Step II OB/GYN Treating Mild Pre-Eclampsia

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futuredoctor10

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Indications for treatment of mild pre-eclampsia HTN:
  • according to UW, use methyldopa if hypertensive
  • according to MTB, do not treat unless BP >160/100
  • according to Up to Date, initiate therapy if SBP >150 or DBP >100.

MTB states that since anti-hypertensives decrease uteroplacental flow, you should NOT treat unless the BP is >160/100 with goal of SBP 140s-150s.

There is a UW question which has a patient with BP 154/98 with mild pre-eclampsia and it asks what is the best treatment, answer methyldopa. I picked this answer, but then when reading my MTB, I came across that tidbit on NOT treating unless BP is that high.

So I got to thinking... what is a test question offered you the choice of methyldopa versus NOT treating, what would you do? I doubt they will make us make this distinction though. And UW and Up to Date both are in line with treating if there is >150 SBP, so I will go with that (instead of MTB 160 rule)?
 
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Additional goodies from Up to Date:
-Lowering blood pressure does not affect the course of preeclampsia because the primary pathogenetic process is an abnormality of the placental vasculature that results in placental underperfusion
 
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evilbooyaa said:
I think if the patient is above 140/90, and it's an option, I would pick it for the exam rather than doing nothing, especially if that's what UWorld is going with.
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Yeah dude, Step 1 studying taught me that whenever there is a disagreement between a review book and UW, one should follow along UW's explanation
 
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Okay thanks guys, I will go with UWorld then!

Interestingly, on another UWorld explanation I just came across, it states "methyldopa can be used to treat sustained BP >160/110" and that most cases of HTN in mild pre-eclampsia respond with close observation and bedrest. That being said, this question was not asking to decide between treating the BP versus just observation.

And I doubt on the exam they will require us to decide between methyldopa (treating) vs. not treating.
 
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futuredoctor10 said:
Okay thanks guys, I will go with UWorld then!

Interestingly, on another UWorld explanation I just came across, it states "methyldopa can be used to treat sustained BP >160/110" and that most cases of HTN in mild pre-eclampsia respond with close observation and bedrest. That being said, this question was not asking to decide between treating the BP versus just observation.

And I doubt on the exam they will require us to decide between methyldopa (treating) vs. not treating.
Click to expand...

It's reasonably safe to consider a systolic bp of >150-160 to be severe pre-eclampsia and warrant bp medication for testing purposes
 
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