/h, with supplemental doses as necessary. Dose is adjusted based on the patient's reflexes, BP, and serum Mg levels (therapeutic range, 4 to 7 mEq/L). Patients with excess Mg levels (eg, with Mg levels > 10 mEq/L or a sudden decrease in reflex reactivity) or hypoventilation are treated with Ca gluconate 1 g IV.

IV Mg sulfate may cause lethargy, hypotonia, and transient respiratory depression in neonates. However, serious neonatal complications are uncommon.

Supportive treatments: Hospitalized patients are given IV Ringer's lactate or 0.9% normal saline solution, beginning at about 125 mL/h (to increase urine output). Persistent oliguria is treated with a fluid challenge, followed by furosemide


10 to 20 mg IV; diuretics are not used otherwise. If fluids plus furosemide


are ineffective, determining intravascular volume and cardiac output with a pulmonary artery catheter may be considered. Anuric patients with normovolemia may require renal vasodilators or dialysis.

If seizures occur despite Mg therapy, diazepam


or lorazepam


can be given IV to stop seizures, and IV hydralazine


or labetalol



is given in a dose titrated to lower systolic BP to 140 to 155 mm Hg and diastolic BP to 90 to 105 mm Hg.

Delivery method: The most efficient method of delivery should be used. If the cervix is favorable and rapid vaginal delivery seems feasible, a dilute IV infusion of oxytocin



is given to accelerate labor; if labor is active, the membranes are ruptured. If the cervix is unfavorable and prompt vaginal delivery is unlikely, cesarean delivery is indicated. Preeclampsia and eclampsia, if not resolved before delivery, usually resolve rapidly afterward, beginning within 6 to 12 h.

All patients are typically given Mg sulfate for 24 h postpartum.

Follow-up: Patients should be evaluated every 1 to 2 wk postpartum with periodic BP measurement. If BP remains high after 6 wk postpartum, patients may have chronic hypertension.