CURRENT Essentials of Critical Care.pdf

288 Current Essentials of Critical Care■■■Preeclampsia and EclampsiaEssentials of Diagnosis• Preeclampsia classically defined as clinical triad of hypertension,proteinuria, edema; because of frequency of edema in pregnancy,edema has been omitted from diagnostic criterion• Severe preeclampsia characterized by additional features: bloodpressure 160/110, more proteinuria, elevated creatinine, pulmonaryedema, oliguria, hemolytic anemia, liver dysfunction,fetal growth restriction• Eclampsia defined by addition of seizures without known cause• May be complicated by HELLP syndrome• Occurs in previously normotensive patients or with preexistingchronic hypertension after 20 weeks gestation; develops earlierwith multiple fetuses, hydatiform moleDifferential Diagnosis• Chronic essential hypertension• Gestational hypertension• Acute fatty liver of pregnancy• Chronic renal diseaseTreatment• Delivery of fetus definitive treatment; delays while administeringantihypertensive therapy remains controversial• Seizure prophylaxis and control with magnesium sulfate fromday of diagnosis until delivery; therapeutic goal range 4.8–8.4mg/dL• Hypertension control if blood pressure 180/110 with agentsincluding hydralazine and labetalol; in severe cases nitroprussidemay be used for limited time due to potential fetal cyanidepoisoning• Pulmonary artery catheter monitoring if oliguria unresponsiveto fluids, pulmonary edema unresponsive to diuretics and positionalchanges, or severe hypertension unresponsive to conventionaltherapy■ PearlThe only known definitive treatment for preeclampsia-eclampsia syndromeis delivery of the fetus.ReferenceRoberts JM et al: Summary of the NHLBI working group on research on hypertensionduring pregnancy. Hypertension 2003;41;437. [PMID:12623940]