Severe Pre-eclampsia

Diagnostic Tests:

Blood test
Urine Analysis
Fetal Ultrasound
Nonstress test or biophysical profile

Signs and Symptoms:

A woman has passed from mild to severe pre-eclampsia when

BP of 160/110 mmHg
proteinuria 34+ on a random sample and 5 g on a 24-hour sample
oliguria (500 mL or less in 24 hours or altered renal function tests
Elevated serum creatinine more than 1.2 mg/dL)
cerebral or visual disturbances (headache, blurred vision)
extensive peripheral edema
hepatic dysfunction
Thrombocytopenia (low platelet count)
Severe epigastric pain
Nausea
Vomiting

Medical Management:

Antihypertensives
Corticosteroids
Anticonvulsant medications

Nursing Management/Interventions:

Support bed rest.

o Most women are hospitalized, for close observation of mothers with
severe pre-eclampsia.
o Vistors are limited and they are admitted to a private room to rest as
undisturbed as possible.
o Raise side rails to prevent injury if a seizure should occur.
o Darken the room because bright lights can also trigger seizures.
o Be certain the woman receives clear explanations of what is happening
and what is planned.
Monitor maternal well-being.
o Take blood pressure frequently (at least every 4 hours) to detect any
increase.
o Obtain blood studies to assess renal and liver function and the
development of DIC.
 o Obtain daily weights at the same time each day for evaluation of fluid
retention.
o Monitor urinary output.

Monitor fetal well-being.

o Assess FHR.

Support a nutritious diet.

o A woman needs a diet moderate to high in protein and moderate in
sodium.

Administer medications to prevent eclampsia.

o Hydralazine (Apresoline), labetalol (Normodyne), or nifedipine may be
prescribed to reduce hypertension.
o Magnesium Sulfate, the drug of choice to prevent eclampsia.
Reduces edema
CNS depressant action
Decreases BP
Anticonvulsant
o IV infusion of salt-poor albumin for severe oliguria.

Before further administration of magnesium sulfate make sure that:

urine output is above 25 to 30 mL/hr, with a specific gravity of 1.010 or
lower.
Respirations should be above 12 per minute
a woman should be able to answer questions asked of her such as her
name or address
ankle clonus (a continued motion of the foot) should be minimal
deep tendon reflexes should be present
Make these assessments every hour if a continuous IV infusion is being used.
A solution of 10 mL of a 10% calcium gluconate soln (1 g) should be kept
ready nearby for immediate IV administration for magnesium toxicity.