PRE-ECLAMPSIA/ECLAMPSIA

What are the parameters for proteinuria in pre-eclampsia?

>1+ (>30mg/dl) or more in 2 random urine specimens collected 6 hours apart w/no UTI present 24 hour specimen - concentration of 300 mg/24 hours (gold standard) Protein in the urine means that the kidneys are not functioning properly

When is pre-eclampsia most likely to develop?

>20 weeks (except in molar pregnancy where it is 9-12 weeks)

What are the parameters for HTN in pre-eclampsia?

BP of >140/90 mmHg during 2nd/3rd trimesters increase in 30 mmHg systolic/15 mmHg diastolic MAP (mean arterial pressure) >105 mmHg BP elevation must be present on 2 separate occasions, 4-6 hours apart in no more than 7 days

What assessments are necessary while giving magnesium sulfate?

BP, pulse, MAP, RR (should not be <12bpm), FHR pattern, uterine contractions q15-30min Watch for respiratory depression I&O, proteinuria, LOC, DTRs, clonus visual disturbances/headache epigastric pain q1h urinary output should be at least 120mL/4 hrs. serum levels of mag sulfate q4-6h: level should be maintained between 6-8 mg/dl

What can be given to help develop the lungs of a premature fetus?

Betamethasone (steroid). If <34 weeks

What are the characteristics of magnesium sulfate?

CNS depressant given to prevent/control seizures give loading dose first followed by a maintenance infusion loading does of 4-6g in 100mL of 5% dextrose in water over 15-20 minutes piggbacked to a primary infusion monitor BP q5m during loading dose maintenance infusion of 2g/hr; piggyback a solution o 40g mag sulfate in 1000 mL of LR to a primary infusion. Note: hospital protocols may vary

What are the signs of magnesium sulfate toxicity?

CNS depression respiratory rate <12 absence of DTR severe hypotension serum mag sulfate level above 4-6 decreased urine output <120 mL/4hrs. treatment readiness for magnesium toxicity is calcium gluconate 10% should be available at or near the bedside

What is the antidote for magnesium sulfate?

Calcium gluconate

Why are seizures especially dangerous for the fetus?

During a seizure, the fetus is not getting any O2. So even though the seizures are usually self-limiting after 3-4 minutes, this is way too long for the fetus to go without O2.

What are the 3 characterizations of pre-eclampsia?

HTN, proteinuria, edema

What are the parameters for severe pre-eclampsia?

HTN: BP >160/110 on bedrest MAP >105 mm Proteinuria: 2-3+ (>2g in 24 hour specimen) Oliguria: urine output less than 400-500mL/in 24 hours) (normal is 30mL/hr) visual changes: headaches, blurred vision, scotomata (spots before eyes), retinal changes weight gain (3-4lbs/day) upper body edema, generalized edema, facial edema pulmonary edema hyperreflexia (4+) Epigastric pain

What is HELLP?

Hemolysis Elevated Liver enzymes Low Platelets Multi-system organ failure - risk for DIC

Refers to a variety of conditions in which there is an elevation of maternal blood pressure with a corresponding risk to maternal and fetal well-being.

Hypertensive Disorders in Pregnancy

What is the major difference between pre-eclampsia and eclampsia?

In pre-eclampsia seizures could happen. In eclampsia, they do happen

Which ethnic groups are at the highest risk for HTN during pregnancy?

Native American and African American women

What are the risk factors for pre-eclampsia?

New partner for current pregnancy extremes of maternal age: <18 or >35 (AMA - advanced maternal age) familial tendency obesity poor diet diabetes women with chronic HTN/vascular disease multifetal gestation maternal infections chronic renal disease Rh imcompatibility African American/Native American ethnicity pre-eclampsia in a previous pregnancy

What is the best management strategy for pre-eclampsia?

PREVENT CONVULSIONS DECREASE BP establish adequate renal function maintain adequate uteroplacental perfusion carefully monitor mother and fetus to continue pregnancy until the fetus is as mature as possible

Why does the woman experience epigastric pain?

The liver is swollen. This is very painful and constant in the upper right ribs. Labs will show elevated creatinine, AST, HCT, thrombocytopenia (low platelet - bleeding risk).

How do you cure pre-eclampsia?

The only cure is to deliver the baby

What does the presence of hyperreflexia in pre-eclampsia indicate?

a high risk for seizures

muscular spasms involving repeated, often rhythmic contractions

clonus

What are the fetal effects of pre-eclampsia?

decrease in placental perfusion (uteroplacental insufficiency IUGR (intrauterine growth restriction) FHR: late decelerations, decreased variability, braycardia (<110), prematurity CNS depression R/T sedation of the mother intrauterine death (stillbirth) neonatal death (to 28 days after birth) normal newborn lower fat distribution which interferes with newborn temperature regulation (thermoregulation)

The only way to cure HELLP is what?

deliver the baby (usually by c-section)

What is the best way to prevent seizures in eclampsia?

environmental modification: quiet, non-stimulating, subdued lighting padding on the side rails bed in lowest position suction and O2 equipment at bedside ready for use emergency antiseizure medication at or near the bedside (mag sulfate, diazepam, amobarbital) Be prepared to take action if a grand mal seizure occurs stay with the patient

What is the best indicator of an impending seizure?

epigastric pain

What are the parameters for edema in pre-eclampsia?

generalized with 12 hours of bedrest present in the morning a weight gain of more than 4 1/2-5 lbs/wk includes upper body edema (puffy eyelids, face, fingers)

What medication is recommended to control HTN?

hydralazine

CNS irritability in the patellar and brachial reflexes

hyperreflexia

What are the causes of pre-eclampsia?

impaired trophoblastic formation placental/endothelium malfunction immune reaction to maternal antigen inflammation response angiotensin imbalance failure of uterine arteries to transform from muscular vessels to flaccid vessels decreased response to prostaglandins convulsions cause the damage of small capillaries which cause small hemorrhages

What are indications of an impending seizure?

increase in DTRs (hyperreflxia) visual disturbances (blurriness, headache, flashing lights, scotomata (spots) severe N/V epigastric pain

What is the best treatment for pre-eclampsia?

magnesium sulfate

What are the symptoms of HELLP?

malaise epigastric pain (liver) N/V flu-like symptoms labor tends to go faster

What is the most common hypertensive disorder in pregnancy?

pre-eclampsia

How can you help manage a seizure once it has begun?

record start and stop time of seizure position patient on left side to increase perfusion to fetus give patient O2 to increase perfusion

What is the term for seeing spots before your eyes?

scotomata