Preeclampsia, the nonconvulsive form of the disorder, is marked by the onset of hypertension after 20 weeks of gestation. It develops in about 7% of pregnancies and may be mild or severe. The incidence is significantly higher in low socioeconomic groups. The classic diagnostic triad included hypertension, proteinuria, and edema. Recently, the National High Blood Pressure Education Working Group recommended eliminating edema as a diagnostic criterion because it is too frequent an observation during normal pregnancy to be useful in diagnosing preeclampsia
Eclampsia, preeclampsia with seizures, the occurrence of seizures defines eclampsia. It is a manifestation of severe central nervous system involvement. The convulsive form occurs between 24 weeks’ gestation and the end of the first postpartum week. The incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease.
· Blood pressure >160 mm Hg systolic or >110 mm Hg diastolic on two occasions at least 6 hours apart while the patient is on bed rest
· Proteinuria of 5 g or higher in 24-hour urine specimen or 3+ or greater on two random urine samples collected at least 4 hours apart
· Oliguria < 500 mL in 24 hours
· Cerebral or visual disturbances
· Pulmonary edema or cyanosis
· Epigastrica or right upper quadrant pain
· Impaired liver function
· Fetal growth restriction
· Blood pressure > 140/90 mm Hg but < 160/110 mm Hg on two occasions at least 6 hours apart while the patient is on bed rest
· Proteinuria > 300 mg/24 h but < 5 g/24 h
Cause of preeclampsia
The cause of preeclampsia is unknown, it is often called the “disease of theories” because many causes have been proposed, yet none has been well established. Geographic, ethnic, racial, nutritional, immunologic, and familial factors may contribute to preexisting vascular disease, which, in turn, may contribute to its occurrence. Age is also a factor. Adolescents and primiparas older than age 35 are at higher risk for preeclampsia. However, a growing body of evidence suggests that maternal vascular endothelial injury plays a central role in the disorder. Other theories include a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.
Risk Factors for Preeclampsia
- Age less than 20 years or more than 35 years
- Multiple gestation
- Hydatidiform mole
- Diabetes mellitus
- Thyroid disease
- Chronic hypertension
- Renal disease
- Collagen vascular disease
- Antiphospholipid syndrome
- Family history of preeclampsia
Complications of Preeclampsia
Generalized arteriolar vasoconstriction is thought to produce decreased blood flow through the placenta and maternal organs. This decrease can result in:
- Intrauterine growth retardation (or restriction),
- Placental infarcts, and
- Abruptio placentae.
Other possible complications include
- Stillbirth of the neonate,
- Premature labor,
- Renal failure
- Hepatic damage in the mother.
Treatment for Preeclampsia
Early recognition is the key to Preeclampsia treatment. Therapy for patients with preeclampsia is intended to halt the progress of the disorder specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown, and to ensure fetal survival. Some physicians advocate the prompt inducement of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include:
- Complete bed res.
- An antihypertensive, such as methyldopa or hydralazine
- Magnesium sulfate to promote diuresis, and reduce blood pressure.
Common nursing diagnosis found in Nursing care plans Preeclampsia-Eclampsia Pregnancy Induced Hypertension PIH
- Activity intolerance
- Disturbed sensory perception (visual)
- Disturbed thought processes
- Excess fluid volume
- Impaired urinary elimination
- Ineffective coping
- Ineffective tissue perfusion: Cerebral, peripheral
- Excess Fluid Volume related to pathophysiologic changes of gestational hypertension and increased risk of fluid overload
- Ineffective Tissue Perfusion: Fetal Cardiac and Cerebral related to altered placental blood flow caused by vasospasm and thrombosis
- Risk for Injury related to seizures or to prolonged bed rest or other therapeutic regimens
- Anxiety related to diagnosis and concern for self and fetus
- Decreased Cardiac Output related to decreased preload or antihypertensive therapy
Nursing outcome nursing interventions, Nursing care plans Preeclampsia-Eclampsia Pregnancy Induced Hypertension PIH
- Control I.V. fluid intake using a continuous infusion pump.
- Monitor intake and output strictly; notify health care provider if urine output is less than 30 mL/hour.
- Monitor hematocrit levels to evaluate intravascular fluid status.
- Monitor vital signs every hour.
- Auscultate breath sounds every 2 hours, and report signs of pulmonary edema (wheezing, crackles, shortness of breath, increased pulse rate, increased respiratory rate).
- Position on side to promote placental perfusion.
- Monitor fetal activity.
- Evaluate NST to determine fetal status.
- Increase protein intake to replace protein lost through kidneys.
- Instruct on the importance of reporting headaches, visual changes, dizziness, and epigastric pain.
- Instruct to lie down on left side if symptoms are present.
- Keep the environment quiet and as calm as possible.
- If patient is hospitalized, side rails should be padded and remain up to prevent injury if seizure occurs.
- If patient is hospitalized, have oxygen and suction setup, along with a tongue blade and emergency medications, immediately available for treatment of seizures.
- Assess DTRs and clonus every 2 hours. Increase frequency of assessment as indicated by patient's condition.
Evaluation: Expected Outcomes
- No evidence of pulmonary edema; urine output adequate
- FHR within normal range; reactivity present
- No seizure activity
- Expresses concern for self and the fetus
- Maintaining bed rest and pursuing diversional activities
- BP and other vital parameters stable