Avoidance of inter-pregnancy weight gain, increased rest at home in the third trimester, and reduction of workload or stress may be helpful in preventing preeclampsia in women at increased risk [2].

The results of a systematic review suggests that the use of low-dose aspirin is associated with a reduction in the relative risk of preeclampsia. There is no difference in effect whether low-dose aspirin is started before or after 20 weeks gestation [1].

The Society of Obstetricians and Gynaecologists of Canada and ,the American College of Chest Physicians recommend low-dose aspirin throughout pregnancy, starting from the second trimester [2,3].

The National Institute for Health and Clinical Excellence (NICE) recommends [4,5] women at high risk of pre-eclampsia should take 75 mg of aspirin daily from 12 weeks until the birth of the baby.

• NICE recommends women at high risk include: hypertensive disease during a previous pregnancy ,chronic kidney disease ,autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome , type 1 or type 2 diabetes and chronic hypertension
• In addition NICE recommends women with more than one moderate risk factor for pre-eclampsia should to take 75 mg of aspirin daily from 12 weeks until the birth of the baby. Moderate risk factors are: first pregnancy , age 40 years or older, pregnancy interval of more than 10 years , body mass index (BMI) of 35 kg/m2 or more at first visit , family history of pre-eclampsia multiple pregnancy.

Calcium supplementation (of at least1 g/d) is recommended for women with low calcium intake [2,6].

Hydralazine (Apresoline) [4,5,6,16]:
Antihypertensive .Peripheral vasodilator.Maintains or increases renal and cerebral blood flow.

Start with 5 mg IV or 10 mg IM.
Onset of action 10 to 20 minutes. Maximal decrease in blood pressure usually occurs 10 - 80 minutes after  injection Duration 3 to 6 hours 

If blood pressure is not controlled, repeat at 20-minute
intervals (5 to 10 mg depending on response). Once BP control is achieved, repeat as needed (usually about 3 hours).
If no success by 20 mg IV or 30 mg IM total, consider another drug.

Contraindicated in patients with hypersensitivity to hydralazine; coronary artery disease; mitral valvular rheumatic heart disease

Hydralazine may produce a clinical picture simulating systemic lupus erythematosus including glomerulonephritis, cause anginal attacks and ECG changes of myocardial ischemia, as well as blood dyscrasias.

Common adverse reactions: Headache, anorexia, nausea, vomiting, diarrhea, palpitations, tachycardia, angina pectoris.
 

(20 mg/mL, supplied in 1 ml vials)

Hydralazine Hydrochloride Injection, USP Cardinal Health. 10/2011
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=43ce0ecb-6d62-44bf-8539-823ae03eb9f4

• For control of blood pressure in severe hypertension

Initially,  20-mg dose by slow IV injection over a 2-minute period.
Onset of action  5 to 10 minutes. Duration 3 to 6  hours

If effect is suboptimal, then give 40 mg 10 minutes later and
80 mg every 10 minutes for two additional doses.
Use a maximum of 220 mg. If desired blood pressure levels are not achieved, switch to another drug.

Avoid giving labetalol to women with asthma, congestive heart failure, patients with sympathetic crises related to the use of  drugs such as cocaine and amphetamine[9].

 Use with caution in patients with impaired hepatic function

(5 mg/mL, is supplied in 20-mL vial)

Labetalol HCl Injection, Akorn Inc. 01/2009
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=17bb21ce-9bb1-4603-b168-abea7fc85d17

Cardene I.V. is NOT compatible with Sodium Bicarbonate (5%) Injection, USP or Lactated Ringer’s Injection, USP.

Avoid administering the  drug through large peripheral veins or central veins rather than arteries or small peripheral veins, such as those on the dorsum of the hand or wrist. To minimize the risk of peripheral venous irritation, change the site of the drug infusion every 12 hours.

 (2.5 mg/mLis supplied in 10 mL ampule)

CARDENE I.V., nicardipine hydrochloride injection, solutionEKR Therapeutics, Inc. 10/2010
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=31752

Initial dose of furosemide is 20 to 40 mg given as a single dose injected  intravenously over 1 to 2 minutes.
Ordinarily a prompt diuresis ensues.
If needed, another dose may be administered in the same manner 2 hours later or the dose may be increased. The dose may be raised by 20 mg and given not sooner than 2 hours after the previous dose until the desired diuretic effect has been obtained.

CONTRAINDICATIONS
Furosemide is contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide. Patients allergic to sulfonamides may also be allergic to furosemide

(10 mg/mL)

Furosemide Injection, USP Hospira, Inc.07/2011 Hospira, Inc.
http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=39fd32f2-6bb7-4a65-d298-e48d26bc80c7

16. Sibai, B, Chames, M, Chronic Hypertension in Pregnancy. Glob. libr. women's med.,
(ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10156 http://www.glowm.com/index.html?p=glowm.cml/section_view&articleid=156

17. RCOG Guideline number 10(A) The Management of Severe Pre-eclampsia/eclampsia March 2006http://www.rcog.org.uk/womens-health/clinical-guidance/management-severe-pre-eclampsiaeclampsia-green-top-10a