Preeclampsia is a multisystem disorder of pregnancy over 20 weeks of gestation that presents with a new onset of hypertension and proteinuria.  Hypertension in women less than 20 weeks gestation is considered pre-existing.  Preeclampsia is diagnosed when the systolic blood pressure is greater than 140 mmHg (or the diastolic blood pressure greater than 90 mmHg) on at least two occasions, at least four hours apart, with proteinuria.  A systolic blood pressure above 160 mmHg, or a diastolic above 110 mmHg, is considered a severe finding. 

There are multiple risk factors for preeclampsia, including prior family or personal history, age (over 40 or below 18), chronic hypertension, obesity, diabetes, multifetal gestation, and renal, autoimmune, or vascular disease. 

• Hypertension in preeclampsia is caused by placental and maternal vascular dysfunction
• Preeclampsia is associated with increased fetal and maternal morbidity and mortality
• Delivery is the definitive treatment

• Preeclampsia is an evolving disease with no effective medical treatment other than delivery of the infant and placenta. Magnesium may provide prophylaxis against seizures.  Women with severe features of preeclampsia are usually delivered promptly to prevent maternal and fetal complications.
• The administration of fluid must be done conservatively due to the risk of pulmonary edema.

Patients who are pregnant and hypertensive should be preferentially transported to an emergency department associated with a labor and delivery unity.  The closest emergency department may, however, be preferred if the patient requires initial resuscitation.  Destination decisions should be made with the overall clinical picture in mind, and in consultation with CliniCall where any doubt exists.

• Preeclampsia is the result of microangiopathy of brain, liver, kidney and placenta, which can lead to pulmonary edema, liver or kidney failure, and cerebral hemorrhage.  Early signs and symptoms can include headache, epigastric pain, thrombocytopenia, abnormal liver function, and visual disturbances. 
• Though the exact initial cause of preeclampsia is unclear, it is provoked by a placental vascular abnormality, which results in relatively placental hypoperfusion.  The placental hypoxia results in an alteration of maternal systemic endothelial function; the end result is hypertension and its downstream effects.
• HELLP syndrome is a form of preeclampsia where patients experience hemolysis, elevated liver enzymes, and low platelets.
• Paramedics should consider bypassing the closest hospital in favour of a facility with advanced obstetrical facilities.  Consultation with CliniCall is strongly recommended.

Pre Eclampsia/Eclampsia

1. Ambulance Victoria. Clinical Practice Guidelines: Ambulance and MICA Paramedics. 2018. [Link]
2. Lain KY, et al. Contemporary concepts of the pathogenesis and management of preeclampsia. 2002. [Link]
3. Norwitz ER. Eclampsia. In UpToDate. 2020. [Link]