Close
20th June 2026
Management
Managing pre-eclampsia requires attention to the following critical considerations:
- Monitoring
- Delivery: date and method
- Controlling blood pressure
- Controlling seizures
- Postnatal fluid management
Important considerations
- Antihypertensive treatment: choice should be based on pre-existing treatment, possible side effects, maternal vs foetal risk, and the woman’s preference. Combination therapy may be required.
- Corticosteroids (e.g. betamethasone) to promote foetal lung maturation, as indicated
- Magnesium sulphate if planned early delivery. It is the treatment of choice for eclampsia. Monitor for signs of magnesium toxicity (e.g. respiratory depression and loss of reflexes); calcium gluconate may be used as a reversal agent.
- Delivery: the definitive management of pre-eclampsia, however it may take a few days to resolve completely. Indications for planned early delivery < 37 weeks may include the following:
- Inability to control maternal BP despite ≥ 3 classes of antihypertensives
- Maternal pulse oximetry < 90%
- Progressive deterioration in blood results
- Ongoing neurological features, e.g. severe intractable headache, repeated visual scotomata
- Placental abruption
- Reversed end-diastolic flow in umbilical artery doppler velocimetry, a non-reassuring CTG, or stillbirth
Table 9. Management of pre-eclampsia
| Management | Hypertension | Severe hypertension |
|---|---|---|
| Admit to hospital | Admit to hospital if clinical concerns for maternal or foetal wellbeing, e.g. impending eclampsia, pulmonary oedema or suspected foetal compromise Admit to hospital. If BP falls < 160/110 mmHg, manage as for hypertension |
|
| Risk prediction models like fullPIERS or PREP-S have been validated and can be used alongside a comprehensive clinical assessment to help guide decisions about admission and thresholds for intervention | ||
| BP monitoring | At least every 48 hours (more frequently if an inpatient) Every 15-30 mins until BP < 160/100 mmHg, then ≥ 4 times daily while an inpatient |
|
| Urine protein levels | Only repeat if clinically indicated, e.g. if new symptoms or signs develop, or if there is uncertainty over diagnosis | |
| Blood tests | FBC, LFTs and renal function 2x / week | FBC, LFTs and renal function 3x / week |
| Foetal assessment | Foetal heart auscultation at every antenatal appointment Foetal US at diagnosis – if normal, repeat every 2 weeks CTG at diagnosis, then only if clinically indicated |
|
| Antihypertensive medication | 1st line: Labetalol 2nd line: Nifedipine 3rd line: Methyldopa |
|
| Offer if BP > 140/90 mmHg Target BP: ≤ 135/85 mmHg |
Offer to all women Target BP: ≤ 135/85 mmHg |
|
| Timing of delivery | < 34 weeks: continue surveillance unless there are indications for planned early birth. Offer IV magnesium sulphate and corticosteroids 34-36+⁶ weeks: continue surveillance unless there are indications for planned early birth. Consider corticosteroids ≥ 37 weeks: initiate birth within 24-48 hours |
|
fullPIERS, Pre-eclampsia Integrated Estimate of RiSk; PREP-S, Prediction of complications in early-onset pre-eclampsia (using a survival model).
Postnatal investigation, monitoring and treatment
- Measure BP at least once between day 3 and 5 after birth, then on alternate days until normal, if BP was abnormal
- Continue antihypertensive treatment if required. Start treatment if BP ≥ 150/100 mmHg and they were not treated during pregnancy. Reduce treatment dosages if BP falls < 130/80 mmHg
- Follow-up with GP or specialist 6-8 weeks after birth, or 2 weeks after transfer to community care for women who remain on antihypertensive treatment
- The main risk to the mother in this period is fluid overload; therefore, fluid management is crucial. NICE guidelines fluid restriction to 80 ml/hour
Complete Guide to Clinical Genetics ST3 Application and Recruitment (2027)
Written by Medibuddy. Last updated: October 2026. Clinical Genetics is
Clinical Genetics ST3
Complete Guide to Clinical Radiology ST3 Application and Recruitment (2027)
Recruitment paused: NHS England is not running Clinical Radiology ST3+ recru
Clinical Radiology ST3
Complete Guide to Paediatric Surgery ST3 Application and Recruitment in United Kingdom (2026)
Written by Medibuddy. Last updated: October 2026. If you’re planning
Paediatric Surgery ST3
Take your subscriptions with you
Our mobile app allows you to access your interview and exam question banks wherever you are.
