Guideline

WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia

Year of Publication

2011

Issuing Institution

World Health Organization

Links

WHO IRIS,WHO IRIS

Recommendations

23 included recommendations

In areas where dietary calcium intake is low, calcium supplementation during pregnancy (at doses of 1.5–2.0 g elemental calcium/day) is recommended for the prevention of pre-eclampsia in all women, but especially those at high risk of developing pre-eclampsia.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

Low-dose acetylsalicylic acid (aspirin, 75 mg per day) for the prevention of pre-eclampsia and its related complications for (Pregnant) women

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Moderate

Low-dose acetylsalicylic acid (aspirin, 75 mg) for the prevention of preeclampsia and its related complications should be initiated before 20 weeks of pregnancy.

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Low

Women with severe hypertension during pregnancy should receive treatment with antihypertensive drugs.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

The choice and route of administration of an antihypertensive drug for severe hypertension during pregnancy, in preference to others, should be based primarily on the prescribing clinician's experience with that particular drug, its cost and local availability

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

Magnesium sulfate is recommended for the prevention of eclampsia in women with severe pre-eclampsia in preference to other anticonvulsants.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Magnesium sulfate is recommended for the treatment of women with eclampsia in preference to other anticonvulsants.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

The full intravenous or intramuscular magnesium sulfate regimens are recommended for the prevention and treatment of eclampsia.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

For settings where it is not possible to administer the full magnesium sulfate regimen, the use of magnesium sulfate loading dose followed by immediate transfer to a higher level health-care facility is recommended for women with severe pre-eclampsia and eclampsia.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Induction of labour is recommended for women with severe preeclampsia at a gestational age when the fetus is not viable or unlikely to achieve viability within one or two weeks

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Very low

In women with severe pre-eclampsia, a viable fetus and before 34 weeks of gestation, a policy of expectant management is recommended, provided that uncontrolled maternal hypertension, increasing maternal organ dysfunction or fetal distress are absent and can be monitored

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In women with severe pre-eclampsia, a viable fetus and between 34 and 36 (plus 6 days) weeks of gestation, a policy of expectant management may be recommended, provided that uncontrolled maternal hypertension, increasing maternal organ dysfunction or fetal distress are absent and can be monitored.

Status

Retired

Recommended in favor

Conditional

Certainty of evidence

Very low

In women with severe pre-eclampsia at term, early delivery is recommended

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In women with mild pre-eclampsia or mild gestational hypertension at term, induction of labour is recommended.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

In women treated with antihypertensive drugs antenatally, continued antihypertensive treatment postpartum is recommended.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Treatment with antihypertensive drugs is recommended for severe postpartum hypertension.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Advice to rest at home is not recommended as an intervention for the primary prevention of pre-eclampsia and hypertensive disorders of pregnancy in women considered to be at risk of developing those conditions

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Low

Strict bedrest is not recommended for improving pregnancy outcomes in women with hypertension (with or without proteinuria) in pregnancy

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Low

Restriction in dietary salt intake during pregnancy with the aim of preventing the development of pre-eclampsia and its complications is not recommended.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Moderate

Vitamin D supplementation during pregnancy is not recommended to prevent the development of preeclampsia and its complications

Status

Retired

Recommended against

Strong

Certainty of evidence

Very low

Individual or combined vitamin C and vitamin E supplementation during pregnancy is not recommended to prevent the development of pre-eclampsia and its complications.

Status

Updated

Recommended against

Strong

Certainty of evidence

High

Diuretics, particularly thiazides, are not recommended for the prevention of pre-eclampsia and its complications

Status

Maintained

Recommended against

Strong

Certainty of evidence

Low

The use of corticosteroids for the specific purpose of treating women with HELLP syndrome is not recommended

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low