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Preeclampsia

What's new

Updated 2024 SOMANZ guidelines for the prevention and management of preeclampsia.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of preeclampsia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2023), the American Diabetes Association (ADA 2024), the Endocrine Society (ES 2024), the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ 2024), the European Association for the Study of the ...
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Screening and diagnosis

Indications for screening, general population: as per SOGC 2022 guidelines, obtain screening at least for clinical risk markers for preeclampsia in early pregnancy. Obtain screening at 11-14 weeks of gestation, if testing is available, using a combination of clinical risk markers, uterine artery pulsatility index, and placental growth factor to individualize the risk of developing preeclampsia.
B
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  • Indications for screening (at-risk population)

  • Indications for screening (intrahepatic cholestasis of pregnancy)

  • Diagnostic criteria

Classification and risk stratification

Severity grading: as per ACG 2016 guidelines, elevate the diagnosis of preeclampsia to severe preeclampsia in the presence of hepatic involvement.
B

Diagnostic investigations

Laboratory testing: as per EASL 2023 guidelines, obtain maternal assessment in patients with preeclampsia, including clinical features (BP and proteinuria) and biochemical tests as components of multivariate models, such as the fullPIERS or PREP models.
A

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  • Screening for proteinuria

  • Abdominal ultrasound

  • ECG

  • Fetal evaluation

Medical management

Setting of care: as per AAFP 2024 guidelines, admit pregnant patients with preeclampsia with severe features between 24 and 34 weeks of gestation without deteriorating maternal or fetal status for inpatient expectant management to 34 weeks with close monitoring.
B

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  • Management of non-severe hypertension (indications and targets)

  • Management of non-severe hypertension (choice of agent)

  • Management of non-severe hypertension (contraindicated agents)

  • Management of severe hypertension

  • Magnesium sulfate

  • Intravenous nitroglycerin

  • Thromboprophylaxis

  • Plasma expansion

Nonpharmacologic interventions

Bed rest: as per SOGC 2022 guidelines, avoid advising bed rest in patients with preeclampsia.
D

Therapeutic procedures

Platelet transfusion: as per EASL 2023 guidelines, consider administering platelet transfusion in pregnant patients with a platelet count < 100×10⁹/L to reduce the risk of abnormal coagulation and adverse maternal outcomes associated with preeclampsia.
B

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  • Timing of delivery

Patient education

Preconception counseling
As per SOGC 2022 guidelines:
Consider providing pre-conception counseling in patients with pre-pregnancy hypertension to advise on individualized management during pregnancy.
C
Replace ACEIs or ARBs with other antihypertensives in patients planning pregnancy unless there is a compelling clinical indication not to.
B

Preventative measures

Weight control: as per ESC 2018 guidelines, consider advising limitation of weight gain to < 6.8 kg in females with obesity.
C

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  • Exercising

  • Low-dose aspirin (general principles)

  • Low-dose aspirin (history of hypertension)

  • Low-dose aspirin (diabetes)

  • Low-dose aspirin (advanced age pregnancy)

  • Vitamin D supplementation

  • Calcium supplementation

Follow-up and surveillance

BP monitoring: as per ESH 2023 guidelines, consider obtaining home BP monitoring as an alternative to conventional office BP measurement to achieve BP control in patients with gestational or preexisting hypertension.
C

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  • Postpartum monitoring

  • Postpartum antihypertensive therapy

  • Breastfeeding

  • Long-term surveillance