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Preeclampsia and eclampsia: 7 management challenges (and zero shortcuts)

OBG Management. 2009 April;21(04):44-55
April 1, 2009|OBG Management
John T. Repke, MD
Author and Disclosure Information

John T. Repke, MD
Baha M. Sibai, MD
Dr. Repke is University Professor and Chairman of the Department of Obstetrics and Gynecology at Penn State University College of Medicine and Obstetrician-Gynecologist-in-Chief at the Milton S. Hershey Medical Center in Hershey, Pa. He serves on the OBG MANAGEMENT Board of Editors.
Dr. Sibai is Professor of Obstetrics and Gynecology at the University of Cincinnati College of Medicine in Cincinnati, Ohio.

From making the diagnosis to treating atypical eclampsia, management of preeclampsia involves serious, often unpredictable challenges

IN THIS ARTICLE

Atypical eclampsia has been defined as eclampsia that occurs before 20 weeks’ gestation or from 48 hours to 14 days after delivery. Its management is similar to the management of eclampsia, with BP control and magnesium sulfate being the mainstays of therapy.

Because of the relative rarity of atypical eclampsia, we recommend neurologic consultation in these cases to evaluate for other possible causes of seizure.

TABLE 4

HELLP syndrome—Sibai criteria

  • Hemolysis: Abnormal peripheral blood smear; total bilirubin >1.2 mg/dL
  • Elevated liver enzymes: AST and ALT more than twice the upper limit of normal for the lab
  • Low platelets: 3/μL

CASE RESOLVED

After initial hospitalization, the patient is monitored as an outpatient until 35 weeks’ gestation, when more labile BP and increased proteinuria necessitate hospitalization. However, her preeclampsia remains mild by definition and, after continued reassuring fetal testing, she undergoes labor induction at 37 weeks.

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