Pre-eclampsia
Description General measures Medicine treatment Referral O11/O14.0-2/O14.9 DESCRIPTION A systolic BP ≥ 140 and/or diastolic BP ≥ 90 mmHg with proteinuria, after 20 weeks of pregnancy (significant proteinuria defined as ≥ 1+ proteinuria). Pre-eclampsia with severe features is a life-threatening condition and needs urgent stabilisation and referral. The following indicate a higher risk of dev
Description
General measures
Medicine treatment
Referral
O11/O14.0-2/O14.9
DESCRIPTION
- A systolic BP ≥ 140 and/or diastolic BP ≥ 90 mmHg with proteinuria, after 20 weeks of pregnancy (significant proteinuria defined as ≥ 1+ proteinuria).
- Pre-eclampsia with severe features is a life-threatening condition and needs urgent stabilisation and referral.
- The following indicate a higher risk of developing pre-eclampsia: nulliparity, obesity, multiple pregnancy, chronic hypertension, kidney disease, diabetes, pre-eclampsia in a previous pregnancy, advanced maternal age or adolescent pregnancy.
GENERAL MEASURES
- Advise all pregnant patients to urgently visit the clinic if severe persistent headache, visual disturbances, epigastric pain (not discomfort).
- If severe features are present:
- Insert a Foley's catheter and monitor urine output hourly
- Monitor BP every 30 minutes
- Check reflexes every hour
MEDICINE TREATMENT
Prevention of pre-eclampsia
See: Antenatal supplements.
Treatment if severe features are present
- Magnesium sulfate, IV, 4 g as a loading dose diluted with 200 mL sodium chloride 0.9% and infused over 20 minutes.
FOLLOWED BY
- Magnesium sulfate, IM, 10 g given as 5 g in each buttock.
- Then IM, 5 g every 4 hours in alternate buttocks.
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Caution: USE OF MAGNESIUM SULFATE
Stop magnesium sulfate if knee reflexes become absent or if urine output < 100 mL/4 hours or respiratory rate < 16 breaths/minute.
If respiratory depression occurs:
• Calcium gluconate 10%, IV, 10 mL given slowly at a rate not > 5 mL/minute.
AND
If systolic BP ≥ 160 and/or a diastolic BP ≥ 110 mmHg:
- Nifedipine, oral, 10 mg (not sublingual) as a single dose.
- May be repeated after 30 minutes if diastolic BP remains ≥ 110 mmHg or if systolic BP remains ≥ 160 mmHg.
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REFERRAL
Urgent
- Pre-eclampsia with severe features
Non urgent
- Pre-eclampsia without severe features (within 24 hours).
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026
Chapter 6: Obstetrics and Gynaecology_6.4.2.4 Pre-eclampsia