Preeclampsia Severity

Identifies severe features of preeclampsia that mandate delivery consideration regardless of gestational age

Indication

Identifies severe features of preeclampsia that mandate delivery consideration regardless of gestational age

id: sbp_severe; label: SBP ≥ 160 mmHg (on two occasions at least 4 hours apart); type: yesno
id: dbp_severe; label: DBP ≥ 110 mmHg (on two occasions at least 4 hours apart); type: yesno
id: plt; label: Platelets < 100,000/µL; type: yesno
id: liver; label: Liver transaminases ≥2x upper limit of normal; type: yesno
id: creatinine; label: Creatinine > 1.1 mg/dL or doubling of baseline; type: yesno
id: pulm_edema; label: Pulmonary edema; type: yesno
id: headache; label: New-onset headache unresponsive to medication (not explained by other dx); type: yesno
id: visual; label: Visual disturbances (scotomata, blurred vision); type: yesno
id: rupain; label: Right upper quadrant or epigastric pain; type: yesno

function(score) { if (score === 0) return { risk: '0 severe features', tier: 'Preeclampsia without Severe Features', action: 'If < 37 weeks: close monitoring, serial labs, fetal surveillance. Delivery at 37 weeks. Antihypertensives for SBP \u2265 140 or DBP \u2265 90.', color: 'yellow' }; return { risk: score + ' severe feature(s)', tier: 'Preeclampsia WITH Severe Features', action: 'Admit. MgSO4 for seizure prophylaxis (4-6g IV load, then 1-2g/hr). Antihypertensives for severe-range BPs. If \u2265 34 weeks: delivery. If < 34 weeks: betamethasone + deliver in 48 hours. Continuous fetal monitoring.', color: 'red' }; }

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of preeclampsia
MgSO4 therapeutic range: 4-7 mEq/L. Monitor patellar reflexes, RR, and urine output
Only cure for preeclampsia is delivery of the placenta
Eclampsia can occur without preceding severe hypertension — always have MgSO4 available