preeclampsia(redirected from preeclamptic)
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preeclampsia/pre·eclamp·sia/ (pre″e-klamp?se-ah) a toxemia of late pregnancy, characterized by hypertension, proteinuria, and edema.
Essentially, the pathology responsible for the elevation of blood pressure is spasm of the blood vessels. Normally, the blood vessels of a pregnant woman have a diminished response to the effects of such pressor substances as angiotensin and norepinephrine. In pregnancy-induced hypertension, resistance to vasospasm is somehow comprised and so blood pressure increases. It is not known whether the change in responsiveness to pressors is a cause or a result of vasospasm and elevated blood pressure.
Blood pressure can also be evaluated by determining the mean arterial pressure on two occasions at least 6 hours apart. A pregnant patient is considered hypertensive when her mean arterial pressure rises 15 mm Hg from her baseline or is over 100 mm Hg.
Pathologic changes in the glomeruli of the kidney produce proteinuria, oliguria, and edema. Increased permeability of the glomerular membrane allows passage of serum proteins into the urine (proteinuria), diminished glomerular filtration lowers urine output, and increased reabsorption of sodium causes fluid retention and edema and weight gain.
Mild preeclampsia is said to be present when the patient has elevated blood pressure, proteinuria of 1+ or 2+ on a reagent test strip or 500 mg/24 hours or more, swelling in the upper part of her body rather than the usual ankle edema associated with pregnancy, and a weight gain of more than 1 kg (2 pounds) a week in the second trimester and 0.5 kg (1 pound) a week in the third trimester.
Mild preeclampsia is managed by bed rest to facilitate sodium excretion, which takes place more rapidly when the body is at rest. While resting in bed the patient is positioned on her left side to avoid pressure of the uterus against the vena cava and supine hypotension syndrome. Rest is often all that is needed to relieve the symptoms of mild preeclampsia. Some physicians also prescribe a high-protein diet to compensate for the protein lost in the urine and, perhaps, mild restriction of sodium intake. However, restriction of sodium can activate the angiotensin system and cause an undesirable elevation in blood pressure.
Diuretics are not used for control of edema because they can only aggravate the condition by increasing glomerular vessel permeability and stimulating angiotension activity.
While magnesium sulfate is being administered, whether intravenously or intramuscularly, the patient must be monitored at frequent intervals to assess deep tendon reflexes and respiratory rate, which are indicators of its depressant effect. Urine output is measured every 4 hours or more often. If a patient excretes less than 100 ml of urine in four hours, she is likely to have a high level of serum magnesium because this mineral is excreted almost exclusively in the urine. In readiness for magnesium overdosage should it occur, a 10 per cent solution of calcium gluconate, the specific antidote for magnesium toxicity, should be on hand.
Other drugs that may be prescribed include hypotensive drugs to reduce blood pressure and sedatives such as phenobarbital to manage central nervous system irritability. Because of the high fetal and maternal morbidity and mortality associated with pre-eclampsia and eclampsia, the pregnancy is terminated as soon as feasible.
Maternal mortality from eclampsia is distressingly high. The cause of death can be cerebral hemorrhage, circulatory collapse, or renal failure. Mothers who survive eclampsia and the birth of their babies can continue to have hypertension for 10 to 14 days after delivery. Follow-up care is needed to evaluate residual or preexisting hypertension and renal disease and to initiate long-term management as indicated.
Infant mortality also is high when the mother is eclamptic. The status of the fetus is closely monitored before delivery to assure that hypoxia and life-threatening acidosis do not develop. When it is necessary to deliver the infant before term, problems of low birth weight and prematurity must be managed.
preeclampsiaObstetrics A hypertensive disorder occurring in the 3rd trimester in ± 5% of pregnancies Clinical HTN, proteinuria, dependent edema, vasospasm, coagulation defects Treatment Low-dose aspirin ↓ preeclampsia in nulliparas, especially with systolic HTN; aspirin ↑ risk of abruptio placentae, but does not ↓ perinatal mortality. See Eclampsia.
Patient discussion about preeclampsia
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