# Pre-eclampsia (Urgent Referral) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): "Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg". The formulary carries no pre-eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's. · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): "Each tablet contains 200 mg Labetalol hydrochloride" and, for hypertension in pregnancy, "The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded." The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling. · RCOG Green-top Guideline No. 10A: Severe Pre-eclampsia/Eclampsia 2010 · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A · NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4 - Verified date: 2026-08 ## Verified against - Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): "Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg". The formulary carries no pre-eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's. - Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): "Each tablet contains 200 mg Labetalol hydrochloride" and, for hypertension in pregnancy, "The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded." The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling. - Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A - NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4 ## Treatment metadata - Labetalol — 200 mg — oral.solid - Nifedipine — 10 mg — oral.solid - Magnesium sulphate — injection ## Complete treatment card ```text PRE-ECLAMPSIA (URGENT REFERRAL) Sources: Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): "Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg". The formulary carries no pre- eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's. · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): "Each tablet contains 200 mg Labetalol hydrochloride" and, for hypertension in pregnancy, "The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded." The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling. · RCOG Green-top Guideline No. 10A: Severe Pre-eclampsia/Eclampsia 2010 · Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A · NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4 Review status: REVIEWED against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - A new headache with no other explanation that painkillers do not touch [headache] - Visual disturbance may or may not come with that headache - Pain under the right ribs or high in the belly, with sickness or vomiting [abdominal pain · right upper quadrant pain · vomiting] - Breathlessness, and swelling that has grown beyond the usual swelling of pregnancy [breathlessness] - It is one spectrum: gestational hypertension first, then severe features, and at the far end eclampsia and HELLP syndrome [hypertension] - Oedema is not part of the diagnosis any more: what defines it is hypertension with organ dysfunction - renal, hepatic, neurological, haematological or uteroplacental [hypertension · oedema] - The first presentation is usually in a pregnancy close to term SIGNS - what you find (9) - Any one of those complaints earns a full examination, starting with the blood pressure - Systolic ≥140 mmHg or diastolic ≥90 mmHg should raise the suspicion - From 20 weeks of pregnancy onward, act on 2 readings taken at least 4 hours apart - Severe-range figures, systolic ≥160 mmHg or diastolic ≥110 mmHg, can be confirmed on a repeat within minutes so treatment is not delayed - A woman already carrying a label of gestational hypertension who reaches severe-range pressures has pre-eclampsia with severe features, whatever else is found [hypertension] - If she is breathless, listen to and percuss the chest for lung trouble - Press over the right upper belly and the epigastrium for tenderness - Look for swelling both where gravity puts it, in the legs, and where it does not, in the face and hands - The same blood pressure figures found before 20 weeks are not this at all, but pre-existing essential or chronic hypertension [hypertension] TESTS (7) - Urine for protein: dipstick ≥2+ where nothing better is available, ≥300 mg on a 24-hour collection, or a protein to creatinine ratio in urine of 0.3 or greater - Full blood count, looking for platelets <100 K/mm - Metabolic panel for liver injury, shown by enzymes more than 2 times the normal upper limit - Kidney impairment on the same panel: serum concentration reaching ≥1.1 mg/dL, or 2 times her own baseline - Each abnormal result only counts once a pre-existing abnormality or a second cause has been excluded - Raised pressure plus protein is the usual pairing, but it is not there in every case - Without protein the diagnosis can rest on low platelets, kidney impairment, fluid on the lungs, liver dysfunction, or a new headache with or without visual change IF NOT THIS - what else fits (9) - High blood pressure that predates the pregnancy - Gestational hypertension without the other features - Antiphospholipid antibody syndrome - A thrombotic microangiopathy - Lupus (SLE) - Epilepsy or another seizure disorder - Long-standing kidney disease - Long-standing liver disease - Phaeochromocytoma or another hormone-producing tumour Source StatPearls "Preeclampsia" - disease-level clinical article Status traced to the source above 1. LABETALOL [1st line] Adult 200 mg orally as initial dose for severe hypertension (BP >=160/110 mmHg) while arranging immediate emergency transport to obstetric unit - Initial dose, immediate hospital transfer Peds Adult-only condition - paediatric section not applicable Choice Alternatives. Labetalol is first-line for severe hypertension in pre-eclampsia; nifedipine is the oral alternative when labetalol is contraindicated, as in asthma. Source Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the product from Trandate (labetalol) 200 mg tablets SmPC sections 4.1-4.2 (eMC product 9168): "Each tablet contains 200 mg Labetalol hydrochloride" and, for hypertension in pregnancy, "The initial dose of 100mg twice daily may be increased, if necessary, at weekly intervals by 100mg twice daily... A total daily dose of 2400mg should not be exceeded." The SmPC's own starting dose in pregnancy is 100 mg twice daily; the single 200 mg dose here is the trust algorithm's and sits well inside the label's 2400 mg daily ceiling. Why Labetalol is a combined alpha- and beta-blocker given to bring severely elevated blood pressure down quickly and safely in pregnancy while emergency transfer to obstetric care is arranged; it treats the acute hypertension, not the underlying pre-eclampsia. Caution URGENT OBSTETRIC EMERGENCY: Arrange immediate hospital transfer to labor ward / obstetric emergency unit. Target blood pressure is 135/85 mmHg (NICE NG133). The older 150/100 figure comes from the withdrawn 2010 guideline and under-treats - NG133 applies the same target to chronic, gestational and pre-eclamptic hypertension. Contraindicated in women with asthma, severe bradycardia, or second/third-degree heart block. Egypt LABIPRESS 200 MG 30 F.C.TAB. DEBEIKY > NOV... 105.00 EGP (3.50/unit) 2. NIFEDIPINE [1st line] Adult 10-20 mg modified-release orally, repeatable every 2-4 hours, as the alternative initial antihypertensive - Initial dose, immediate hospital transfer Peds Adult-only condition - paediatric section not applicable Source Newcastle upon Tyne Hospitals NHS Foundation Trust, Hypertension in pregnancy maternity guideline v9, July 2024 (based on NICE NG133), Algorithm A for the pathway, with the products from Egyptian National Drug Formulary, cardiovascular 2025, nifedipine monograph (endf-cardiovascular.txt): "Soft Gelatin Capsule: 10mg Retard Tablet (sustained release): 20mg Sustained Release Hard Gelatin Capsules: 30 mg, 60 mg". The formulary carries no pre-eclampsia indication and states no 2 to 4 hourly repeat; that is the trust algorithm's. Why Nifedipine is the primary oral alternative for severe hypertension in pre-eclampsia when Labetalol is contraindicated (e.g. maternal asthma). Caution Modified-release only. The immediate-release capsule is not in the guidance this row rests on, and an unpredictable pressure drop is the one thing to avoid in a pre- eclamptic woman - the placenta does not tolerate it. DO NOT administer sublingually; sublingual nifedipine causes unpredictable, precipitous hypotension and fetal distress. Monitor for maternal headache, facial flushing, and reflex tachycardia. Egypt EPILAT 10MG 30 S.G.CAPS. EIPICO 18.00 EGP 3. MAGNESIUM SULPHATE [add-on - not a substitute] Adult 4 g IV loading dose over 5-15 minutes followed by 1 g/hour IV infusion (hospital specialist administration for severe pre-eclampsia / eclampsia prevention) x 24 hours post-delivery or post-seizure Peds Adult-only condition - paediatric section not applicable Source NICE NG133 Hypertension in pregnancy: diagnosis and management, 2019, rec 1.8.4 Why Magnesium sulphate is given alongside blood pressure control to prevent and treat the seizures of eclampsia by reducing neuronal excitability; it is hospital-administered specialist therapy and does not substitute for urgent transfer and obstetric management. Caution Magnesium sulphate is hospital IV therapy only, under specialist obstetric oversight. Monitor deep tendon reflexes, respiratory rate (>16/min), and urine output (>25 mL/hour) to avoid magnesium toxicity. Keep Calcium Gluconate 10% injection available at bedside as antidote for magnesium toxicity. Egypt MAGNESIUM SULFATE 10% (OTSUKA) I.V. AMP. 25 ML OTSUKA 10.45 EGP MAGNESIUM SULFATE 10% (EIPICO) 5 I.V. AMPS. 10 ML EIPICO 25.00 EGP MAGNISOL 0.5GM/5ML 6 AMPS. MEMPHIS 66.00 EGP MAGNESIUM SULFATE 10% (EIPICO) 50 I.V. AMPS. 10ML EIPICO 250.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)