ICU · Obstetric
Pre-eclampsia with severe features, eclampsia, and HELLP: ICU management
Also known as Pre-eclampsia severe · Eclampsia · HELLP syndrome · Hypertensive emergency pregnancy · Magnesium sulfate · Pre-eclampsia ICU
Pre-eclampsia (new hypertension after 20 weeks + proteinuria/end-organ dysfunction) affects 5-8% of pregnancies. SEVERE FEATURES: BP ≥160/110, thrombocytopenia (<100), elevated transaminases (2x), renal insufficiency (Cr 1.1 or 2x baseline), pulmonary oedema, cerebral/visual symptoms. ECLAMPSIA = seizures (new-onset, no other cause). HELLP = Haemolysis, Elevated Liver enzymes, Low Platelets (variant of severe pre-eclampsia). MANAGEMENT: (1) MAGNESIUM SULFATE for seizure prophylaxis/treatment (4 g IV loading + 1-2 g/hr infusion — monitoring reflexes, urine output, respirations). (2) BP control: IV labetalol, hydralazine, oral nifedipine (target 140-150/90-100 — avoid precipitous drops). (3) DELIVERY is the definitive treatment (timing based on maternal/fetal status). (4) Steroids (betamethasone) for fetal lung maturity (<34 weeks). COMPLICATIONS: stroke (leading cause of death), pulmonary oedema, AKI, hepatic rupture/infarction, DIC, placental abruption, fetal demise. POSTPARTUM: pre-eclampsia can develop/worsen up to 6 weeks postpartum.
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Target exams
Red flags
Pre-eclampsia spectrum
| Condition | Definition | Key features | Management priority |
|---|---|---|---|
| Gestational hypertension | New BP ≥140/90 after 20 weeks, no proteinuria/end-organ | Mild — no severe features | Monitor; deliver at 37 weeks |
| Pre-eclampsia | Hypertension + proteinuria (>300 mg/24h) or end-organ dysfunction | Mild (140-159/90-109) or severe (≥160/110 or severe features) | Monitor; magnesium if severe; deliver at 37 (mild) or 34 (severe) |
| Severe pre-eclampsia | BP ≥160/110 OR end-organ (thrombocytopenia, AST 2x, Cr >1.1, pulmonary oedema, cerebral/visual) | High maternal/fetal risk | Magnesium + BP control + delivery (often urgent) |
| Eclampsia | Seizures in pre-eclampsia (no other cause) | Life-threatening | Magnesium loading + delivery |
| HELLP | Haemolysis + Elevated Liver enzymes + Low Platelets | Variant of severe pre-eclampsia; high morbidity | Urgent delivery (esp <34 weeks); supportive |
| Chronic hypertension with superimposed pre-eclampsia | Known chronic HTN + new proteinuria/end-organ | Higher risk than either alone | Treat as severe pre-eclampsia |
ICU management of severe pre-eclampsia / eclampsia
- RECOGNISE + RESUSCITATE — ABC: oxygenate, IV access, continuous fetal monitoring (if antepartum). Eclamptic seizure: protect airway (left lateral position — prevents aspiration + improves venous return), give MAGNESIUM SULFATE (4-6 g IV loading over 20 min). Severe hypertension: IV labetalol (10-20 mg, repeat) or hydralazine (5 mg) — target BP 140-150/90-100
- MAGNESIUM SULFATE — seizure prophylaxis/treatment — LOADING: 4-6 g IV over 20 min (4 g for prophylaxis, 6 g for eclampsia). MAINTENANCE: 1-2 g/hr infusion (continue 24h postpartum or 24h after last seizure). MONITORING: reflexes (patellar — loss = early toxicity), respiratory rate (>12), urine output (>25 mL/hr — magnesium renally excreted). TOXICITY: loss of reflexes → respiratory depression → cardiac arrest. ANTIDOTE: CALCIUM GLUCONATE 10% 10 mL IV (over 10 min). CONTRAINDICATION: myasthenia gravis, heart block. Magnesium halves eclampsia risk (MAGPIE trial)
- BLOOD PRESSURE CONTROL — Target: 140-150 systolic, 90-100 diastolic. RATIONALE: lower compromises placental perfusion (fetal); higher risks maternal stroke. AGENTS: (a) IV LABETOL (alpha+beta blocker) — 10-20 mg IV q10min (max 300 mg) — first-line. (b) IV HYDRALAZINE (direct vasodilator) — 5 mg IV q20min (max 20 mg) — second-line. (c) ORAL NIFEDIPINE (CCB) — 10 mg PO, repeat in 30 min (slower onset but effective). (d) AVOID: ACEi/ARB (fetotoxic — renal malformation), nitroprusside (cyanide — fetal), diuretics (reduce placental perfusion). CHIPS trial: target diastolic 85 (vs 100) — no difference in pregnancy outcomes, less severe HTN
- FLUID MANAGEMENT — CAUTIOUS: pre-eclamptics have LOW intravascular volume (leaky capillaries -> third-spacing) but are prone to PULMONARY OEDEMA (capillary leak + low colloid oncotic pressure). Give maintenance crystalloid (75-125 mL/hr) — AVOID boluses unless hypotensive/oliguric. Monitor: input/output, JVP, oxygenation (pulmonary oedema). If pulmonary oedema: oxygen, diurese (small-dose frusemide), positional
- LABORATORY MONITORING — Full blood count (platelets — HELLP), U&E (renal function), LFTs (AST/ALT — HELLP, hepatic dysfunction), coagulation (INR, fibrinogen — DIC), uric acid (marker of pre-eclampsia), lactate (perfusion), magnesium level (if renal impairment or toxicity). Repeat every 6-12h. Monitor for: thrombocytopenia (HELLP), rising transaminases (HELLP), AKI, DIC (low fibrinogen, high INR/PTT, elevated D-dimer)
- DEFINITIVE — DELIVERY — The ONLY cure for pre-eclampsia/eclampsia/HELLP is DELIVERY (removal of placenta). TIMING: (a) Severe pre-eclampsia at TERM (≥37 weeks): DELIVER. (b) Severe pre-eclampsia at 34-37 weeks: deliver (after stabilising mother). (c) Severe pre-eclampsia <34 weeks: EXPECTANT management (if stable) with steroids for fetal lung maturity, close monitoring — deliver at 34 weeks or if maternal/fetal deterioration. (d) ECLAMPSIA or HELLP with complications: deliver URGENTLY (regardless of gestation) — after stabilising mother (BP, magnesium). MODE: vaginal (induction) preferred if feasible; caesarean if obstetric indication or unstable. MULTIDISCIPLINARY: obstetrician, anaesthetist, neonatologist, ICU
SAQ — Eclamptic seizure in the ICU: magnesium sulfate and blood pressure control
10 minutes · 10 marks
A 27-year-old primigravida at 36 weeks gestation, admitted to HDU 6 hours ago with severe pre-eclampsia (BP 168/108, proteinuria 3+, platelets 112, AST 95), on a maintenance magnesium sulfate infusion at 1 g/hr following a 4 g loading dose, has a generalised tonic-clonic seizure lasting 90 seconds. She is now post-ictal, drowsy, RR 8, SpO2 90 percent on room air, BP 184/116, patellar reflexes absent, urine output 12 mL/hr for the last 2 hours.
SAQ — HELLP syndrome with coagulopathy and postpartum deterioration
10 minutes · 10 marks
A 34-year-old woman (gravida 3 para 2) at 32 weeks gestation presents with 3 days of epigastric and right-upper-quadrant pain, nausea and malaise. She is alert, HR 108, BP 158/102, RR 20, SpO2 96 percent. Bloods: platelets 42 × 10⁹/L, AST 340 U/L, LDH 1450 U/L, bilirubin 38 micromol/L, INR 1.8, fibrinogen 1.4 g/L, Hb 86 g/L with schistocytes on film, creatinine 145 micromol/L. CTG is reactive.
Clinical pearls
Red flags
Prognosis
Pre-eclampsia/eclampsia/HELLP evidence and outcomes
Magnesium (MAGPIE 2002 — prophylaxis halves eclampsia; Collaborative Eclampsia Trial 1995 — magnesium superior to diazepam/phenytoin). CHIPS (2015, NEJM): target diastolic 85 — no fetal harm, less severe HTN. Aspirin prophylaxis (ASPRE 2017, meta-analyses): 50-60% reduction in preterm pre-eclampsia in high-risk women. BP control: labetalol/hydralazine/nifedipine — target 140-150/90-100. WOMAN trial (2017, Lancet): TXA reduces death from postpartum haemorrhage. Maternal mortality: severe pre-eclampsia 0.2-1%; eclampsia 1-2%; HELLP 1-3% (higher with hepatic rupture). Recurrence: pre-eclampsia in 15-20% of subsequent pregnancies (higher if early-onset, severe). Long-term: 2-4x cardiovascular risk (HTN, IHD, stroke) after pre-eclampsia.
Definitions and classification
Diagnostic criteria — pre-eclampsia spectrum (ACOG/NICE)
| Category | BP criteria | Proteinuria / end-organ | Onset | Delivery |
|---|---|---|---|---|
| Chronic hypertension | ≥140/90 before 20 wk or persists >12 wk postpartum | None | Pre-pregnancy / early | Term (manage HTN) |
| Gestational hypertension | ≥140/90 after 20 wk | No proteinuria, no end-organ | After 20 wk | 37 weeks |
| Pre-eclampsia (uncomplicated) | 140-159/90-109 | Proteinuria >300 mg/24h OR PCR >30 mg/mmol OR end-organ | After 20 wk | 37 weeks |
| Pre-eclampsia with severe features | ≥160/110 (confirmed on two readings 4 hr apart) OR any severe feature | Thrombocytopenia <100, AST/ALT ≥2× normal, Cr >1.1 mg/dL or 2× baseline, pulmonary oedema, new-onset headache unresponsive to analgesia, visual disturbance | After 20 wk | 34 weeks (or earlier if unstable) |
| Eclampsia | Any | New-onset generalised seizure — no alternative cause | Antepartum (60%), intrapartum (20%), postpartum (20%) | Stabilise then deliver |
| HELLP syndrome | May be normal / mildly elevated | Haemolysis + AST ≥70 + platelets <100 | After 20 wk (peak 27-37 wk) | Stabilise then deliver |
| Chronic HTN + superimposed pre-eclampsia | Known chronic + sudden rise or new severe feature | New/worsening proteinuria or end-organ | After 20 wk | Treat as severe |
Severe features of pre-eclampsia (memorise these — any one mandates magnesium + ICU-level care):
- Severe hypertension: SBP ≥160 or DBP ≥110 on two occasions ≥4 hr apart (unless antihypertensive started before this time).
- Thrombocytopenia: platelet count <100 × 10⁹/L.
- Elevated transaminases to twice the upper limit of normal (AST/ALT ≥70 IU/L) or severe RUQ/epigastric pain unresponsive to analgesia.
- Renal insufficiency: serum creatinine >1.1 mg/dL (97 µmol/L) or doubling of baseline (in absence of other renal disease).
- Pulmonary oedema.
- New-onset headache unresponsive to analgesia and not accounted for by alternative diagnosis.
- Visual disturbance: scotomata, diplopia, photopsia, cortical blindness (PRES). [1]
HELLP syndrome classification
HELLP classification systems
| System | Class/grade | Criteria |
|---|---|---|
| Tennessee (strict) | Complete HELLP | All of: (a) haemolysis — abnormal smear OR LDH >600 OR bilirubin ≥20 mg/dL; (b) AST ≥70 IU/L; (c) platelets <100 × 10⁹/L. Partial HELLP = 1-2 of the three. |
| Mississippi (tripart) | Class 1 | Platelets ≤50 × 10⁹/L |
| Class 2 | Platelets 51-100 × 10⁹/L | |
| Class 3 | Platelets 101-150 × 10⁹/L + AST ≥40 + LDH ≥600 | |
| Swansea (AFLP) | Differentiates AFLP from HELLP | AFLP needs ≥6 of 11 criteria (vomiting, abdominal pain, polydipsia/polyuria, encephalopathy, hyperbilirubinaemia, hypoglycaemia, urate, AST, leukocytosis, ascites/echo, renal dysfunction) |
HELLP vs AFLP vs TTP/HUS vs viral hepatitis — the dangerous mimics
| Feature | HELLP | AFLP | TTP / HUS | Viral hepatitis |
|---|---|---|---|---|
| Trimester | 27-37 wk (can postpartum) | 3rd trimester | Any (often postpartum for HUS) | Any |
| Hypertension | Usually present | ~50% | Usually absent | Absent |
| Platelets | Low (<100) | Low-normal | Very low (<30) | Normal |
| AST/ALT | ≥70 (mild-moderate) | Very high (often >1000) | Mild | Very high (>1000) |
| Bilirubin | Mild ↑ (haemolysis) | Marked ↑ | Marked ↑ (haemolysis) | Marked ↑ |
| Glucose | Normal | LOW (hypoglycaemia — hallmark) | Normal | Normal |
| Coagulation | INR may rise late | INR ↑, fibrinogen ↓ early | Normal | Normal |
| ADAMTS13 | Normal | Normal | <10% (TTP) | Normal |
| Hallmark clue | Schistocytes, RUQ pain | Hypoglycaemia + encephalopathy | Severe MAHA | Viral serology |
| Treatment | Deliver | Deliver + glucose + FFP | Plasmapheresis (do NOT deliver alone) | Antiviral / supportive |
Magnesium sulphate regimens
Magnesium sulphate dosing regimens
| Regimen | Loading dose | Maintenance | Setting / comment |
|---|---|---|---|
| Zuspan (IV) | 4-6 g IV over 20 min | 1-2 g/hr IV infusion | ICU/HDU standard; titratable; needs infusion pump; preferred in monitored setting |
| Pritchard (IM) | 4 g IV + 10 g IM (5 g each deep gluteal) | 5 g IM q4h alternate buttock | WHO/MAGPIE; rural/field; reliable; painful; sterile abscess risk |
| Sibai (high-dose) | 6 g IV over 20 min | 2 g/hr IV | Active eclampsia / recurrent seizure; close monitoring |
| Low-dose (renal) | 4 g IV over 20 min | 0.5-1 g/hr IV | Cr >90 µmol/L, oliguria, elderly — check level at 4-6 hr |
| Recurrent seizure | 2 g IV bolus over 3-5 min (after loading) | Continue infusion | If seizure recurs after loading → 2 g bolus (up to 8-10 g total in 1 hr) |
Therapeutic range: 2-4 mmol/L (4-8 mEq/L). Level vs toxicity: loss of reflexes 4-7 mmol/L; somnolence/weakness 5-8; respiratory depression 7-10; PR prolongation/QRS widening 8-12; cardiac arrest >12-15 mmol/L. Monitoring (hourly): patellar/biceps reflex, RR ≥12, urine output ≥25 mL/hr (≥0.5 mL/kg/hr), SpO₂, conscious state. Draw level at 4-6 hr and in renal impairment. Antidote: calcium gluconate 10% — 10 mL (1 g) IV over 10 min (reverses cardiotoxicity and respiratory depression; effect lasts 30-60 min — repeat if needed). Stop magnesium infusion immediately. Keep drawn-up syringe at bedside. Contraindications/caution: myasthenia gravis, heart block, severe renal impairment, digitalis toxicity, concurrent aminoglycosides/neuromuscular blockers (potentiation). [1]
Antihypertensive agents
Antihypertensive agents in severe pre-eclampsia
| Agent | Class | Dose | Onset | Repeat / max | Cautions |
|---|---|---|---|---|---|
| Labetalol | α + non-selective β blocker | 10-20 mg IV, then 20-80 mg q10min | 5-10 min | Max 300 mg total; or 20-160 mg/hr infusion | Avoid in asthma, heart block; first-line for most |
| Hydralazine | Direct arteriolar vasodilator | 5 mg IV over 1-2 min | 10-20 min | Repeat 5-10 mg q20-30min; max 20-30 mg | Reflex tachycardia, headache, flush; give with fluid to avoid precipitant drop |
| Nifedipine | Dihydropyridine CCB | 10 mg PO (bite-and-swallow) | 10-20 min | Repeat 10 mg q20-30min; max 30 mg then 10-20 mg q4-6h | Caution with magnesium (severe hypotension — myth largely refuted, still monitor) |
| Nitroglycerine | Venous/arterial dilator | 5-100 µg/min IV | 1-3 min | Titrate | Pulmonary oedema; very short-acting; tachyphylaxis |
| Nicardipine | Dihydropyridine CCB | 5 mg/hr IV, titrate 2.5-15 mg/hr | 5-15 min | Continuous | Refractory HTN; avoid abrupt drop |
| Esmolol | β1-selective (short-acting) | 250-500 µg/kg load then 50 µg/kg/min | 1-2 min | Titrate | Fetal bradycardia — reserve for aortic dissection/thyrotoxic crisis |
| AVOID | ACE-i/ARB (fetotoxic — oligohydramnios, renal agenesis), nitroprusside (fetal cyanide), diuretics (reduce placental perfusion unless pulmonary oedema) |
Magnesium toxicity emergency management
- SUSPECT — loss of reflexes, RR <12, somnolence, slurred speech, hypotension, ECG changes (PR ↑, QRS widening) in any woman receiving magnesium
- STOP the magnesium infusion immediately — do not wait for level
- CALCIUM GLUCONATE 10% — 10 mL (1 g) IV over 10 min (slow); revers cardiotoxicity and respiratory depression within minutes; effect lasts 30-60 min — repeat at 10 min if no response
- AIRWAY / BREATHING — high-flow oxygen; if RR depressed or apnoea → bag-mask ventilation → intubation; do not delay ventilation awaiting reversal
- CIRCULATION — IV crystalloid bolus if hypotensive; vasopressor (noradrenaline) if refractory; treat bradycardia
- CHECK magnesium level, U&E, ABG (respiratory + metabolic acidosis), ECG
- ELIMINATE — if severe toxicity, oliguria, or renal impairment → haemodialysis (magnesium is small ion, readily dialysed); forced diuresis only if urine output preserved
- RE-START magnesium only once toxicity resolved, level <3 mmol/L, reflexes present — consider lower infusion rate or alternative (e.g. benzodiazepine-based protocol)
- DOCUMENT and review dosing error / renal function
HELLP syndrome ICU pathway
- DIAGNOSE — FBC (platelets), LFTs (AST/ALT), LDH, bilirubin, coagulation (INR, fibrinogen), peripheral smear (schistocytes). Cross-match. Exclude AFLP (hypoglycaemia, low fibrinogen, encephalopathy).
- STABILISE MOTHER — magnesium for seizure prophylaxis (severe features present), BP control (140-150/90-100), fluid restrict (80 mL/hr — pulmonary oedema risk), correct coagulopathy (FFP if INR >1.5, cryoprecipitate if fibrinogen <2 g/L, platelets <20 or before procedure).
- STEROIDS for fetal lung maturity — betamethasone 12 mg IM q24h × 2 (or dexamethasone 6 mg q12h × 4) if 24-34 weeks and delivery can be deferred 48 hr. Maternal high-dose dexamethasone for HELLP remains controversial — not routinely recommended (no consistent survival benefit).
- DELIVER — definitive. Stabilise mother first (magnesium loaded, BP controlled, coagulopathy corrected). Caesarean often if <30 wk or unstable; induction if viable cervix and stable. Continue magnesium 24 hr postpartum.
- POSTPARTUM MONITORING — platelet and LFT typically worsen for 24-72 hr postpartum before recovery; ICU monitoring throughout this nadir. Watch for hepatic rupture, AKI, pulmonary oedema, DIC.
- COMPLICATIONS — hepatic haematoma/rupture (CT, surgery/IR embolisation), AKI (rare dialysis), pulmonary oedema (diurese), DIC (blood products, TXA), eclampsia (magnesium).
- PLASMAPHERESIS — consider in refractory cases (persistent thrombocytopenia, multi-organ failure, atypical haemolytic-uraemic overlap) — usually 3-5 sessions postpartum.
Additional clinical pearls
Postpartum pre-eclampsia / late-onset — ICU workup
- DIAGNOSE — new BP ≥140/90 within 6 weeks postpartum (de novo OR persistence/worsening of antepartum), ± proteinuria or end-organ. Common day 2-7 but up to 6 weeks.
- SEVERE FEATURES? (BP ≥160/110, headache, visual symptoms, epigastric/RUQ pain, dyspnoea) → MAGNESIUM + ICU admission + IV antihypertensive
- LABS — FBC (platelets), LFTs, U&E, coagulation, urinalysis/PCR, magnesium level; exclude other causes (sepsis, renal, VTE)
- MAGNESIUM — full loading + maintenance for 24 hr after delivery / onset of severe features (postpartum eclampsia is the most dangerous — often unwitnessed at home)
- BP CONTROL — IV labetalol/hydralazine then convert to oral (labetalol, nifedipine, methyldopa — avoid ACE-i if breastfeeding within first 2 weeks)
- FLUID — restrict; pulmonary oedema is the commonest postpartum complication (auto-ADH + capillary leak)
- DISCHARGE only after BP controlled on oral for 24 hr, labs improving, magnesium completed; community BP follow-up; counsel on symptoms; 6-week postnatal review with cardiovascular risk assessment
- ANTIHYPERTENSIVES postpartum — labetalol, nifedipine, enalapril, captopril all SAFE in breastfeeding (avoid atenolol — high milk levels + neonatal bradycardia)
Additional red flags
Trials and evidence (extended)
Pre-eclampsia/eclampsia/HELLP — landmark trials and data
MAGPIE (2002, Lancet — Altman): 10,000 women; magnesium vs placebo for pre-eclampsia — eclampsia 0.8% vs 1.9% (58% RRR); no serious maternal harm; cornerstone of magnesium prophylaxis. Collaborative Eclampsia Trial (1995, Lancet — Duley): magnesium vs diazepam vs phenytoin for eclampsia — magnesium superior (recurrent seizure 9.4% vs 23% vs 27%); magnesium is drug of choice. CHIPS (2015, NEJM — Magee): target DBP 85 vs 100 — no difference in perinatal/primary outcomes; less-tight arm had more severe HTN → current practice favours tighter control (≤85 DBP). ASPRE (2016, NEJM — Rolnik): aspirin 150 mg from 11-14 wk in high-risk (by first-trimester screening) — 62% reduction in preterm pre-eclampsia; basis for universal aspirin in high-risk. WOMAN (2017, Lancet — Shakur-Still): TXA within 3 hr of postpartum haemorrhage — 19% reduction in bleed-related death (1.5% vs 1.9%); no increase in thromboembolism. CLASP (1994): low-dose aspirin — modest effect, established safety in pregnancy. Cochrane (Duley): magnesium halving of eclampsia confirmed across 10,000+ women. Maternal mortality: severe pre-eclampsia 0.2-1%; eclampsia 1-2%; HELLP 1-3% (up to 25% with hepatic rupture); AFLP 7-18%. Perinatal mortality: HELLP 7-20%; eclampsia 5-15%; placental abruption 10-30%. Recurrence: pre-eclampsia 15-20%; early-onset (<34 wk) 25-40%; HELLP 2-6%. Long-term: 2-4× cardiovascular risk (HTN, IHD, stroke) — pre-eclampsia is a cardiovascular risk amplifier.
ICU complications of severe pre-eclampsia/eclampsia/HELLP — frequency and management
| Complication | Frequency | Presentation | Management |
|---|---|---|---|
| Pulmonary oedema | 3-5% severe PE; commonest postpartum | Dyspnoea, hypoxia, crackles, fluffy CXR | Oxygen, frusemide, CPAP, restrict fluid, vasopressor if hypotensive |
| AKI | 1-2% severe PE; 7-15% HELLP | Oliguria, ↑Cr, ↑K⁺ | Fluid challenge, nephrology, CVVH if indicated |
| DIC | 10-15% HELLP; high with abruption | ↓Platelets, ↓fibrinogen, ↑INR, ↑D-dimer | Deliver, blood products, TXA, supportive |
| Stroke (haemorrhagic/ischaemic) | Leading cause of PE death | Focal deficit, coma, seizure | Aggressive BP control, magnesium, neurosurgery/ thrombolysis case-by-case |
| PRES | Up to 25% neurologically symptomatic | Cortical blindness, headache, seizure | BP control, magnesium, delivery |
| Hepatic haematoma/rupture | 1-2% HELLP | Sudden RUQ/shoulder pain + shock | CT, surgery/IR embolisation, deliver |
| Placental abruption | 3-4× risk | Pain, hypertonus, fetal distress, bleed | Resuscitate, emergency caesarean, MTP |
| AFLP coexistence | Rare but catastrophic | Hypoglycaemia, encephalopathy | Deliver, 10% dextrose, FFP/cryo |
| Eclampsia | 1-2% severe PE on no magnesium | Generalised seizure | Magnesium loading + repeat bolus; deliver |
| Retinal detachment | Rare | Visual loss; inferotemporal | Conservative; resolves postpartum |
| HELLP syndrome | 0.5-0.9% of all pregnancies | RUQ pain, thrombocytopenia, AST ↑ | Deliver; supportive |
| Retroplacental/apoptosis-related ARDS | Variable | Refractory hypoxia | Lung-protective ventilation; consider delivery |
References
- [1]American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
- [2]Magee LA, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy N Engl J Med, 2015.PMID 26061848
- [3]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
- [4]The Eclampsia Trial Collaborative Group. Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial Lancet, 1995.PMID 7769899
- [5]ElFarra J, Bean C, Martin JN Jr. Management of Hypertensive Crisis for the Obstetrician/Gynecologist Obstet Gynecol Clin North Am, 2016.PMID 27816151
- [6]Schwaiberger D, Karcz M, Menk M, et al. Respiratory Failure and Mechanical Ventilation in the Pregnant Patient Crit Care Clin, 2016.PMID 26600446
- [7]Shakur-Still S, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
- [8]Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia N Engl J Med, 2017.PMID 28657417
- [9]Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count Obstet Gynecol, 2004.PMID 15121574