Preeclampsia/Eclampsia

Omar Amireh, Steven Lukac, Sabrina Nichols

What is it?
● Preeclampsia is an increase in the previously normal expectant mother’s
blood pressure after 20 weeks gestation with protein found in the urine
○ mild - > 140/90
○ severe - > 160/110
● Eclampsia is a more severe form that leads to seizures or coma, and can
ultimately lead to death of the mother and fetus
 Significance
● It affects 2 to 8 percent of pregnancies worldwide and is the cause of 15% of the preterm births
in the United States
● Risks- <19 and >40, preeclampsia during a previous pregnancy, family history, African descent,
multifetal pregnancy, infection during pregnancy, and pre-existing medical problems (renal
disease, obesity, pregestational diabetes mellitus)
● May lead to HELLP Syndrome
○ H- hemolysis of RBCS
○ EL- elevated liver enzymes causing liver damage
○ LP- low platelets leading to excess bleeding
○ Can cause death of the mother and fetal demise
Effects on fetus
Fetal growth restriction - affects the arteries carrying blood to the placenta and if the
placenta does not get enough blood the fetus will get much less oxygen, and nutrients which
can potential cause slow growth, low birth weights, and preterm birth

Placental abruption- increases risks for placental abruption; this is where the placenta
separates from the uterus before delivery which can lead to severe bleeding and can be life
threatening to both the mother and the baby

- Infants born preterm are at risk for learning disorders, cerebral palsy, epilepsy, deafness,
blindness, heart problems and other complications.
Signs and Symptoms
● Preeclampsia
○ Proteinuria - trace; 1+ to 2+
○ mild to moderate edema and periorbital edema
○ 2 - 2.5 pound increase
○ headache, blurred vision, abdominal pain, hyperreflexia, twitching, oliguria, pulmonary edema
● Eclampsia
○ Proteinuria - copious; 3+ to 4+
○ Severe edema in hands and face
○ Sudden large increase in weight
○ N & V, dizziness,severe headache and abdominal pain, blindness, low urine output or no output at all, organ
damage, SOB
○ Leads to tonic-clonic seizures, coma, and maternal or fetal death if not Tx
Pathophysiology
- The etiology is unknown, but researchers believe certain risk factors can predispose
mothers, including:

● toxins in the blood ● maternal autoimmune disorders(Dm)

● genetics
● environmental factors
● placental abnormalities
● nutritional factors
● cardiovascular/inflammatory changes
● hormone imbalance
● Multifetal gestation
● Family history
Treatments
● Dependent on the severity of the situation
● Mild - “expectant management”
○ restricted activity
○ encourage rest and avoid stress
○ diet - low sodium intake, adequate fluid intake and adequate protein intake
○ educate the mother
● Severe
○ immediate delivery is necessary
○ seizure precautions - suction equipment, oxygen, call button within reach
○ quiet, non-stimulating environment
Treatments cont.
● Non Stress Tests
○ Assesses the fetus by monitoring the fetal heart rate and its responsiveness to movement.
○ Monitor absence of uterine contractions, AKA "reactive" or "nonreactive".
● BP twice weekly; Weight, VS, at every prenatal visit
○ serum Creatinine, platelets and liver enzymes assessed weekly
○ Urine checked at every prenatal visit to monitor for proteinuria, oliguria
○ Use these to determine if the disease has progressed
○ Assess for edema
Treatments cont.
● Oral hypertensive medications
○ hydralazine (Apresoline) - monitored in the icu
○ labetalol Hydrochloride (Normodyne)
○ methyldopa (Aldomet)
○ nifedipine (Procardia)
● Other Nursing Interventions
○ Monitor for abnormal bleeding
○ Assess for labor signs
○ Monitor for CNS irritability
Treatments cont.
● Betamethasone given under 34 weeks gestation for fetal lung maturity
● Magnesium Sulfate is given during labor to prevent eclamptic seizures
○ given IV piggyback usually
○ Position the woman on their side while administering
○ Monitor MgSo4 levels
○ calcium Gluconate is the antidote for an overdose (Magnesium Toxicity)
● After delivering, the mother is at risk for preeclampsia for 6 weeks and eclampsia for 48
hours. The Magnesium Sulfate infusion continues.
Health Promotion
Preventing preeclampsia is the same as preventing other hypertensive disorders

● Maintaining a healthy weight (keeping your BMI between 19-25)

● low sodium intake (1.5 grams or less)
● drinking 6-8 glasses of water a day
● very little fried or junk foods
● get enough rest (7+ hours a night)
● exercise regularly (30 minutes light exercise every day)
● avoid drinking alcohol, high caffeine intake, smoking, and illicit drug use
Areas of Future Studies
● Proper screening tests for preeclampsia are not available for widespread
clinical use
● How to decrease your chances of developing preeclampsia
cASE sTUDY
Jill, a G1P0 expecting mother who is 26 weeks pregnant, comes in through the ER with her
husband. She was concerned because she developed a headache and complained of blurry
and double vision. She also complained of pain in her abdomen which prompted her to
go to the hospital. Assessments and screenings reveal a Bp of 150/100 and +1 protein in
the urine. When the physician comes in to see Jill on the labor and delivery unit, she
notices her upper extremities suddenly become stiff and she is not relaxed, the nurse
takes another Bp and it shows that it went up to 155/106.
questions
Is there sufficient evidence to determine that this patient has developed preeclampsia?
yes or no
What is the evidence that reveals that she may have developed preeclampsia?
What should be done to prevent her problems from becoming worse?