Lecture Notes: Preeclampsia Management
Introduction
- Presenter: Professor D
- Topic: Patient management for preeclampsia (Part 3)
- Focus: Managing preeclampsia without severe features and with severe features
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Preeclampsia Without Severe Features
- Management:
- Most women can be managed at home with frequent monitoring
- Vaginal birth recommended at 37 weeks, induction if necessary
- Outpatient Management:
- Suitable for reliable women with controlled blood pressure (≤ 155/105)
- Regular diet without salt restriction (caution on added salt)
- Warning Signs for Immediate Medical Attention:
- Abdominal pain, significant headache, uterine contractions, vaginal spotting, decreased fetal movement
- Maternal and Fetal Assessment:
- Weekly checks: serum creatinine, platelet count, liver enzymes
- Blood pressure monitored twice weekly, proteinuria assessed weekly
- Fetal evaluation: daily movement counts, non-stress testing, biophysical profile
- Ultrasound for amniotic fluid and fetal weight
- Doppler studies if intrauterine growth retardation suspected
Activity Restrictions
- Recommendations:
- Partial bed rest
- Gentle exercises (e.g., range of motion, Kegel exercises)
- Diversionary activities to combat boredom
Severe Gestational Hypertension/Preeclampsia With Severe Features
- Hospitalization Required
- Treatment:
- Magnesium sulfate to prevent seizures
- Antihypertensive medication for blood pressure control
- Maternal Assessments: Blood pressure, urine output, cerebral status, epigastric pain, labor, vaginal bleeding
- Laboratory & Fetal Evaluation:
- Platelet count, liver enzymes, serum creatinine
- Continuous fetal heart monitoring, biophysical profile, ultrasound
- Doppler studies for fetal growth restriction
- Management:
- After 34 weeks: Immediate birth recommended
- Less than 34 weeks: Expectant management possible, with corticosteroids for fetal lung maturation
Indications for Immediate Birth
- Eclampsia, uncontrolled hypertension, pulmonary edema, placental abruption, DIC, non-reassuring fetal status, gestation <24 weeks, fetal demise
Conclusion
- Next Video: Intrapartum Care
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Note: Understanding these management strategies is crucial for nursing students and professionals involved in maternal-fetal healthcare.