Preeclampsia: The Importance of Education

Pregnancy is a beautiful journey for a Women, however, it can also be a stressful or even a life threating experience.  A mother’s anticipation for her new baby carries her through the fear of numerous possible complications that can affect herself or her baby. When a life threatening complication such as preeclampsia develop, many become extremely anxious and worried, fearing for the future of their unborn child and themselves. It is a nurse’s role during the pregnancy is to educate as well as support the soon to be mother on what preeclampsia is, the complications it can lead to, the early warning signs and how to identify these signs when they are no longer under the direct care of a health care professional.

Hypertensive disorders of pregnancy are one of the most common medical disorders that increase maternal and perinatal morbidity and mortality. Preeclampsia alone is responsible for 75,000 deaths per year worldwide (Davidson, London, & Ladewig, 2020). Preeclampsia is one of the many possible complications that can happen to an expecting mother. Exclusive to pregnancy preeclampsia affects about five to ten percent of all pregnancies in the united states… Preeclampsia is characterized by new-onset hypertension, and proteinuria, usually after 20 weeks’ gestation (Davidson, London, & Ladewig, 2020). Witcher states “Preeclampsia is typically diagnosed by new-onset hypertension (systolic blood pressure of ≥ 140 mm Hg or diastolic blood pressure of ≥ 110 mm Hg) with proteinuria (≥ 300 mg protein in 24-hour urine specimen or protein-to-creatinine ratio of ≥ 0.3 mg/dL).” (Witcher, P.M. 2018). In addition, clinical manifestations such as visual disturbances, thrombocytopenia, hyper-reflexive changes, severe headaches, impaired kidney function/liver function and epigastric pain can occur

Pregnant females spend most of their pregnancy out of the hospital setting unless absolutely necessary, that being said, the patient is not being monitored frequently under a professional health care provider. In hopes of preventing the possible major complications caused by preeclampsia, extensive teaching, maternal and fetal monitoring is required. It is extremely important for the nurse to educate and instruct their patient about prenatal check ups, what preeclampsia is, the clinical manifestations, and complication along with the danger signs of these complications. Educating the can aid in early diagnosis of preeclampsia, which can help prevent preeclampsia from becoming more severe then it already is and intervene in a timely manner. The role of the nurse in caring for patients with preeclampsia is to maintain the safety and wellbeing of both mother and child. Many of these deaths that resulted from preeclampsia could have been prevented through timely and appropriate interventions, including surveillance for clinical manifestations that indicate progression in severity and appropriate timing of delivery” (Witcher, P.M. 2018).

“Given the maternal and fetal consequences of chronic hypertension, it is recommended that a hypertensive patient be followed closely as an outpatient; in fact, it is advisable that she check her BP at least twice daily. Beginning at 24 weeks of gestation, serial ultrasonography should be performed every 4 to 6 weeks to evaluate interval fetal growth. Twice-weekly antepartum testing should begin at 32 to 34 weeks of gestation.” (Incerpi, M. H. (2018).  Elevated blood pressure is an indicator of preeclampsia. It is a vital intervention to educate the mom on how to preform blood pressure monitoring at home and ensure that the patient has an adequate understanding of that teaching. If the mom performs her blood pressure at least twice a day this can help identify preeclampsia early. A recent study that provided 161 women with sufficient teaching on how to use an automated electronic sphygmomanometer, found that of those women in the group who developed preeclampsia, 39% recorded high blood pressure reading before their health care provided did in the clinical setting (Tucker, et al., 2017). This demonstrates the importance of patient teaching by the nurse, not only can it be effective but can also yield pertinent information that can lead to early detection of a possibly deadly pregnancy complication.

It is also vital for the nurse to educate the patient on the complications of preeclampsia because the patient can then identify these complications before they progress. The maternal complications include eclampsia, intracranial hemorrhage, hemorrhagic complications such as DIC, acute kidney injury, and cardiac compromise (Witcher, P.M. 2018). Preeclampsia can cause fetal complications such as placental abruption, fetal growth restriction, and fetal death (Incerpi, M. H. (2018).  If these complications are identified and acknowledged by the patient, it can be managed earlier then later which can be vital to the mother and fetus. It will allow us, the health care team to tailor our management and individualize accordingly.

As mentioned, a nurse’s obligation for their patient is to promote both the wellbeing of the mother and child. In order to do this the nurse must educate the patient that preeclampsia is an extremely serious complication that can occur during pregnancy. After properly educating their patient will be able to identify risk factors, early indicators of preeclampsia and the early indicators of the complications that result from preeclampsia; by doing so the patient can contact their health care provider within a quicker manner which can be vital to theirs and the fetus health and wellbeing. Mothers who are uninformed may not be as aware of the early signs of preeclampsia or complications of preeclampsia which prevents them from receiving early intervention treatment.

References:

• Davidson, M. R., London, M. L., & Ladewig, P. A. (2020). Olds' Maternal-Newborn Nursing & Women's Heslth Across the Lifespan. Pearson.
• Incerpi, M. H. (2018). Importance of providing standardized management of hypertension in pregnancy: Good outcomes depend on following best-practice recommendations for preventive, emergent, and routine care, based on our improving understanding of pathophysiology and risk. OBG Management, 30(9), 21+.
• Tucker, K. L., Taylor, K. S., Crawford, J., Hodgkinson, J. A., Bankhead, C., Carver, T., . . . McCour. (2017). Blood pressure self-moinitoring in pregnancy: examining feasibility in a prospective cohort study. BMC Pregnancy and Childbirth, 2-10.
• Witcher, P. M. (2018). Preeclampsia: Acute Complications and Management Priorities. AACN Advanced Critical Care, 29(3), 316–326.