Preeclampsia is a complication of pregnancy that causes excessive increase in high blood pressure, and high levels of protein in the urine. This may affect several organs of the body of a pregnant woman including the liver, kidney, and the brain. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range.
SIGNS AND SYMPTOMS
Although in some women, there are no evident clinical manifestation other than increased blood pressure, the following are other signs and symptoms of preeclampsia:
- high blood pressure
- proteinuria
- thrombocytopenia or decreased platelets in blood
- increased liver enzymes, severe headache
- changes in vision or loss of vision
- shortness of breath or difficulty breathing
- pain in the upper abdomen
- nausea and vomiting
- sudden weight gain
- sudden swelling
RISK FACTORS
Although the main cause of preeclampsia is still unknown, researchers
suspect that it begins in the placenta where the blood vessels that supply
oxygen to the baby do not seem to develop or work properly. Problems with how
well blood circulates in the placenta may lead to the irregular regulation of
blood pressure in the mother. In addition, the following are some risk factors that increase the risk of preeclampsia:
- preeclampsia in a previous pregnancy
- pregnant with twins or more
- chronic high blood pressure
- diabetes
- autoimmune disorders
- obesity
- family history of the disorder
- maternal age of more than 40 years old
- more than 10 years since previous pregnancy
- first pregnancy with partner
COMPLICATIONS
If left untreated, Preeclampsia may have the following complications:
- Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, the baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction
- Preterm birth. Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risk
- Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby
- HELLP syndrome. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother
- Eclampsia. Eclampsia is the onset of seizures or coma with signs or symptoms of preeclampsia. It is very difficult to predict whether a patient with preeclampsia will develop eclampsia. Eclampsia can happen without any previously observed signs or symptoms of preeclampsia
- Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on how severe the preeclampsia is
- Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery.
PREVENTION
- Medication - The best clinical
evidence for prevention of preeclampsia is the use of low-dose aspirin. Primary care provider may recommend taking an 81-milligram aspirin tablet daily
after 12 weeks of pregnancy if a woman have one high-risk factor for preeclampsia
or more than one moderate-risk factor. It's important that you talk
with your provider before taking any medications, vitamins or supplements to
make sure it's safe for you.
- Lifestyle and healthy choices - Before one becomes pregnant, especially if she had preeclampsia before, it's a good idea to be
as healthy as she can be hence, it is important to talk to a health care provider about managing any conditions
that increase the risk of preeclampsia.
NURSING INTERVENTION
- Monitor patient's blood pressure
- Health Teaching on stress management
- Monitor weight of patient
- Health teaching on proper nutrition
- Monitor fetal heart rate
- Regular OB/GYNE follow-up check ups and prenatal care
- Administer medications as prescribed by physician
- Health teaching on limited physical activities
- Assess for edema and other health deviations related to illness
DIAGNOSTICS
- Urine Analysis - necessary to detect presence of proteinuria. (+2) or a result of ≥0.3 g protein in a 24-hour urine specimen
- Complete Blood Count Test - measures levels of a protein called placental growth factor (PIGF). If PIGF levels are high, it's highly likely that the patient do not have pre-eclampsia. If PIGF levels are low, it could be a sign of pre-eclampsia, but further tests are needed to confirm the diagnosis.
- Routine Physical Examinations - assess for signs of sudden edema and sudden weight gain
- Ultrasound Cardiotocograph (CTG)
TREATMENT
- Anti-convulsant medications - to prevent seizures
- Anti-hypertensive medications - to stabilize and lower blood pressure
- Cortecosteroids - to treat and prevent inflammations
UPDATES
Several studies have shown a greater risk of preeclampsia among Black women compared with other women. There's also some evidence of an increased risk among indigenous women in North America.
A growing body of evidence suggests that these differences in risk may not necessarily be based on biology. A greater risk may be related to inequities in access to prenatal care and health care in general, as well as social inequities and chronic stressors that affect health and well-being. Lower income also is associated with a greater risk of preeclampsia likely because of access to health care and social factors affecting health.
In the Philippines, Preeclampsia and Eclampsia were the cause of up to 30% of maternal deaths in 2017 according to the Philippine Department of Health.
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