Which of the following medications is the drug of choice for severe preeclampsia ?
Ans- A Labetalol Diagnostic Criteria for Preeclampsia- ACOG 2013 ^ Blood pressure * Greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hg diastolic on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure * Greater than or equal to 160 mm Hg systolic or greater than or equal to 110 mm Hg diastolic, hypertension can be confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy and Proteinuria * Greater than or equal to 300 mg per 24 hour urine collection (or this amount extrapolated from a timed collection) or * Protein/creatinine ratio greater than or equal to 0.3* * Dipstick reading of 1+ (used only if other quantitative methods not available) Or in the absence of proteinuria, new-onset hypertension with the new onset of any of the following: Thrombocytopenia * Platelet count less than 100,000/microliter Renal insufficiency * Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease Impaired liver function * Elevated blood concentrations of liver transaminases to twice normal concentration Pulmonary edema Cerebral or visual symptoms * Each measured as mg/dL The Revised Definition of Preeclampsia According to the new ACOG guidelines, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). Evidence shows organ problems with the kidneys and livers can occur without signs of protein, and that the amount of protein in the urine does not predict how severely the disease will progress. Prior to this time, most healthcare providers traditionally adhered to a rigid diagnosis of preeclampsia based on blood pressure and protein in the urine(proteinuria). Preeclampsia is now to be diagnosed by persistent high blood pressure that develops during pregnancy or during the postpartum period that is associated with a lot of protein in the urine or the new development of decreased blood platelets, trouble with the kidney or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances. Other Big Changes in Diagnosis and Management Evidence tells us that preeclampsia is a dynamic process. Diagnosing a woman's condition as "mild preeclampsia" is not helpful because it is a progressive disease, progressing at different rates in different women. Appropriate care requires frequent re-evaluation for severe features of the disease and appropriate actions outlined in the new guidelines. Mild to moderate high blood pressure (140-159 mm Hg systolic or 90-159 mm Hg diastolic measured on two occasions at least four hours apart) warrants close evaluation and monitoring. High blood pressure greater than or equal to 160 mm Hg systolic or greater than or equal to 110 mm Hg diastolic is a feature of severe preeclampsia. To prevent eclampsia (seizures), magnesium sulfate should be given if your blood pressure is 160/110 or higher. If your blood pressure is less than 160/110 and you have other severe symptoms that usually precede seizures, you should be given magnesium sulfate. Severe hypertension can be confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy. Guidelines for the timing of delivery have been modified based on data indicating best outcomes for mother and baby. One of the biggest changes in preeclampsia management relates to the timing of delivery in women with preeclampsia without severe features. Studies suggest that the best time of delivery is at 37 weeks of gestation. It has been known for many years that preeclampsia can worsen or become apparent for the first time after delivery. The new guidelines include specific recommendations to improve outcomes for women who have postpartum preeclampsia. Evidence firmly tells us that preeclampsia is associated with later life cardiovascular disease (CVD), and the ACOG report calls for research to learn how to use this information to help patients. A new recommendation is to educate all pregnant and postpartum patients about the signs and symptoms of preeclampsia. The Preeclampsia Foundation advocated for this addition based on the evidence of its own research study that has just been published.
Labetalol
Metoprolol
Alpha - methyldopa
Nifedipine