CLINICAL PRACTICE RECOMMENDATIONS FOR THE PREVENTION AND MANAGEMENT OFPRE-ECLAMPSIA AND ECLAMPSIA
During Antenatal CarePractices
NOT RecommendedPractice Implication
Calcium supplementation during pregnancy in areas where calciumintake is low
- Vitamin D supplementationduring pregnancy
- Calcium supplementationduring pregnancy in areaswhere calcium deficiency is notpresentProvide calcium to all women andacetylsalicylic acid to selectedgroups for the prevention of PE/E.While vitamin supplementationcan be useful for other healthconditions, do not provideVitamins C, D, or E, to pregnantwomen as part of a strategy forprevention of PE/E.
Low-dose acetylsalicylic acid(aspirin, 75 mg) for the prevention of pre-eclampsia in women at high riskof developing the condition
- Individual or combinedvitamin C and vitamin Esupplementation
Antihypertensive drugs forpregnant women with severehypertension
- Use of diuretics, particularlythiazides, for prevention of pre-eclampsia and itscomplicationsGive antihypertensive drugs, butnot diuretics, to pregnant womenwith severe hypertension.
- Advice to rest at homeDo not advise rest or dietary saltrestriction for pregnant women toprevent pre-eclampsia or itscomplications.
- Strict bed rest for pregnantwomen with hypertension (withor without proteinuria)
- Restriction in dietary saltintake
In women with severe pre-eclampsia, if there is a viable fetusand the pregnancy is less than 36(plus 6 days) weeks of gestation,expectant management can beconsidered, provided thatuncontrolled maternal hypertension,increasing maternal organdysfunction, and fetal distress do notoccur and the conditions can bemonitored.For a woman with pre-eclampsiaduring a preterm pregnancy (< 37weeks), clinicians can monitor thewoman if: (1) her blood pressure isunder control, (2) there is no fetaldistress, and (3) there are no signsof maternal organ dysfunction.Continuous monitoring isnecessary during this period of expectant management.
During Labor and Birth
Induction of labor for women with severe pre-eclampsia at a gestational age when the fetus is notviable or is unlikely to achieve viability within one ortwo weeksConduct an expedited delivery for women withsevere pre-eclampsia remote from term, whether ornot the fetus is viable.
Expedited delivery for women with severe pre-eclampsia at term
A full report of the recommendations can be found in
WHO Recommendations for Prevention and Treatment of Pre-eclampsia andEclampsia
(http://whqlibdoc.who.int/publications/2011/9789241548335_eng.pdf), and a full listing of the evidence supporting these recommendations can be found in
WHO Recommendations for Prevention and Treatment of Pre-eclampsia and Eclampsia:Evidence Base