USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

Complications can include intracerebral hemorrhage, with possible death.

Table I-9-1. Preeclampsia–Eclampsia Spectrum

Preeclampsia    without Severe

Features

Preeclampsia    with    Severe

Features

Eclampsia

Symptoms None Headache  or  epigastric  pain

or  visual  changes

Unexplained

convulsions

Sustained   ↑

blood

pressure

>140/90 mm  Hg  <160/110

mm  Hg

At  least   >140/90 mm  Hg  (if

other   findings)   or  >160/110

mm  Hg

At  least   >140/90

mm  Hg

Laboratory

tests

Hemoconcentration   >300    mg

proteinuria in  24  hrs

No  DIC,    normal  liver

function    tests

Hemoconcentration,  or  DIC,

or  ↑   liver   function    tests

Hemoconcentration

At  least   1-2 +

proteinuria

Other

findings

None Pulmonary  edema May   or  may not be

present

Management <36  wk: observe in  hospital,

no  MgSO 4 ,    or  blood   pressure

meds

≥36 wks:    prompt  delivery

MgSO 4 :    prevent or  treat   convulsions

Lower   diastolic,  BP  to  90–100  mm  Hg

Prompt  delivery:   not necessarily Cesarean    section

Administer  MgSO 4  with    an  IV  bolus   of  5   g   to  stop    seizures,   continuing

maintenance infusion    rate    of  2   g/h.    Continue    IV  MgSO 4  for 24  hours   after

delivery.

Aggressive  prompt  delivery    is  indicated   for eclampsia   at  any gestational age

after   stabilization   of  the mother  and the fetus.  Attempt vaginal delivery    with

IV  oxytocin    infusion    if  mother  and fetus   are stable.

Lower   diastolic   BP  between 90–100  mm  Hg  with    IV  hydralazine and/or

labetalol.