HIM FPX 4610 Assessment 6 Health Topic Presentation

Hello, Good Morning! My name is Selinthia Collins, and I would like to thank you all for joining me this morning. I have been asked to present and discuss a very important health topic. Today’s topic is pre-eclampsia, which is a serious potentially dangerous complication during pregnancy and is linked to high blood pressure. Before we begin I would like to share with you all a personal story of my own if that’s okay with everyone.

       I remember finding out I was expecting I was very excited for this would be my first child. I was already considered a high-risk pregnancy due to multiple miscarriages in the past so it goes without saying even though I was excited there was some fear as well. Due to my past history I was seen in the high risk clinic for monitoring this made me feel at ease. I received an ultrasound early on in my pregnancy to check for any abnormal findings. After my first ultrasound I started to bleed, heavy bleeding including clots I was scared that I was miscarrying again, after another ultrasound I was told everything looked good and that it was unknown why I was bleeding I didn’t care just happy my baby was okay. After two months of constant bleeding stopped, my blood pressure started to rise. I was placed on hypertensives and started having appointments every week.

        I did a 24-hour urine catch twice and no protein was in my urine which was a good thing but I started to notice I couldn’t breath if I laid flat and had to prop up on 2-3 pillows, my face and lips became very swollen and I was increasingly tired I even started having dreams that I delivered my baby but didn’t get a chance to see her because I died. I constantly told my physician my symptoms and was told that it was normal because I was pregnant to have swelling and feeling like I couldn’t breathe I trusted him (he had the degree). Fast forward to my 28th week I had an appointment and my doctor placed the doppler on my stomach but looking at his facial expression was concerned he started tapping my stomach and moving the doppler around after 1-2 minutes he said with a sigh of relief aww there she go, I said is everything okay he said yeah she was just sleeping I than said yeah but your heart beats in your sleep why were you having trouble hearing her heartbeat he stated it was due to how she was laying. Before I left, I had a plan of care to have an ultrasound next week and if my blood pressure was still elevated I would be admitted for monitoring. I never made it to next week. Two days later I felt bad I couldn’t explain it just off. My brother & sister-in-law took me to the ED and they transferred me straight to labor & delivery. The on-call OB came in and said hi I heard about you; you were in the clinic the other day she said we were discussing you we tend to do that with difficult cases I thought what? I had been told I was fine all this time. After being admitted for observation my oxygen levels dropped low and the fetal monitor showed distress I couldn’t breathe, and the oxygen placed on me felt like it was more hurtful than helpful at that point. Two doctors made the decision to perform a c-section which turned into a crash c-section. I flatlined on the table so my heart was defibrillated while the surgeons were getting my daughter out. 

        She was born 29weeks & 4days with an APGAR score of 0 showing no signs of life, my heart was restarted and I went into a coma (lasted four days) my daughter APGAR got up to a 5 after 10 minutes and she was rushed to the NICU fighting for her life weighing less than 2 pounds and I laid in the SICU (surgical intensive care unit) fighting for mine. Twelve years later we are here she has a traumatic injury (TBI) from birth, global developmental delay, complex medical needs, AUTISM, cortical vision impairment, and is non-verbal. Long story short, these are the effects of pre-eclampsia and I urge any and everyone experiencing any symptoms that doesn’t feel right to advocate for yourself and your unborn baby. I must say this experience is the reason I became a nurse and I believe my child has some amazing things in store for her. It will be challenging but what isn’t. Now let’s start our presentation.

What Causes Preeclampsia?

    Preeclampsia is a condition characterized by high blood pressure sometimes accompanied with fluid retention and proteinuria (protein in urine). In this condition the placenta is not developing properly due to a problem with the blood vessels.

 Etiology

    The condition begins in the placenta the organ that nourishes the fetus, a problem occur with how the blood circulate in the placenta. This condition also known as toxemia usually begins after 20 weeks of pregnancy and can be fatal for both mother & Fetus (baby) if left untreated.

Signs & Symptoms

    Signs and symptoms that should be monitored for include: high blood pressure (HTN), proteinuria (protein in urine), decreased platelets in blood (Thrombocytopenia), increased liver enzymes, severe headaches, changes in vision (blurry, temporary loss, & light sensitivity), SOB (shortness of breath), right side abdominal pain, swelling in hands & feet (edema) & nausea and vomiting. The three main symptoms are high blood pressure, swelling of hands & feet, and proteinuria. If these symptoms are present the physician will determine a diagnosis of preeclampsia. Often there are no symptoms so any changes during pregnancy should be promptly reported to the provider.

HIM FPX 4610 Assessment 6 Health Topic Presentation

Risk Factors

    There are many risk factors for pre-eclampsia and being aware of them can identify a potential risk of developing the condition. These factors include: the use of in vitro fertilization, obesity, older maternal age, autoimmune disorders such as lupus, kidney disease, type 1 or 2 diabetes present before pregnancy, chronic high blood pressure (HTN), carrying multiples, preeclampsia in a previous pregnancy, & a family history of the condition. “Although preeclampsia occurs primarily in first pregnancies, a woman who had preeclampsia in a previous pregnancy is seven times more likely to develop preeclampsia in a later pregnancy” (Duckitt, 2016). 

 Complications

   Preeclampsia can cause serious complications for the mother which may include: cardiovascular disease, pulmonary edema, acute renal failure which may require dialysis, eclampsia (seizures) HELLP syndrome with or without liver damage, placental abruption, retinal detachment, stroke, respiratory distress, and death.  HELLP syndrome is a liver and blood clotting disorder that affect pregnant women. Also known as hemolysis, it is rare, life threatening and require urgent medical attention. A timely diagnosis is required to reduce mortality. “The mortality rate of women with HELLP syndrome is 0 to 24%, with a perinatal death rate of up to 37%” (van Lieshout, 2019).

   Fetal complications include hypoxia (low level of oxygen in tissues), preterm birth (before 37 weeks), fetal growth restriction, death there can be some long-term effects as well such as a neurological deficit, cerebral palsy, and cardiovascular disease.

Diagnosis

   Preeclampsia is diagnosed if high blood pressure develops at or after 20 weeks of pregnancy with one other factor present which include proteinuria, low blood platelet count, elevated liver enzymes, pulmonary edema, vision changes, new onset of headaches not resolved by medication, signs of kidney problems. Blood pressure will be monitored closely at every prenatal appointment. Regular symptoms of pregnancy such as headaches, SOB, & weight gain/swelling can cause the condition to go misdiagnosed.

Tests

  Preeclampsia screening is important to identify and diagnose the condition early so that mom can be monitored and condition can be managed. Tests include urine analysis and blood tests (CBC), ultrasound (monitor fetal growth), a non-stress test is performed to monitor baby heartrate during movement, and a biophysical profile is performed to measure the baby’s breathing, muscle tone, movement and volume of amniotic fluid.

Treatment

   The primary treatment is to deliver the baby or manage the condition until the baby can be safely delivered. Physicians will make the decision to deliver the baby based on the severity of the condition, vital signs will continue to be closely monitored. In severe cases the provider may admit the mother to the hospital for close monitoring of complications. Severe preeclampsia is treated with medications which include antihypertensive drugs to lower the blood pressure, anticonvulsant such magnesium sulfate to prevent seizures, and corticosteroids will be administered to help baby lung development. “The American College of Obstetricians recommends that healthcare providers closely monitor women who had high blood pressure or preeclampsia during pregnancy for 72 hours after delivery, either at home or in the hospital” (Leeman, 2016).

Prevention

    If one or more moderate or one high risk factor is present healthcare provider may recommend a low dose aspirin after 12 weeks of pregnancy. It is important to talk with your provider before taking any over-the-counter drugs yourself. “The best clinical evidence for prevention of pre-eclampsia is the use of low dose aspirin” (JAMA, 2021). 

Prognosis

     I diagnosed early it can be treated and managed to keep mother and baby safe and healthy. It’s important to attend all appointments and to report any changes or gut feeling of doom to the provider that may be experienced throughout the pregnancy. “African American women have case fatality rates related to preeclampsia 3 times higher than rates among white women (73.5 vs. 27.4 per 100,000 cases). Higher prevalence and case fatality rates factor into why African American women are 3 times more likely to die of preeclampsia than whit women. Inequalities in access to adequate prenatal care may contribute to poor outcomes associated with preeclampsia in African American women” (Henderson, 2017).

Support 

“Preterm birth is a live birth that occurs before 37 completed weeks of pregnancy. Approximately 15 million babies are born preterm annually worldwide, indicating a global preterm birth rate of about 11%” (Walani, 2020).

   Seeking support for high-risk pregnant women would be a great way to gain knowledge, encouragement, and support from other women with similar circumstances in a safe space that feelings can be expressed. There are many nonprofit organizations that offer support, provide education, and is bringing public awareness to this condition and other pregnancy related conditions. Highlighted here is two organizations that advocate for the health of moms and babies, whose missions is to reduce maternal and infant illness/death.

  1)  Preeclampsia Foundation- can be contacted at www.preeclampsia.org.

  2) March of Dimes Organization can be contacted at 888-MODIMES (888-663-4637)

Conclusion

   Preeclampsia is a complication of pregnancy some signs and/or symptoms include high blood pressure, high levels of protein in the urine indicating kidney damage, and other signs of organ damage. Being open with healthcare providers about any changes during pregnancy is important to monitor for this serious condition. If left untreated there can be serious complications to the mother and baby including death.

HIM FPX 4610 Assessment 6 Health Topic Presentation

References

Duckitt K., & Harrington D. (2005). Risk factors for pre-eclampsia at 

       antenatal booking: Systematic review of controlled studies. British 

       Medical Journal, 330(7491), 565. Retrieved December 30, 2016

       https://www.ncbi.nlm.nih.gov/pmc/articles/PMC554027 [In-text Citation]

Henderson JT, Thompson JH, Burda BU, Cantor A, Beil T, Whitlock EP. Screening for Preeclampsia: A Systemic Evidence Review

       for the U.S. Preventive Services Task Force. Evidence synthesis no. 148. AHRQ publication no. 14-05211-EF-1.

       Rockville, Md.:  Agency for Healthcare Research and Quality; 2017.

Leeman L., Dresang L.T., & Fontaine P. (2016). Hypertensive disorders of pregnancy. American Family Physician, 93(2), 121-127.

        retrieved November 15, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/26926408.

Mendola P., Mumford S. L., Mannisto T. I., Holston A., Reddy U. M., & Laughon S. K. (2015). Controlled direct effects of 

       pre-eclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology, 26(1), 17-26.

       Retrieved January 4, 2017, https://www.ncbi.nlm.nih.gov/pubmed/25437315 [In-text citation]

Screening for Preeclampsia: Recommendation Statement (2018).  https://www.aafp.org

Van Lieshout LCEW, Koek GH, Spaanderman MA, van Runnard Heimel PJ. Placenta derived

          factors involved in the pathogenesis of the liver in the syndrome of haemolysis,

          elevated liver enzymes and low platelets (HELLP): A review. Pregnancy Hypertens. 2019 

Walani SR. Global burden of preterm birth. Int J Gynaecol Obset. 2020 Jul; 150(1): 31-33. https://doi.10.1002/ijgo.13195.

What are the risks of pre-eclampsia & eclampsia to the fetus? (2017). https://www.nichd.nih.gov

Who is at risk of pre-eclampsia? (2022). https://www.nichd.nih.gov 

U.S. Preventive Services Task Force, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive 

       Services Task Force recommendation statement. JAMA. 2021; https://doi:10. 1001/jama.2021.14781

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