Here comes the day of your pre-natal appointment and you’re thrilled. By this time around, the sex of the baby can be determined. You feel relaxed and well rested since you got a good night’s sleep. You’re excited to see how your baby’s doing! The nurse comes in with a smile and assists you. She makes an assessment, weighs you, and takes your blood pressure. After a few minutes, she comes back together with your doctor and asks you to pee in that tiny urine cup. Here’s the news. “You’re blood pressure is 140/90mmHG.”
When a blood pressure shows a systolic of more than 140 and a diastolic more than 90, you are most likely to be hypertensive. Hypertension is also known as high blood pressure which is commonly seen in adults who are obese, who smoke, drinks, and those who live a sedentary lifestyle. To be considered hypertensive, there should be a persistent elevation of blood pressure taken at different and multiple times.
Unfortunately, hypertension can also happen to any pregnant women. Toxemia or Pre-Eclampsia is basically hypertension that develops during pregnancy. Pre-eclampsia is diagnosed when a patient’s blood pressure is more than 140/90 and when there is a presence of protein in the urine.
If Pre-Eclampsia is not managed and treated, it can further lead to Eclampsia which is potentially life-threatening to both the mother and the baby. Pre-Eclampsia and Eclampsia are included in the leading causes of pregnancy related mortality of the World Health Organization. According to studies, Pre-Eclampsia can also cause fetal growth restriction, a pre-term delivery and placental abruption.
Pre-eclampsia often occurs in the 2nd trimester and symptoms included are persistent headaches, lightheadedness, nausea, edema, neck pains, weight gain and blurring of vision. Put in mind that not all women will experience these symptoms. Most of the time, women are unaware that their blood pressures are high and they only discover it during a pre-natal check-up. There are several risk factors that are associated with pre-eclampsia. Having chronic hypertension, gestational diabetes, obesity and an advance maternal age over 35 increases the risk of developing pre-eclampsia. Though the reason behind pre-eclampsia is still unknown, experts suggest that it is somehow related with the development of the placenta.
Pregnant women in developing countries, often come to the emergency room unaware that pre-eclampsia is impending. According to WHO’s (World Health Organization) research, women in developing countries are more likely to develop pre-eclampsia than those in developed countries. This is due to the lack of knowledge of its severity and because of inaccessible health institutions that can provide them quality pre-natal care.
When hypertension is detected on pre-natal check-ups, antihypertensive drugs like Methyldopa, Nifedipine and Beta Blockers are commonly prescribed. Patients are usually sent home and BP monitoring is advised. When blood pressure becomes significantly high and uncontrollable, hospital admission is then required.
The initial nursing assessment that we do when a patient arrives in the emergency room is to take their vital signs. Upon recording a blood pressure more than 140/90mmHg, an immediate referral is done to the physician. The OB-GYN will then request for laboratories like Urinalysis, LDH, SGPT, SGOT, BUN, Crea and a 24hr urine collection to check for proteinuria, the liver and the kidneys. An IV line will be inserted, and a loading dose of Magnesium Sulfate is administered. Hydralazine is also given in 5mg or 10mg especially when blood pressure reaches more the 160/100mmHg. Physicians often request an insertion of a foley catheter especially when magnesium sulfate is infused. This will help monitor the urine output of the patient.
It is vital to control severe hypertension since risks of cerebral hemorrhage and eclampsia also increases. When the blood pressure reaches 170/110mmHG, a higher dose of Hydralazine or Nicardipine are also prescribed. If eclampsia is inevitable and seizures occur, the patient’s safety is the utmost priority. The next goal is to provide adequate airway, stop the convulsion and to prevent it from happening again. Anti-convulsant are given and immediate stabilization of the patient is done. Since the only main treatment of pre-eclampsia is the expulsion on the baby, an immediate delivery either by vaginal birth or thru cesarean section is done. Management among post-partum women are crucial since women with pre-eclampsia are also at risk of hemorrhage.
Low salt intake, low fat diet and smoking cessation are recommended to prevent an increase in blood pressure during pregnancy. I remember the quote said by one of our physicians, “When you are pregnant, your other foot is in the grave”. There are things that we can prevent, but still can happen anytime. The exact cause of pre-eclampsia is still unknown. This is why regular pre-natal consultations and blood pressure monitoring are a must.
A post-partum check-up especially after getting discharged from the hospital is also essential. Pre-eclampsia does not only happen during pregnancy and can also occur after delivery. Post-partum women are still advised to do a follow up check up to monitor hypertension and possible complications brought about by pre-eclampsia.
If you feel that you might be at risk of developing this condition, please do contact your healthcare provider.
Author: Bernice Tan RN
1. Elizabeth Eden “A Guide to Pregnancy Complications” 16 November 2006. HowStuffWorks.com. https://health.howstuffworks.com/pregnancy-and-parenting/pregnancy/complications/a-guide-to-pregnancy-complications-ga.htm
2. World Health Organization Fact Sheet, May 2012.
3. Pre Eclampsia Foundation. “Pre-Eclampsia and Maternal Mortality: a Global Burden”. 01 May 2013. https://www.preeclampsia.org/health-information/149-advocacy-awareness/332-preeclampsia-and-maternal-mortality-a-global-burden
4. “Toxaemia of pregnancy”. http://www.mydr.com.au/babies-pregnancy/toxaemia-of-pregnancy
5. Johns, Andrew. “Toxemia in Pregnancy”. 29 March 2016. http://infobaby.org/toxemia-in-pregnancy/
6. “Preeclampsia (Toxemia, Pregnancy-induced hypertension)” 19 October 2004. https://www.myvmc.com/diseases/preeclampsia-toxemia-pregnancy-induced-hypertension