Severe pre-eclampsia

Diagnosis: The severe pre-eclampsia — the hypertension in the severe range (the 174 over 114), the proteinuria (the 3 plus dipstick), and the cerebral and the visual symptoms (the severe headache, the visual disturbance). The severe features are present (the severe-range blood pressure and the cerebral symptoms).^[1]

Assessment: ABCDE, the intravenous access, the continuous monitoring, the continuous cardiotocography for the fetus. The bloods — the full blood count (the platelets), the urea and electrolytes (the creatinine), the liver function (the transaminases), the LDH and the haemolysis (the HELLP), the coagulation. The urine protein-creatinine ratio or the 24-hour collection. The fetal ultrasound for the growth and the Doppler (the delayed). The obstetric and the midwifery involvement at once. ^[1]

Management: ^[1]

1. The magnesium sulphate — the seizure prophylaxis. The loading 4 to 6 grams intravenously over 20 minutes, the infusion 1 to 2 grams per hour. The monitoring for the toxicity — the reflexes, the respiratory rate, the urine output, the consciousness. The calcium gluconate at the bedside for the toxicity.
2. The blood-pressure control — the intravenous labetalol (the 10 to 20 mg, titrated) or the hydralazine, or the oral nifedipine. The target 140 to 150 over 90 to 100 (the avoidance of the precipitous drop). The ACE inhibitors, the ARBs, and the direct renin inhibitors are CONTRAINDICATED.
3. The delivery — the definitive cure. At the 36 weeks, the obstetric decision for the delivery (the induction or the caesarean). The magnesium sulphate continues through the delivery and the 24 hours postpartum.
4. The fluids — the cautious, given the endothelial dysfunction and the capillary leak.
5. The transfer to the maternity unit with the neonatal capability.

The disposition: The admission to the maternity/high-dependency unit, the obstetric and the neonatal teams, the continuous monitoring of the mother and the fetus.^[1]