BY: MARIUS CLIFFORD R.

BILLEDO BSN II ANGELICA

PREECLAMPSIA
Defined as high blood pressure and excess protein in the urine after 20 weeks of pregnancy in a woman who previously had normal blood pressure. A set of symptoms rather than any causative factor. It usually arises during the second half of pregnancy, and can even occur some days after delivery. May also be called toxaemia because it was thought to be caused by a toxin in a pregnant woman's bloodstream, and is often precluded by gestational hypertension. If you have preeclampsia, the only cure is delivery of your baby Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain.

Risk factors:
History of preeclampsia. A personal or family history of preeclampsia increases your risk of developing the condition. First pregnancy. The risk of developing preeclampsia is highest during your first pregnancy. New paternity. Each pregnancy with a new partner increases the risk of preeclampsia over a second or third pregnancy with the same partner. Age. The risk of preeclampsia is higher for pregnant women younger than 20 and older than 40. Obesity. The risk of preeclampsia is higher if you're obese. Multiple pregnancies. Preeclampsia is more common in women who are carrying twins, triplets or other multiples. Prolonged interval between pregnancies. This seems to increase the risk of preeclampsia. Diabetes and gestational diabetes. Women who develop gestational diabetes have a higher risk of developing preeclampsia as the pregnancy progresses. History of certain conditions. Having certain conditions before you become pregnant such as chronic high blood pressure, migraine headaches, diabetes, kidney disease, rheumatoid arthritis or lupus increases the risk of preeclampsia.

Other possible factors

Having other health conditions. There's some evidence that both urinary tract infections and periodontal disease during pregnancy are associated with an increased risk of preeclampsia, which may indicate that antibiotics could play a role in prevention of preeclampsia. More study is needed. Vitamin D insufficiency. There's also some evidence that insufficient vitamin D intake increases the risk of preeclampsia, and that vitamin D supplements in early pregnancy could play a role in prevention. More study is needed. High levels of certain proteins. Pregnant women who had high levels of certain proteins in their blood or urine have been found to be more likely to develop preeclampsia than are other women. These proteins interfere with the growth and function of blood vessels lending evidence to the theory that preeclampsia is caused by abnormalities in the blood vessels feeding the placenta. Although more research is needed, the discovery suggests that a blood or urine test may one day serve as an effective screening tool for preeclampsia.

Preeclampsia Signs & Symptoms

The various changes and symptoms that occur with preeclampsia vary according to the organ system or systems that are affected. These changes can affect the mother only, baby only, or more commonly affect both mother and baby. Some of these symptoms give the woman warning signs, but most do not. The most common symptom and hallmark of preeclampsia is high blood pressure. Blood pressure may be only minimally elevated initially, or can be dangerously high; symptoms may or may not be present. However, the degree of blood pressure elevation varies from woman to woman and also varies during the development and resolution of the disease process. The kidneys are unable to efficiently filter the blood (as they normally do). This may cause an increase in protein to be present in the urine. The first sign of excess protein is commonly seen on a urine sample

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obtained. Rarely does a woman note any changes or symptoms associated with excess protein in the urine. In extreme cases affecting the kidneys, the amount of urine produced decreases greatly. Nervous system changes can include blurred vision, seeing spots, severe headaches, convulsions, and even occasionally blindness. Any of these symptoms require immediate medical attention. Changes that affect the liver can cause pain in the upper part of the abdomen and may be confused with indigestion or gallbladder disease. Other more subtle changes that affect the liver can affect the ability of the platelets to cause blood to clot; these changes may be seen as excessive bruising. Changes that can affect your baby can result from problems with blood flow to the placenta, and therefore, your baby not getting proper nutrients. As a result, the baby may not grow properly and may be smaller than expected, or worse the baby will appear sluggish or seem to decrease the frequency and intensity of its movements. Call the doctor immediately if the baby's movements slow down. Sudden weight gain (more than 2-5 pounds in a week)

Diagnosis
Preeclampsia is diagnosed when a pregnant woman develops high blood pressure (two separate readings taken at least six hours apart of 140 or more in systolic blood pressure and/or 90 or more in diastolic blood pressure) and 300 mg of protein in a 24-hour urine sample (proteinuria). A rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is still considered important to note, but is not considered diagnostic. Swelling or edema (especially in the hands and face) was originally considered an important sign for a diagnosis of preeclampsia, but in current medical practice only hypertension and proteinuria are necessary for a diagnosis. Pitting edema(unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider. If you're diagnosed with preeclampsia, your doctor may recommend additional tests, including: Blood tests. These can determine how well your liver and kidneys are functioning and whether your blood has a normal number of platelets the cells that help blood clot. Prolonged urine collection test. Urine samples taken over at least 12 hours and up to 24 hours can quantify how much protein is being lost in the urine, an indication of the severity of preeclampsia. Fetal ultrasound. Your doctor may also recommend close monitoring of your baby's growth, typically through ultrasound. This test directs high-frequency sound waves at the tissues in your abdominal area. These sound waves bounce off the curves and variations in your body, including your baby. The sound waves are translated into a pattern of light and dark areas creating images of your baby on a monitor that can be recorded electronically or on film for a look at the inside of your uterus. Nonstress test or biophysical profile. These make sure your baby is getting enough oxygen and nourishment. A nonstress test is a simple procedure that checks how your baby's heart rate reacts when your baby moves. Your baby is doing fine if the heart rate increases at least 15 beats a minute for at least 15 seconds twice in a 20-minute period. A biophysical profile combines an ultrasound with a nonstress test to provide more information about your baby's breathing, tone, movement and the volume of amniotic fluid in your uterus.

NURSING MANAGEMENT
1. Monitor for, and promote the resolution of, complications. Monitor vital signs and FHR. Minimize external stimuli; promote rest and relaxation Measure and record urine output, protein level, and specific gravity. Assess for edema of face, arms, hands, legs, ankles, and feet. Also assess for pulmonary edema. Weigh the client daily. Assess deep tendon reflexes every 4 hours. Assess for placental separation, headache and visual disturbance, epigastric pain, and altered level of consciousness. 2. Provide treatment as prescribed. Mild preeclampsia treatment consists of bed rest in left lateral recumbent position, balanced with moderate to high protein and low to moderate sodium, and administration of magnesium sulfate Severe preeclampsia treatment consists of complete bed rest, balanced diet with high protein and low to moderate sodium, administration of sulfate, fluid and electrolyte replacements and sedative hypertensives such as diazepam or phenobarbital or an anticonvulsant such as phenytoin Eclampsia treatment consists of administration of magnesium sulfate intravenously 3. Institute seizure precautions. Seizures may occur up to 72 hours after delivery.

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Address emotional and psychosocial needs.

Antihypertensive Drugs Commonly Used in the Treatment of Severe Preeclampsia

Hydralazine (Apresoline) Initial dose: 5 mg IV or 10 mg IM When blood pressure is controlled, repeat initial dose as needed (usually about every 3 hours; maximum, 400 mg per day). If blood pressure is not controlled in 20 minutes, repeat initial dose every 20 minutes until maximum dosage is reached, or go immediately to next step. If blood pressure is not controlled with a total of 20 mg IV or 30 mg IM, consider using a different antihypertensive drug (labetalol, nifedipine *Procardia+, sodium nitroprusside *Nitropress+). Labetalol (Normodyne, Trandate) Initial dose: 20 mg in IV bolus If blood pressure is not controlled, give 40 mg 10 minutes after initial dose and then 80 mg every 10 minutes for two additional doses (maximum: 220 mg). If blood pressure is not controlled, use a different antihypertensive drug (hydralazine, nifedipine, sodium nitroprusside).

Indications for Delivery in Preeclampsia

Fetal indications Severe intrauterine growth restriction Nonreassuring fetal surveillance Oligohydramnios Maternal indications Gestational age of 38 weeks or greater* 3 3 Platelet count below 100 10 per mm (100 9 10 per L) Progressive deterioration of hepatic function Progressive deterioration of renal function Suspected placental abruption Persistent severe headache or visual changes Persistent severe epigastric pain, nausea, or vomiting *Delivery should be based on maternal and fetal conditions as well as gestational age.

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