Current and emerging pharmacotherapy for emergency management of preeclampsia

ABSTRACT

Introduction: Preeclampsia is a disease specific to pregnancy characterised by new onset hypertension with maternal organ dysfunction and/or fetal growth restriction. It remains a major cause of maternal and perinatal morbidity and mortality. For fifty years, antihypertensives have been the mainstay of treating preeclampsia, reducing maternal morbidity and mortality. With increased knowledge of the mechanisms underlying the disease has come opportunities for novel therapies that complement antihypertensives by protecting the maternal vasculature.

Areas covered: In this review, the authors consider, in detail, the antihypertensives commonly used today in the emergency care of women with severe preeclampsia. They also review less common anti-hypertensive agents and discuss the role of magnesium sulphate in the management of preeclampsia and the prevention of eclampsia. Finally, they explore novel therapeutics for the acute management of preeclampsia.

Expert opinion: The rapid control of maternal hypertension will, and must, remain the mainstay of emergency treatment for women with severe preeclampsia. The role of magnesium sulphate as a primary prevention for eclampsia is context dependant and should not displace a focus on correcting blood pressure safely. The exploration of novel adjuvant therapies will likely allow us to prolong pregnancy longer and improve perinatal outcomes safely for the mother.

KEYWORDS:

• Preeclampsia
• antihypertensives
• eclampsia
• mortality
• pregnancy

Article highlights

• Tight and rapid blood pressure control remains the mainstay of emergency management of severe preeclampsia.

• Oral nifedipine and intravenous labetalol are the first line agents of choice to control blood pressure.

• Magnesium sulphate is the sole agent of choice for the prevention of eclampsia but blood pressure control is more important.

• Predictive modelling can accurately identify which women require escalated care.

• Future improvements in care will come from therapies directly targeting endothelial damage

This box summarizes key points contained in the article.

Declaration of interest

AG Cox has a PHD scholarship provided by Monash University. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by a National Health and Medical Research Council (NHMRC) Program grant to EM Wallace.