This mortality rate is almost double that in normotensive pregnancies. Unless the ED physician maintains a high index of suspicion, these patients may be misdiagnosed with gastritis, cholecystitis, or hepatitis. The most serious complication of pregnancy-induced hypertension is eclampsia, which is severe preeclampsia complicated by seizures or coma. Seizures and mental status changes in eclampsia are thought to be secondary to hypertensive encephalopathy. Mild preeclampsia presents without clinical evidence of end-organ pathology, except for minimal proteinuria.
Severe preeclampsia is indicated by end-organ damage due to systemic vasoconstriction.
Utilize to assess for intracranial hemorrhage or cerebrovascular accident. Transabdominal ultrasound Utilize to estimate gestational age. Rule out abruptio placentae, which could complicate severe preeclampsia. EMS personnel should secure an IV line, place the patient on a cardiac monitor and oxygen and transport the patient in the left lateral decubitus position. The mildest form of hypertension in a pregnant patient without proteinuria, edema or evidence of end-organ damage may be managed on an outpatient basis, as this does not meet the diagnostic criteria for true preeclampsia.