Preeclampsia

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Preeclampsia
Maternal Affinity Group
October 23, 2013
Objectives
• Risks factors of Preeclampsia
• Name 5 symptoms of Preeclampsia
• Understand PERT (Preeclampsia Early
Recognition Tool)
• Identify contents of Preeclampsia toolkit
It’s just high blood pressure!
• One of the biggest risks for maternal mortality
• If undetected, preeclampsia can lead to
eclampsia which is one of the top 5 causes of
maternal and fetal death in the world.
▫ 13% of all maternal deaths
• In US, accounts for 18% of all maternal deaths
• Causes 15% of premature deaths in
industrialized countries
• AND….
It’s just high blood pressure!
Most can be prevented with early detection of
risks and symptoms!!
Risk Factors
• Multiple pregnancies
• Obesity and primigravida
• Medical History of chronic high blood pressure,
renal disease, or diabetes
• Pregnancy in early teens or past 40
• Preexisting:
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▫
▫
▫
Hypertension
Diabetes
Rheumatoid Arthritis or Lupus
Kidney Disease
Symptoms
•
•
•
•
•
•
•
Headache
Blurred Vision
Upper abdominal pain
Unexplained anxiety
Seizures
Increased weight gain
Decreased urine output
Diagnosis
• Blood pressure of 140 mmHg systolic or higher or
90 mmHg diastolic or higher that occurs after 20
weeks gestation in a women with previously normal
blood pressure.
• Proteinuria, defined as urinary excretion of 0.3
grams protein or higher in a 24 - hour urine
specimen.
• New onset hypertension without proteinuria but
with signs and symptoms of major end organ
involvement such as headache, upper abdominal
pain, hepatic dysfunction, pulmonary edema, or
severe renal dysfunction, would potentially be
indicative of “atypical” preeclampsia.
Blood Pressure Readings
• Competency with accurately recording blood
pressures
• Do not have patient lay on left side just to get a
better reading
Acute Treatment
• Antihypertensive medications administered within 1 hour and
ideally within 30 minutes of arrival at a healthcare facility for
blood pressures of 160 systolic, and/or 105 -110 diastolic or
greater is a critical initial step in decreasing morbidity and
mortality.
• Magnesium sulfate therapy for seizure prophylaxis should be
administered to any patients with:
▫ Severe preeclampsia,
▫ Preeclampsia with severe features, also known as atypical
(subjective neurological symptoms such as headache or blurry
vision or right upper quadrant or epigastric abdominal pain)
AND
▫ Should be considered in patients with mild preeclampsia
(preeclampsia without severe features).
• Magnesium sulfate is the approved initial therapy for an
eclamptic seizure.
Adapted
from the
Modified
Obstetric
Early
Warning
System
(MEOWS)
2003-05
PERT
Green = Normal
Proceed with Protocol
Yellow = Worrisome
Increase assessment frequency
# of Triggers:
To Do:
1
Notify Provider
>/= 2
Notify Charge RN
In-person Evaluation
Order labs/tests
Anesthesia Consult
Consider Mag Sulfate
Supplemental O2
PERT
RED=SEVERE
Trigger: 1 of any type listed below
1 of any type
• Immediate Evaluation
• Transfer to higher acuity level
• 1:1 Staff Ratio
Awareness
Headache
Visual
• Consider Neurology consult
• CT Scan
• R/O SAH/Intracranial Hemorrhage
BP
Chest Pain
Respiration, SOB,
O2 Sat
• Labetalol/Hydralazine in 30 min
• In-person evaluation
• Magnesium Sulfate loading or maintenance
infusion
• Consider CT Angiogram
• O2 at 10/L
• R/O pulmonary edema
• CXR
KEY LEARNING POINTS
• 1. Assess for signs and symptoms of worsening or
severe preeclampsia and notify provider if any of
these are present:
▫ Increasing blood pressure
▫ Headache
▫ Altered level of consciousness –agitation, restless,
lethargy, hallucinations, confusion
▫ Visual disturbances –blurred vision, floaters, spots,
blind spot
▫ Upper abdominal pain
▫ Urine output <30 ml/hr
▫ Shortness of breath
KEY LEARNING POINTS
• 1. Assess for signs and symptoms of worsening or
severe preeclampsia and notify provider if any of
these are present:
▫
▫
▫
▫
▫
▫
▫
▫
Complaints of chest pain
SaO2 < 95%
Cough
Tachypnea > 26 breaths per minute
Tachycardia > 100 bpm
Adventitious breath sounds
Eclamptic seizure
Magnesium toxicity
KEY LEARNING POINTS
2. Patient care assignments should take into account
the level and expertise of the clinician or nurse
assigned to care.
▫ Patients diagnosed with severe preeclampsia should be
staffed with a 1:1 nurse to patient ratio, with the most
experienced nurse available.
3. Women with severe preeclampsia should receive
care by a multi-disciplinary team.
▫ The team should consist of an obstetric provider
credentialed to perform cesarean sections, nursing,
anesthesia, NICU, laboratory, blood bank, social work,
and other sub-specialties as needed.
References
• http://www.pqcnc.org/documents/cmop/Preecl
ampsiaToolkitSubmissionDraft20130805.pdf
• http://www.preeclampsia.org/pdf/Preeclampsia
%20Fact%20sheet%20v2.pdf
• http://www.rightdiagnosis.com/p/preeclampsia
/stats.htm
Questions??
Lynne Hall
770-249-4525
[email protected]
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