Pre-Eclampsia

Key points

• PROPHYLAXIS is the highest-yield point: advise aspirin 75-150 mg daily from 12 weeks until birth for any woman with ONE high-risk factor, or MORE THAN ONE moderate-risk factor. This reduces pre-eclampsia, preterm birth and fetal/neonatal mortality.
• High-risk factors: hypertensive disease in a previous pregnancy · chronic kidney disease · autoimmune disease (SLE, antiphospholipid syndrome) · type 1 or type 2 diabetes · chronic hypertension. Moderate: first pregnancy · age ≥ 40 · pregnancy interval > 10 years · BMI ≥ 35 at booking · family history of pre-eclampsia · multiple pregnancy.
• Definition: new hypertension after 20 weeks (> 140/90) with significant proteinuria — quantified as urinary albumin:creatinine ratio ≥ 8 mg/mmol or protein:creatinine ratio ≥ 30 mg/mmol. Oedema is no longer part of the definition.
• Treat blood pressure above 140/90 mmHg with a target of 135/85 — NG133 lowered both thresholds from the older 150/100. Oral labetalol is first-line; nifedipine and methyldopa are named alternatives. STOP ACE inhibitors and ARBs.
• Consider placental growth factor (PlGF)-based testing between 20 and 35 weeks to help rule out pre-eclampsia in suspected cases.
• Severe features: severe hypertension not responding to treatment · headache · visual disturbance · papilloedema · RUQ or epigastric pain · clonus and hyperreflexia (not diminished reflexes) · falling platelets, rising transaminases or haemolysis suggest HELLP. Delivery is the definitive treatment · magnesium sulfate for eclampsia and for severe pre-eclampsia at risk of it.

Decision points in this pathway

• One HIGH-risk factor, or MORE THAN ONE moderate-risk factor?
• Severe features present? (severe hypertension unresponsive to treatment · headache · visual disturbance · papilloedema · RUQ/epigastric pain · clonus · falling platelets or rising transaminases)

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.