Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Stabilize ABCs; treat seizures with magnesium; control BP.
- Assess maternal labs and fetal status; manage HELLP if present.
- Proceed to delivery once stabilized; continue magnesium 24 h postpartum; follow-up for postpartum hypertension.
Clinical Synopsis & Reasoning
New-onset seizures in pregnancy/postpartum (eclampsia) or preeclampsia with severe features. Stabilize airway/breathing, give magnesium sulfate for seizure control and prophylaxis, control blood pressure (labetalol, hydralazine, or nifedipine), and expedite delivery once maternal stabilized; manage HELLP and monitor fetus.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| BP trend, urine protein/creatinine, platelets, AST/ALT, creatinine | Diagnosis/severity | Severe features and HELLP | Guide management |
| Fetal monitoring and ultrasound (gestational age) | Fetal status | Growth, fluid, BPP | Plan delivery |
| Neuro evaluation (CT if atypical) | Rule out alternative | ICH, PRES | — |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Seizure, severe hypertension, or HELLP | Maternal/fetal risk | Magnesium sulfate; BP control; plan delivery |
| Refractory seizures | Status risk | Benzodiazepines; additional Mg or alternative anticonvulsants |
| Severe thrombocytopenia or DIC | Hemorrhage risk | Hematology/anesthesia planning |
| Preterm gestation with unstable mother/fetus | Timing dilemma | Transfer to higher level care; MFM input |
| Pulmonary edema/renal failure | Multiorgan involvement | ICU; careful fluids/diuretics |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Magnesium sulfate 4–6 g IV load → 1–2 g/h infusion | Anticonvulsant | Minutes | Seizure control/prophylaxis | Monitor DTRs/respiration; calcium gluconate for toxicity |
| Labetalol IV (20–80 mg boluses) or Hydralazine 5–10 mg IV or Nifedipine 10 mg PO | Antihypertensives | Minutes | Control severe BP (≥160/110) | Avoid ACEi/ARB |
| Delivery planning (timing/mode) | Definitive therapy | Hours | After maternal stabilization; consider steroids for fetal lung maturity if preterm | Multidisciplinary team |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- ACOG Practice Bulletin on Gestational Hypertension and Preeclampsia — Link