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PREECLAMPSIA
Case Study

Submitted by:
RAMOS, BIATRIX MAE

REGALA, BIANCA YSABELLE

SABANAL, IRENE

SARMIENTO, ERNESTINE

TABUZO, REGINA

BSN IV – B

Group 4
PREECLAMPSIA
What is Preeclampsia?

Preeclampsia is a complication of pregnancy. With preeclampsia, you might have

high blood pressure, high levels of protein in urine that indicate kidney damage
(proteinuria), or other signs of organ damage. Preeclampsia usually begins after 20
weeks of pregnancy in women whose blood pressure had previously been in the
standard range.

Left untreated, preeclampsia can lead to serious — even fatal — complications

for both the mother and baby.

Early delivery of the baby is often recommended. The timing of delivery depends
on how severe the preeclampsia is and how many weeks pregnant you are. Before
delivery, preeclampsia treatment includes careful monitoring and medications to lower
blood pressure and manage complications.

Preeclampsia may develop after delivery of a baby, a condition known as

postpartum preeclampsia.

Risk Factors

Conditions that are linked to a higher risk of preeclampsia include:

 Preeclampsia in a previous pregnancy
 Being pregnant with more than one baby
 Chronic high blood pressure (hypertension)
 Type 1 or type 2 diabetes before pregnancy
 Kidney disease
 Autoimmune disorders
 Use of in vitro fertilization

Conditions that are associated with a moderate risk of developing preeclampsia include:
 First pregnancy with current partner
 Obesity
 Family history of preeclampsia
 Maternal age of 35 or older
 Complications in a previous pregnancy
 More than 10 years since previous pregnancy

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Other risk factors

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. For the purposes of
making decisions about prevention strategies, a Black woman or a woman with a low
income has a moderately increased risk of developing preeclampsia.

Pathophysiology

Symptoms

The defining feature of preeclampsia is high blood pressure, proteinuria, or other

signs of damage to the kidneys or other organs. You may have no noticeable
symptoms. The first signs of preeclampsia are often detected during routine prenatal
visits with a health care provider.

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 Along with high blood pressure, preeclampsia signs and symptoms may include:
 Excess protein in urine (proteinuria) or other signs of kidney problems
 Decreased levels of platelets in blood (thrombocytopenia)
 Increased liver enzymes that indicate liver problems
 Severe headaches
 Changes in vision, including temporary loss of vision, blurred vision or light
sensitivity
 Shortness of breath, caused by fluid in the lungs
 Pain in the upper belly, usually under the ribs on the right side
 Nausea or vomiting
 Weight gain and swelling (edema) are typical during healthy pregnancies.
However, sudden weight gain or a sudden appearance of edema — particularly
in your face and hands — may be a sign of preeclampsia

Causes

The exact cause of preeclampsia likely involves several factors. Experts believe
it begins in the placenta — the organ that nourishes the fetus throughout pregnancy.
Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and
nutrients to the placenta.

In women with preeclampsia, these blood vessels don't 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.

Other high blood pressure disorders during pregnancy

Preeclampsia is one high blood pressure (hypertension) disorder that can occur
during pregnancy. Other disorders can happen, too
 Gestational hypertension is high blood pressure that begins after 20 weeks
without problems in the kidneys or other organs. Some women with gestational
hypertension may develop preeclampsia.
 Chronic hypertension is high blood pressure that was present before pregnancy
or that occurs before 20 weeks of pregnancy. High blood pressure that continues
more than three months after a pregnancy also is called chronic hypertension.
 Chronic hypertension with superimposed preeclampsia occurs in women
diagnosed with chronic high blood pressure before pregnancy, who then develop
worsening high blood pressure and protein in the urine or other health
complications during pregnancy.

Complications

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 Complications of preeclampsia may include:
 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 risks.
 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.

Signs and symptoms include nausea and vomiting, headache, upper right belly pain,
and a general feeling of illness or being unwell. Sometimes, it develops suddenly, even
before high blood pressure is detected. It also may develop without any symptoms.
 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.
 Signs and symptoms that may appear before seizures include severe
headaches, vision problems, mental confusion or altered behaviors. But, there
are often no symptoms or warning signs. Eclampsia may occur before, during or
after delivery.
 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.

Diagnostic Test

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 A diagnosis of preeclampsia happens if you have high blood pressure after 20
weeks of pregnancy and at least one of the following findings:

 Protein in your urine (proteinuria), indicating an impaired kidney

 Other signs of kidney problems
 A low blood platelet count
 Elevated liver enzymes showing an impaired liver
 Fluid in the lungs (pulmonary edema)
 New headaches that don't go away after taking pain medication
 New vision disturbances

High blood pressure

A blood pressure reading has two numbers. The first number is the systolic
pressure, a measure of blood pressure when the heart is contracting. The second
number is the diastolic pressure, a measure of blood pressure when the heart is
relaxed.

In pregnancy, high blood pressure is diagnosed if the systolic pressure is 140

millimeters of mercury (mm Hg) or higher or if the diastolic pressure is 90 mm Hg or
higher.

A number of factors can affect your blood pressure. If you have a high blood
pressure reading during an appointment, your health care provider will likely take a
second reading four hours later to confirm a diagnosis of high blood pressure.
Additional tests

If you have high blood pressure, your health care provider will order additional tests
to check for other signs of preeclampsia:

 Blood tests. A blood sample analyzed in a lab can show how well the liver and
kidneys are working. Blood tests can also measure the amount of blood platelets,
the cells that help blood clot.
 Urine analysis. Your health care provider will ask you for a 24-hour urine sample
or a single urine sample to determine how well the kidneys are working.
 Fetal ultrasound. Your primary care provider will likely recommend close
monitoring of your baby's growth, typically through ultrasound. The images of
your baby created during the ultrasound exam allow for estimates of the baby's
weight and the amount of fluid in the uterus (amniotic fluid).

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  Nonstress test or biophysical profile. A nonstress test is a simple procedure
that checks how your baby's heart rate reacts when your baby moves. A
biophysical profile uses an ultrasound to measure your baby's breathing, muscle
tone, movement and the volume of amniotic fluid in your uterus.

Treatment

The primary treatment for preeclampsia is either to deliver the baby or manage
the condition until the best time to deliver the baby. This decision with your health care
provider will depend on the severity of preeclampsia, the gestational age of your baby,
and the overall health of you and your baby.

If preeclampsia isn't severe, you may have frequent provider visits to monitor
your blood pressure, any changes in signs or symptoms, and the health of your baby.
You'll likely be asked to check your blood pressure daily at home.

Treatment of Severe Preeclampsia

Severe preeclampsia requires that you be in the hospital to monitor your blood
pressure and possible complications. Your health care provider will frequently monitor
the growth and well-being of your baby.

Medications to treat severe preeclampsia usually include:

 Antihypertensive drugs to lower blood pressure
 Anticonvulsant medication, such as magnesium sulfate, to prevent seizures
 Corticosteroids to promote development of your baby's lungs before delivery

Delivery

If you have preeclampsia that isn't severe, your health care provider may
recommend preterm delivery after 37 weeks. If you have severe preeclampsia, your
health care provider will likely recommend delivery before 37 weeks, depending on the
severity of complications and the health and readiness of the baby.

The method of delivery — vaginal or cesarean — depends on the severity of

disease, gestational age of the baby and other considerations you would discuss with
your health care provider.

After delivery

You need to be closely monitored for high blood pressure and other signs of
preeclampsia after delivery. Before you go home, you'll be instructed when to seek
medical care if you have signs of postpartum preeclampsia, such as severe headaches,
vision changes, severe belly pain, nausea and vomiting.

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Prevention

Medication

The best clinical evidence for prevention of preeclampsia is the use of low-dose
aspirin. Your primary care provider may recommend taking an 81-milligram aspirin
tablet daily after 12 weeks of pregnancy if you 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 you become pregnant, especially if you've had preeclampsia before, it's a
good idea to be as healthy as you can be. Talk to your provider about managing any
conditions that increase the risk of preeclampsia. It's also a good idea to
learn CPR properly so you can help someone who's having a heart attack. Consider
taking an accredited first-aid training course, including CPR and how to use an
automated external defibrillator (AED).

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 DRUG
DRUGSTUDY
STUDY
ACE Inhibitors

Name of the Drug Mechanism of Action Indications Contraindications Adverse Reaction Nursing Consideration

 Morphine sulfate is an  Known  Most common  Monitor blood

Name of Drug: Morphine sulfate produces
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Morphine Sulfate respiratory depression seen on initiation of
for the relief of morphine. administration.
therapy are:
by direct action on brain
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Drug Class: stem respiratory centers. and chronic pain where depression in the nausea, BP < 100 mm
somnolence,
an opioid analgesic is absence of Hg or 30 mm Hg
Opiate (narcotic) The respiratory depression lightheadedness,
appropriate. resuscitative dizziness, sedation, below baseline.
analgesics involves a reduction in the
equipment. vomiting, and  Monitor patient's
responsiveness of the brain sweating.
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Dosage & Route: stem respiratory centers to bronchial asthma or prior to
with acute coronary depression:
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syndrome
hours (adults)  Paralytic ileus. elderly, debilitated  Reassess pain
dioxide tension and  Acute cardiogenic patients, those
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electrical stimulation. pulmonary edema suffering from
mg slow IV push q 4 opiates conditions administration of
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hypoxia,
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colitis depressive effects Accompany
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 Prolonged gastric
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 especially paralytic
ileus.
 Sphincter of Oddi
spasm and
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