Preeclampsia is among the most commonly encountered obstetric emergencies. Definitions and optimal therapies have changed significantly over the past few years. Although specialists in Obstetrics will invariably be involved in these cases, all resuscitationists need to have a firm grasp of this topic.
The optimal therapies for preeclampsia remain controversial. For example, the International Society for the Study of Hypertension in Pregnancy (ISSHP) recommends a magnesium infusion at 1 gram/hour (4 mM/hr), whereas the American College of Obstetrics and Gynecology (ACOG) recommends an infusion at 2 grams/hour (8 mM/hr) in most patients.1,2 Of course, when dueling guidelines disagree, this merely highlights the fact that no definitive evidence exists. Overall the chapter has been written to be consistent with the American College of Obstetrics and Gynecology guidelines, which are extremely fresh (just released in 2019). However, in practice, treatment should be tailored to the individual woman.
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The IBCC chapter is located here.
- The podcast & comments are below.
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There’s a lot of good information on the pathophysiology included in this which I think is useful for both obstetric and non-obstetric doctors, but overall, I’m seriously concerned that the message this podcast is giving out is that pre-eclampsia can, or should, be managed by critical care personnel with obstetric input and delivery as an afterthought. Yes, the priority is to stabilise the woman with correction of as much systemic disturbance as possible, firing off into theatre without doing this is not going to make for a good outcome, but without evacuating the uterus, this woman is not going to get better. I think that if a woman is sick enough to land in the ITU as a result of pre-eclampsia, and that woman is still pregnant, regardless of gestation, then the ultimate curative treatment is to evacuate the uterus and remove that placenta to start the woman on a trajectory towards recovery. Whilst I appreciate that there are legal ramifications for those in non-UK practice regarding pre-viable deliveries, as this essentially amounts to termination of pregnancy, it is fundamentally at the heart of the treatment of antenatal women with severe pre-eclampsia. In addition, the general consensus is obstetric practice… Read more »
I’m not at all suggesting that OBGYN shouldn’t be immediately involved in these patients.
Generalist resuscitationists (e.g. ED/ICU docs) needs to understand the management of these patients for many reasons. First, not all hospitals have an ObGYN on staff or in the hospital. Even if an ObGYN service is available, they won’t necessarily be present at the bedside 24/7. Treatment shouldn’t be delayed while waiting for a consultant to arrive at the bedside.