Patient handout

Pre-eclampsia, Early-Onset (< 34 weeks gestational age)

PRODUCTION

1. Your condition

This handout is for pre-eclampsia, early-onset (< 34 weeks gestational age). Your care team identified this based on: bp ≥ 160/110 sustained × 15 min at < 34 wk gestation (acog 767; acog 222 2020).

Other reasons your team may use this plan: new bp ≥ 140/90 between 20+0 and 33+6 wk (acog practice bulletin 222 2020); severe ha + visual changes + ruq pain at < 34 wk (acog 222 severe-feature criteria); spot upcr ≥ 0.3 or urine protein ≥ 300 mg/24 h at < 34 wk (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
aspirin	81–150 mg PO daily from 11–14 wk (ASPRE protocol) or from 12 wk (USPSTF) through 36 wk; 150 mg is the ASPRE-validated dose for preterm-PE prevention in first-trimester-screen-positive high-risk	PO	daily	USPSTF 2021 (PMID 34581729) + ASPRE 2017 (PMID 28657417) — preterm-PE reduction ~ 62 % (OR 0.38, 95 % CI 0.20–0.74); the most-impactful single intervention for early-onset PE prevention
calcium carbonate	1.5–2 g elemental Ca PO daily	PO	daily	WHO 2018 + Cochrane — reduces PE risk in low-calcium-intake populations; small benefit in adequately-supplied populations

Plan: Early-onset pre-eclampsia (< 34 wk) — severity-driven (aspirin prophylaxis + magnesium at severe-features + BP control + antenatal corticosteroids + delivery per GA tier + complications) (ACOG 222 + ISSHP 2024 + ASPRE 2017 + USPSTF 2021)

3. When to call your provider

Contact your care team if any of the following happen:

New severe HTN ≥ 160/110 → ED (ACOG 767)
New severe-feature symptoms → ED (ACOG 222)
Decreased fetal movement → L&D (ACOG 222)
New proteinuria UPCR ≥ 0.3 + < 34 wk → admit per ACOG 222
Postpartum severe HTN ≥ 160/110 within 6 wk → ED for IV antihypertensive + magnesium prophylaxis (AHA 2021 + ACOG 222)
sFlt-1/PlGF ratio > 85 at suspected-PE assessment → intensive surveillance + delivery planning within 72 h (PARROT 2019)

4. When to seek emergency care

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

Severe-features early-onset PE at 24+0–33+6 wk + maternal-fetal stable + tertiary centre + no complications mandating immediate delivery → 48 h antenatal corticosteroid window (betamethasone 12 mg IM × 2 doses 24 h apart) then deliver OR sooner if deterioration (ACOG 222 + ACOG 713 + Roberts Cochrane 2017 PMID 28321847)
Severe-features early-onset PE at < 34 wk + rapidly worsening / HELLP / eclampsia / abruption / refractory severe HTN / pulmonary edema / AKI requiring CRRT / hepatic complications → emergent delivery regardless of GA (ACOG 222 + ISSHP 2024)(life-threatening)
New tonic-clonic seizure in early-onset PE (< 34 wk) → magnesium load 4–6 g IV (Magpie 2002 PMID 12057549) + delivery after stabilization + seizure precautions + airway protection + neuroimaging if focal/atypical (PRES vs CVA)(life-threatening)
sFlt-1/PlGF ratio > 85 in suspected early-onset PE between 24+0 and 33+6 wk (PARROT Lancet 2019 PMID 30948284) — LR+ ≈ 10 for adverse outcome / delivery within 1 wk
Early-onset PE + FGR (EFW < 10th centile) + absent / reverse end-diastolic flow on umbilical artery Doppler at < 34 wk (TRUFFLE / GRIT decision-anchor) → MFM + delivery decision per GA + Doppler severity
Magnesium sulphate NOT loaded (4–6 g IV over 15–30 min) within 1 h of severe-features confirmation in early-onset PE OR within minutes of any eclamptic seizure (ACOG 222 + ACOG 2025; ISSHP 2024)
Subsequent pregnancy after prior early-onset PE (recurrence ≈ 25–40 %, higher than late-onset ≈ 16–25 %) → preconception MFM consultation + early-aspirin prophylaxis + close first-trimester surveillance + sFlt-1/PlGF screening
Postpartum BP ≥ 160/110 within 6 wk after early-onset PE pregnancy (ACOG 222 + AHA 2021) → urgent reassessment + IV antihypertensive within 30–60 min (ACOG 767) + magnesium prophylaxis consideration + lifelong CV-risk surveillance initiation
New oxygen level (SpO₂) < 94 % + bilateral crackles + tachypnea in early-onset PE (ACOG 222 severe-feature criterion + NICE NG133 fluid-restriction pattern)(life-threatening)

5. Follow-up

BP + lab check 3–7 d postpartum + 1–2 wk + 4–6 wk per ACOG 222 + ACOG 2025; lifetime CV-risk follow-up (early-onset PE doubles future CV risk, with risk gradient steepest after early-onset variant per AHA 2021); next-pregnancy aspirin 81–150 mg PO daily from 12 wk per USPSTF 2021 (PMID 34581729) given recurrence 25–40 %; preconception MFM consultation for next pregnancy; postpartum BP self-monitoring daily × 1 wk → weekly × 6 wk; psychosocial screen (PE / preterm delivery increase PPD / PTSD risk); endocrine-renal review at 6 wk (lipid panel, fasting glucose / HbA1c, UACR, Cr, BMI per AHA 2021 + ACOG 2025)

6. Sources

Guideline: ACOG Practice Bulletin 222 (2020, reaffirmed 2024) + ACOG 2025 update on severe-features pre-eclampsia management + ACOG 713 antenatal corticosteroids (2017) + ACOG 767 emergent severe HTN (2017, reaff 2020) + NICE NG133 (2023) + ISSHP 2024 (Mol et al; supersedes ISSHP 2018) + PARROT Lancet 2019 + PROGNOSIS NEJM 2016 + ASPRE NEJM 2017 + CHAP NEJM 2022 + CHIPS NEJM 2015 + Magpie Lancet 2002 + Roberts Cochrane antenatal steroids 2017 + Liggins 1972 betamethasone original + USPSTF aspirin 2021 + CRADLE-3 Lancet 2019 + HYPITAT-II Lancet 2015 (late-onset comparator)