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Preeclampsia Prevention

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].

Acetylsalicylic acid (low dose aspirin, low strength aspirin)
Nonsteroidal anti-inflammatory (NSAID)

  • For the prevention of preeclampsia in patients at increased risk for developing preeclampsia.

    81 mg orally daily from 12 weeks until the birth of the baby.

Contraindicated in persons with a severe allergy (eg, severe rash, hives, breathing difficulties, dizziness), to aspirin, tartrazine, or an NSAID (eg, ibuprofen, naproxen, celecoxib) , persons with bleeding problems such as hemophilia, von Willebrand disease, or low blood platelets, or teenagers with influenza (flu) or chickenpox

(81 mg tablets)

Calcium  OsCal+D
Each tablet contains calcium elemental 500 +vitamin D 200 units (5 mcg)

  • For the treatment or prevention of hypocalcemia. For the prevention of preeclampsia in women with low dietary intake of calcium [2,6]

1 tablet orally twice daily

(500 mg tablets)


1. Duley L, et al., Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004659.  PMID:17443552
2. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Society of Obstetricians and Gynaecologists of Canada (SOGC)Clinical Practice guideline. J Obstet Gynaecol Can. 2008 Mar;30(7):S
Available at : Accessed 7/12/2010
3. Bates SM, VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-736S.PMID:22315276
4. Hypertension in pregnancy:the management of hypertensive disorders during pregnancy
August 2010 (revised reprint January 2011) .Accessed 7/12/2012
5. NICE clinical guideline 107 – Hypertension in pregnancy: the management of
hypertensive disorders during pregnancy
Available at :
Available at : Accessed 7/12/2012
Hofmeyr GJ, Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010 Aug 4;8:CD001059.PMID:20687064

Prophylaxis and Treatment of Eclamptic Seizures

See Magnesium

Treatment of Acute Severe Hypertension in Preeclampsia [4]

Blood pressure should be gradually lowered to <160 mmHg systolic and < 110 mmHg diastolic.

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

  • For control of blood pressure in severe hypertension

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

Labetalol hydrochloride (Trandate) [4,7,8,16]
Adrenergic receptor blocking agent that has both selective alpha1-adrenergic and nonselective beta-adrenergic receptor blocking actions

  • 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

Nicardipine (Cardene) [9,10,13,14,16]
Calcium ion influx inhibitor (slow channel blocker or calcium channel blocker).

  • Cardene I.V. is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable

    Initiate therapy at 50 mL/hr (5.0 mg/hr).
    Onset of action 5 to 10 minutes >Duration of action 1 to 4 hours.

    If desired blood pressure reduction is not achieved at this dose, the infusion rate may be increased by 25 mL/hr (2.5 mg/hr) every 15 minutes up to a maximum of 150 mL/hr (15.0 mg/hr), until desired blood pressure reduction is achieved.

    Contraindicated in advanced aortic stenosis
    Discontinue the infusion if the patient develops tachycardia or hypotension.
    Lower the dosage in patients with cardiac, renal, or hepatic dysfunction.

    Most common adverse reactions are headache (15%), hypotension (6%), tachycardia (4%) and nausea/vomiting (5%).

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

Sodium nitroprusside, SNP  (Nitropress) [4,11,12,16]
Vasodilator of peripheral arteries and veins.
 The solution containing 50 mg of NITROPRESS must be further diluted in 250-1000 mL of sterile 5% dextrose injection.

  • Indicated for the immediate reduction of blood pressure of patients in hypertensive crises.

Sodium nitroprusside 0.25mcg/kg/min to a maximum dose of 5 mcg/kg/min [4]
Onset of action immediate. Duration 1 to 2 minutes.

Infusion of sodium nitroprusside should be started at a very low rate, with upward titration every few minutes until the desired effect is achieved or the maximum recommended infusion rate has been reached.
While the average effective rate in adults and children is about 3 mcg/kg/min, some patients will become dangerously hypotensive when they receive NITROPRESS at this rate

Sodium nitroprusside should not be used in the treatment of compensatory hypertension, where the primary hemodynamic lesion is aortic coarctation or arteriovenous shunting renal?

Except when used briefly or at low (< 2 mcg/kg/min) infusion rates, sodium nitroprusside gives rise to important quantities of cyanide ion, which can reach toxic, potentially lethal levels 
The package insert should be thoroughly reviewed before administration of NITROPRESS.

(single-dose 50 mg/2 mL vial)

NITROPRESS (sodium nitroprusside) Hospira, Inc. 01/2011

Pulmonary Edema
Fluid restriction is advisable in patients with preeclampsia to reduce the risk of fluid overload in the intrapartum and postpartum periods. In usual circumstances, total fluids should be limited to 80 ml/hour or 1 ml/kg/hour [17] .

Furosemide (Lasix)
Furosemide inhibits primarily the reabsorption of sodium and chloride not only in the proximal and distal tubules but also in the loop of Henle

  • The intravenous administration of furosemide is indicated when a rapid onset of diuresis is desired, e.g., in acute pulmonary edema

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.

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.


1. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Society of Obstetricians and Gynaecologists of Canada (SOGC)Clinical Practice guideline. J Obstet Gynaecol Can. 2008 Mar;30(7):S Accessed 7/12/2010

2.Duley L, Henderson-Smart DJ, Knight M, King JF. Antiplatelet agents for
preventing pre-eclampsia and its complications. Cochrane Database Syst
Rev 2004;CD004659.


4. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol  2000;183:S1–S22 PMID: 10920346 . a href=""

5. Hydralazine prescribing information Akorn Inc.April 2009

6. Magee LA, et al. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ. 2003 Oct 25;327(7421):955-60. PMID: 14576246

7.Trandate prescribing information Prometheus Laboratories Inc. January  2003

8.Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial. Vigil-De Gracia P, Lasso M, Ruiz E, Vega-Malek JC, de Mena FT, López JC; or the HYLA treatment study. Eur J Obstet Gynecol Reprod Biol. 2006 Sep-Oct;128(1-2):157-62. Epub 2006 Apr 18. PMID: 16621226

9. Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007 Jun;131(6):1949-62. Chest. 2007 Nov;132(5):1721. PMID: 17565029

10.Cardene prescribing information Baxter Healthcare Corporation January 2006

11. Nitropress prescribing information Hospira ,Inc. March 2006

12. Sass N, Does sodium nitroprusside kill babies? A systematic review.Sao Paulo Med J. 2007 Mar 1;125(2):108-11. PMID: 17625709

13. Hanff LM, Intravenous use of the calcium-channel blocker nicardipine as second-line treatment in severe, early-onset pre-eclamptic patients. J Hypertens. 2005 Dec;23(12):2319-26.
PMID: 16269975

14. Elatrous S, et al., Short-term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol. Intensive Care Med. 2002 Sep;28(9):1281-6. Epub 2002 Jul 26. PMID: 12209278

15. Furosemide prescribing information American Regent Laboratories. April 2006

16. Sibai, B, Chames, M, Chronic Hypertension in Pregnancy. Glob. libr. women's med.,
(ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10156

17. R
COG Guideline number 10(A) The Management of Severe Pre-eclampsia/eclampsia March 2006

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