Two of the most common complications during pregnancy are preeclampsia and eclampsia. To help prevent further danger to both the mother and fetus, nurses should be highly knowledgeable about these two conditions and skilled enough to apply proper nursing care. In this article, we will talk about the following topics to help you with your “preeclampsia and eclampsia” review:
- Signs and Symptoms of Preeclampsia
- Signs and Symptoms of Eclampsia
- Diagnostic Tests of Preeclampsia
- Risk factors of Preeclampsia
- Causes of Preeclampsia
- Complications of Preeclampsia
- Medical Management
- Nursing Responsibility
Preeclampsia is characterized as a hypertensive disorder that developed as a complication of pregnancy. The disorder begins as early as the 20th week, and the pregnant mother has a normal blood pressure the weeks prior or before being pregnant.
Postpartum preeclampsia occurs when the mother develops hypertension after childbirth. This is a rare condition where blood pressure is elevated and there is excess protein in the urine after childbirth.
Signs and Symptoms of Preeclampsia
It is the nurse’s responsibility to monitor signs of preeclampsia and report it to the attending physician immediately. The nurse should look out for signs and symptoms of preeclampsia such as:
- Elevated blood pressure: 140/90 mmHg taken six hours apart
- Proteinuria: 1+ or 2+ using a Reagent Test Strip
- Weight gain: More than 2lbs per week during the second trimester or 1lb per week on the third trimester
- Low platelet
- Signs of impaired liver
- Signs of kidney problems
- Visual disturbances
- Pulmonary edema
Signs and Symptoms of Eclampsia
When preeclampsia is not managed properly, it may lead to eclampsia which can be fatal to the mother and the fetus. The nurse should look for signs and symptoms such as:
- Blood Pressure reading: 160/110 mmHg taken six hours apart
- Proteinuria: 3+ or 4+
- Severe fluid retention or edema: Puffy hands and face
- Oliguria due to impaired kidney function as manifested by urine output is less than 400 mL per day
- Elevated creatinine
- Blurred vision
- Fluid retention
- Epigastric pain
To remember this well, the three clinical manifestations of eclampsia are HYPERTENSION, EDEMA, and PROTEINURIA. When three of these signs and symptoms appear, assess further data to confirm the presence of preeclampsia.
Diagnostic Tests for Preeclampsia:
If the physician suspects of the presence of preeclampsia, the confirmatory tests are:
- Liver functions (ALT and AST): To determine the presence or extent of liver damage.
- Kidney functions (BUN, creatinine, and Uric Acid): To determine the presence of kidney malfunction.
- Platelets: To determine the presence of thrombocytopenia.
- Urinalysis: The urine is checked for the presence of proteinuria.
- Fetal Ultrasound: To closely monitor the growth of the fetus.
- Nonstress Test: To monitor the heart rate of the fetus.
- Biophysical profile: An ultrasound measuring the breathing, movement, muscle tone, and amniotic fluid of the fetus.
Risk factors of Preeclampsia
Keep in mind that preeclampsia is pregnancy-induced hypertension, which means it develops as a complication brought by pregnancy. Some of the risk factors are:
- Preeclampsia on previous pregnancy
- Family history of preeclampsia
- Presence of chronic hypertension before pregnancy
- First pregnancy
- Women above 35 years old
- Obese women
- Multiple pregnancies
- Interval of pregnancy (e.g., first pregnancy and second pregnancy has a 10-year difference)
- Different father of previous and next pregnancy
- Kidney disease
- In vitro fertilization
Causes of Preeclampsia
It starts with the development of new blood vessels to adequately supply blood flow to the placenta. When these blood vessels do not develop or function the way they should, this causes elevated blood pressure and preeclampsia.
The new blood vessels for women with preeclampsia are narrower than the normal size. The new blood vessels could not react to hormone stimulation as well. This leads to a limited supply of blood to the placenta as the circulatory system puts in more effort to pump blood and raise the blood pressure.
The abnormal development of these blood vessels may be caused by insufficient blood supply to the uterus, damage to certain blood vessels, immune system problems, and genetic predisposition.
Complications of Preeclampsia
Now that we are aware of the causes, risk factors, and signs and symptoms of preeclampsia, the nurse must be knowledgeable of the complications of the disorder. The complications of preeclampsia are:
- HELLP Syndrome: Hemolysis, Elevated Liver enzymes, and Low Platelets
- Eclampsia: Eclampsia is a severe form of preeclampsia that can lead to convulsion. Seizures occurring in eclampsia may lead to coma or death.
- Premature placental separation or abruption
- Restricted fetal growth
- Infant Delivery: When preeclampsia is prolonged and is left untreated, it can lead to life-threatening complications to both the mother and the fetus. The recommended treatment for preeclampsia is to deliver the fetus.
If it is too early to deliver the fetus, the physician and mother need to take extra precautions through the pregnancy until the baby is prepared for delivery. When preeclampsia is not managed accordingly, it may lead to eclampsia.
- Magnesium Sulfate: If the fetus is mature enough for labor and delivery, the physician may recommend childbirth. If not, there are control measures to decrease the risk of seizure.
The drug of choice in decreasing seizure activity is Magnesium Sulfate. The nurse needs to monitor the mother for Magnesium Sulfate toxicity by checking decreased or absent reflexes. When Magnesium Sulfate toxicity occurs, the nurse should be prepared with the antidote: Calcium Gluconate.
- Medications to reduce hypertension: To prevent the occurrence of eclampsia, the doctor will most likely prescribe antihypertensive medications like Hydralazine, Labetalol, or Nifedipine.
The nurse must be responsible for monitoring further signs and symptoms to ensure the safety of both the mother and the baby and for promoting comfort. The nurse should be responsible for:
- Monitoring vital signs especially blood pressure.
- When prescribed Magnesium Sulfate, monitor for absence or decreased reflexes.
- Monitor intake and output, especially the urinary output for signs of kidney impairment. If the urinary output is less than 30ml per hour, this indicates that the kidneys are not perfusing well.
- Assess for edema: face, extremities, and fingers
- Recumbent position of the mother aide in sodium secretion
- Ensure proper nutrition of the mother, and decrease sodium intake in the diet.
- Monitor CNS status, hyper reflexes, vision changes, headache, and ankle clonus as signs of seizure.