Category: Maternal Neonatal Nursing Seizures and coma are the hallmarks of eclampsia, the ultimate consequence of preeclampsia. As in all seizure patients, hypoglycemia, drug overdose and other causes of seizures should be excluded with appropriate tests.
Category: Maternal Neonatal Nursing The patient who has severe preeclampsia should have an IV line and fetal monitoring initiated. Blood testing should include complete blood cell count, renal function studies, liver function tests, platelet count and coagulation profile.
Category: Maternal Neonatal Nursing The most dangerous complication is of preeclampsia is eclampsia - which is the occurrence of seizures or coma in the setting of preeclampsia. Warning signs for the development of eclampsia include headache, vomiting and visual disturbances.
Category: Maternal Neonatal Nursing The HELLP syndrome, a particularly severe form of preeclampsia, is characterized by hemolysis, elevated liver enzyme levels (alanine transaminase [ALT] and aspartate transaminase [AST]) and low platelet count.
Category: Maternal Neonatal Nursing Gestational hypertension or preeclampsia is a vasospastic disease of unknown cause unique to pregnant women. Vasospasm, ischemia and thrombosis are associated with preeclampsia and can cause injury.
Category: Maternal Neonatal Nursing Patients who have significant abruptio placentae may require early delivery - vaginal or surgical, depending on fetal status. If placenta previa is diagnosed or if abruptio placentae is considered mild, the patient is admitted for close monitoring.
Category: Maternal Neonatal Nursing Fetomaternal hemorrhage can occur with abruption. If the Rh-negative patient has not yet received her routine Rh immune globulin prophylaxis at 28 weeks, 300 µg of Rh immune globulin should be administered within 72 hours.
Category: Maternal Neonatal Nursing Blood loss requiring transfusion can occur in patients with placenta previa or abruptio placentae. Fresh-frozen plasma or fresh whole blood may be needed because of the coagulopathy associated with significant abruptio placentae.
Category: Maternal Neonatal Nursing Ultrasonography is the diagnostic procedure of choice for localization of the placenta and diagnosis of placenta previa. Accuracy is excellent, but visualization of the placenta and of the internal cervical os is required.
Category: Maternal Neonatal Nursing Most cases of placenta previa identified during the midtrimester resolve by the time of delivery as the lower uterine segment elongates and the placenta no longer overlaps the cervical os.
Category: Maternal Neonatal Nursing All patients with painless, second-trimester vaginal bleeding should be assumed to have placenta previa until proven otherwise. Digital or instrumental probing of the cervix should be avoided until the diagnosis is excluded via ultrasound.
Category: Maternal Neonatal Nursing Painless, fresh vaginal bleeding is the most common symptom of placenta previa. In 20% of cases, some degree of uterine irritability is present, but this is generally minor. Vaginal examination usually reveals bright red blood from the cervical os.
Category: Maternal Neonatal Nursing Placenta previa, or implantation of the placenta over the cervical os, is the other major cause of bleeding during pregnancy. The risk of placenta previa is increased with smoking, cesarean section, prior miscarriage and preterm labor.
Category: Maternal Neonatal Nursing Fetal distress and death occur with abruptio placentae by interruption of placental blood and oxygen flow. Risk of fetal death increases in proportion to the percentage of the placental surface involved and rapidity of separation.
Category: Maternal Neonatal Nursing Abruptio placentae is most clearly associated with maternal hypertension and preeclampsia. It is also more common with parity of three or more, unexplained infertility, history of smoking, thrombophilia, prior miscarriage and cocaine use.
