What is preeclampsia and eclampsia?

Eclampsia is a serious, and often fatal condition in pregnancy where uncontrolled hypertension causes seizures. Preeclampsia refers to a hypertensive state during pregnancy or the postpartum period that precedes eclampsia. This is a very serious complication of pregnancy, so let’s discuss some preeclampsia nursing basics together, shall we?

How is preeclampsia diagnosed?

While traditional guidelines state that the hallmark signs of preeclampsia are hypertension with proteinuria, the new guidelines from ACOG (American College of Obstetricians and Gynecologists) no longer require proteinuria as part of the diagnostic criteria. According to ACOG, the data shows that organ damage to the liver and kidneys can be present even without seeing protein in the urine. With that said, be aware that your exams and the NCLEX will likely include proteinuria as a key symptom along with hypertension. 

The new ACOG guidelines indicate that preeclampsia is present with the following criteria:

  • Persistent hypertension during pregnancy or postpartum along with
  • Protein in the urine OR
  • New onset thrombocytopenia OR
  • Any new abnormal kidney or liver function OR
  • New development of fluid in the lungs OR
  • New onset neurological symptoms such as visual changes or seizure

How do you conduct a preeclampsia nursing assessment?

Knowing how to conduct a preeclampsia nursing assessment can help alert you to possible complications that could, if left untreated, be fatal for both mom and baby. Women with preeclampsia may report having a headache that doesn’t resolve, dizziness or even visiual disturbances like blurred vision and seeing spots. She may also complain of nausea and/or vomiting. Another common symptom is sudden weight gain of 2-5 pounds in one week or swelling in the face, hands or legs. Fluid building up in the lungs can caues mom to feel short of breath as well. As for protein in the urine, it can sometimes be noticed due to its foamy nature, but don’t take the absence of foamy urine as proof the patient doesn’t possibly have this condition. However, on exams, proteinuria is almost always described as “foamy urine.”

How is preeclampsia treated?

Preeclampsia nursing interventions and medical treatment will vary based on the severity of the condition, but please note that it is considered a progressive disease that needs careful monitoring and frequent reevaluation. Your patient with mild preeclampsia (defined by ACOG as 140-159 systolic or 90-109 diastolic) requires very close monitoring. Higher blood pressures (above 160 systolic or 110 diastolic) are considered to be in the “severe preeclampsia” category and guidelines indicate treatment is necessary at this point to prevent seizure (eclampsia).

The treatment for preeclampsia is magnesium sulfate for those who fall into that higher blood pressure category or who have symptoms that typically precede seizures such as headache, visual disturbances or other neurological changes.

Note that the magnesium is used to prevent and treat seizure. We still need to decrease blood pressure and this is typically done using IV labetalol and/or hydralazine, though studies show that one antihypertensive is not necessarily more effective than another. Many times clinicians will use medications they are most familiar with, and the group I work with tends to use nicardipine as a continuous infusion or labetalol and hydralazine as IV push medications.  If IV access is not available, PO nifedipine, a calcium-channel blocker, is often used.

What about delivery?

Preeclampsia resolves after delivery, though it’s important to note that it can developing the postpartum period as well. In some cases, immediate delivery of the baby may be necessary to alleviate the hypertensive condition. Be aware that once the baby is born, the magnesium infusion will likely continue for a period of time and the mom will need to be monitored for several weeks after giving birth.

What are some risk factors for preeclampsia? 

  • History or family history of preeclampsia
  • Pregnant with twins, triplets or even more!
  • History of hypertension, lupus, diabetes or kidney disease
  • Older than 35
  • In vitro fertilization
  • Obesity

What are the complications of preeclampsia?

Left untreated, preeclampsia can cause serious problems for mom and baby:

  • Seizures (eclampsia). When preeclampsia progresses to this point, emergent delivery is typically necessary.
  • Preterm birth and low birthweight are significant concerns when the condition is severe enough to necessitate an early delivery. 
  • Growth restriction of the fetus due to impaired blood flow to the placenta.
  • HELLP, which is a complex and life-threatening syndrome consisting of hemolysis, elevated liver enzymes and low platelets.
  • Placental abruption, where the placenta separates from the wall of the uterus prior to delivery. This can cause severe life-threatening hemorrhage.
  • Stroke can occur due to the effects of hypertension.

What is ACOG? 

You may be saying, “Yeah, all this is great…but what the heck is ACOG?” ACOG is an excellent resource for you guys, so I’m glad you asked! It is the American College of Obstetricians and Gynecologists, a group dedicated to the development and promotion of  best practice guidelines in women’s health. You can learn all about them at their website at www.acog.org.

Get this on audio in Episode 68 of the Straight A Nursing Podcast!


References

ACOG. (2017, September). Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Retrieved from The American College of Obstetricians and Gynecologists website: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Emergent-Therapy-for-Acute-Onset-Severe-Hypertension-During-Pregnancy-and-the-Postpartum-Period?IsMobileSet=false

Lew, M., & Klonis, E. (2003). Emergency management of eclampsia and severe pre-eclampsia. Emergency Medicine (Fremantle, W.A.)15(4), 361–368.

March of Dimes. (n.d.). Preeclampsia. Retrieved from http://www.marchofdimes.org/complications/preeclampsia.aspx

Mayo Clinic. (n.d.). Preeclampsia Symptoms and causes – Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745