Content: Part 1 of a multi-part series on Preeclampsia
Additional Resources: Audio lessons available at nexusnursinginstitute.com
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Overview of Preeclampsia
Definition: Preeclampsia is a pregnancy-specific condition characterized by hypertension and proteinuria after 20 weeks of gestation in a woman who previously did not have these conditions.
Key Elements:
Hypertension
Proteinuria
Develops after 20 weeks gestation
Etiology
Higher Incidence in:
Multifetal gestation (twins, triplets, etc.)
History of preeclampsia
Chronic hypertension
Pre-existing diabetes
Pre-existing thrombophilias
Importance: Knowledge of risk factors is crucial for select-all-that-apply questions in exams.
Classifications of Hypertensive States
Preeclampsia: Hypertension and proteinuria after 20 weeks gestation.
Absence of Proteinuria: New onset hypertension with symptoms such as thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral/visual symptoms.
Pathophysiology
Progressive Disorder: Gets worse over time, with the placenta as the root cause.
Resolution: Begins post-partum after the placenta is expelled.
Current Thought: Disruptions in placental perfusion lead to pathologic changes.
Vascular Remodeling in Pregnancy: Normally, spiral arteries widen, increasing capacity for blood flow. In preeclampsia, this does not occur, resulting in decreased placental perfusion and hypoxia.
Diagnostic Criteria
Hypertension: BP > 140/90 mmHg at least twice, four hours apart, after 20 weeks gestation.
Proteinuria: > 300 mg in 24-hour specimen or protein creatinine ratio ≥ 0.3.
Lab Changes in Preeclampsia
Platelets: Decrease (<100,000).
BUN & Creatinine: Increased.
Creatinine Clearance: 130-180 (higher than normal).