OVERVIEW OF THE DISEASE

Preeclampsia is a major cause of maternal and perinatal morbidity and mortality.

It accounts to 28.4% of maternal morbidity and mortality in the Philippines according to
DOH (as of Feb. 2008). The condition sometimes referred to as pregnancy-induced
hypertension is defined by high blood pressure and excess protein in the urine after
20 weeks of pregnancy.
Often, preeclampsia causes only modest increases in blood pressure. Left
untreated, however, preeclampsia can lead to serious even fatal complications for
both mother and baby.
The only cure for preeclampsia is delivery of the baby. If preeclampsia develops
near the end of your pregnancy, delivery is the obvious solution. If you're diagnosed with
preeclampsia earlier in your pregnancy, you and your doctor face the delicate task of
prolonging your pregnancy to allow your baby more time to mature, without putting you
or your baby at risk of serious complications.

ETIOLOGY
Although there is unknown cause of pre-eclampsia.

The signs of preeclampsia are elevated blood pressure (hypertension) and the
presence of excess protein in your urine (proteinuria) after 20 weeks of pregnancy. The
excess protein is related to problems with your kidneys. Your doctor may identify these
signs of preeclampsia at one of your regular prenatal visits.
Other signs and symptoms of preeclampsia which can develop gradually or
strike suddenly, often in the last few weeks of pregnancy may include:

Severe headaches

Changes in vision, including temporary loss of vision, blurred vision or light

sensitivity
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Upper abdominal pain, usually under the ribs on the right side

Nausea or vomiting

Dizziness

Decreased urine output

Sudden weight gain, typically more than 2 pounds a week

Swelling (edema), particularly in the face and hands, often accompanies

preeclampsia as well. Swelling isn't considered a reliable sign of preeclampsia,

however, because it also occurs in many normal pregnancies.
CAUSES
Preeclampsia used to be called toxemia because it was thought to be caused by
a toxin in a pregnant woman's bloodstream. Although this theory has been debunked,
researchers have yet to determine what causes preeclampsia. Possible causes may
include:

Insufficient blood flow to the uterus

Damage to the blood vessels

A problem with the immune system

RISK FACTORS
Preeclampsia develops only during pregnancy. Risk factors include:

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 or your first pregnancy with a new partner.

Age. The risk of preeclampsia is higher for pregnant women who are older than age

35.

Obesity. The risk of preeclampsia is higher if you're obese.

Multiple pregnancy. Preeclampsia is more common in women who are carrying

twins, triplets or other multiples.

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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, diabetes, kidney disease or lupus
increases the risk of preeclampsia.

CLASSIFICATIONS
1. Mild Preeclampsia
o 140/90
o Proteinuria is +1 or +2 on dipstick reading
o No hyperreflexia Noted
o Liver Enzyme may be elevated soon
o Edema may or may not present
HOME CARE
If a womens preeclampsia is considered mild enough for home care the
following are monitored:

BP, weight, protein in the urine is checked daily

Weight gains of 3lbs. in 24 hours in a 3 day period is cause of concern
Remote non-stress test are performed on daily or biweekly basis
It is extremely important to report to physician if worsening signs of Preeclampsia
develops

HOSPITAL CARE

The women is placed on bedrest

She is weigh daily
She is assessed for visual disturbances
Persistent headache
Epigastric pain
Worsening edema
BP is checked at least 4 times daily

The following tests are performed in hospital:

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Fetal movement record

Nonstress test
Ultrasonography every 3 or4 weeks
Biophysical profile
Amniocentesis to determine fetal lung maturity

2. Severe
o 160/110 and over twice at least 4 to 6 hours apart
o Cerebral or visual disturbances (scotomata)
o Epigastric Pain
o Pulmonary edema
o Thrombocytopenia (platelet count less than 10,000)
o Impaired liver function as indicated by abnormally elevated blood
concentration of liver enzymes
o Hyperreflexia
HOSPITAL CARE OF SEVERE PREECLAMPSIA
Complete Bed rest. Seizure inducing stimuli must be reduced
High protein , moderate sodium diet is given
Anticonvulsants such as Mag Sulf is treatment of choice. Increased levels of mag
sulfate include diminished reflexes, decreased respirations, difficulty swallowing,
drooling is indicative of toxic levels.
Electrolyte and fluid replacement. Iv lines are kept open in case they are needed
for drug therapy.
Corticosteroids, betamethasone or dexamethasone is administered if the fetus
has an immature lung profile.
Antihypertensives is given for systolic of 160 to 180 mm hg of higher, and
diastolic

105-110

mm

hg

or

higher

(Hydralazine

is

most

commonly

used)Methyldopa is for chronic hypertension in pregnancy

LABOR INDUCTION:

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Labor may be induced by IV oxytocin when there is evidence of fetal

maturity and cervical readiness

Severe cases may require c-section
The woman may receive mag sulfate and Pitocin simultaneously
If an epidural block is used it should be done by someone skilled in
preeclampsia Spinal or epidural anesthesia is contraindicated if there is
coagulopathy or platelet count lower than 50,000/mm
Oxygen may be administered to woman during labor according to fetal
response
Birth should be in the Sims or semi-sitting position

POSTPARTUM MANAGEMENT:
Although the woman with preeclampsia usually improves rapidly after giving
birth, there is still a risk for seizure during the 48 hrs postpartum.
Medical Management: the only cure for preeclampsia is to give birth.
Bed rest, must be complete in non-stimulating environment.
Diet: a high protein diet with moderate sodium
Anticonvulsant medication: magnesium sulfate is the treatment of
choice for convulsion, its depressant quality reduces
NURSING MANAGEMENT:
Assessment during hospitalization includes:

Assess BP every 1 to 4 hrs

Temperature is taken every 4 hours, if elevated then 2 hrs
Fetal heart rate
Urinary output, measure every voiding. Output should be 700 ml or greater in 24

hours, or at least 30 ml/hr

Urine protein checked hourly if cath is in place. Readings of +3 or 4+ indicate
loss of 5g of protein in 24 hours

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 The woman should be weighed daily at the same time everyday, with the same

article of clothing. If she is on strict bed rest this might be contraindicated

Pulmonary edema, observe for coughing
Deep tendon reflex
Ask about the presence of headaches
Ask about visual disturbances
Ask about epigastric pain

LABORATORY TESTS:

Daily tests of hematocrit to measure hemoconcentration

Bun, creatinine and uric acid levels to assess kidney functioning
Clotting studies for signs of thrombocytopenia or DIC
Liver enzymes
Magnesium levels

ENVIRONMENT CONSIDERATIONS:

Maintain a quiet , low stimulating room

Should be in a private room
Eliminate phone, unless preplanned
Limit visitors
Woman should maintain the left lateral position with side rails up

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