SCIENCE

1. PRE-ECLAMPSIA
BY
MAKERERE
UNIVERSITY

2. CASE
A 34 year old G5P3+1 Female is diagnosed with preeclampsia during
pregnancy. Discuss the nursing assessments, interventions, and
monitoring required to manage preeclampsia and ensure a safe birth.
Outline;
Definition
Nursing assessment
Nursing diagnosis
Interventions
Monitoring

3. DEFINITION
Pre-eclampsia
• This is a condition where the BP is greater than or equal to
160/110mmHg confirmed within 15 minutes with or without
proteinuria after 20 weeks of gestation in a previously normotensive
mother.
• Do atleast 2 readings to confirm pre-eclampsia.
• Pre- eclampsia can occur upto 6 weeks post partum

4. Pre-eclampsia with severe features
• Severe pre-eclampsia is high-blood pressure of systole >160 mmHg or
diastole >110 mmHg on 2 occasions and significant proteinuria and
has atleast 2 of the features below:
• Low –blood platelet count <100 ×106/l
• Haemolysis Elevated Liver enzymes and Low Platelet count (HELLP) syndrome
• Pulmonary edema
• Epigastric pain
• Severe headache
• Visual disturbance (flashing light similar to migraine)

5. RISK FACTORS
Maternal factors
• Primipaternity (Ist pregnancy
with a new partner)
• Extremes of maternal age (<20
>40 years
• Family history
• Obesity
• Pre-existing diabetes
• Chronic HTN
• Pre-existing medical conditions,
e.g. renal disease
Pregnancy related factors
• First pregnancy
• Multiple pregnancy
• Developing a medical disorder
during pregnancy, gestational
diabetes, gestational HTN

6. NURSING ASSESSMENTS
Maternal assessments;
• History of headache, visual and hearing disturbances, palpitations
• Blood pressure
• Vital sign assessments i.e. heart rate, respiratory rate, weight,
temperature
• Assess pulmonary edema i.e. oxygen saturation, crackles, dyspnea,
respiratory rate
• Urinalysis; Urine output for amount and proteinuria
• Blood tests; CBC, RFTs, LFTs, coagulation time
• Neurological status
• Indications for an earlier delivery

7. ASSESSMENTS CONTINUED....
Fetal assessment
Heart rate
Movements
Liquor
Growth( fundal height)
NB; And ensure continuous monitoring of all these aspects of fetus
to ensure fetal welbeing

8. NURSING DIAGNOSIS
• Impaired breathing pattern RT increased fluid retention as evidenced
by pulmonary edema, crackles
• Impaired vision RT disease process as evidenced by
photophobia,visual disturbance
• Imbalanced fluid volume RT decreased kidney function, plasma
protein loss as evidenced by pulmonary edema
• Decreased cardiac output RT decreased venous return as evidenced
by edema, dyspnea

9. INTERVENTIONS
Goals/ nursing concerns
1. Prevention or and control of convulsions
2. Control blood pressure ( target 135/85mmHg)
3. Plan for delivery within 24 hours
NB, Interventions to the mother will also aim at maintaining fetal
welbeing

10. 1. PREVENTION & /CONTROL OF
CONVULSIONS
• Admit all mothers with severe pre- eclampsia
• Give Magnesium sulphate
Loading dose( 14g)
IV 4g of 20% followed by IM 5g of 50% with 1ml of 2% Lignocaine in
each buttock
Maintenance dose
IM 5g of 50% with 1ml of 2 % Lignocaine in alternate buttock 4 hourly
for 24 hours after delivery or last fit depending on what occurs first.
• If convulsions happens again before the maintenance dose;
Give IV 2g of 20% and continue with maintenance for 24 hours after
delivery or last fit depending on what occurs first.

11. Cont………
Observe the mother for Magnesium toxicity
1. Hyporeflexia
2. Respiratory depression; RR< 6bpm.
3. Oliguria, < 100 mls in 24 hours
Management
• Stop Magnesium sulphate
• Give Calcium gluconate
• IV Calcium gluconate 1 g of 10% over 10 minutes
NB: Ensure proper reconstitution of MgSO4 as;

12. Dose of
MgSO4 20%
(g)
Volume of
50% of
MgSO4
Volume of
water for
injection
Total
volume of
20%
MgSO4
2g 4ml 6ml 10ml
4mg 8ml 12ml 20ml

13. 2. CONTROL OF BLOOD PRESSURE
Target BP 135/85mmHg (130-139/80-89 mmHg)
If BP is > 160/110mmHg ;
• IV hydralazine 5mg , repeat every 30 minutes until BP<160/110
mmHg ( max dose : 30mg in 24hrs)
OR
• IV Labetalol 20mg every 10mins, double the dose to 40mg then 80mg
as needed ( max dose: 300mg in 24 hours)

14. CONTROL OF BP CONT…..
• Oral immediate release Nifedipine 10mg, Max 3 doses. If BP remains
>160/110mmHg, at 20 mins, give 10 or 20 mg orally, depending on
the initial response.
If BP <160/110 ,
• oral Nifedipine starting at 20 mg 12 hourly,
• methyldopa at 250mg 8 hourly,
• labetalol starting 200mg 12 hourly OR
• a combination of doses.
N.B Dosing should be adjusted according to the response observed.

15. 3. PLAN FOR DELIVERY
If >=37 weeks;
Consider immediate delivery after stabilization within 24 hours
If 34-<37 weeks;
Expectantly manage the mother if there's no indication for immediate
delivery;
These signs include;
• Lab findings in severe range Uncontrolled blood pressure>160/110
• Pulmonary edema or SPO2 <90% HELLP syndrome
• Placental abruption Preterm labour
• PPROM Oligohydramnios
• IUGR Abnormal neurological features,stroke

16. EXPECTANT MANAGEMENT
• Admit in hospital till delivery
• Daily assessment of mother and fetus
• Daily lab tests; CBC, LFT, RFT
• Administer corticosteroid ie IM dexamethasone 6mg 12hourly for 48
hours ( lung maturation, neuroprotection)
• Control BP with oral Nifedipine or methyldopa
• Complete maintenance dose of MgSO4

17. INTRA-PARTUM CARE
• Do obstetric assessment
• Determine the method of delivery ( ie SVD or C- section)
• Continuous maternal and fetal monitoring
• Treat severe HTN promptly with anti- hypertensives
• Limit fluid intake to 60-80mL/hr.
Monitoring
maternal Fetal
• Blood pressure •Fetal heart rate ,movement,
• Urine output and input • Liqour
• Proteinuria

18. POST- PARTUM CARE AND FOLLOW UP
IMMEDIATE & INTERMEDIATE
• Monitor vital signs 2 hourly then
4- 6 hours for atleast 3 days
• Complete MgSO4 dose
• Repeat lab tests daily till 2
consecutive normal results
• Do urinalysis
• Monitor urine output and input
SHORT $ LONG TERM
• Review Postpartum within 1
week, 2 weeks till 6 weeks and
monthly till 3 months
• Repeat lab tests each review
• Assess for depression,
Postpartum blue
• Screen for other causes of HTN

19. REFERENCE
• Myles textbook of Midwifery 16th edition
• Maternal and Newborn Critical Care Guidelines 2022

20. SEVERE PRE ECLAMPSIA $ ECLAMPSIAIS MISSED WHEN THE
SIGNS $ Symptoms ARE DISMISSED👁👁