Download hypertension in pregnancy - Svetlana Avsyanik, RN, BSN

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To educate pregnant women on the importance of
prenatal care and educate them on the
complications that pertain to human pregnancy.
 To be knowledgeable of signs and symptoms of
preeclampsia
 To be knowledgeable of eclampsia and what signs to
report to physician
 To be knowledgeable of what HELLP syndrome is and the
consequences it can have on a patient and their baby
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To educate my co-workers of signs and symptoms of
preeclampsia, eclampsia and HELLP syndrome to
safely manage our patients and their unborn child.
 To be knowledgeable of eclamptic lab values (CBC, CMP,
Uric acid, LDH,)
 To be knowledgeable of normal/abnormal urine results
(proteinuria)
Population: Pregnant women in 3rd trimester
 Intervention: What is the best prevention
treatment for high blood pressure in
pregnancy- MgSo4 infusion therapy, IV push
drugs or oral medications?
 Comparison: Caucasian vs. African
American females
 Outcome: To decrease high blood pressure
which can lean to preeclampsia,
eclampsia or HELLP syndrome in pregnancy
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A multisystem disorder characterized by
elevated blood pressure and proteinuria
that is unique to human pregnancy.
› Because the cause is largely hypertension, it is
more frequently seen in African American
patients, women of maternal age or obese.
 The Magpie trial Collaborative Group, 2002 did an
international large controlled, randomized study of
10,110 women to evaluate the effects of MgSo4 on
women and their babies
 Conclusion: MgSo4 therapy halves the risk of eclampsia,
and reduces risk of placental abruption by 27% and the
risk of maternal death by 45%.
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Commonly defined as a new onset of
Grand-Mal seizure activity in pregnant
women that are not otherwise related to
an existing brain condition.
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Muscle aches and pains
Seizures
Severe agitation
Unconsciousness
Severely elevated BP’s
Eclampsia follows a pre-existing condition called
preeclampsia with elevated BP’s, excess and rapid
weight gain (>2lbs/wk).
H - hemolysis (breaking down of red
blood cells)
 EL – elevated liver enzymes
 LP – low platelet count
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› Most common reason for mothers to get ill or
die are liver rupture or stroke
 cerebral edema or cerebral hemorrhage
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Monitor BP’s (SBP >140 and/or DBP >90)
Assess reflexes
Assess edema
Ask about visual disturbances
Monitor lab values – CBC, CMP, Uric Acid, LDH
Check for proteinuria
Manage medications
 MgSo4 IV infusion
 IV push drugs – Labetalol, Hydralazine
 Oral medications – Niphedipine, Labetalol, Aspirin, Calcium
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Assess for possible transfer to higher level of care
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Women with preeclampsia or eclampsia
have higher risk of:
 Preterm delivery that can lead to
complications in the baby
 Placental abruption of placenta from the uterus
 Blood clotting problems
Early diagnosis of HELLP syndrome is crucial because the
morbidity/mortality rates associated with this syndrome
can be as high as 25%.
Most often the definitive treatment for these
complications are delivery of baby and placenta.
Transfusions of some form of blood product is often
needed –red cells, platelets or plasma.
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Unfortunately there is still no tool to aid the early
diagnosis of pre-eclampsia; therefore pregnant
women will continue to present with severe preeclampsia and will require quick and effective
management from a collaborative team of
healthcare professionals.
› This disease can come on quick and if symptoms are not
related to the physician, it can have devastating effects
on the patient and her unborn child
 Preeclampsia (PE) is a serious multisystem disorder in
pregnancy and is a leading cause of maternal and
fetal morbidity and mortality worldwide (Wiebke,
Sarosh & Holger, 2013).
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Altman, D., Carroli, G., Duley, L., Farrell, B., Moodley, J., Neilson, J., & Smith,
D. (2002). Do women with pre-eclampsia, and their babies, benefit
from magnasium sulphate? the magpie trial: a randomized placebocontrolled trial. Europepmc, 359(9321), 1877-1890. Retrieved from
http://www.europepmc.org
Eiland, E., Nzerue, C., & Faulkner, M. (2012). Preeclampsia 2012. Hindawi
publishing corporation: Journal of Pregnancy, 2012, 7 pages. doi:
10.1155/2012/586578
Foundation, P. (November, 2013 25). HELLP syndrome. Retrieved from
http://www.preeclampsia.org/health-information/hellp
Health, U.D. (October, 2013 31). Eclampsia. Retrieved from Medline Plus:
http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm
(n.d.). Retrieved from http://www.nursing-theory.org
Morley, A. (2004). Pre-eclampsia: Pathophysiology and its
management. British journal of midwifery, 12(1), 30-37.
Wiebke, S., Sarosh, R., & Holger, S. (2013). The course of angiogenic factors in
early- vs. late onset preeclamppsia and HELLP syndrome. Perinatal
Med.,41(5), 511-516. doi: 10.1515