Termination o/pregnancy is the ony cure or preeclampsia. Head ache, visual disturbances, or epigastric pain are indicative that convulsions may be imminent, and oliguria is another ominous sign. Severe preeclampsia demands anticonvulsant and often antihypertensive therapy, followed by delivery. Treatment for eclampsia is identical. The prime objectives are to forestall con vulsions, to prevent intracranial hemorrhage and serious dam age to other vital organs, and to deliver a healthy newborn.
his is true even when the cervix is unfavorable (T ajik, 2012). Labor induction is carried out, usually with preinduc tion cervical ripening with a prostaglandin or osmotic dilator (Chap. 26, p. 505).
Concerns stemming from an unfavorable cervix, a perceived sense of urgency because of preeclampsia severity, and a need to coordinate neonatal intensive care have led some to advocate cesarean delivery. Alexander and colleagues (1999) reviewed 278 singleton liveborn neonates weighing 750 to 1500 g delivered of women with severe preeclampsia at Parkland Hospital. In half of the women, labor was induced, and the remainder underwent cesarean delivery without labor. Induction was successful in accomplishing vaginal delivery in a third, and it was not harmful to very-low-birthweight neonates. Others have reported similar observations (Alanis, 2008; Roland, 2017). However, whenever it appears that induction almost certainly will not succeed or attempts have failed, then cesarean delivery is indicated.
For a woman near term, with a soft, partially efaced cervix, even a milder degree of preeclampsia probably carries more risk to the mother and her fetus-newborn than does induction of labor (Tajik, 2012). A randomized trial of 756 women with mild preeclampsia supported delivery after 37 weeks' gestation (Koopmans, 2009).
When the fetus is preterm, the tendency is to temporize in the hope that additional weeks in utero will reduce the risk of neonatal death or serious morbidity from prematurity. Such a policy certainly is justified in milder cases. Assessments of fetal well-being and placental function are performed, especially when the fetus is immature. Most recommend frequent performance of nonstress testing or biophysical proiles to assess fetal well-being (American College of Obstetricians and Gynecologists, 20 16a). Several tests can be used to provide evidence of lung maturity (Chap. 34, p. 638). An sFlt-lIPlGF ratio <38 is predictive of the short-term absence of preeclampsia, but this ratio testing is still investigational (Zeisler, 2016a,b). Also, women with higher ratios tend to have more adverse outcomes (Baltajian, 2016).
The decision to deliver late-preterm fetuses is less clear. Barton and coworkers (2011) reported excessive neonatal morbidity in women delivered before 38 weeks despite having stable, mild, nonprotein uric hypertension. The Netherlands study of 4316 newborns delivered, between 34°/7 and 36617 weeks also described substantive neonatal morbidity in these cases (Langenveld, 201l). Another Dutch study-HYPITAT-II-randomly assigned women with nonsevere hypertension between 34 and 37 weeks to immediate delivery or to expectant management (Broekhuijsen, 2015). Immediate delivery reduced the risks for adverse maternal outcomes-I. 1 versus 3.1 percent. However, it increased the risk for neonatal respiratory distress syndrome-5.7 versus 1. 7 percent.
For women with mild-to-moderate stable hypertension is continued. During surveillance, reduced physical activity throughout much of the day, at least intuitively, seems beneicial.