Commentary

If you think it’s preeclampsia, get aggressive


 

PREECLAMPSIA AND ECLAMPSIA: 7 MANAGEMENT CHALLENGES (AND ZERO SHORTCUTS)
JOHN T. REPKE, MD, AND BAHA M. SIBAI, MD (APRIL 2009)

I enjoyed the informative article on preeclampsia by Dr. John T. Repke and Dr. Baha M. Sibai. I would summarize it by saying: Always think preeclampsia in a patient who even looks “toxic,” and always be aggressive.

A blood pressure level of 140/90 mm Hg has been my cutoff ever since my residency in the 1970s, when Dr. Leon Chesley oversaw all of our toxemic patients—and we had them each and every day of our training at Kings County Hospital in Brooklyn, New York. Over my 35 years in practice, I would estimate that 90% of the severe complications that have occurred during pregnancy in my patients have been related to preeclampsia. Yes, there were patients who had diabetes or cardiac conditions, but the hypertensive gravida has always been the one to be on the lookout for.

Here’s my advice if you want to stay out of trouble: Don’t be conservative, try to avoid expectant management, get out the old mag sulfate, and plan on getting that patient delivered as quickly as possible.

Barry Kramer, MD
Bay Shore, NY

Dr. Repke and Dr. Sibai respond:

We appreciate Dr. Kramer’s remarks and largely agree with him. Meticulous attention to examination of the patient, careful regard for gestational age, and vigilance to avoid the complications associated with uncontrolled hypertension and eclampsia will yield the best outcomes. Not all associated complications are preventable, and delivery of the fetus and placenta remains the cure for this disease.

Next Article: