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why not magnesium sulfate
59450
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mag sulph is for seizure prophylaxis if i recall correctly, but you'd want to address the hypertension first
59511
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iona
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I second this - I gave her magnesium sulphate bc she had hyperreflexia which is a sign of severe pre-eclampsia and you can give mgso4 in severe pre-eclampsia! if anyone knows the answer pls comment 
59522
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Myopathy Myotonia
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the qu asked for what will help her hypertension tho
61871
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Defibrillator Dominant
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NICU Jaundice
QuestionComment
why isnt oral labetalol hydrochloride accepted? treatment summary says oral or iv for bp>160/110
60568
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CT Kawasaki
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under bnf hypertensive emergencies it recommends prescribing labetalol 50mg, why is this wrong?
60685
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Inpatient Hereditary
Concept
Chapter
# Summary

Pre-eclampsia is a placental condition that often affects pregnant women from around 20 weeks of gestation, characterised by hypertension and proteinuria. Other symptoms include peripheral oedema, severe headache, drowsiness, visual disturbances, epigastric pain, nausea/vomiting and hyperreflexia. The exact aetiology is not entirely understood, but it may be due to dysfunctional trophoblast invasion of the spiral arterioles. Key investigations include blood pressure and urine protein measurements. Management strategies include anti-hypertensive treatment, with labetalol as the first-line agent. Magnesium sulphate is used to prevent and treat eclamptic seizures, but the ultimate curative treatment is delivery of the placenta.

# Epidemiology



Pre-eclampsia affects a significant percentage of pregnancies worldwide, although the exact number varies significantly between different populations and healthcare settings. Risk factors include nulliparity, a previous history or family history of pre-eclampsia, increasing maternal age, pre-existing diseases such as hypertension, diabetes, renal disease, autoimmune disease, obesity, and multiple pregnancies.


# Aetiology



The exact aetiology of pre-eclampsia remains unclear. However, it's believed to be related to dysfunctional trophoblast invasion of the spiral arterioles, which results in decreased uteroplacental blood flow and subsequent endothelial cell damage.


# Signs and Symptoms


Pre-eclampsia is characterised by:

- Hypertension
- Proteinuria
- Peripheral oedema
- Severe headache
- Drowsiness
- Visual disturbances
- Epigastric pain
- Nausea/vomiting
- Hyperreflexia

# Maternal complications

- Eclampsia (seizures due to cerebrovascular vasospasm)
- Organ failure
- Disseminated intravascular coagulation (DIC)
- HELLP syndrome (the presence of haemolysis (H), elevated liver enzymes (EL) and low platelets (LP))

# Foetal complications

- Intrauterine growth restriction
- Pre-term delivery
- Placental abruption
- Neonatal hypoxia


# Differential Diagnosis


The differential diagnosis for pre-eclampsia includes other conditions that can present with hypertensive disorders in pregnancy, such as chronic hypertension, gestational hypertension, and HELLP syndrome. Key signs and symptoms for these conditions include persistent high blood pressure, proteinuria, and various combinations of haemolysis, elevated liver enzymes, and low platelet levels.

# Investigations


Key investigations for pre-eclampsia include:

- Blood pressure measurement: To confirm hypertension.
- Urinalysis: To confirm proteinuria.
- Blood tests: To assess kidney function, liver function, and clotting status.

# Management

Aspirin is used for prophylaxis against the development of pre-eclampsia. It is given from 12 weeks gestation until birth to women with one high risk factor or two (or more) moderate risk factors. 

Management of pre-eclampsia primarily involves anti-hypertensive treatment, with labetalol being the recommended first-line agent. Other agents that can be used include Nifedipine, Methyldopa and hydralazine. 

Magnesium sulphate can be administered for the prevention and treatment of eclamptic seizures. 

The only definitive curative treatment is the delivery of the placenta. It is also crucial to monitor the mother and foetus closely for complications.

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Obstetrics & Gynaecology
# Drug choice feedback

This woman is likely suffering from pre-eclampsia. As her systolic blood pressure is above 150mmHg, pharmacological management is indicated. The first line agent for controlling this is with labetalol. Other options include nifedipine or methyldopa. As she does not have any major complications (haemodynamically unstable, coagulation abnormalities or HELLP syndrome), she can be managed conservatively for now i.e. without delivery of the foetus.

# Dose/Route/Frequency/Duration feedback

There is no fixed dose stated for labetalol as it is given as a continuous infusion, hence a rate instead is recommended which is titrated every 30 minutes according to clinical improvement. Although labetalol can be taken orally, the patient is having nausea and a cannula has been inserted, making the intravenous route preferred.
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4 mL
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labetalol hydrochloride 5 mg/mL injection
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30m
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once only (STAT)
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intravenous (IV)
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20 mg
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labetalol hydrochloride 5 mg/mL injection
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30m
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once only (STAT)
PrescribeAnswerData
intravenous (IV)
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4 mL
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labetalol hydrochloride 5 mg/mL injection
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intravenous (IV)
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PrescribeAnswerData
20 mg
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labetalol hydrochloride 5 mg/mL injection
PrescribeAnswerData
Once-off
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once only (STAT)
PrescribeAnswerData
intravenous (IV)
Case Presentation: A 41-year-old woman, G1P0, who is 32 weeks pregnant is brought to the Emergency Department by her partner with severe headache, blurry vision, severe abdominal pain, nausea and sudden swelling of hands.


## PH

Type 2 Diabetes Mellitus, Obesity

## DH

Metformin 1g PO OD, Aspirin 75mg PO OD (started from 12th week of gestation) (NKDA)

## On examination

Alert but in pain. Hyperreflexia noted. Mild tenderness in right upper quadrant of abdomen. Generalised oedema noted. No clonus. Cannula in situ.

Temperature 36.2°C, HR 67, RR 13, BP 162/98, O<sub>2</sub> 98% RA, GCS 14, Weight 98kg

## Investigations

Proteinuria 2+ on dipstick, no blood noted

FBC, U&E, LFT and Clotting: Normal, HEELP syndrome negative.

# Prescribing Request

Write a prescription for one drug that is most appropriate for treating her blood pressure. 