140-159 mm Hg systolic or 90-109 mm Hg diastolic on 2 occasions, 6 hours apart
Proteinuria 0.3-4.9 g in 24 hours
In mild preeclampsia, antihypertensive drugs may mask disease progression
In severe disease, expectant management is warranted only between 23 and 32 weeks, and only if mother and fetus are stable
Use calcium-channel blockers to control blood pressure in pregnant women with diabetes
Lowering blood pressure too rapidly during labor can reduce maternal organ perfusion, including uteroplacental blood flow
Start ACE inhibitors immediately postpartum in women with vascular diabetes or diabetic nephropathy
Baha
M.
Sibai,
MD
Professor and Chairman,
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine
Once you decide to expectantly manage a patient with preeclampsia, the balancing act begins. That means weighing fetal benefits against maternal risks, since the only justification for expectant management is to prolong pregnancy for fetal gain—there is no advantage to the mother.
The best approach is to classify the woman’s preeclampsia by the degree of severity and gestational age at the time of diagnosis, then follow recommendations tailored to that particular category.
