Management and monitoring of severe preeclampsia.
Preeclampsia is associated with increased maternal and perinatal morbidity and mortality. Preeclampsia is more than pregnancy-induced hypertension. The hypertension is only one manifestation of an underlying multifactorial, multisystem disorder, initiated early in pregnancy. In established severe disease there is volume contraction, reduced cardiac output, enhanced vascular reactivity, increased vascular permeability and platelet consumption. Medical treatment of severe hypertension in pregnancy is required. The more controversial issues are the role of pharmacological treatment in conservative management of severe preeclampsia aiming at prolongation of pregnancy, the ability of such therapy to modify the course of the underlying systemic disorder and the effects on fetal and maternal outcome. This paper presents an overview concerning the current developments in management and monitoring of severe preeclampsia. Controversial topics such as the role of plasma volume expansion in preeclampsia, expectant versus aggressive management of severe preeclampsia remote from term, and pharmacological interventions in the management of eclampsia and the HELLP syndrome are addressed.
Bolte
A C
AC
Department of Obstetrics and Gynecology, Free University Hospital, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands. ac.bolte@azvu.nl
van Geijn
H P
HP
Dekker
G A
GA
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D017359:HELLP Syndrome / Q000453:epidemiology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007743:Labor, Obstetric; D008278:Magnesium Sulfate / Q000627:therapeutic use; D009553:Nimodipine / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000627:therapeutic use; D010953:Plasma Volume; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000188:drug therapy*; D011247:Pregnancy; D012640:Seizures / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D000959:Antihypertensive Agents; D010952:Plasma Substitutes; D009553:Nimodipine; D008278:Magnesium Sulfate