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Preeclampsia

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!.

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Preeclampsia

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  1. Preeclampsia Maternal Affinity Group October 23, 2013

  2. Objectives • Risks factors of Preeclampsia • Name 5 symptoms of Preeclampsia • Understand PERT (Preeclampsia Early Recognition Tool) • Identify contents of Preeclampsia toolkit

  3. 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….

  4. It’s just high blood pressure! Most can be prevented with early detection of risks and symptoms!!

  5. 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: • Hypertension • Diabetes • Rheumatoid Arthritis or Lupus • Kidney Disease

  6. Symptoms • Headache • Blurred Vision • Upper abdominal pain • Unexplained anxiety • Seizures • Increased weight gain • Decreased urine output

  7. 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.

  8. Blood Pressure Readings • Competency with accurately recording blood pressures • Do not have patient lay on left side just to get a better reading

  9. 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.

  10. Adapted from the Modified Obstetric Early Warning System (MEOWS) 2003-05

  11. 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

  12. PERT RED=SEVERE Trigger: 1 of any type listed below • Immediate Evaluation • Transfer to higher acuity level • 1:1 Staff Ratio • Consider Neurology consult • CT Scan • R/O SAH/Intracranial Hemorrhage • 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 1 of any type Awareness Headache Visual BP Chest Pain Respiration, SOB, O2 Sat

  13. 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

  14. 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 • Eclampticseizure • Magnesium toxicity

  15. 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.

  16. References • http://www.pqcnc.org/documents/cmop/PreeclampsiaToolkitSubmissionDraft20130805.pdf • http://www.preeclampsia.org/pdf/Preeclampsia%20Fact%20sheet%20v2.pdf • http://www.rightdiagnosis.com/p/preeclampsia/stats.htm

  17. Questions?? Lynne Hall 770-249-4525 lhall@gha.org

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