My Daily Domestic Diigolet 03/27/2008

Delivery is generally recommended for women with severe preeclampsia, even if the fetus is at less than 38 weeks’ gestation (Table 3). When severe preeclampsia is diagnosed in a pregnant woman at preterm gestation (usually <32 wk), however, an initial observation period and conservative expectant management in a tertiary care center may be attempted cautiously (Table 3).[65,66] When eclampsia develops, expedient delivery is mandated, regardless of gestational age.Once it is determined that delivery is required, labor induction should be performed without delay. The goals during the intrapartum period are to prevent seizures, stabilize blood pressure, and promote delivery. During labor and delivery, women with preeclampsia-eclampsia receive IV magnesium sulfate for seizure prophylaxis, usually as a loading dose of 4 to 6 g magnesium sulfate × 7H2O infused for 20 minutes followed by a continuous IV infusion at 2 g/h. Because magnesium is excreted in the urine, blood levels also depend on urine output. Serum blood levels should be monitored. The therapeutic range for magnesium sulfate is generally considered to be 4 to 8 mg/dl. In a patient with elevated creatinine or oliguria, the patient’s magnesium level should be followed carefully and the magnesium sulfate infusion adjusted accordingly.

Continuous electronic fetal heart rate and uterine activity monitoring should be instituted in all cases. Vaginal delivery is safer than cesarean section in women with preeclampsia-eclampsia and usually should be attempted unless there are other obstetric indications for cesarean delivery. Certain women at preterm gestation with severe preeclampsia or eclampsia in whom the cervix is unfavorable for vaginal delivery may benefit from cesarean section without attempting labor induction.

A cesarean section (an operation to deliver the baby) is more likely if your health or your baby’s health is in danger.