120 Obstetrics and Gynecology Board Review •••
❍ Name a few imitators of severe preeclampsia/HELLP syndrome.
Acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, and acute
exacerbation of systemic lupus erythematosus.
❍ What may a high fever associated with preeclampsia indicate?
A central nervous system hemorrhage.
❍ What is the recommended screening test for preeclampsia?
No screening test is currently recommended. Tests of interest have been studied and include uric acid level,
fibronectin level, plasminogen activator inhibitor-1 levels and ratio, and homocysteine level.
❍ Can preeclampsia be prevented?
No. Treatment is currently recommended to prevent preeclampsia, but a study regarding treatment with vitamin C
and vitamin E showed promising findings that should be confirmed in a larger study.
❍ Is there a role for medications in the prevention of preeclampsia?
The Cochrane review reports a 15% reduction in the risk of preeclampsia associated with the use of antiplatelet
agents. Low-dose aspirin has not been shown to prevent preeclampsia in women at low risk and therefore is not
recommended.
❍ Name a few experimental treatments that may prevent preeclampsia.
Calcium supplementation, fish oil, low-dose aspirin, and antioxidants.
❍ What is the definitive treatment of preeclampsia?
Delivery of the fetus is the cornerstone of treatment but maternal and fetal risks must be optimized prior to
making this decision.
❍ Does the severity of preeclampsia guide management?
For mild disease with a preterm fetus continued observation may be appropriate. It may include weekly nonstress
test (NST) and/or biophysical profile (BPP) (or twice weekly for suspected IUGR or oligohydramnios), and
ultrasound for growth scan and amniotic fluid assessment every 3 weeks. Maternal evaluation should include
platelet count, liver enzymes, and renal function and 24-hour urine collection for protein weekly. If continued
observation is chosen for a severe disease (remote from term), it may include daily evaluation of fetal and maternal
status including laboratory evaluation, depending on the severity and the progression.
❍ When should antihypertensive treatment be given during expectant management of preeclampsia?
When systolic blood pressure is above 150 to 160 mmHg or diastolic blood pressure above 100 to 110 mmHg,
since at these levels there is a higher risk of maternal complications such as cerebral hemorrhage.
❍ Is there a role for antihypertensive medications in mild preeclampsia?
The only proven effect of treatment of mild preeclampsia is a reduced incidence of severe preeclampsia.