Patient handout

Pre-eclampsia / Eclampsia / HELLP

PRODUCTION

1. Your condition

This handout is for pre-eclampsia / eclampsia / hellp. Your care team identified this based on: bp ≥160/110 in pregnancy / postpartum (acog 767).

Other reasons your team may use this plan: new bp ≥140/90 after 20 wk (acog practice bulletin 222 2020); headache + visual changes + ruq pain (acog 222 severe-feature criteria); spot upcr ≥0.3 / urine protein ≥300 mg/24h (acog 222 2020).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
labetalol	20 mg IV bolus, then 40 mg if no response in 10 min, then 80 mg in 10 min, then 80 mg in 10 min (max cumulative 220 mg); maintenance 1–2 mg/min infusion if needed	IV	q10 min escalating	ACOG 767 — first-line; avoid in severe asthma/HF/heart block
hydralazine	5–10 mg IV bolus over 1–2 min, repeat 10 mg q20 min × 2 if needed (max 30 mg)	IV	q20 min	ACOG 767 — equivalent first-line; can cause maternal tachycardia + reflex hypotension
nifedipine immediate-release	10 mg PO, repeat 20 mg q20 min × 2 if needed	PO	q20 min	ACOG 767 — equivalent first-line; PO option when IV unavailable

Plan: Pre-eclampsia / eclampsia / HELLP — severity-driven (severe HTN → IV antihypertensive; severe features → MgSO4 + delivery)

3. When to call your provider

Contact your care team if any of the following happen:

New severe HTN → ED (ACOG 767)
New severe-feature symptoms → ED (ACOG 222)
Decreased fetal movement → L&D (ACOG 2020)
Postpartum severe HTN ≥160/110 within 6 wk → ED for IV antihypertensive + magnesium prophylaxis (AHA 2021 + ACOG 222)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

BP ≥160/110 sustained × 15 min antepartum/intrapartum/postpartum (ACOG 767)
Any severe feature per ACOG 222: BP ≥160/110, severe HA, vision changes, RUQ pain, AST/ALT ≥2× ULN, plt <100K, Cr ≥1.1 (or doubling), pulmonary edema, new neuro symptoms
New tonic-clonic seizure in pregnancy or up to 6 wk postpartum (ACOG 222; Magpie Trial, Lancet 2002)(life-threatening)
Platelets <50K + AST/ALT >70 + LDH >600 + LDH/AST > schistocytes (Mississippi classification; ISSHP 2021)(life-threatening)
Loss of DTRs OR RR <12 OR UOP <30 mL/h OR Mg >9 mEq/L (ACOG 222)
New oxygen level (SpO₂) <94% + crackles + tachypnea (ACOG 222 severe feature)
New severe HTN ≥160/110 up to 6 weeks postpartum (ACOG 222; AHA 2021)
Magnesium sulphate NOT loaded (4–6 g IV over 15–20 min) within 1 h of severe-features confirmation OR within minutes of any eclamptic seizure (ACOG 222 + ACOG 2025; ISSHP 2024)
HELLP Mississippi class progression within 24 h: class III → II (plt 100-150 → 50-100) OR class II → I (plt 50-100 → <50), OR rapidly rising AST/ALT >2× baseline, OR new schistocytes (ISSHP 2024 progression criteria)
Second eclamptic seizure on adequate magnesium infusion (1–2 g/h running, prior 4–6 g IV load given) — antepartum, intrapartum, or postpartum (ACOG 222; Magpie 2002 + Altman 2002)(life-threatening)
Superimposed pre-eclampsia + sustained severe HTN ≥160/110 refractory to maximum IV antihypertensive (labetalol max 220 mg + hydralazine 30 mg cumulative) AND new pulmonary edema (oxygen level (SpO₂) <94%, bilateral crackles, CXR vascular congestion) within 30–60 min (ACOG 222 severe feature + ACOG 767 refractory definition)(life-threatening)

5. Follow-up

BP check 3-7 days postpartum + 1-2 wk + 4-6 wk per ACOG 222; lifelong CV risk follow-up (PE doubles future CV risk per AHA 2021); aspirin 81-162 mg from 12-16 wk in next pregnancy (ASPRE, Rolnik NEJM 2017); AHA/CDC postpartum hypertension awareness

6. Sources

Guideline: ACOG Practice Bulletin 222 (2020, reaffirmed 2023) + ACOG 2025 update on severe-features pre-eclampsia management + ACOG 767 (severe HTN in pregnancy) + ACOG 203 (chronic HTN, CHAP) + ISSHP 2024 (Mol et al; supersedes ISSHP 2021) + NICE NG133 (2023) + USPSTF aspirin 2021 + MAGPIE Lancet 2002 + CHAP NEJM 2022 + CHIPS NEJM 2015 + HYPITAT-II Lancet 2015 + ASPRE NEJM 2017 + PARROT Lancet 2019 + CRADLE-3 Lancet 2019