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Preeclampsia/Eclampsia, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Hypertension in pregnancy:

    • 1% of all pregnancies

    • 16% of maternal deaths

  • Gestational hypertension (GH)

    • Hypertension associated with pregnancy

    • Resolves with delivery

    • 6–7% of all pregnancies

  • P...

Diagnosis

  • GH

    • Normotensive prior to 20 wk gestation

    • SBP >140 or DBP >90 on 2 separate measurements

    • Severe: SBP >160 and DBP >110

  • Preeclampsia

    • GH and proteinuria

    • 300 mg protein on 24 hr urine

    • 1+ pr...

Treatment

Pre-Hospital

  • ABCs

  • Oxygen

  • Place patient in left lateral decubitus position

Initial Stabilization/Therapy

  • ABCs

  • 100% oxygen

  • Left lateral decubitus position (reduces pressure on inferior vena cava, enh...

Follow-Up

Disposition

Admission Criteria

  • Preeclampsia

  • Eclampsia

  • HELLP syndrome

  • ICU, labor and delivery, OR

Discharge Criteria

  • Isolated hypertension with workup negative for preeclampsia

  • Asymptomatic

  • Close obst...

Pearls and Pitfalls

  • Delivery is the definitive treatment for preeclampsia and eclampsia

  • BP of 130/80 mm Hg in a pregnant woman requires investigation

  • Postpartum presentation: Consider preeclampsia/eclam...

Additional Reading

  • Deak  TM, Moskovitz  JB. Hypertension and pregnancy. Emerg Med Clin N Am.  2012;30:903–917.

  • Leeman  L, Fontaine  P. Hypertensive disorders of pregnancy. Am Fam Physician.  ...

Codes

ICD9

  • 642.40 Mild or unspecified pre-eclampsia, unspecified as to episode of care

  • 642.60 Eclampsia complicating pregnancy, childbirth or the puerperium, unspecified as to episode of care

  • 642.64 Ecla...

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