Preeclampsia

O11/O14.0-2/O14.9

DESCRIPTION

Preeclampsia is defined as hypertension with significant proteinuria developing for the first time after 20 weeks’ gestation, and can also be superimposed on chronic hypertension - evidenced by the new onset (after 20 weeks’ gestation) of persistent proteinuria in a woman who had an initial diagnosis of chronic hypertension.

Pre-eclampsia without severe features:

A diastolic BP of 90-109 mmHg and/or systolic BP of 140-159 mmHg; but no symptoms or organ dysfunction.

Maternal features of severe disease:

• Acute severe hypertension (diastolic BP ≥ 110 mmHg and/or systolic ≥160 mmHg). 
• Thrombocytopenia (platelet <100 000/μL).
• Impaired liver function (ALT or AST >40 U/L).
• Severe persistent right upper quadrant or epigastric pain. 
• HELLP syndrome (platelets <100 000 and AST >70 U/L and LDH >600 U/L).
• Serum creatinine ≥120 micromol/L.
• Pulmonary oedema.
• New-onset severe headache unresponsive to medication.
• Visual disturbances. 

Prevention of pre-eclampsia Z29.2 + O10.0/O24.0-3/O99.1/O99.8 + (D68.6/M32.9)

For women at high risk of pre-eclampsia, e.g. pre-eclampsia in a previous pregnancy, chronic hypertension, diabetes, antiphospholipid syndrome, or SLE. 

From 6 weeks’ gestation onwards, preferably starting before 16 weeks’ gestation:

• Aspirin, oral, 150 mg daily until 36 weeks.

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At confirmation of pregnancy

• Calcium, oral.
  • For high-risk patients: Calcium (elemental), oral, 1 gram daily.
  • Although the benefit is greatest in high-risk women, consider use of this agent in all pregnant women.
  • When using iron together with calcium supplementation, ensure that iron and calcium are taken at least 4 hours apart from one another.

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Prevention of eclampsia

To prevent eclamptic seizures, magnesium sulphate is recommended for patients with severe features. In some cases this allows for delivery to be delayed to improve neonatal outcome. When used for prevention of eclampsia, magnesium sulphate is administered for 24 hours, and then stopped. The same dose regimens are used as for eclampsia. Women with severe features should be managed under specialist care.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026

Chapter 6 Obstetrics_6.4 Hypertensive Disorders in Pregnancy_6.4.1 Preeclampsia