تسمم الحمل

Definition

Pre-eclampsia is hypertension appearing after 20 weeks with proteinuria or organ involvement such as the kidneys, liver, brain or platelets.

Cause

Abnormal placental vessel development causing widespread damage to the mother’s vessel lining.

Risk factors

First pregnancy, previous pre-eclampsia, twins, diabetes, chronic hypertension, kidney disease, obesity and age over 40.

Signs and symptoms

• BP 140/90 or more
• Severe headache, visual disturbance
• Epigastric or right upper quadrant pain
• Sudden facial and hand swelling

Complications

• Eclampsia: seizures
• HELLP syndrome: haemolysis, elevated liver enzymes, low platelets
• Placental abruption and fetal growth restriction

Treatment

• Delivery is the definitive cure, timed by severity and gestation
• Antihypertensives: labetalol, nifedipine, hydralazine
• Magnesium sulphate to prevent seizures

Nursing care

• Monitor BP, protein, reflexes, breathing and urine output
• Calcium gluconate ready at the bedside

Exam point

Low-dose aspirin from 12 weeks lowers the risk in high-risk pregnancies.