Please Reply to the following 2 Discussion posts:
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DISCUSSION POST # 1 Reply to Thalia
Preeclampsia is defined as hypertension that is new onset. Parameters for diagnosis include twenty weeks or greater gestation and two occurrences at least four hours apart of a systolic blood pressure of greater than 140 mmHg or a diastolic blood pressure of greater than 90 mmHg or systolic blood pressure of 160 mmHg and diastolic blood pressure of 110 mmHg or greater (Karrar & Hong, 2023). Other findings may include proteinuria, edema, headache, persistent abdominal pain, and other alterations in lab findings (Karrar & Hong, 2023).
The etiology of preeclampsia is not well-defined. Preeclampsia is thought to be caused by abnormal placentation, which is the arrangement of the placenta in the uterus, leading to dysfunction remodeling of the aberrant spiral arteries, oxidative stress, placental ischemia, or hypoxia (Karrar & Hong, 2023). As many as 50,000 maternal deaths worldwide may be attributed to preeclampsia and eclampsia every year and it is correlated to ethnicity and race, African American and Hispanics being the most prevalent (Karrar & Hong, 2023). Risk factors include advanced age, obesity, comorbidities, and family history (Karrar & Hong, 2023).
The pathophysiology involves multisystem dysfunction. Remodeling of the arteries leads to ischemia triggering the release of antiangiogenic and pro-inflammatory factors which causes abnormal vessel formation and inadequate blood supply to multiple organ systems (Karrar & Hong, 2023).
Early detection with a focus on blood pressure management is important in the treatment of preeclampsia. Maternal labs and fetal evaluation should be monitored closely. Ultrasound of the amniotic fluid index and fetal status are key to determining delivery or medical management of preeclampsia (Karrar & Hong, 2023). Complications of preeclampsia include eclampsia, HELLP syndrome, myocardial infarction, stroke, bleeding, or pulmonary edema. In severe cases with imminent delivery prior to thirty-four weeks gestation, administration of antenatal steroids is recommended however should not delay delivery (Magee et al., 2022). Intravenous medications for severe cases include labetalol, hydralazine, and magnesium sulfate (Magee et al., 2022). For pregnant women with a high risk for preeclampsia, exercise, low dose aspirin, and calcium in greater than twenty weeks gestation (Magee et al., 2022). Low molecular weight heparin is not recommended as it has not shown to impact outcomes (Magee et al., 2022).
Maternal and fetal morbidity and mortality associated with preeclampsia are decreased with early detection and medical management. Patient education is essential beginning with defining preeclampsia and the associated signs and symptoms. Recommendations for prevention of preeclampsia include exercise and healthy diet for all pregnant women. Provide patient education that includes signs and symptoms such as unrelieved headache, visual changes, and upper abdominal pain (Magee et al., 2022). Instruct the patient to monitor blood pressure in high-risk pregnancies and explain that preeclampsia can cause inappropriate fetal growth and decrease amniotic fluid (Magee et al., 2022). Provide information about treatment options and prevention.
Instruct patient to contact the doctor or nurse immediately with symptoms of severe preeclampsia. These symptoms include severe headache, vision disturbances such as seeing spots, blurred vision or flashes of light, abdominal pain, or new shortness of breath. Also contact the doctor is there is vaginal bleeding, reduced or no fetal movement or are in labor (Magee et al., 2022).
DISCUSSION POST # 2 Reply to Aslesha
