What are the treatments for preeclampsia, eclampsia, & HELLP syndrome?

Delivering the fetus can help resolve preeclampsia and eclampsia, but symptoms can continue even after delivery, and some of them can be serious.

Treatment decisions for preeclampsia, eclampsia, and HELLP syndrome need to take into account how severe the condition is, the potential for maternal complications, how far along the pregnancy is, and the potential risks to the fetus. Ideally, the healthcare provider will minimize risks to the mother while giving the fetus as much time as possible to mature before delivery.

The U.S. Preventive Services Task Force recommends that women at high risk for preeclampsia take low-dose aspirin starting after 12 weeks of pregnancy to prevent the condition from occurring.1

If the pregnancy is at 37 weeks or later, the healthcare provider will usually want to deliver the fetus to treat preeclampsia and avoid further complications.

If the pregnancy is at less than 37 weeks, however, the woman and her healthcare provider may consider treatment options that give the fetus more time to develop, depending on how severe the condition is. A healthcare provider may consider the following options:

  • If the preeclampsia is mild, it may be possible to wait to deliver. To help prevent further complications, the healthcare provider may ask the woman to go on bed rest to try to lower blood pressure and increase blood flow to the placenta.
  • Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment.
  • Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure.
  • In some cases, such as with severe preeclampsia, the woman will be admitted to the hospital so she can be monitored closely and continuously. Treatment in the hospital might include intravenous medication to control blood pressure and prevent seizures or other complications, as well as steroid injections to help speed up the development of the fetus's lungs.

When a woman has severe preeclampsia and is at 34 weeks of pregnancy or later, the American College of Obstetricians and Gynecologists recommends delivery as soon as medically possible. If the pregnancy is at less than 34 weeks, healthcare providers will probably prescribe corticosteroids to help speed up the maturation of the fetal lungs before attempting delivery.2

Preterm delivery may be necessary, even if that means likely complications for the infant, because of the risk of severe maternal complications.

The symptoms of preeclampsia usually go away within 6 weeks of delivery.3

Eclampsia—the onset of seizures in a woman with preeclampsia—is considered a medical emergency. Immediate treatment, usually in a hospital, is needed to stop the mother's seizures, treat blood pressure levels that are too high, and deliver the fetus.

Magnesium sulfate (a type of mineral) may be given to treat active seizures and prevent future seizures. Antihypertensive medications may be given to lower the blood pressure.

HELLP syndrome, a severe complication of preeclampsia and eclampsia, can lead to serious complications for the mother, including liver failure and death, as well as the fetus. The healthcare provider may consider the following treatments after a diagnosis of HELLP syndrome:

  • Delivery of the fetus
  • Hospitalization to provide intravenous medication to control blood pressure and prevent seizures or other complications as well as steroid injections to help speed up the development of the fetus's lungs4

As mentioned earlier, some women develop preeclampsia or eclampsia after they deliver their babies. The American College of Obstetricians and Gynecologists recommends that healthcare providers closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery, either at home or in the hospital.5 Because postpartum preeclampsia and eclampsia can progress quickly and can have serious effects, it is important to get treatment immediately.

Depending on a woman’s specific health situation, treatment may include medications to prevent blood pressure from reaching dangerously high levels and causing stroke or other problems associated with extremely high blood pressure. It may also include medications to treat or prevent seizures.

One study looked at women who came to the emergency room with a diagnosis of postpartum preeclampsia. The most common warning symptoms in these cases were headache, vision changes, and nausea or abdominal pain. Nearly all of these women had high blood pressure when admitted, and some had already had seizures at home before coming to the hospital. Treatment for postpartum preeclampsia follows the guidelines used to treat preeclampsia during pregnancy. The women in the study received magnesium sulfate to treat or prevent seizure and, if needed, additional treatment for their high blood pressure.6

Citations

  1. U.S. Preventive Services Task Force. (2015). Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: Recommendation statement. American Family Physician, 91(5). Retrieved August 8, 2016, from http://www.aafp.org/afp/2015/0301/od1.html external link
  2. March of Dimes. (2013). Premature babies. Retrieved June 6, 2016, from http://www.marchofdimes.org/complications/premature-babies.aspx external link
  3. Sibai, B. M. (2012). Hypertension. In S. G. Gabbe, J. R. Niebyl, J. L. Simpson, M. B. Landon, H. L. Galan, E. R. M. Jauniaux, & D. A. Driscoll (Eds.), Obstetrics: Normal and problem pregnancies (6th ed., pp. 631–666). Philadelphia, PA: W. B. Saunders.
  4. Haram, K., Svendsen, E., & Abildgaard, U. (2009). The HELLP syndrome: Clinical issues and management. A review. BMC Pregnancy & Childbirth, 9, 8. Retrieved June 6, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654858/
  5. Leeman, L., Dresang, L. T., & Fontaine, P. (2016). Hypertensive disorders of pregnancy. American Family Physician, 93(2), 121–127. Retrieved November 15, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/26926408
  6. Yancey, L. M., Withers, E., Bakes, K., & Abbott, J. (2011). Postpartum preeclampsia: Emergency department presentation and management. Journal of Emergency Medicine, 40(4), 380–384. Retrieved November 14, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/18814997
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