SNO TIME OBJECTIVES CONTENT TEACHING METHOD AV AIDS EVALUATION

1 2mints To explain about Preeclampsia Lecture OHP

Preeclampsia
Preeclampsia is a pregnancy condition in which high blood pressure
and protein in the urine develop after the 20th week (late 2nd or 3rd
trimester) of pregnancy.
Describe the Causes, incidence, and risk factors
2 5mnt
causes of
preeclampsia The exact cause of preeclampsia is not known. Possible causes
include:

 Autoimmune disorders
 Blood vessel problems
 Diet
 Genes

Preeclampsia occurs in a small percentage of pregnancies. Risk

factors include:

 First pregnancy
 Multiple pregnancy (twins or more) Lecture cum OHP-
 Obesity discussion
 Older than age 35
 Past history of diabetes, high blood pressure, or kidney
disease
 Explain the Symptoms
symptoms of pre
4
eclamsia Often, women who are diagnosed with preeclampsia do not feel sick.

Symptoms of preeclampsia can include:

 Swelling of the hands and face/eyes (edema)

 Weight gain
o More than 2 pounds per week
o Sudden weight gain over 1 - 2 days

Note: Some swelling of the feet and ankles is considered normal with
pregnancy.

Symptoms of more severe preeclampsia:

 Headaches that are dull or throbbing and will not go away

 Abdominal pain, mostly felt on the right side, underneath the
ribs. Pain may also be felt in the right shoulder, and can be
confused with heartburn, gallbladder pain, a stomach virus,
or the baby kicking
 Agitation
 Decreased urine output, not urinating very often
 Nausea and vomiting (worrisome sign)
 Vision changes -- temporary loss of vision, sensations of
flashing lights, auras, light sensitivity, spots, and blurry vision
Signs and tests

The doctor will perform a physical exam and order laboratory tests.
Signs of preclampsia include:

 High blood pressure, usually higher than 140/90 mm/Hg

 Protein in the urine (proteinuria)

The physical exam may also reveal:

 Swelling in the hands and face

 Weight gain

Blood and urine tests will be done. Abnormal results include:

 Protein in the urine (proteinuria)

 Higher-than-normal liver enzymes
 Platelet count less than 100,000 (thrombocytopenia)

Your doctor will also order tests to see how well your blood clots,
and to monitor the health of the baby. Tests to monitor the baby's
well-being include pregnancy ultrasound, non-stress test, and a
biophysical profile. The results of these tests will help your doctor
decide whether your baby needs to be delivered immediately.

Women who began their pregnancy with very low blood pressure,
but had a significant rise in blood pressure need to be watched
closely for other signs of preeclampsia.
Discuss the Treatment
treatment of
preeclampsia The only way to cure preeclampsia is to deliver the baby.

If your baby is developed enough (usually 37 weeks or later), your

doctor may want your baby to be delivered so the preeclampsia does
not get worse. You may receive different treatments to help trigger
labor, or you may need a c-section.

If your baby is not fully developed and you have mild preeclampsia,
the disease can often be managed at home until your baby has a
good chance of surviving after delivery. The doctor will probably
recommend the following:

 Getting bed rest at home, lying on your left side most or all
of the time
 Drinking extra glasses of water a day and eating less salt
 Following-up with your doctor more often to make sure you
and your baby are doing well
 Taking medicines to lower your blood pressure (in some
cases)

Immediately call your doctor if you gain more weight or have new
symptoms.

In some cases, a pregnant woman with preeclampsia is admitted to

the hospital so the health care team can more closely watch the baby
and mother.

Treatment may involve:

  Medicines given into a vein to control blood pressure, as well
as to prevent seizures and other complications
 Steroid injections (after 24 weeks) to help speed up the
development of the baby's lungs

You and your doctor will continue to discuss the safest time to deliver
your baby, considering:

 How close you are to your due date. The further along you
are in the pregnancy before you deliver, the better it is for
your baby.
 The severity of the preeclampsia. Preeclampsia has many
severe complications that can harm the mother.
 How well the baby is doing in the womb.

The baby must be delivered if you have signs of severe preeclampsia,

which include:

 Tests (ultrasound, biophysical profile) that show your baby is

not growing well or is not getting enough blood and oxygen
 The bottom number of the mother's blood pressure is
confirmed to be over 110 mmHg or is greater than 100
mmHg consistently over a 24-hour period
 Abnormal liver function tests
 Severe headaches
 Pain in the belly area (abdomen)
 Eclampsia
 Fluid in the mother's lungs (pulmonary edema)
 HELLP syndrome
 Low platelet count (thrombocytopenia)
  Decline in kidney function (low amount of urine, large
amount of protein in the urine, increase in the level of
creatinine in the blood)

Expectations (prognosis)

Usually the high blood pressure, protein in the urine, and other
effects of preeclampsia go away completely within 6 weeks after
delivery. However, sometimes the high blood pressure will get worse
in the first several days after delivery.

A woman with a history of preeclampsia is at risk for the condition

again during future pregnancies. Often, it is not as severe in later
pregnancies.

Women who have high blood pressure problems during more than
one pregnancy have an increased risk for high blood pressure when
they get older.

Death of the mother due to preeclampsia is rare in the U.S. The

infant's risk of death depends on the severity of the preeclampsia
and how prematurely the baby is born.

Complications

Preeclampsia can develop into eclampsia if the mother has seizures.

Complications in the baby can occur if the baby is delivered
prematurely.

There can be other severe complications for the mother, including:

  Bleeding problems
 Premature separation of the placenta from the uterus before
the baby is born (placental abruption)
 Rupture of the liver
 Stroke
 Death (rarely)

However, these complications are unusual.

Severe preeclampsia may lead to HELLP syndrome.

Prevention

Although there is no known way to prevent preeclampsia, it is

important for all pregnant women to start prenatal care early and
continue it through the pregnancy. This allows the health care
provider to find and treat conditions such as preeclampsia early.

Proper prenatal care is essential. At each pregnancy checkup, yor

health care provider will check your weight, blood pressure, and
urine (through a urine dipstick test) to screen you for preeclampsia.

As with any pregnancy, a good prenatal diet full of vitamins,

antioxidants, minerals, and the basic food groups is important.
Cutting back on processed foods, refined sugars, and cutting out
caffeine, alcohol, and any medication not prescribed by a doctor is
essential. Talk to your health care provider before taking any
supplements, including herbal preparations.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001900
Preeclampsia

Definition

Preeclampsia is a condition of pregnancy marked by high blood

pressure and excess protein in your urine after 20 weeks of
pregnancy. Preeclampsia often causes only modest increases in
blood pressure. Left untreated, however, preeclampsia can lead to
serious — even fatal — complications for both you and your baby.

If you have preeclampsia, the only cure is delivery of your baby. If

you're diagnosed with preeclampsia too early in your pregnancy for
delivery to be an option, you and your doctor need to allow your
baby more time to mature, without putting you or your baby at risk
of serious complications.

Symptoms

Preeclampsia can develop gradually but often attacks suddenly, after

20 weeks of pregnancy. Preeclampsia may range from mild to severe.
If your blood pressure was normal before your pregnancy, signs and
symptoms of preeclampsia may include:

 High blood pressure (hypertension) — 140/90 millimeters of

mercury (mm Hg) or greater — documented on two
occasions, at least six hours but no more than seven days
apart
 Excess protein in your urine (proteinuria)
 Severe headaches
  Changes in vision, including temporary loss of vision, blurred
vision or light sensitivity
 Upper abdominal pain, usually under your ribs on the right
side
 Nausea or vomiting
 Dizziness
 Decreased urine output
 Sudden weight gain, typically more than 2 pounds (.9
kilograms) a week

Swelling (edema), particularly in your face and hands, often

accompanies preeclampsia. Swelling isn't considered a reliable sign
of preeclampsia, however, because it also occurs in many normal
pregnancies.

When to see a doctor

Contact your doctor immediately or go to an emergency room if you
have severe headaches, blurred vision or severe pain in your
abdomen.

Because headaches, nausea, and aches and pains are common

pregnancy complaints, it's difficult to know when new symptoms are
simply part of being pregnant and when they may indicate a serious
problem — especially if it's your first pregnancy. If you're concerned
about your symptoms, contact your doctor.

Causes

Preeclampsia used to be called toxemia because it was thought to be

caused by a toxin in a pregnant woman's bloodstream. This theory
has been discarded, but researchers have yet to determine what
causes preeclampsia. Possible causes may include:

 Insufficient blood flow to the uterus

 Damage to the blood vessels
 A problem with the immune system
 Poor diet

Other high blood pressure disorders during pregnancy

Preeclampsia is classified as one of four high blood pressure
disorders that can occur during pregnancy. The other three are:

 Gestational hypertension. Women with gestational

hypertension have high blood pressure, but no excess
protein in their urine. Some women with gestational
hypertension eventually develop preeclampsia.
 Chronic hypertension. Chronic hypertension is high blood
pressure that appears before 20 weeks of pregnancy or lasts
more than 12 weeks after delivery. Usually, chronic
hypertension was present — but not detected — before
pregnancy.
 Preeclampsia superimposed on chronic hypertension. This
term describes women who have chronic high blood pressure
before pregnancy and then develop worsening high blood
pressure and protein in the urine during pregnancy.

Risk factors

Preeclampsia develops only during pregnancy. Risk factors include:

  History of preeclampsia. A personal or family history of
preeclampsia increases your risk of developing the condition.
 First pregnancy. The risk of developing preeclampsia is
highest during your first pregnancy or your first pregnancy
with a new partner.
 Age. The risk of preeclampsia is higher for pregnant women
younger than 20 and older than 40.
 Obesity. The risk of preeclampsia is higher if you're obese.
 Multiple pregnancy. Preeclampsia is more common in women
who are carrying twins, triplets or other multiples.
 Prolonged interval between pregnancies. This seems to
increase the risk of preeclampsia.
 Gestational diabetes. Women who develop gestational
diabetes have a higher risk of developing preeclampsia as the
pregnancy progresses.
 History of certain conditions. Having certain conditions before
you become pregnant — such as chronic high blood pressure,
migraine headaches, diabetes, kidney disease, rheumatoid
arthritis or lupus — increases the risk of preeclampsia.

Other associated factors

Other factors that may be associated with a higher risk of
preeclampsia include:

 Having other health conditions. There's some evidence that

both urinary tract infections and periodontal disease during
pregnancy are associated with an increased risk of
preeclampsia, which may indicate that antibiotics could play
a role in prevention of preeclampsia. More study is needed.
  Vitamin D insufficiency. There's also some evidence that
insufficient vitamin D intake increases the risk of
preeclampsia, and that vitamin D supplements in early
pregnancy could play a role in prevention. More study is
needed.
 High levels of certain proteins. Pregnant women who had high
levels of certain proteins in their blood or urine have been
found to be more likely to develop preeclampsia than are
other women. These proteins interfere with the growth and
function of blood vessels — lending evidence to the theory
that preeclampsia is caused by abnormalities in the blood
vessels feeding the placenta. Although more research is
needed, the discovery suggests that a blood or urine test may
one day serve as an effective screening tool for preeclampsia.

Complications

Most women with preeclampsia deliver healthy babies. The more

severe your preeclampsia and the earlier it occurs in your pregnancy,
however, the greater the risks for you and your baby. Preeclampsia
may require induced labor and delivery by Caesarian section.
Complications of preeclampsia may include:

 Lack of blood flow to the placenta. Preeclampsia affects the

arteries carrying blood to the placenta. If the placenta
doesn't get enough blood, your baby may receive less oxygen
and fewer nutrients. This can lead to slow growth, low birth
weight, preterm birth and breathing difficulties for your
baby.
  Placental abruption. Preeclampsia increases your risk of
placental abruption, in which the placenta separates from
the inner wall of your uterus before delivery. Severe
abruption can cause heavy bleeding, which can be life-
threatening for both you and your baby.
 HELLP syndrome. HELLP — which stands for hemolysis (the
destruction of red blood cells), elevated liver enzymes and
low platelet count — syndrome can rapidly become life-
threatening for both you and your baby. Symptoms of HELLP
syndrome include nausea and vomiting, headache, and
upper right abdominal pain. HELLP syndrome is particularly
dangerous because it can occur before signs or symptoms of
preeclampsia appear.
 Eclampsia. When preeclampsia isn't controlled, eclampsia —
which is essentially preeclampsia plus seizures — can
develop. Symptoms of eclampsia include upper right
abdominal pain, severe headache, vision problems and
change in mental status, such as decreased alertness.
Eclampsia can permanently damage your vital organs,
including your brain, liver and kidneys. Left untreated,
eclampsia can cause coma, brain damage and death for both
you and your baby.
 Cardiovascular disease. Having preeclampsia may increase
your risk of future cardiovascular disease.

Tests and diagnosis

Preeclampsia usually shows up during a routine prenatal blood

pressure check and urine test. The diagnosis depends on the
presence of high blood pressure and protein in your urine after 20
weeks of pregnancy. Certain markers in your blood and urine may be
indications of preeclampsia. That's why it's essential to seek early
and regular prenatal care throughout your pregnancy.

A blood pressure reading in excess of 140/90 mm Hg clearly is

abnormal in pregnancy. However, a single high blood pressure
reading doesn't mean you have preeclampsia. If you have one
reading in the abnormal range — or a reading that's substantially
higher than your usual blood pressure — your doctor will closely
observe your numbers. You may also be asked to come in for
additional blood pressure readings and urinary protein
measurements.

Additional tests
If you're diagnosed with preeclampsia, your doctor may recommend
additional tests, including:

 Blood tests. These can determine how well your liver and
kidneys are functioning and whether your blood has a normal
number of platelets — the cells that help blood clot.
 Prolonged urine collection test. Urine samples taken over at
least 12 hours and up to 24 hours can quantify how much
protein is being lost in the urine, an indication of the severity
of preeclampsia.
 Fetal ultrasound. Your doctor may also recommend close
monitoring of your baby's growth, typically through
ultrasound. This test directs high-frequency sound waves at
the tissues in your abdominal area. These sound waves
bounce off the curves and variations in your body, including
your baby. The sound waves are translated into a pattern of
 light and dark areas — creating images of your baby on a
monitor that can be recorded electronically or on film for a
look at the inside of your uterus.
 Nonstress test or biophysical profile. These make sure your
baby is getting enough oxygen and nourishment. A nonstress
test is a simple procedure that checks how your baby's heart
rate reacts when your baby moves. Your baby is doing fine if
the heart rate increases at least 15 beats a minute for at least
15 seconds twice in a 20-minute period. A biophysical profile
combines an ultrasound with a nonstress test to provide
more information about your baby's breathing, tone,
movement and the volume of amniotic fluid in your uterus.

Treatments and drugs

The only cure for preeclampsia is delivery. You're at increased risk of

seizures, placental abruption, stroke and possibly severe bleeding
until your blood pressure decreases. Of course, if it's too early in your
pregnancy, delivery may not be the best thing for your baby.

If you've had preeclampsia in one or more previous pregnancies,

some experts recommend more frequent prenatal visits than
normally recommended for pregnancy. Your doctor may ask you to
come in every two weeks between the 20th and 32nd week of your
gestation, and weekly after that until delivery.

Medications
Your doctor may recommend the following:
  Medications to lower blood pressure. These medications,
called antihypertensives, are used to lower your blood
pressure until delivery.
 Corticosteroids. If you have severe preeclampsia or HELLP
syndrome, corticosteroid medications can temporarily
improve liver and platelet functioning to help prolong your
pregnancy. Corticosteroids can also help your baby's lungs
become more mature in as little as 48 hours — an important
step in helping a premature baby prepare for life outside the
womb.
 Anticonvulsive medications. If your preeclampsia is severe,
your doctor may prescribe an anticonvulsive medication,
such as magnesium sulfate, to prevent a first seizure.

Bed rest
If you aren't near the end of your pregnancy and you have a mild
case of preeclampsia, your doctor may recommend bed rest to lower
your blood pressure and increase blood flow to your placenta, giving
your baby time to mature. You may need to lie in bed, only sitting
and standing when necessary. Or you may be able to sit on the couch
or in bed and strictly limit your activities. Your doctor may want to
see you a few times a week to check your blood pressure, urine
protein levels and your baby's well-being.

If you have more severe preeclampsia, you may need bed rest in the
hospital. In the hospital, you may have regular nonstress tests or
biophysical profiles to monitor your baby's well-being and measure
the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor
blood supply to the baby.
Delivery
If you're diagnosed with preeclampsia near the end of your
pregnancy, your doctor may recommend inducing labor right away.
The readiness of your cervix — whether it's beginning to open
(dilate), thin (efface) and soften (ripen) — also may be a factor in
determining whether or when labor will be induced.

In more severe cases, it may not be possible to consider your baby's

gestational age or the readiness of your cervix. If it's not possible to
wait, your doctor may induce labor or schedule a C-section earlier in
your pregnancy. During delivery, you may be given magnesium
sulfate intravenously to increase uterine blood flow and prevent
seizures.

After delivery, expect your blood pressure to return to normal within

a few weeks.

Coping and support

Discovering that you have a potentially serious pregnancy

complication can be frightening. If you're diagnosed with
preeclampsia late in your pregnancy, you may be surprised and
scared to know that you'll be induced right away. If you're diagnosed
earlier in your pregnancy, you may have many hours of bed rest to
worry about your baby's health.

It may help to learn as much as you can about your condition. In

addition to talking to your doctor, do some research. On the other
hand, if reading about preeclampsia and its possible complications
only makes you more nervous and worried, find a distraction. Make
sure you understand when to call your doctor, and then find
something else to occupy your time.

Coping with bed rest

For the first few hours, bed rest may seem wonderful. But the reality
of life in bed — waiting and worrying — is often not so wonderful.
You may feel frustrated by the forced lack of activity, especially if you
haven't had time to finish preparations for your baby's arrival.

To make bed rest tolerable, consider these tips:

 Make sure you understand the ground rules. Ask your doctor
for specifics. What position should you use while lying down?
Can you sit up at times? If so, for how long? Are you allowed
any other type of physical activity?
 Prepare your resting room. Whether you choose to spend
your time in your bedroom or a more central spot in your
home, make sure everything you need is within reach.
 Organize your day. The hours will pass more quickly if you
have some sort of routine. Schedule specific times to phone
the office, watch television and read. It may help to stick to
some parts of your normal schedule, such as lunchtime and
lights out.
 Keep busy. Use your time to balance the checkbook, organize
your photo albums or catch up on phone calls. Shop for baby
supplies, either online or from catalogs. Take up a new
hobby, such as knitting. Or learn relaxation and visualization
 techniques. They'll help not only during bed rest but also
during labor and delivery.

Make the best of the situation by focusing on the fact that you're
doing what's best for you and your baby.

http://www.mayoclinic.com/health/preeclampsia/DS00583