Pre-eclampsia Nursing Notes: Definition, Symptoms, Diagnosis and Management

Pre-eclampsia Nursing Notes: Definition, Causes, Symptoms, Diagnosis and Management

Quick Definition: Pre-eclampsia is a pregnancy-specific hypertensive disorder that develops after 20 weeks of gestation. It is characterized by new-onset high blood pressure with proteinuria and/or maternal organ dysfunction or uteroplacental dysfunction.

Definition of Pre-eclampsia

Pre-eclampsia is a serious pregnancy complication in which a pregnant woman develops new-onset hypertension after 20 weeks of gestation, usually associated with proteinuria or signs of damage to organs such as the kidneys, liver, brain, blood system or placenta.

It is a multisystem disorder and can affect both the mother and fetus. If untreated, it may progress to severe pre-eclampsia, eclampsia, HELLP syndrome, placental abruption, organ failure or fetal complications.

Incidence

• Pre-eclampsia affects approximately 2–8% of pregnancies worldwide.
• It is more common in first pregnancy, multiple pregnancy, chronic hypertension, diabetes and kidney disease.

Causes and Risk Factors

Main Cause: The exact cause is not fully understood, but the major underlying cause is believed to be abnormal placental development, leading to poor blood flow to the placenta.

Important Risk Factors

• First pregnancy / primigravida
• Previous history of pre-eclampsia
• Family history of pre-eclampsia
• Multiple pregnancy such as twins or triplets
• Chronic hypertension
• Diabetes mellitus
• Chronic kidney disease
• Autoimmune disease such as SLE or antiphospholipid syndrome
• Obesity, BMI ≥30 kg/m²
• Maternal age above 35 years
• IVF pregnancy
• Molar pregnancy

Pathophysiology of Pre-eclampsia

1. Abnormal placental implantation: Trophoblastic invasion is inadequate and spiral arteries fail to remodel properly.
2. Reduced uteroplacental blood flow: Placental perfusion decreases.
3. Placental ischemia and hypoxia: The placenta receives reduced oxygen supply.
4. Release of inflammatory and anti-angiogenic factors: These substances enter maternal circulation.
5. Maternal endothelial dysfunction: Blood vessel lining becomes damaged.
6. Generalized vasospasm: Blood vessels constrict, causing hypertension.
7. Increased capillary permeability: Fluid leaks into tissues, causing edema.
8. Organ hypoperfusion: Kidneys, liver, brain and placenta may be affected.

Simple Flow:
Abnormal placentation → Placental ischemia → Endothelial dysfunction → Vasospasm → Hypertension → Proteinuria and organ damage.

Clinical Manifestations / Symptoms

Common Symptoms

• High blood pressure ≥140/90 mmHg
• Protein in urine
• Severe headache
• Blurred vision or flashing lights
• Swelling of face, hands and feet
• Rapid weight gain due to fluid retention
• Upper abdominal pain or right upper quadrant pain
• Nausea and vomiting
• Shortness of breath
• Reduced urine output
• Hyperreflexia or clonus

Danger Signs: Severe headache, visual disturbance, severe epigastric pain, shortness of breath, reduced fetal movement, seizures or very high blood pressure need urgent medical attention.

Diagnostic Criteria of Pre-eclampsia

Pre-eclampsia is diagnosed when hypertension develops after 20 weeks of pregnancy with proteinuria and/or maternal organ dysfunction.

Criteria	Details
Blood Pressure	≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation
Proteinuria	≥300 mg protein in 24-hour urine OR protein/creatinine ratio ≥0.3 OR dipstick ≥1+
Renal Dysfunction	Serum creatinine >1.1 mg/dL or oliguria
Liver Dysfunction	Elevated liver enzymes, right upper quadrant pain or epigastric pain
Neurological Features	Severe headache, visual disturbance, hyperreflexia, seizures
Hematological Changes	Platelets <100,000/mm³, hemolysis
Uteroplacental Dysfunction	Fetal growth restriction or abnormal fetal Doppler studies

Severe Pre-eclampsia Criteria

• Blood pressure ≥160/110 mmHg
• Severe persistent headache
• Visual disturbances
• Pulmonary edema
• Platelet count <100,000/mm³
• Elevated liver enzymes with severe pain
• Progressive renal insufficiency
• Eclampsia / seizures

Investigations

Maternal Investigations

• Blood pressure monitoring
• Urine protein testing
• Complete blood count
• Platelet count
• Liver function test
• Renal function test
• Coagulation profile if severe disease suspected

Fetal Assessment

• Ultrasound for fetal growth
• Amniotic fluid assessment
• Non-stress test
• Biophysical profile
• Doppler studies
• Fetal movement monitoring

Complications

Maternal Complications

• Eclampsia
• HELLP syndrome
• Placental abruption
• Acute kidney injury
• Pulmonary edema
• Stroke
• DIC
• Liver rupture
• Maternal death

Fetal Complications

• Fetal growth restriction
• Prematurity
• Low birth weight
• Fetal hypoxia
• Placental insufficiency
• Intrauterine fetal death
• Neonatal death

Management of Pre-eclampsia

Mild Pre-eclampsia

• Regular antenatal follow-up
• Blood pressure monitoring
• Urine protein monitoring
• Fetal movement count
• Ultrasound for fetal growth
• Patient education about danger signs

Moderate Pre-eclampsia

• Hospital admission if required
• Frequent maternal and fetal monitoring
• Antihypertensive therapy as prescribed
• Blood investigations such as CBC, LFT and RFT

Severe Pre-eclampsia

• Immediate hospital admission
• Close maternal and fetal monitoring
• Control severe hypertension
• Magnesium sulfate for seizure prophylaxis
• Strict fluid balance monitoring
• Oxygen therapy if required
• Prepare for timely delivery

Common Medications

Medication	Purpose
Labetalol	Controls high blood pressure
Nifedipine	Controls high blood pressure
Methyldopa	Antihypertensive used in pregnancy
Hydralazine	Used in severe hypertension
Magnesium sulfate	Prevents and treats seizures
Calcium gluconate	Antidote for magnesium sulfate toxicity

Definitive Treatment

Delivery of the baby and placenta is the only definitive cure for pre-eclampsia.

The timing of delivery depends on gestational age, severity of disease, maternal condition and fetal condition.

Nursing Management

• Monitor blood pressure regularly.
• Assess headache, visual disturbance and epigastric pain.
• Monitor urine output; report if less than 30 mL/hour.
• Check deep tendon reflexes and clonus.
• Maintain seizure precautions.
• Keep oxygen and suction available.
• Monitor fetal heart rate.
• Maintain strict intake and output chart.
• Administer antihypertensive medications as prescribed.
• Monitor for magnesium sulfate toxicity.
• Educate mother and family about warning signs.
• Document maternal and fetal condition accurately.

Nursing Care Plan

Nursing Diagnosis: Risk for decreased maternal and fetal tissue perfusion related to vasospasm and hypertension.

Goals

• Maintain maternal blood pressure within target range.
• Prevent seizures.
• Maintain adequate fetal oxygenation.
• Prevent maternal and fetal complications.

Nursing Interventions

• Monitor vital signs frequently.
• Assess neurological status.
• Administer prescribed medications.
• Monitor laboratory results.
• Provide calm and quiet environment.
• Prepare patient for delivery if condition worsens.

Expected Outcomes

• Mother remains stable.
• No seizure activity occurs.
• Fetal heart rate remains reassuring.
• Safe delivery achieved.

Key Nursing Points

• Pre-eclampsia usually occurs after 20 weeks of pregnancy.
• Hypertension is the most important diagnostic feature.
• Proteinuria may be present, but organ dysfunction can also confirm diagnosis.
• Severe headache, visual disturbance and epigastric pain are warning signs.
• Magnesium sulfate is used to prevent seizures.
• Delivery of placenta is the definitive treatment.

Frequently Asked Questions

What is pre-eclampsia?

Pre-eclampsia is a pregnancy-related condition causing high blood pressure after 20 weeks of pregnancy with proteinuria or organ dysfunction.

What are the warning signs of pre-eclampsia?

Warning signs include severe headache, blurred vision, swelling of face and hands, epigastric pain, shortness of breath and reduced fetal movements.

What is the main treatment for pre-eclampsia?

The only definitive cure is delivery of the baby and placenta. Supportive treatment includes blood pressure control, magnesium sulfate and close monitoring.

What is eclampsia?

Eclampsia is the occurrence of seizures in a woman with pre-eclampsia.

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Disclaimer: This article is for nursing education only and should not replace clinical judgment, local hospital guidelines or medical advice.