This disease is progressive, and it can be unpredictable. It obviously affects pregnant women usually after 20 weeks' gestation. BUT...... What may surprise you is that it can also exist up to 6 weeks AFTER delivery in that immediate post partem period. On exam hypertension and proteinuria may be some of the hallmark signs + earliest clues that something may be going awry. This is why antepartum care is devoted in large part to blood-pressure screening for hypertension. This condition seems to be most common in first time moms, moms over the age of 35, and lastly in multigravid moms. The expectant mother may be totally symptom free, but as the pregnancy progresses, pre-eclampsia can become life threatening.
Most cases of preeclampsia arise at term and are mild and transient and resolve soon after the delivery. However, 5 to 20% of women, especially those in whom preeclampsia arises well before term, have life-altering, life-threatening, or fatal complications. If the pre-eclamptic patient starts to seize, things get a little more complicated and the diagnosis then coverts over to full blown eclampsia. If left untreated this can cause both maternal and fetal death.
A personal anecdote, my own mother had toxemia (the historic term for pre-eclampsia) and her BP was dangerously high. My twin and I were born emergently via c-section 3 months early and weighed < 4 lbs. combined. Safe to say it's a miracle any of us survived as this was nearly 40 years ago. Babies born at 27 weeks' gestation really had an uphill battle in the mid-80's.
Of note, while most pregnancies are benign and only require a BLS skill set, we cannot lose sight of the fact that pregnancy is a physiologic stressor for the mom to be. Lots of dramatic changes happen as they set up shop and prepare for the developing fetus over the next 9 months. Hormones and blood volume increase, the diaphragm elevates, and lung volumes decrease just to name a few. If mom has any baseline issues like HTN, DM, seizure disorders, they will tend to be exacerbated during the pregnancy. Close physician surveillance will be required, and the odds of early bed rest are nearly a guarantee. These same problems above also increase the chances that pre-eclampsia occurs.
The exact cause of preeclampsia is unknown. Many think it is likely related to abnormalities in the placental development taking place early in the pregnancy, leading to a lack of the normal dilation (enlargement) of the small arteries in the placenta, and reduced blood flow to the placenta, fetus, and pregnant woman’s organs.
Diagnosis requires at least (3) symptoms:
HTN, plus any of the following:
Visual disturbances
Altered mental status
The aforementioned proteinuria
Stroke
Elevated liver enzymes
Acute kidney injury (think severely reduced urine output)
Fluids (be careful and calculated around this therapy), Magnesium, and Benzodiazepines are the mainstays of treatment especially if seizures are occurring. The good news is that most of the seizures associated with eclampsia are self-limiting.
Prevention of preeclampsia is a health care priority, given that only delivery of the placenta has been proven to initiate the resolution of preeclampsia once it has developed. Exercise, ASA, and induction of labor have been studies as effective strategies towards prevention. Delivery of the baby is the DEFINITIVE treatment!!
June 24, 2024
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC