What are the severe features of preeclampsia/eclampsia and ED treatment steps?

What are the severe features of preeclampsia/eclampsia and ED treatment steps?

• A. Severe hypertension with proteinuria or end-organ dysfunction; seizures (eclampsia); treat with magnesium sulfate, BP control, and expedite delivery.
• B. Mild hypertension with no proteinuria; observe and discharge.
• C. Hypertension with normal labs; treat with diuretics only.
• D. Proteinuria without hypertension; monitor without intervention.

Answer: (B)

Severe features signal a high risk to both mother and baby and require urgent ED stabilization and delivery planning. In preeclampsia/eclampsia, severe features include very high blood pressure (systolic 160 or higher or diastolic 110 or higher on two occasions at least a few hours apart), and signs of end‑organ involvement such as low platelets, markedly elevated liver enzymes, renal impairment, pulmonary edema, or new cerebral symptoms (headache, visual changes, confusion) or severe RUQ/epigastric pain. If seizures occur, that’s eclampsia. The ED approach is to stabilize and prevent progression while preparing for delivery. Secure the airway and breathing, establish IV access, and initiate seizure prophylaxis with magnesium sulfate. Control blood pressure with IV antihypertensives (options include labetalol, hydralazine, or nifedipine) to avoid extreme swings while aiming for a safer range, and provide continuous fetal monitoring. Obtain relevant labs (platelets, liver enzymes, creatinine, urinalysis) and monitor for worsening end-organ function, then expedite delivery when maternal or fetal status warrants, since delivery is the definitive treatment for severe preeclampsia/eclampsia. Observation and discharge would be inappropriate when these severe features are present, because the risk of rapid deterioration remains high.

Severe features signal a high risk to both mother and baby and require urgent ED stabilization and delivery planning. In preeclampsia/eclampsia, severe features include very high blood pressure (systolic 160 or higher or diastolic 110 or higher on two occasions at least a few hours apart), and signs of end‑organ involvement such as low platelets, markedly elevated liver enzymes, renal impairment, pulmonary edema, or new cerebral symptoms (headache, visual changes, confusion) or severe RUQ/epigastric pain. If seizures occur, that’s eclampsia.

The ED approach is to stabilize and prevent progression while preparing for delivery. Secure the airway and breathing, establish IV access, and initiate seizure prophylaxis with magnesium sulfate. Control blood pressure with IV antihypertensives (options include labetalol, hydralazine, or nifedipine) to avoid extreme swings while aiming for a safer range, and provide continuous fetal monitoring. Obtain relevant labs (platelets, liver enzymes, creatinine, urinalysis) and monitor for worsening end-organ function, then expedite delivery when maternal or fetal status warrants, since delivery is the definitive treatment for severe preeclampsia/eclampsia.

Observation and discharge would be inappropriate when these severe features are present, because the risk of rapid deterioration remains high.