Not quite understanding preeclampsia

mitchsmom · Jul 1, 2005

I'm just a student too but I had to do a presentation on this... it's because the (severe) edema & HTN are actually causing any or all of the following: swelling the brain, thrombus, hemmorhage; and thereby affecting the CNS AEB headache, disturbed vision, seizures, etc...

These two links are great on PIH/preeclampsia:

http://www.emedicine.com/emerg/topic480.htm

Preeclampsia Foundation:

http://www.preeclampsia.org/about.asp

as for the comparison, a non-pregnant woman of the same age just doesn't typically have HTN that severe (as actual eclampsia)... but non-pregnant severe HTN can manifest with headaches, neuro sx, etc... I haven't noticed seizures but maybe that's where the swelling comes in... anyone more savvy feel free to jump in! :)

NurseNora, BSN, RN · Jul 1, 2005

You have some major research to do, but here's a quick answer.

The cause still isn't completely known, but some women develop a condition associated with high blood pressure, protein in the urine, damage to the liver and kidneys. It's called PREeclampsia in those women who have not yet had a seizure. Once they've seized, it's called eclampsia.

The seizure is caused by swelling of the brain. This is also what causes the classic symptoms of severe headache and visual disturbances. (I've seen women so far advanced in the disease that they were blind by the time they were transferred to my hospital). Since the brain is in a closed space, swelling will result in increased intracranial pressure. This pressure can cause the headaches, visual disturbances, and seizures.

The kidneys start loosing protein into the urine (another of the classic symptoms), and the blood vessels spasm (associated with the high blood pressure). As a result, fluid is forced out of circulation into the isnterstitial spaces and there is enough loss of protein in the blood that there isn't enough osmotic pressure to pull it back into the blood. So t he women get a lot of swelling. All pregnant women swell a little just from the pressure of the baby, but preeclamptic women swell everywhere, so be on the lookout for swelling of the face and hands as well as feet and legs. Epigastric pain is secondary to swelling of the liver.

The treatment of choice is Magnesium Sulfate to prevent seizures. Other drugs may be given to lower the BP, or treat other symptoms. But the only cure is to deliver the baby. A woman may seize up to 24 (or more) hours after delivery, so the MgSO4 is often continued for 24 hour PP.

Standard checks include asking patient about headache, blurry vision, spots in front of her eyes, sharp pain up under her ribs that isn't associated with the baby's position. Assesment of edema (ask the patient and her family about hand and face swelling, you don't know what she usually looks like), and reflexes (the more hyperreflexive, the closer to a seizure--and eclamptic seizures are ugly, they just go on and on. At one time the maternal mortality rate was >50 per cent once a woman seized, don't know if that's improved recently). Be sure the urinary output stays over 30cc/hr; MgSO4 is excreted through the kidneys and it's easy to get toxic levels. Clotting studies are usually done as liver damage and other aspects of the disease can cause clotting disorders and the woman can develop DIC.

There's more to preeclampsia than this, but this should be enough to get you started.

nursejoey05 · Jul 1, 2005

Thanks mitchsmom and nursenora. I appreciate your information and your valuable time. People willing to share their knowldege to advance the learning of others is what makes this board so great. :yelclap:

Krysten · Jul 1, 2005

I learned that if women are dx with Preeclampsia, that if she starts to have the epigastric pain that the pain is a precursor to having a seizure and more than likely will have a seizure.