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Mild Preeclampsia

- exhibit few if any symptoms
- BP elevated to 140/90 or higher
- Proteinuria: 1g or less in 24 hr (2+ dipstick)
- generalized edema (puffy face or hands) and on dependent areas
- wt gain of more than 1.5 kg (3.3 lb)/mth in 2nd trimester
- wt gain of 0.5 kg (1.1 lb)/mth in 3rd trimester

Severe Preeclampsia

- may develop suddenly
- BP 160/110 or higher on 2 occasions at least 6 hrs apart when bedrest
- proteinuria of 5g or more found in 24-hr urine collection
- urine dipstick: 3+ to 4+ on two random samples in at least 4hrs apart

Symptoms of Severe Preeclampsia

- oliguria: 500mL or less in 24 hrs
- visual or cerebral disturbance
- cyanosis or pulmonary edema
- epigastric or right upper quadrant pain
- impaired liver function
- thrombocytopenia and or hemolysis
- intrauterine fetal growth restriction
- nausea, vomiting, irritability, hyperreflexia and retinal edema

Epigastric pain in preeclampsia

- sign of impending convulsion
- caused by increased vascular engorgement of the liver

Eclampsia

- characterized by grand mal convulsion or coma
- may occur before the onset of and during labor, or early in the postpartum period

Warning signs of mild preeclampsia

- weight gain of 1.4 kg (3lb) in 24 hrs
- weight gain of 1.8 kg (4lb) 4-day period

Management of mild preeclampsia

- usually home care
- daily BP, wt, urine protein and fetal movement monitoring
- remote nonstress tests (NSTs) twice per week
- weekly biophysical profiles
- nursing contacts varies from daily to weekly
- report worsening signs

Management of worsening preeclampsia

- bedrest on left side
- weighed daily
- evaluated for worsening edema, persistent headache, visual changes, or epigastric pain
- daily urine dipstick
- BP at least 4 times a day
- moderate to high protein diet

Moderate to high protein diet

- for severe preeclampsia to replace protein loss in urine
- 80-100 g/day or 1.5g kg-1 day-1
- moderate sodium intake, not exceed 6g/day
- no sodium restriction and no diurectics use

Fetal tests in pre-eclampsia

- more frequently done
- fetal movement record
- nonstress test
- ultrasonography every 3 or 4 weeks for serial determination of growth
- biophysical profile
- amniocentesis to determine fetal lung maturity
- doppler velocimetry beginning at 30-32 weeks of gestation to screen for fetal compromise

Hydralazine (Apresoline)

- Antihypertensives used in severe preeclampsia
- IV bolus

Methyldopa (Aldomet)

- Antihypertensives used in severe preeclampsia
- long-term control of mild to moderate HTN in pregnancy

labetalol (Normodyne, Trandate)

- Antihypertensives used in severe preeclampsia
- IV
- as effective as IV hydralazine but fewer side effects

nifedipine (Adalat, Afeditab CR, Nifediac, Nifedical & Procardia)

- Antihypertensives used in severe preeclampsia
- oral
- as effective as IV hydralazine but fewer side effects

Management of Eclampsia

- bolus of 4-6g of Ma Sulfate in 100mL NS IV over 15-30 mins to control convulsion
- antihypertensives to keep diastolic BP to 90-110 => to avoid potential reduction of uteroplacental blood flow or cerebral perfusion
- if seizure not controlled by Ma Sulfate => diazepam or amobarbital
- Dilantin => may be used to prevent seizure
- auscultate lungs to detect pulmonary edema
- Observed for circulatory and renal failure and signs of cerebral hemorrhage
- Furosemia: may be given for pulmonary edema
- Digitalis: may be given for circulatory failure
- Hourly I & O
- Signs of labor; bleeding, abd rigidity
- if comatose => position to side with side rails up

Anagelsics used in labor with eclampsia

- Meperidine (Demerol)
- Fentanyl
- pudendal block => vaginal birth
- epidural block => if adm by skilled anesthesiologist

Contraindication of spinal or epidural anesthesia in elcampsia

- presence of coagulopathy
- platelet count of 50,000/mm3

Birth position in eclampsia

- Sims' or semi-sitting position preferred
- a wedge under right buttock if lithotomy position and C-section

Assessment of proteinuria

- place an indwelling catheter
- evaluated hourly
- 3+ or 4+ urine dipstick: 5g or more of protein in 24 hrs

Diagnostics for PIH

- An increase of 30 mmHg systolic and 15 mmHg diastolic on two occasions

Indication(s) for Magnesium Toxicity

- Diminished reflexes

Indication(s) for Therapeutic magnesium level

- Slurred speech
- Decreased appetite
- and awkward movements

Treatment of choice for chronic HTN during pregnancy

- Methyldopa (Aldamet)

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