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Most women are hesitant to expose their fetus to medication, and thus must be in therapeutic alliance with their obstetrician and consultants.

The overriding principle of medication use in pregnancy is that a healthy fetus requires a healthy mother, and medication use is justified when there is definite benefit to the mother.

In these individuals, preeclampsia is more likely to present early (before 34 weeks gestation) or with severe disease.1Preeclampsia is defined as hypertension and proteinuria (greater than 300 mg/day) at or beyond 20 weeks gestation in a previously normotensive woman.

Preeclampsia rates vary from 5% to 10% of nulliparous women, to much higher rates in women with medical comorbidities or fetal factors (e.g., multiple gestations, molar pregnancies, hydrops, or triploidy).

Preeclampsia’s pathogenesis is attributed to abnormal placental implantation with abnormal maternal immune adaptation, altered angiogenic factors with increased systemic vascular resistance and endothelial dysfunction leading to the clinically apparent maternal syndrome.11Severe preeclampsia criteria include any of the following: eclampsia, HELLP syndrome (platelets less than 100,000/mm³, transaminases more than twice the upper limit of normal, and/or epigastric pain), SBP ≥160 mm Hg, DBP ≥110 mm Hg, proteinuria ≥5 grams per day, oliguria, pulmonary edema, placental abruption, or fetal manifestations such as intrauterine growth restriction (≤10th percentile of expected fetal weight based on gestational age), decreased amniotic fluid index, or fetal demise.2,5,12Maternal symptoms might include headache, visual disturbances, epigastric or right upper quadrant (RUQ) pain, rapid weight gain, and severe edema. Preeclampsia can rapidly progress from “less severe” to severe.

Maternal symptoms and abnormal lab findings are more predictive of adverse pregnancy outcomes than the degree of hypertension and/or proteinuria.1It is always in the mother’s interest to deliver when preeclampsia is diagnosed, because preeclampsia will not resolve until after delivery, with hypertension and lab abnormalities sometimes persisting for months postpartum.

Preeclampsia might be diagnosed before fetal viability (approximately 24 weeks gestation), although the vast majority of cases occur near term.

Risks of premature delivery must be balanced with the risks of progressively severe manifestations for the mother and fetus.

Maternal symptoms, transaminase elevation, thrombocytopenia, or fetal manifestations further support this diagnosis., previously known as pregnancy-induced hypertension, is defined as hypertension in the absence of proteinuria in the latter half of pregnancy.

Due to increased metabolism during pregnancy, medications otherwise dosed once per day often require two doses per day, and those dosed twice daily often require every-eight-hour dosing to maintain efficacy.

Additionally, titration up every few days may be required.

Although prescribed metformin and lisinopril, she ran out of both four months ago. Her blood pressure is 140/90 mm Hg in both arms, with an appropriately sized manual cuff while seated.

She does not have retinopathy, nephropathy, or neuropathy.

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