REPUBLIC OF THE PHILIPPINES

UNIVERSITY OF NORTHERN PHILIPPINES

TAMAG, VIGAN CITY
2700 ILOCOS SUR

COLLEGE OF NURSING

A CASE STUDY ON

PRE-ECLAMPSIA SECONDARY

TO UNCONTROLLED HYPERTENSION

IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS OF THE COURSE

VIGAN CITY HEALTH OFFICE DUTY

RELATED LEARNING EXPERIENCE

SUBMITTED TO:

JERMIE ALLEN A. ALCONIS, RN

(Clinical Instructor)

SUBMITTED BY:

AZUR, RHOSE ANGEL B. BSN 2E

DATE OF SUBMISSION:

June 0 ,2021
 PARAMETER PERCENTAGE (%) ACTUAL GRADE

INTRODUCTION AND
OBJECTIVES 5

PERSONAL DATA

NURSING HISTORY OF PAST 5

AND PRESENT ILLNESS

PEARSON ASSESSMENT (IDEAL) 15

DIAGNOSTIC PROCEDURES 5

A. IDEAL

ANATOMY AND PHYSIOLOGY 5

(IDEAL)
PATHOPHYSIOLOGY
A. ALGORITHM
B. EXPLANATION 15

MANAGEMENT
A. MEDICAL AND
SURGICAL (IDEAL) 5
B. NCP
C. PROMOTIVE AND 25
PREVENTIVE
5

DRUG STUDY 5

DISCHARGE PLAN 5

UPDATES & ORGANIZATION 2.5

BIBLIOGRAPHY 2.5

TOTAL: 100
I. INTRODUCTION AND OBJECTIVES

Pre-eclampsia is one of the most common serious condition that affects

pregnant women with increasing significance throughout the world. Preeclampsia

complicates 2%–8% of all pregnancies, contributes to 15% of preterm deliveries,

and between 9% and 26% of maternal deaths worldwide.  Preeclampsia is more

common in Afro-Caribbean women, multifetal gestation, and primigravidas.

According to a study, the incidence of preeclampsia is increasing with the global

increase in maternal age, obesity, assisted reproductive techniques, and medical

comorbidities that predispose to preeclampsia, such as diabetes, hypertension, and

renal disease.

Preeclampsia is defined as the presence of a systolic blood pressure (SBP)

greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater

than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a

previously or a SBP greater than or equal to 160 mm Hg or a DBP greater than or

equal to 110 mm Hg or higher normotensive patient. It is also defined as

hypertension and either proteinuria or thrombocytopenia, renal insufficiency,

impaired liver function, pulmonary edema, or cerebral or visual symptoms. 

This study presents the case of patient Elizabeth, a 20 year old pregnant

woman and was uncompliant for her prenatal checkup due to some reasons. It was

her 2nd pregnancy and the first time she got medical assistance is when a medical

mission was conducted in her community then she was transferred to the nearest

hospital.
Further assessment reveals she has Preeclampsia Secondary to Uncontrolled

Hypertension.

OBJECTIVES

At the end of the study, the student nurse will be able to gain knowledge, skills

and give appropriate intervention in caring for patient diagnosed with

Preeclampsia Secondary to Uncontrolled Hypertension. This is presented by the

student’s ability to:

a. Present accurately the patient’s profile

b. Present a comprehensive past, present and family history of patient’s

illness

c. Assess the patient’s baseline data and observe for abnormal changes

d. Know the diagnostic procedure (ideal) related to the patient’s condition

e. Plan for appropriate nursing intervention and study the outcomes or result

f. Discuss the anatomy and physiology of the organ involved in the study

g. Illustrate the pathophysiology of the patient’s case

h. Present a medical and surgical management done to patient

i. Formulate appropriate plan of care, promotive and preventive teachings

and study of the medications list used by the patient

j. Formulate a discharge plan for the patient

II. PATIENT’S PROFILE

Personal data

Name: ELIZABETH DOE

Address: Vigan City

Age: 20

Sex: Female

Educational Attainment High School Graduate

Occupation: Food Vendor

Civil Status: Married

Religion: Roman Catholic

Nationality: Filipino

Clinical Data

Weight: 78 kgs

Height: 151 cm

Chief Complaint: Shows signs and symptoms of Preeclampsia

Diagnosis: PRE-ECLAMPSIA SECONDARY TO

UNCONTROLLED HYPERTENSION
History of Past and Present Illness

a. Present Illness

Patient Elizabeth is 20 years old and is currently on her second pregnancy. She

was uncompliant with her prenatal checkup due to Covid and financial reasons.

During a medical mission in her community, she went for a pre-natal checkup.

Upon further assessment, she was experiencing excessive sweating, flushing of

the face, and verbalizes extreme fatigability and dizziness, occurring at times.

After her vital signs were taken, she informs the nurse that she is starting to feel

contraction characterized by painless irregular to regular that lasts for 20-30

seconds throughout the day however contraction stops during rest.

She was then transfer and admitted to the nearest hospital. She undergo

clinical test and was assessed by the obstetrician. During the assessment and

interview, she mentions that she woke up with frontal headache which has

continuing despite Paracetamol, her vision is a bit blurred but she can’t describe it

more. She also reports nausea and gastric discomfort without vomiting. She denies

leg and finger swelling.

According to the ultrasound result, she was in her 3rd trimester already, and at

38 weeks AOG. Vital signs include a rapid and bounding pulse at a rate of 127

bpm in 1 full minute, respiratory rate of 23 cycles per minute, afebrile with a

temperature of 37.3 degrees Celsius/ axilla, no difficulty of breathing was noted,

and BP is 160/100 mmHg, this is repeated twice with 15 minutes interval and is

found to be 150/90mmHg and 150/100 mmHg. Her face is minimally swollen and
fundoscopy is normal. Abdominally she is tender in the epigastrium and beneath

the right costal margin but the uterus is soft and non-tender. The fetus is in a

cephalic position and palpable. The nurse noticed that her legs and fingers mildly

edematous and her lower limbs reflexes are brisk with clonus.

Doctor’s order:
-CBC typing
-VDRL
-HBSAG
-UA
-Antigen
-IVF: PLRS 1L x 30gtts/min
-Hydralazine 5mg IV now then 5mg IV every 30 minutes for BP 150/100 mmHg.
-complete bed rest without bathroom privileges
-NPO temporarily

After several hours, patient’s condition become unstable, blood pressure was

uncontrolled and patients complains of difficulty of breathing. Assessment and

interventions were established.

The obstetrician was informed and ordered:

-MagSO4 4-grams SIVP and 5 grams on each buttocks 30 minutes apart
-Insert IFC
-Hooked to oxygen 2-3 lpm
-Limited physical activity
-Cefazolin 2grams IV PTOR ( ) ANST
-Metoclopramide 1-amp IV ptor
-Ranitidine 1-amp IV ptor
-Inform OR/Anes
-Inform NICU
-Refer

She then undergo an emergency C.S and the baby was delivered healthy. Both of
them were safe.
 b. Past Illness
According to her, she has a history of miscarriage with an obstetric history of
G2T0P0A1L0. She also had a history of hypertension, Diabetes Mellitus and
Cardiovascular Disease on both sides of the family.
III. PEARSON ASSESSMENT
May 24, 2021
Check up
ASSESSMENT
 Patient verbalizes of frontal
headache which has persistent
despite paracetamol, her
vision is a bit blurred
 Reports nausea and epigastric
discomfort
 Sweating
 Flushing of the face
 Swollen face
 Painless contractions with 20-
30 seconds
PHYSIOLOGICA  Has signs of swelling
 Abdominally she is
L  tender in the epigastrium and
beneath the right costal
margin but the uterus is
 soft and non-tender.
 Conscious
 Urinates frequently
 No vomiting
ELIMINATION  (-)BM
 With pads
 Patient verbalizes extreme
May 24, 2021
Admission to delivery
 She was at the 3rd
trimester
 38 weeks of gestation
 Fetus is in a cephalic
position and palpable
 Weighs 79 kg
 Height of 151 cm
 Fundoscopy is normal
 Legs and fingers
mildly edematous
 Lower limbs reflexes
are brisk with clonus
 Kept comfortable and
rested
 Conscious
 Test for proteinuria
 Urinates frequently
 No vomiting
 (-)BM
 With pads
 Observed for
decreased of urine
volume
 Limited physical
ACTIVITY AND fatigability activity
 Dizziness occurring at times  Changes in positions
REST  Limited physical activity  Complete bed rest
 Changes in positions without bathroom
 Weak in appearance privileges
 Complete bed rest without  Kept rested and
bathroom privileges comfortable

 Uncompliant with her  Assessed for allergies

prenatal check up  Examined pelvic and
SAFETY AND  NPO temporarily vaginal occassionally
 Assessed for allergies  NPO temporarily
SECURITY  Performed leopold maneuver  Administered Mgso4
safety  Undergo cesarian
section

 Rr: 22 cpm  Rr: 23 cpm

 Pr: 110 bpm  Pr: 127 bpm
OXYGENATION
 O2 saturation: 97%  Bp:
 FHT:153 bpm  160/100mmHg
 Bp: 140/90 mmHg 150/90mmHg
 No difficulty of breathing was 150/100mmHg
noted  Patient complaint of
 Continue monitoring difficulty of breathing
 Administered
hydralazine every 3
minutes for BP of
150/100
 Oxygen provided 2-3
lmp

 On DASH diet  On DASH diet

 Fair appetie  Good appetite
NUTRITION  Ate meal at the right time  IVF of PLRS 1L x 30
gtts/min
 Increased fluid intake
 Increased protein
intake
 Eat fibre rich foods
IV. DIAGNOSTICS
A. Ideal
1. Physical Examination

The physician may ask you about the signs and symptoms of the patient’s

current condition. By assessing the baseline data and by doing physical exam,

patient may suspect to have Preeclampsia if there is a rapid increase in blood

pressure, blurry of the vision, face, hand feet edema and many more.

2. Blood Test

The doctor will order liver function tests, kidney function tests and also

measure your platelets — the cells that help blood clot.

3. Urine Analysis

The doctor may ask you to collect urine sample for 24 hours, for measurement

of the amount of protein in your urine. A single urine sample that measures the

ratio of protein to creatinine — a chemical that's always present in the urine —

also may be used to make the diagnosis.

4. Fetal Ultrasound

The doctor may also recommend close monitoring of your baby's growth,

typically through ultrasound. The images of your baby created during the

ultrasound exam allow your doctor to estimate fetal weight and the amount of

fluid in the uterus (amniotic fluid).

 5. Non stress test or Biophysical Profile

A nonstress test is a simple procedure that checks how your baby's heart rate

reacts when your baby moves. A biophysical profile uses an ultrasound to

measure your baby's breathing, muscle tone, movement and the volume of

amniotic fluid in your uterus

V. ANATOMY AND PHYSIOLOGY

During pregnancy, the pregnant mother undergoes significant anatomical and

physiological changes in order to nurture and accommodate the developing foetus.

These changes begin after conception and affect every organ system in the body. For

most women experiencing an uncomplicated pregnancy, these changes resolve after

pregnancy with minimal residual effects. It is important to understand the normal

physiological changes occurring in pregnancy as this will help differentiate from

adaptations that are abnormal.

Cardiac output increases throughout pregnancy. Cardiac output measurements

are usually made with the mother in the left lateral decubitus position to avoid

positional variation. The sharpest rise in cardiac output occurs by the beginning of the

first trimester, and there is a continued increase into the second trimester. After the

second trimester, there is debate as to whether cardiac output increases, decreases, or

plateaus. By 24 weeks, the increase in cardiac output can be up to 45% in a normal,

singleton pregnancy. Echocardiography and cardiac magnetic resonance imaging

estimates of cardiac output trend similarly in pregnancy. ardiac output in a twin

pregnancy is 15% higher than that of a singleton pregnancy, and a significantly larger

increase in left atrial diameter is seen, consistent with volume overload. Cardiac
output early in gestation is thought to be mediated by the increase in stroke volume,

whereas later in gestation, the increase is attributable to heart rate. Stroke volume

increases gradually in pregnancy until the end of the second trimester and then

remains constant or decreases late in pregnancy.

Blood Pressure

There is a decrease in arterial pressures, including systolic blood pressure

(SBP), diastolic blood pressure (DBP), mean arterial pressure, and central SBP during

pregnancy. DBP and mean arterial pressure decrease more than SBP during the

pregnancy. Arterial pressures decrease to a nadir during the second trimester

(dropping 5–10 mm Hg below baseline), but the majority of the decrease occurs early

in pregnancy (6- to 8-week gestational age) compared with preconception values.

Because many of these changes occur very early in pregnancy, they emphasize the

importance of comparing hemodynamic measurements with preconception values

rather than early pregnancy values when changes have already occurred. Arterial

pressures begin to increase during the third trimester and return close to preconception

levels postpartum. In a longitudinal study of blood pressure at 16 weeks postpartum,

both brachial and central SBPs remained lower than preconception values but similar

to early

pregnancy

levels.
Although a decrease in blood pressure during pregnancy has been found in most

studies.

Heart rate increases during normal gestation. Unlike many of the prior parameters that

reach their maximum change during the second trimester, heart rate increases

progressively throughout the pregnancy by 10 to 20 bpm, reaching a maximum heart

rate in the third trimester. The overall change in heart rate represents a 20% to 25%

increase over baseline.

The cardiovascular system undergoes significant structural and hemodynamic

changes during the course of pregnancy. There are major increases in cardiac output

and a decrease in maternal systemic vascular resistance; the renin-angiotensin-

aldosterone system is significantly activated; and the heart and vasculature undergo

remodeling. These adaptations allow adequate fetal growth and development, and

maladaptation has been associated with fetal morbidity.

VI. PATHOPHYSIOLOGY

EXPLANATION:

Preeclampsia is a complication of pregnancy in which affected women

develop high blood pressure (hypertension) they can also have abnormally high levels

of protein in their urine (proteinuria). This condition usually occurs in the last few

months of pregnancy and often requires early delivery of the infant. However, this

condition can also appear shortly after giving birth (postpartum preeclampsia).

Researchers are studying whether variations in genes involved in fluid balance, the

functioning of the vascular endothelium, or placental development affect the risk of

developing preeclampsia or its severity. Additional genes with no known function in

pregnancy have also been associated with preeclampsia risk.

Many other factors likely also interact with genetic factors and contribute to

the risk of developing this complex disorder. These risk factors include a pregnancy

with twins or higher multiples, being older than 35 or younger than 20, and

preexisting health conditions. Socioeconomic status and ethnicity have also been

associated with preeclampsia risk, and nutritional and other environmental factors are

thought to affect the likelihood of developing this disorder. Studies conclude after this

is that abnormal reactions to the changes of pregnancy vary in different women and may differ

depending on the stage of the pregnancy at which the condition develops. Su ch as problem with

the placenta, the link between the mother's blood supply and the fetus then the

placenta responds by releasing a variety of substances, including chemicals that affect

 the lining of blood vessels (the vascular endothelium) and then systemic vascular

dysfunction happens.

VII. MANAGEMENT

MEDICAL MANAGEMENT

 Medications to lower blood pressure. These medications, called antihypertensive, are

used to lower your blood pressure if it's dangerously high. Blood pressure in the

140/90 millimeters of mercury (mm Hg) range generally isn't treated. Although there

are many different types of antihypertensive medications, a number of them aren't

safe to use during pregnancy. Discuss with your doctor whether you need to use an

antihypertensive medicine in your situation to control your blood pressure

 Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid

medications can temporarily improve liver and platelet function 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 preparing a premature baby for life outside

the womb.

 Anticonvulsant medications. If your preeclampsia is severe, your doctor may

prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first

seizure.

 Bed rest used to be routinely recommended for women with preeclampsia. But

research hasn't shown a benefit from this practice, and it can increase your risk of

blood clots, as well as impact your economic and social lives. For most women, bed

rest is no longer recommended

 SURGICAL MANAGEMENT
Cesarean Section Delivery
 A cesarean section delivery is used when: A rapid delivery is medically needed for the

mother's or baby's well-being or survival. Induction of labor has not been successful,

usually after 24 hour

VIII. DRUG STUDY

NAME AND DOSE, MECHANISM INDICATI CONTRA ADVERSE NURSING

CLASSIFICA FREQUENCY, OF ACTION ONS INDICATIO EFFECT RESPONSIBILITIE
TION OF ROUTE, NS S
DRUG DURATION

Generic 5 mg now and Hydralazine Hydralazine Contraindicati  Headache, Assess patient for
Name: then after 30 may interfere is indicated ons include: loss of any allergies
HYDRALAZI minutes for BP with calcium alone or Allergy to the appetite,
150/100 mmHg transport in adjunct to medication. nausea, Monitor blood
NE
Parenteral vascular smooth standard Coronary vomiting, pressure before and
muscle by an therapy to diarrhea, after taking the
Brand name: artery disease
unknown treat fast heart medications
Apresoline mechanism to essential due to the rate, and
relax arteriolar hypertensio increased chest pain. Administer with
Classification: smooth muscle n oxygen Don't stop meals consistently to
and lower blood demand by taking hydr enhance absorption.
Vasodilator
pressure.  The the heart due alazine sud
interference to stimulation denly. Teach patient the
with calcium of the Doing so importance of taking
transport may sympathetic may lead to the medication
be by system. There uncontrolle
preventing d high Encourage patient to
have been
influx of blood comply with
calcium into reports of pressure. It additional
cells, angina and can raise interventions for
preventing myocardial your risk hypertension (weight
calcium release ischemia for heart reduction, low-
from problems, sodium diet,
intracellular such as smoking cessation,
compartments, chest pain moderation of
directly acting or heart alcohol intake,
on actin and attack regular exercise, and
myosin, or a stress management
combination of
these actions. Advise patient to
notify health care
professional
immediately if
general tiredness;
fever; muscle or joint
aching; chest pain;
 skin rash; sore
throat; or numbness,
tingling, pain, or
weakness of hands
and feet occurs

Generic 4 grams The mechanism It is used to

Name: MAGN Slow IV push of prevent Flushing, Assess patient if
Hypersensitivi
ESIUM action of magne seizures in sweating, she/he has allergic to
ty
SULFATE 5 grams on each sium sulfate is women with extreme magnesium sulfate
Myocardial
Brand buttocks thought to preeclampsi damage, diabe thirst, or any ingredients
name:SulfaMa trigger cerebral a. It can also tic coma, sedation, contained in this
g 30 mins apart vasodilation, help prolong heart block, confusion drug
thus reducing a pregnancy hypermagnese
ischemia for up to Depressed
mia,
Drug generated by two days. reflexes,
hypercalcemia Check serum
Class: Antidysr cerebral This allows flaccid
magnesium level
hythmics, V; vasospasm drugs that paralysis,
Administratio prior to
Electrolytes during an speed up respiratory
n during 2 administration.
eclamptic your baby’s paralysis
hours
event. The lung Cardiac monitor
preceding Heart
substance also developmen should be used on
delivery for
acts t to be block,
mothers with patients receiving
competitively in administere cardiac
toxemia of MgSO4 intravenousl
blocking the d. arrest
pregnancy y.
entry of
calcium into Monitor hourly urine
synaptic output.
endings,
thereby altering Instruct patient not
neuromuscular not to breast feed
transmission. while receiving
MgSO4

Generic 2 grams First-generation It is used to It is Severe Monitor signs of

Name: After negative semisynthetic treat or contraindicate diarrhea allergic reactions and
CEFALOZIN skin test cephalosporin prevent d to patients anaphylaxis,
Parenteral / I.V that binds to 1 infections with Seizures including pulmonary
or more that are Hypersensitivi symptoms (tightness
Brand name: penicillin- proven or ty to cefazolin Rash in the throat and
Kefzol binding strongly or other chest, wheezing,
chest pain
Classification: proteins, suspected to cephalosporin cough dyspnea) or
Cephalosporin thereby be caused class Swelling of skin reactions
antibiotic arresting by antibacterial
bacterial cell- susceptible drugs, the face, Assess muscle aches
wall synthesis bacteria. penicillins, or eyes, lips, and joint pain
and inhibiting other beta- (arthralgia) that may
bacterial lactams tongue, be caused by serum
replication; has arms, or sickness
poor capacity to
legs
cross blood- Instruct patient to
brain barrier; report signs of
Difficulty
primarily active leukopenia and
against skin breathing or neutropenia (fever,
flora, including swallowing sore throat, signs of
S aureus. infection) or
thrombocytopenia
(bruising, nose
bleeds, and bleeding
 gums)

Monitor injection
site for pain,
swelling, and
irritation. Report
prolonged or
excessive injection
site reactions to the
physician

Generic 1 amp PTOR Metoclopramid  Used for Metocloprami drowsiness Assess patient for
Name: Parenteral/I.V e enhances the nausea and de is contrain any allergies before
METOCLOP motility of the vomiting dicated in giving the
excessive
upper GI tract in pregnanc patients with medications
RAMIDE
and increases y, is thought the following: tiredness
gastric to be safe, Gastrointestin Monitor BP carefully
Brand name: emptying but al bleeding. weakness during IV
Apo-Metoclop without information ObstructionPe administration.
affecting on the risk rforation headache
Classification: gastric, biliary of specific Pheochromoc Monitor for
GI stimulant or pancreatic malformatio ytoma extrapyramidal
dizziness
secretions. It ns and fetal Seizures. reactions, and
increases death is consult physician if
duodenal lacking. Depression. diarrhea they occur.
peristalsis Parkinson
which decreases disease. nausea Monitor diabetic
intestinal transit History of patients, arrange for
time, and tardive vomiting alteration in insulin
increases lower dyskinesia dose or timing if
oesophageal diabetic control is
breast
sphincter tone. compromised by
It is also a enlargemen alterations in timing
potent central t or of food absorption.
dopamine-
discharge
receptor Teach patient not use
antagonist and alcohol, sleep
may also have missed remedies, sedatives;
serotonin- menstrual serious sedation
receptor (5- period could occur.
HT3) antagonist
properties. Instruct that patient
decreased may experience
sexual these side effects:
ability Drowsiness,
dizziness (do not
drive or perform
frequent
other tasks that
urination require alertness);
restlessness, anxiety,
inability to depression,
control headache, insomnia
(reversible); nausea,
urination diarrhea.
history of Report involuntary
seizures. movement of the
face, eyes, or limbs,
severe depression,
 severe diarrhea.

Generic 1 amp PTOR Ranitidine is a This drug Headache, Assess patient

Name: competitive helps to dizziness. history of allergy to
RANITIDINE inhibitor of prevent and Rarely ranitidine, impaired
histamine H2- treat gastric- hepatitis, renal or hepatic
receptors. The acid thrombocyt function, lactation,
Brand name: reversible associated opaenia, pregnancy
Zantac inhibition of conditions, leucopaenia
H2-receptors in including ,
Classification: gastric parietal ulcers, hypersensiti
Histamine2 cells results in a because of vity,
(H2) antagonist reduction in its ability to confusion,
both gastric decrease gynaecoma
acid volume gastric acid stia,
and secretion. impotence,
concentration somnolence
, vertigo,
hallucinatio
ns.
Potentiall
y
Fatal: Ana
phylaxis,
hypersensi
tivity
reactions.

DISCHARGE PLAN
 Hydralazine 2 to 4 times daily or as
MEDICATION directed by your doctor
 Take pain relieving medication as
doctor’s prescribed
 Antihypertensive oral medications as
doctors prescribed

 Take a deep breathing 2-3 times per

EXERCISE hour
 Do walking every morning
 Do Kegel exercises
  Use warmth on your wound. Warmth
can have a soothing effect. Try a
TREATMENT
wheat bag or hot water bottle.
 Keep your wound clean and dry.
Look for signs of infection (such as
redness, pain, swelling of the wound
or bad-smelling discharge)
 Follow up check up

 Do proper way of getting into and out

HEALTH TEACHINGS of bed
 Whether breastfeeding or bottle
feeding, make sure person has
adequate support for low back and
uses a cushion or pillow to bring the
baby close to avoid slouching or
leaning. Remember client can also lie
on side for feeding


 When coughing and sneezing ou can
lean forward, resting your hands on
your legs or bring your knees to your
chest if you are lying in bed. Support
your belly with your hands or a small
pillow
 Wear clothing that is comfortable

 Eat a healthy, high-fibre diet and

drink plenty of water. Do this every
DIET
day to avoid constipation.
 Avoid fatty, salty and oily foods

 Avoid any activities that cause

straining: Do not lift anything
SAFETY AND SECURITY
heavier than the baby for the first few
weeks.

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Antenatal screening for pre-eclampsia: evaluation of the NICE and pre-eclampsia

community guidelines.
Verghese L, Alam S, Beski S, Thuraisingham R, Barnes I, MacCallum P
J Obstet Gynaecol. 2012 Feb; 32(2):128-31.

Clinical biochemistry of pregnancy.

Lockitch G
Crit Rev Clin Lab Sci. 1997; 34(1):67-139

Haematological problems in obstetrics.

Rodger M, Sheppard D, Gándara E, Tinmouth A
Best Pract Res Clin Obstet Gynaecol. 2015 Jul; 29(5):671-84

Bader RA, Bader ME, Rose DF, Braunwald E. Hemodynamics at rest and during
exercise in normal pregnancy as studies by cardiac catheterization.J Clin
Invest. 1955; 34:1524–1536.

Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing
changes in cardiac output during human pregnancy.Am J Physiol. 1989; 256(pt
2):H1060–H1065.

Hunter S, Robson SC. Adaptation of the maternal heart in pregnancy.Br Heart

J. 1992; 68:540–543.

Mahendru AA, Everett TR, Wilkinson IB, Lees CC, McEniery CM. A longitudinal
study of maternal cardiovascular function from preconception to the postpartum
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WEBSITES
Preeclampsia - Diagnosis and treatment - Mayo Clinic
Cardiovascular Physiology of Pregnancy | Circulation (ahajournals.org)
Preeclampsia: MedlinePlus Genetics