Prenatal and Postpartum Preeclampsia Treatment with Drugs

As mentioned in my earlier post, preeclampsia cannot be cured. It is a visitor who will stay throughout your pregnancy. There are treatment options and guidelines, which only keep the condition under control and prevent complications.

The only way to get rid of it is to deliver the baby after which the condition resolves. However, for the sake of the baby’s safety, delivery of the baby can be considered only after 37 weeks of gestation.

Before that, your health provider will consider other treatment options and formulate a carefully prepared plan.

But, a high maternal mortality risk or presence of eclampsia at gestation more than 20 weeks will also require induced delivery.

Further indications for delivery in preeclampsia include intrauterine fetal growth restriction, thrombocytopenia, impaired hepatic or renal function, severe epigastric pain, nausea, or vomiting. Any other cause of fetal distress also forms an indication.

But, what if the baby is not fully developed and the risks do not appear so bad?

In such a case, if the preeclampsia is mild and not beset with complications, you will be admitted to the hospital to closely monitor your condition and the progress of the baby till the baby is ready to be delivered.

Guidelines for preeclampsia treatment before delivery and after delivery are standard and follow a fixed protocol.

Besides close monitoring, you will be periodically investigated, given pregnancy-safe medication to control your blood pressure, the baby’s growth scanned through ultrasound till delivery.

After delivery, your hospital stay will continue to check for any postpartum effects of preeclampsia on you and your baby.

Bed rest

You will be asked to rest in bed and to lie specifically on your left side to take the weight of the baby off your major blood vessels. This will help to maintain good blood circulation while in bed.

However, benefits of bed rest are debated as some feel it only increases the chances of blood clot formation. Therefore, many doctors are not in favor of advocating bed rest.

Diet

A carefully formulated diet with the required amount of nutrients (especially protein), minerals and other nutritional intervention acts as an effective add-on to the treatment. You should necessarily read about this diet for preeclampsia patients.

Close monitoring of the mother and the fetus

In the hospital, your blood pressure will be checked regularly every four hours during the day to check that it is under control. Daily weight changes will be recorded.

Urine samples will be tested to check for the amount of protein that you pass in the urine. you should know that proteinuria (presence of protein in the urine) is a common sign of preeclampsia.

Due to fear of complications such as organ damage in preeclampsia, liver and kidney function tests are carried out to rule out any organ involvement.

Your baby’s health is scanned through ultrasound and non-stress testing (NST) to check its growth. This will involve checking for proper blood flow through the placenta, normalcy of the breathing and fetal movements.

Your doctor may recommend regular nonstress tests to check the fetal health and measure the amniotic fluid, which is an indicator of good or bad blood supply to the baby.

Monitoring fetal heart sounds  

The fetal heart beats will be monitored by using the cardiotocograph, more commonly known as an electronic fetal monitor (EFM). This helps to detect any fetal distress.

Medications for preeclampsia

Medications are used in preeclampsia to reduce or keep in check the high blood pressure and to prevent or stop seizures.

Blood pressure drugs

You have a wide range of drugs to lower elevated blood pressure (antihypertensives) but you cannot use them all during pregnancy for fear of harm to the fetus.

Your doctor will choose the specific agent best suited and its dose will depend on the following factors:

  • Severity of preeclampsia
  • Maternal and fetal compromise
  • Gestational period
  • Cervical status.

Blood pressure that is marginally high is usually left alone to be controlled by diet and prenatal exercises. The higher range of blood pressure is controlled with drugs that are carefully chosen so that no harm comes to the fetus.

Three antihypertensive drugs are approved for use in pregnancy and can be used:

  • Labetol
  • Methyl Dopa
  • Nifidepine

In cases of chronic or mild hypertension, oral methyldopa may be administered on an outpatient basis.

Methyldopa may be used in combination with or as an alternative to oral labetalol or nifedipine in patients with mild preeclampsia.

Severely high blood pressure (hypertensive emergencies) may be controlled by intravenous hydralazine hydrochloride in a dose of 5-10 mg (i.v. or i.m.) every 15 minutes up to a maximum dose of 30 mg i.m. or 20 mg i.v. A watch should be kept for unpredictable hypotension that may occur.

Though hydralazine is not an ideal drug for use during pregnancy, the benefits far outweigh the risks in severely acute cases.

Labetolol is safe for use and can be used through intravenous or oral route.

Nifedipine, an oral calcium-channel blocker has limited use in the treatment of acute severe preeclampsia.

Treating HELLP syndrome during pregnancy

HELLP syndrome occurs as a dangerous complication in about 2-10% of preeclampsia cases.

Once HELLP syndrome is diagnosed by blood tests and careful monitoring in a high-risk hospital, the best option is to deliver the baby.

Damaged kidneys may require dialysis. Low platelets may require blood transfusion. High doses of steroids may also be indicated for low platelets count, to improve liver function and prolong pregnancy.

Many centers use steroids, although ACOG practice guidelines do not yet endorse routine use of corticosteroids for HELLP syndrome.

In cases of severe preeclampsia, your medication may also include anticonvulsant medicines to prevent seizures.

Preeclampsia treatment after delivery

Management of preeclampsia after delivery primarily consists of keeping the blood pressure under check, prevent any complications such as seizures and keep a tab on the function of the body organs such as liver and the kidneys.

Medicines for blood pressure

After delivery, the main aim of treatment is to keep the blood pressure under control. During pregnancy, there is a restriction on the types of drugs to be used for fear of harm to the fetus.

Once the baby is out, your doctor may switch to more effective drugs to control your blood pressure.

Drugs to prevent seizures

Your doctor may advise magnesium sulphate as a preventive measure to avoid seizures. It is generally given for 24 hours postpartum.

Close monitoring

Besides your blood pressure, your protein in urine will be checked to see if your kidneys are functioning properly.

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