Hypertension in pregnancy: preeclampsia-eclampsia.

Diagnosis of preeclampsia involves consideration of many different factors. It is desirable to make the diagnosis early in the disease course for the best possible outcome for mother and fetus. Overdiagnosis may occur in some cases; however, given the severe maternal and fetal morbidity in cases of untreated disease, it is best to monitor and treat symptoms before they become severe. Overall goals of treatment include prolonging the pregnancy as long as possible without compromise of maternal health, while monitoring the fetus for signs of distress. Treatment for the mother is symptomatic, with seizure prophylaxis and hypertension control. In gestations less than 32 weeks, it is desirable to expose the fetal lungs to at least 48 hours of corticosteroids before delivery to enhance lung maturity. Studies of preeclampsia have demonstrated high fetal morbidity/mortality for gestations less than 24 weeks. With expectant management, decreased fetal morbidity and mortality are shown for both 24- to 27- and 28- to 34-week gestations. Secondary to excellent fetal survival, immediate delivery is indicated for severe disease at gestation greater than 34 weeks.