PRE ENCLAMPSIA

PREGNANCY INDUCED HYPERTENSION (PREECLAMPSIA)

Pregnancy induced hypertension (PIH) is spasm of arterial vessels during pregnancy manifested by hypertension, edema and albuminuria.

Preeclampsia

ETIOLOGY

It remains obscure. It only occurs after 20 wks of gestation & is uncommon before 30 wks.

PATHOLOGICAL CHANGES

Cardiac output appears to decrease as preeclampsia worsen, generalized vasoconstriction occurs affecting much of the physiological activities of the body. Capillary permeability increases and the fluid which escapes contribute to the oedema within the tissues. The presence of excessive fluid retention producing generalized oedema. The uterus is also affected, particularly the vessels supplying the placental bed. Vasoconstriction and Disseminated intravascular coagulation (DIC) reduce the uterine blood flow and vascular lesions occur in the placental bed. Placental abruptio can be the result.

The liver: Intracapsular hemorrhages and necrosis occur in the liver in severe cases. Oedema of the liver cells produces epigastric pain and impaired liver function result in jaundice.

The brain: Becomes oedematous and this, in conjuction with DIC, produce thrombosis and necrosis of the blood vessel walls resulting in cerebrovascular accident.

The lungs: Becomes congested with fluid in severe cases, oxygenation impaired and cyanosis occurs.

DIAGNOSIS OF PREECLAMPSIA: Symptoms usually appears at an advanced state. Symptoms are identified by the following cardinal signs.

a. Blood pressure: A rise of 15-20 mmHg above the normal diastolic pressure or an increase above 90 mmHg on two occasions.

b. Proteinuria: The presence of protein in urine is indicative of renal damage.

c. Oedema: It may appear rather suddenly and be associated with a rapid rate of weight gain. Generalized oedema is significant and classified as occult or clinical.

Occult oedema is suspected if there is a marked increase in weight.

Clinical oedema is either be mild or severe in nature and, the severity is related to the worsening of the pre-eclampsia.

Classification of Preeclampsia

1. Mild Preeclampsia: Is diagnosed when the mother’s diastolic blood pressure raises 15-20 mmHg above the base line blood pressure recorded in early pregnancy or when the diastolic blood pressure rises above 90 mmHg. Oedema of the feet, ankles and pretibial region may be present.

2. Moderate Preeclampsia: Is usually diagnosed when there is a marked rise in the systemic and diastolic pressures. When proteinuria is present in the absence of a urinary tract infection and when there is evidence of a more generalized edema.

3. Severe Preeclampsia: Is diagnosed when the blood pressure exceeds 170/110mmHg, when there is an increase in the proteinuria and when oedema is marked. The mother may complain of frontal headaches and visual disturbances.

Effects on the Mother

- The condition may worsen and Eclampsia may occur

- Placenta abruptio may occur with all its complications

- Hematological disturbance can occur and the kidneys, lungs, heart and liver may be seriously damaged.

- The capillaries within the fundus of the eye may be irreparably damaged and blindness can occur.

Effects on the Fetus

- Reduced placental function can result in low birth weight.

- There is an increased incidence of hypoxia

- Placental abruptio, if minor, will contribute to fetal hypoxia,

 -Intrauterine death with occurring major placental abruptio

MANAGEMENT

 ✔Admission : Depending upon the severity of the disease mother .

 Treatment is symptomatic because the cause of pre eclampsia is unknown.

 ✔Bed rest

 ✔Diet: As for any pregnant woman, a diet rich in protein, fiber and vitamin is recommended .Fluid intake encouraged.

✔-Weight: Check and record twice weekly .If the mother is ambulant , observe oedema  daily.

✔ Urine: Tested for protein and ketones.

✔Monitor Fluid intake and output continuously.

✔Blood pressure is ascertained 4hrly but 2hrly or more frequently in severe case.

✔Abdominal examination

    For Check:

     ↔discomfort,

     ↔tenderness or pain experienced by the mother

     ↔Record and report findings immediately.

✔Monitor fetal heart rate and fetal wellbeing and record.

✔Give prescribed Sedative prescribed.

Management during Labour

✔The nurse/midwife remains with the mother throughout the course of labour because preeclampsia can suddenly worsen at any.

✔Vital signs: BP, urinary output and oedema be monitored.

✔Positioning: Mother positioned on her left side will prevent supine hypotension.

✔Bladder Care: Mother be encouraged to void urine regularly.

✔Obstetrician and pediatrician be notified when second stage commenced. 

Care after Delivery

✔Check and record blood pressure at least 4hrly for 24 hrs.

✔Urine tested for proteinuria once or twice daily until it is clear.

✔urinary output monitored and recorded.

✔Provide Postnatal care as needed. Strict follow up especially first 24-48 hours.

Signs of Impending Eclampsia

- A sharp rise in blood pressure

- Diminished urinary output (oliguria)

- Increase in proteinuria

- Headache which is severe, persistent and frontal or occipital in location.

- Drowsiness or confusion

- Visual disturbances such as blurring of vision or flashing lights due to retinal oedema

- Nausea and vomiting

- Epigastric pain

 NB=The nurse who observed any one of these signs in a woman with pre-eclampsia must make a full examination in order to establish if other are present and report for urgent action.