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ob.preeclampsia-early-onset.v1PRODUCTION
ob.preeclampsia-early-onset.v1

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

obstetricsacutepregnancyadult
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Canonical 12-phase frame with authored status for this dossier.

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Detailed

Confirm early-onset pre-eclampsia (HTN ≥ 140/90 after 20 wk + < 34 wk + proteinuria OR severe features) per ACOG 222 (2020) + ISSHP 2024; distinguish from gestational HTN (no proteinuria + no severe features), chronic HTN (pre-existing or before 20 wk), and late-onset PE (≥ 34 wk → routes to parent ob.pre-eclampsia.core.v1)

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Early-onset classification assigned (< 34 wk + PE-criteria met)

Patient inputs (23)

Drives delivery timing tier: < 24 wk extreme-early (counsel re termination); 24+0–27+6 very-early (extreme-NICU coordination); 28+0–33+6 early (glucocorticoid window 48 h); also defines the < 34 wk scope of this dossier (≥ 34 wk routes to ob.pre-eclampsia.core.v1 parent)

Persistent severe HA = severe feature; eclampsia precursor (ACOG 222 2020; Magpie 2002 PMID 12057549)

Scotomata / blurred vision / photopsia = severe feature; PRES precursor (ACOG 222 2020)

Persistent RUQ / epigastric pain = severe feature; also AFLP / hepatic-capsular-distension differential (ACOG 222 2020)

Pre-existing chronic HTN = substrate for superimposed pre-eclampsia; CHAP target < 140/90 (Tita NEJM 2022 PMID 35363951)

Recurrence ≈ 25–40 % in subsequent pregnancy after prior early-onset PE (higher than late-onset ≈ 16–25 %); strongest indication for aspirin prophylaxis (USPSTF 2021 PMID 34581729; ASPRE 2017 PMID 28657417)

< 100 K = severe feature; also HELLP-overlap criterion (routes to ob.hellp-syndrome.v1) (ACOG 222 2020)

Cr ≥ 1.1 mg/dL OR doubling = severe-feature criterion + AKI overlay (routes to neph.aki.core.v1) (ACOG 222 2020)

AST/ALT ≥ 2× ULN = severe-feature criterion; HELLP-overlap if combined with thrombocytopenia + LDH > 600 (ACOG 222 + Sibai 1993/2004)

UPCR ≥ 0.3 or 24-h ≥ 300 mg = pre-eclampsia diagnosis substrate; not required if severe features present (ACOG 222)

≥ 160 = severe; sustained × 15 min triggers IV antihypertensive within 30–60 min (ACOG 767); same threshold as late-onset

≥ 110 = severe; same trigger as SBP (ACOG 222 2020)

< 25 mg/dL confirms intravascular hemolysis; supports HELLP-overlap diagnosis (ISSHP 2024)

Autoimmune disease + antiphospholipid syndrome = high-risk per USPSTF 2021; aspirin + low-dose LMWH consideration

Aspirin prophylaxis status per ASPRE / USPSTF; ACE-I / ARB / renin-inhibitor teratogen check; LMWH if VTE history

LDH > 600 IU/L signals hemolysis + HELLP-overlap; routes to ob.hellp-syndrome.v1 if Tennessee criteria met (ISSHP 2024)

Elevated uric acid is a supportive marker in pre-eclampsia + correlates with severity (ACOG 222)

Umbilical artery Doppler: absent / reverse end-diastolic flow → MFM + expedited delivery decision (TRUFFLE / GRIT decision-anchor)

EFW < 10th centile + AC < 5th centile = FGR; q1–2 wk in early-onset PE (ACOG 222 2020)

New tonic-clonic seizure → magnesium load 4–6 g IV (Magpie 2002 PMID 12057549) + delivery + neuro imaging if focal/atypical

Painful uterine bleeding ± fetal distress = placental abruption → emergent delivery + MTP anticipation; routes to ob.postpartum-hemorrhage.core.v1 (ACOG 222 2020)

New dyspnea + SpO2 < 94 % + bilateral crackles + tachypnea = severe-feature criterion + life-threatening overlay (ACOG 222; NICE NG133 fluid-restriction pattern 80 mL/h)

Ratio > 85 → LR+ ≈ 10 for adverse outcome / delivery within 1 wk in early-onset (PARROT 2019 PMID 30948284); ≤ 38 → NPV ~99.3 % for adverse outcome within 1 wk (PROGNOSIS 2016 PMID 26735990)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (10)

10 need judgement
  • informationallife_threateningearly_onset_severe_rapid_deterioration_emergent_delivery
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningeclampsia_seizure_in_early_onset
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningpulmonary_edema_in_early_onset
    New SpO2 < 94 % + bilateral crackles + tachypnea in early-onset PE (ACOG 222 severe-feature criterion + NICE NG133 fluid-restriction pattern)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereearly_onset_severe_features_with_glucocorticoid_window_eligible
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveresflt_plgf_ratio_above_85_within_72h_delivery_likely
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverefgr_with_abnormal_doppler_indication_for_delivery
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveremagnesium_timing_miss_in_severe_features
    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)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevererecurrent_early_onset_in_subsequent_pregnancy
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepostpartum_severe_htn_early_onset_residual
    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
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmildaspirin_prophylaxis_eligible_at_high_risk_history
    Preconception / first-trimester high-risk-for-PE patient: prior early-onset PE / prior PE / chronic HTN / T1/T2DM / CKD / autoimmune / APS / multiple gestation / age ≥ 40 / BMI ≥ 35 → aspirin 81–150 mg PO daily from 11–14 wk (ASPRE) or from 12 wk (USPSTF) through 36 wk (USPSTF 2021 PMID 34581729; ASPRE 2017 PMID 28657417)
    Trigger could not be auto-evaluated — needs clinician judgement.

Workflow calculators

Run this disease's risk and dosing calculators inline.

RISK_STRATIFICATIONrequiredDrives severity classification
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Recommended regimen

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)
axis: early_onset_pe_severity_drivenstep 1 - Tier 1 — Aspirin prophylaxis (preconception / first-trimester through 36 wk) (USPSTF 2021 PMID 34581729; ASPRE 2017 PMID 28657417)
Selected step "Tier 1 — Aspirin prophylaxis (preconception / first-trimester through 36 wk) (USPSTF 2021 PMID 34581729; ASPRE 2017 PMID 28657417)" — ≥ 1 high-risk factor (chronic HTN, T1/T2DM, CKD, autoimmune / APS, multiple gestation, prior PE / early-onset PE, age ≥ 40, BMI ≥ 35) OR ≥ 2 moderate-risk factors; especially after prior early-onset PE (recurrence 25–40 %)
  • aspirin
    first line
    antiplatelet
    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
    triggers: high_or_moderate_PE_risk_factors, prior_early_onset_pe, aspre_first_trimester_screen_positive
    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
    rxcui 1191
  • calcium carbonate
    add on
    mineral_supplement
    1.5–2 g elemental Ca PO daily • PO • daily
    triggers: low_dietary_calcium, high_PE_risk
    WHO 2018 + Cochrane — reduces PE risk in low-calcium-intake populations; small benefit in adequately-supplied populations
    rxcui 1897

outpatient playbook — drug actions (3)

  1. 1. aspirin 81–150 mg
    rxcui 1191
    81–150 mg PO daily from 11–14 wk (ASPRE protocol) or from 12 wk (USPSTF) through 36 wk • PO • daily
    trigger: high_or_moderate_PE_risk_factors OR prior_early_onset_pe OR planning_next_pregnancy
    USPSTF 2021 (PMID 34581729) + ASPRE 2017 (PMID 28657417) — preterm-PE reduction 62 %; the most-impactful single intervention for early-onset PE prevention
  2. 2. PO labetalol OR nifedipine ER OR methyldopa
    Labetalol 100–200 mg BID; nifedipine ER 30–60 mg daily; methyldopa 250 mg BID • PO • BID/daily
    trigger: BP ≥ 140/90 chronic or new
    CHAP target < 140/90 (Tita NEJM 2022 PMID 35363951) + CHIPS (Magee NEJM 2015 PMID 25629739)
  3. 3. enoxaparin if APS or VTE history
    rxcui 67108
    40 mg SC daily prophylactic; therapeutic 1 mg/kg q12h if VTE history • SC • daily or q12h
    trigger: Antiphospholipid syndrome + planning pregnancy or pregnant
    APS gets aspirin + LMWH combination for PE / VTE prevention

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: BP ≥ 160/110 sustained × 15 min at < 34 wk gestation (ACOG 767; ACOG 222 2020); 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).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Pre-eclampsia, Early-Onset (< 34 weeks gestational age)** (ob.preeclampsia-early-onset.v1).
Phenotype framing: Phenotype per ACOG 222 + ISSHP 2024 + first-trimester risk-stratification: early-onset PE with vs without severe features; superimposed-on-chronic-HTN; HELLP-overlap (routes to ob.hellp-syndrome.v1); eclampsia; rule out gestational HTN, chronic HTN, secondary HTN, AFLP, TTP, aHUS, SLE flare, viral hepatitis, peripartum cardiomyopathy
Scope: Confirm early-onset pre-eclampsia (HTN ≥ 140/90 after 20 wk + < 34 wk + proteinuria OR severe features) per ACOG 222 (2020) + ISSHP 2024; distinguish from gestational HTN (no proteinuria + no severe features), chronic HTN (pre-existing or before 20 wk), and late-onset PE (≥ 34 wk → routes to parent ob.pre-eclampsia.core.v1)

No severity triggers fired against current inputs.

Plan

Regimen axis: **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)** — step "Tier 1 — Aspirin prophylaxis (preconception / first-trimester through 36 wk) (USPSTF 2021 PMID 34581729; ASPRE 2017 PMID 28657417)".
1. 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 (antiplatelet, first line) — 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
2. calcium carbonate 1.5–2 g elemental Ca PO daily PO daily (mineral_supplement, add on) — WHO 2018 + Cochrane — reduces PE risk in low-calcium-intake populations; small benefit in adequately-supplied populations

Setting playbook (outpatient) — Preconception + first-trimester surveillance + aspirin prophylaxis (ASPRE 2017 PMID 28657417 + USPSTF 2021 PMID 34581729) for high-risk + prior early-onset PE (recurrence 25–40 %), postpartum follow-up through 6-week visit (ACOG 222 + ACOG 2025), lifelong CV-risk reduction (early-onset PE doubles future CV risk with steepest gradient per AHA 2021), endocrine-renal review post-PE, preconception MFM for next pregnancy
3. aspirin 81–150 mg 81–150 mg PO daily from 11–14 wk (ASPRE protocol) or from 12 wk (USPSTF) through 36 wk PO daily — high_or_moderate_PE_risk_factors OR prior_early_onset_pe OR planning_next_pregnancy (USPSTF 2021 (PMID 34581729) + ASPRE 2017 (PMID 28657417) — preterm-PE reduction 62 %; the most-impactful single intervention for early-onset PE prevention)
4. PO labetalol OR nifedipine ER OR methyldopa Labetalol 100–200 mg BID; nifedipine ER 30–60 mg daily; methyldopa 250 mg BID PO BID/daily — BP ≥ 140/90 chronic or new (CHAP target < 140/90 (Tita NEJM 2022 PMID 35363951) + CHIPS (Magee NEJM 2015 PMID 25629739))
5. enoxaparin if APS or VTE history 40 mg SC daily prophylactic; therapeutic 1 mg/kg q12h if VTE history SC daily or q12h — Antiphospholipid syndrome + planning pregnancy or pregnant (APS gets aspirin + LMWH combination for PE / VTE prevention)

Non-pharmacologic actions:
- Aspirin counseling per ACOG 222 / ASPRE (USPSTF 2021 PMID 34581729 + Rolnik NEJM 2017 PMID 28657417)
- Preconception MFM consultation for next pregnancy (recurrence 25–40 % after prior early-onset PE)
- First-trimester risk-stratification (FMF triple-test) per ASPRE protocol
- BP self-monitoring training — daily × 1 wk post-discharge → weekly through 6 wk (AHA 2021)
- Severe-feature symptom education + return precautions (ACOG 222)
- Postpartum BP plan + 6-week comprehensive visit (ACOG 222 + ACOG 2025)
- Lifetime CV follow-up education — early-onset PE doubles future CV risk; annual BP / lipid / glucose / UACR screening (AHA 2021)
- Next-pregnancy aspirin counseling: 81–150 mg PO daily from 12 wk per USPSTF 2021
- Endocrine-renal review at 6 wk: lipid panel, fasting glucose / HbA1c, UACR + Cr, BMI trajectory (AHA 2021 + ACOG 2025)
- Mental health support — refer to perinatal mental health if EPDS ≥ 10 or PTSD screen positive (early-onset PE + preterm delivery increase PPD / PTSD risk)
- Contraception counseling: short-interval pregnancy (< 18 mo) increases recurrence risk per ACOG 736
- Vaccinations review

AVOID / contraindication checks:
- Never ACE ARB in pregnancy (ACOG 2020)
- Never renin inhibitor in pregnancy (ACOG 2020)
- Nitroprusside caution cyanide toxicity after 4h (ACOG 767)
- Methylergonovine avoid in severe HTN (ACOG 2020)
- NSAIDs avoid post partum PE (ACOG 2020)
- Check DTRs RR urine output with MgSO4 (ACOG 2020)
- Mg level if AKI or oliguria (ACOG 2020)
- Fluid restriction 80 mL per h in PE pulmonary edema (NICE NG133)
- Avoid atenolol pregnancy FGR risk (NICE 2019)
- Do not delay delivery for steroid completion if life threatening (ACOG 222)

Monitoring

Regimen monitoring:
- BP q15min during severe HTN treatment (ACOG 767)
- BP q1h after control x 4h then q4h (ACOG 767)
- continuous fetal monitoring when delivery pending (ACOG 2020)
- MgSO4 DTRs q1h (ACOG 2020)
- MgSO4 RR q1h minimum 12 per min (ACOG 2020)
- MgSO4 urine output q1h minimum 30 mL per h (ACOG 2020)
- Mg level if oliguria or AKI (ACOG 2020)
- CBC LFT Cr LDH fibrinogen q4-6h in severe-features early-onset (ISSHP 2024)
- umbilical artery Doppler + fetal growth q1-2 wk (ACOG 2020)
- sFlt-1/PlGF ratio repeat per local protocol (PARROT 2019 PMID 30948284; PROGNOSIS 2016 PMID 26735990)
- fetal kick counts q visit (ACOG 2020)
- postpartum BP daily x 1 wk weekly x 6 wk (ACOG 222 + AHA 2021)
- postpartum 72h continued deterioration window (ACOG 222)

Setting (outpatient) monitoring:
- BP q visit (q1–2 wk in third trimester for PE history per ACOG 222)
- UPCR if BP elevated (ACOG 222)
- Fetal growth US + umbilical artery Doppler q1–2 wk in early-onset PE (ACOG 222)
- Postpartum BP: daily × 1 wk → weekly × 6 wk + visits at 3–7 d, 1–2 wk, 4–6 wk, 6-week comprehensive visit (ACOG 222 + ACOG 2025)
- Annual CV-risk screening (BP, lipids, glucose, BMI, UACR) lifelong post-early-onset-PE (AHA 2021)

Follow-up plan: 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)
- Close-out criterion: Postpartum BP + recurrence counseling + next-pregnancy aspirin plan + preconception MFM plan + lifetime CV surveillance documented

Monitoring phase: Continuous fetal monitoring antepartum; BP q15min during severe-HTN treatment then q1h × 24 h then q4h (ACOG 767); magnesium toxicity (DTRs, RR ≥ 12, urine output ≥ 30 mL/h, Mg level if AKI per ACOG 222); CBC + LFT + Cr + LDH + fibrinogen + UPCR q6–12 h (q4–6 h if severe-features or HELLP-overlap); fetal growth + umbilical artery Doppler q1–2 wk (TRUFFLE / GRIT decision-anchor); daily fluid balance; postpartum 72-h continued deterioration window

Disposition

Current setting: outpatient — Preconception + first-trimester surveillance + aspirin prophylaxis (ASPRE 2017 PMID 28657417 + USPSTF 2021 PMID 34581729) for high-risk + prior early-onset PE (recurrence 25–40 %), postpartum follow-up through 6-week visit (ACOG 222 + ACOG 2025), lifelong CV-risk reduction (early-onset PE doubles future CV risk with steepest gradient per AHA 2021), endocrine-renal review post-PE, preconception MFM for next pregnancy

Disposition criteria:
- Outpatient management acceptable for non-severe early-onset PE remote from term with reassuring fetal status + reliable surveillance + tertiary-centre access per ACOG 222
- 6-week postpartum: BP < 140/90 on oral regimen (or off), no severe features, endocrine-renal review complete, next-pregnancy aspirin counseling documented → transition to long-term annual CV surveillance (AHA 2021)

Escalation triggers (move to higher acuity):
- 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)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] 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] New SpO2 < 94 % + bilateral crackles + tachypnea in early-onset PE (ACOG 222 severe-feature criterion + NICE NG133 fluid-restriction pattern)

Citations

- 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) [PMID:30948284](https://pubmed.ncbi.nlm.nih.gov/30948284/)
- Cited evidence (PMID 26735990) [PMID:26735990](https://pubmed.ncbi.nlm.nih.gov/26735990/)
- Cited evidence (PMID 28657417) [PMID:28657417](https://pubmed.ncbi.nlm.nih.gov/28657417/)
- Cited evidence (PMID 34581729) [PMID:34581729](https://pubmed.ncbi.nlm.nih.gov/34581729/)
- Cited evidence (PMID 35363951) [PMID:35363951](https://pubmed.ncbi.nlm.nih.gov/35363951/)

Last reconciled with current guidelines: 2026-05-25.
References
  • 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) — PMID:30948284
  • Cited evidence (PMID 26735990) — PMID:26735990
  • Cited evidence (PMID 28657417) — PMID:28657417
  • Cited evidence (PMID 34581729) — PMID:34581729
  • Cited evidence (PMID 35363951) — PMID:35363951