Research Paper on Pregnancy Induced Pre-Eclampsia

Introduction

Pregnancy-induced hypertension is a severe condition that is identified by high blood pressure during the gestation period. This condition can lead to the development of Preeclampsia which is one of the pregnancy conditions that occurs due to high blood pressure in women thus affecting the mothers' organs like the liver and kidney. Preeclampsia occurs in the third trimester after twenty weeks of gestation in mothers who had normal blood pressure. If the preeclampsia condition is left untreated, then it may be fatal for both the mother and the fetus. The most efficient mode of treatment is delivering the baby. If the preeclampsia condition is diagnosed too early in the pregnancy that the baby cannot be delivered, the state proves to be more challenging as the fetus still needs more time to develop therefore the mother is advised to avoid activities that may put both the mother and the fetus at risk. The condition may also post pregnancy, thus, termed as postpartum preeclampsia. Therefore this paper will highlight the pregnancy-induced preeclampsia, its signs and symptoms, causes and the nursing care management of the expectant women with preeclampsia and how the condition can be treated.

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Pathophysiology

Signs and Symptoms

Preeclampsia may develop without any signs and symptoms since hypertension might develop slowly over time or it may occur suddenly. Therefore, expectant women are advised to have prenatal care checks where their blood pressure is monitored because it appears as the first sign of preeclampsia. If high blood pressure is documented on two occasions in at least four hours apart, then the high blood pressure is recorded as abnormal. High blood pressure may also be associated with other symptoms that include proteinuria (which is considered as excess proteins in urine) or other kidney problems, severe headaches, swelling of hands and feet, blurry vision, nausea, and pulmonary edema. Also, the patients might experience abdominal pain mostly under the ribs, fluid in lungs causing shortness of breath, decreased number of platelets and a noticeable decrease in urine (Stratieva, 2016). When an expectant mother is exhibiting the signs and symptoms even with the absence of a diagnosed preeclampsia test especially for first-time pregnancy they should be prompted to contact a doctor immediately for obstetric, prenatal care, especially when one is experiencing the different signs of pregnancy.

Causes of Preeclampsia

The exact reason underlying the preeclampsia is unknown, but the doctors believe that preeclampsia begins in the placenta where the fetus is nourished throughout the pregnancy. In the first trimester of gestation there is a development of new blood vessels, and after that, they evolve so that they can effectively transport blood to the placenta. The expectant mothers who suffer from preeclampsia the new blood vessels do not develop, or they may not function effectively to carry blood to the placenta. These blood vessels are narrower than the healthy blood vessels, and therefore they react differently to hormonal signals being passed from mother to child hence making the amount of blood flowing through the vessels to become limited (Stratieva, 2016). The causes of the abnormal development of the blood vessels may include damage of the blood vessels, a significant problem with the immune system, genetic disorders and insufficient flow of blood to the uterus.

Other High Blood Pressure Disorders

Preeclampsia is one of the four blood pressure disorders that are likely to occur during pregnancy. Also, chronic hypertension during pregnancy is detected as high blood pressure during the first trimester before the twenty weeks of gestation, and it then normalizes postpartum. Chronic hypertension with superimposed preeclampsia is a serious condition as the prognosis of the mother, and the fetus is worse than the disease being diagnosed. Women with chronic hypertension develop proteinuria before twenty weeks of gestation, but some women develop it after the twenty weeks. They experience an exacerbate fluctuate in their high blood pressure, which is followed by a manifestation of other symptoms that include increasing the liver enzymes to an abnormal number, followed by a decrease in the number of platelets. Mothers also manifest upper abdominal pain with severe headaches (Magee et al., 2015). The manifestation of high blood pressure with proteinuria is considered as superimposed preeclampsia which may lead to severe organs dysfunction.

Moreover, pregnancy-induced hypertension that is identified by the absence of proteinuria can be normalized through prenatal care and hypertension management treatment. Outcomes of the gestation hypertension in expectant women have dimmed to be successful through preventive medicine, although failure to normalize the blood pressure leads to chronic hypertension which may be a future sign of preeclampsia. Also, the condition which occurs after post pregnancy leads to preeclampsia that is characterized by seizures accompanied by systemic organ dysfunction (Magee et al., 2015). This condition is often diagnosed after two to six weeks of pregnancy, which when treated with preventive medication may help normalize the high blood pressure slowly throughout the year.

Eclampsia is preeclampsia which is not controlled; it is characterized by the presence of seizures in expectant mothers. Eclampsia may occur either before, during and after labor. Seizures during pregnancy can occur due to bleeding artery malformation, a ruptured aneurysm. It is recommendable that the expectant mother is administered with parental magnesium sulfate to control eclampsia. HELLP syndrome is also associated with the destruction of red blood cells, increased liver enzymes, and low platelets (Magee et al., 2015). This is a more severe form of preeclampsia and can rapidly develop into a life-threatening condition for both the mother and the child.

Prediction of Preeclampsia

Expectant women with preeclampsia symptoms are put through a predictive test to get results. The best way to access the specific results is to use likelihood ratio which results in the proportions of the patients with the target condition and have a positive result test relative to the percentage of the target group with the same results tests. More ways of predicting preeclampsia are prediction using uterine artery Doppler Velocimetry as well as clinical experiments testing the epidemiology and the risk factors of preeclampsia (Vest & Cho, 2014). There is also the use of biomarkers for prediction which is integral to targeted therapy and even speculation of an adverse outcome of patients with gestation hypertension.

Prevention of Preeclampsia

Strategies to prevent preeclampsia have been studied, but no intervention has proven to be effective. A few methods of treatment have been found to avoid preeclampsia which includes low dose aspirin that helps in reduction in morbidity of preeclampsia cases. The use of antioxidant supplements that are rich in vitamin C and vitamin E are characterized not to be useful in the prevention of preeclampsia. However, it is recommendable that dietary salt intake should be restricted since it causes preeclampsia (Stratieva, 2016). Also, expectant mothers are advised to improve their lifestyle, bed rest and minimize the physical activities. Some women take calcium supplements in their diets to prevent preeclampsia.

Nursing Care Management

Nursing care plays a significant role when it comes to the health care of expectant mothers and the fetus. The first consideration when managing the health care is the safety of the mother and the fetus, while the second consideration is the safe delivery of the newborn in that it will not require the extended neonatal care. When the expectant mother is diagnosed with mild preeclampsia without severe features, successive management of the condition is dependent on the maternal and fetal evaluation. During the assessment, the expectant mother should have a complement blood count with platelets and presence of the liver enzymes in the urine protein thus enabling preeclampsia diagnosis (Vest & Cho, 2014). The fetal evaluation should include an ultrasound to determine the fetal weight as well as the amniotic fluid levels.

Women who have not reached the required gestation period cannot deliver the newborn hence they need a continued evaluation of assessing the fetal daily kick count, biophysical profile and ultrasound to determine the fetal weight as well as the amniotic fluid levels. Mothers with preeclampsia require a non-stress test that should be frequently administered as women with gestation hypertension are to be evaluated for proteinuria (Vest & Cho, 2014). The nurses advise the women to contact the doctor and report any severe and non-pregnancy symptoms as they monitor mothers with gestation hypertension weekly with the assessment of proteinuria. Antihypertensive therapy is used to prevent severe gestation hypertension, but it is recommended that women who have mild gestation hypertension or suffering from preeclampsia with persistently high blood pressure should not be administered with the antihypertensive medication. Bed rest is recommended for expectant mothers to improve the pregnancy outcome, but women with preeclampsia are not advised to take bed rest.

Severe preeclampsia can result in long term complication of the mother or the newborn baby; therefore, it is advisable that after the stabilization of the mother the newborn should be delivered immediately. The maternal indications for delivery include chronic hypertension, pulmonary edema, ruptured membranes, eclampsia, progressive labor, and progressive renal insufficiency. The fetal evidence for delivery comprises 34 weeks of gestation, growth restriction of the fetus, persistent high blood pressure, and fetal deaths (Vest & Cho, 2014). Therefore, mode of delivery for women with preeclampsia is determined by fetal gestation age since normal birth can occur when the fetus is old enough but the likelihood of caesarian increases with the reduction of gestation age of the fetus.

Summary of the Journal

A task force of obstetricians and gynecologists was convened to assess the management of hypertension in pregnancy. Hypertensive disorders in expectant women remain a significant health risk to both the mother and the fetus. Preeclampsia either on its own or when superimposed on chronic hypertension presents a risk to the expecting mothers. Through prenatal care and careful monitoring of women with preeclampsia signs and the delivery of the newborn to terminate the disorder has proven to be immensely helpful in reducing maternal-fetal motility rates. Although most problems that are associated with neonatal care as a result of preeclampsia, a large proportion is believed to be secondary prematurity which occurs as a result of effective induction delivery of the fetus of expectant mothers who are supposed to be ill (Stratieva, 2016). The optimal management plan is to offer keen observation for premonitory signs and establish diagnosis and delivery of the newborn at the most optimal time for both the maternal and fetal well-being.

Chronic hypertension is associated with fetal mortality and growth restriction as well as maternal morbidity which manifests as severely increased high blood pressure. One major challenge of prenatal care for the mother and fetus is determining whether chronic hypertension has worsened or preeclampsia has developed in the mother. Through a broad research, it has been proved that preeclampsia is associated with cardiovascular diseases that happen later in life (Stratieva, 2016). The health task force has identified problems leading to preeclampsia mismanagement which include ignorance by the health care provi...