Pre-eclampsia and Complications Associated

Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).

Medical and technological advances in maternal and neonatal care have significantly reduced maternal and infant mortality and medical interventions have become commonplace and arguably routine. Used appropriately, they can be lifesaving procedures. Routine use, without valid indication though, can transform childbirth from a natural physiologic process and family event into a medical or surgical procedure. Every intervention presents the possibility of unwanted effects and subsequent risks that can potentiate more interventions with their own inherent risks (McKinney, 2014).

As woman age, they will find that pregnancy can be extra hard on the body, causing health issues such as high blood pressure, with some woman developing preeclampsia. Preeclampsia, a pregnancy-induced hypertension disorder which affects both mother and fetus poses the real possibility of impacting renal function along with the development of HELLP syndrome. When a woman develops this HELLP syndrome they are a risk of hemolysis; the breakdown of red blood cells, elevated liver enzymes, and low plate count putting her a greater risk of complications that cause death (Preeclampsia Foundation, pg1). The only known way to cure this disorder is to deliver the baby and placenta, even if the baby is premature because not only can this kill the mother, but it has repercussions for the fetus as well. When it comes to the fetus, preeclampsia causes an inadequate nutrition supply because of the insufficiency of the placenta to regulate how the fetus gets its nutrients, which can lead to growth retardation and further heath compilations later in life (Lapidus MD,

The stern figures of the global burden of pregnancy-related deaths are now so well known. Every year, approximately eight million women suffer pregnancy-related complications 289 000 women die due to complications in pregnancy and childbirth, and 6.6 mil¬lion children below 5 years of age die of complications in the newborn period and of common childhood diseases. Worldwide, the majority of maternal and newborns deaths occur around the time of birth, typically within the first 24 hours after childbirth. In developing countries, one woman in 16 may die due to pregnancy-related complications compared to one in 2800 in developed countries. Many of these maternal and neonatal deaths more than 80% of could be prevented or avoided through actions

Obstetric haemorrhage, or heavy bleeding during pregnancy, can take place either before or after delivery.(1)The most common obstetric difficulty is postpartum haemorrhage, commonly characterised by blood loss of 500ml or more within 24 hours after delivery.(2)With postpartum haemorrhage affecting almost 2% of all woman who give birth(2), minimising the risks in paramedic practice is imperative. Ways to minimise the risk of postpartum haemorrhage in paramedic practice began by focusing only on psychological management of the third stage of labour although now, due to higher educational programs, paramedics are introduced to active management of the third stage. This includes administering drugs such as oxytocin, ergometrine and misoprostol,

Sherry is a 39yo, G1 P0 female, who is now 37 weeks 3 days, who is admitted with preeclampsia and vaginal bleeding.

Eclampsia is a known cause of significant maternal and fetal death secondary to pulmonary edema and cerebrovascular hemorrhage. (1) One UK study found that of women presenting with eclampsia, one out of 14 of the infants did not survive. (3) This word “eclampsia” literally means lightning, and appropriately so considering its rapid onset and often-fatal outcome. While many women receive high quality, consistent prenatal care, many others do not. As a result, early signs of pre-eclampsia can easily be over looked. Additionally, because these same women often live a significant distance from adequate neonatal resources, without rapid emergency intervention they would likely have a negative outcome in the pregnancy. For this reason, it

A total of 90 patients were admitted to the ICU during the study period. This represents 0.65 percent of all deliveries during this time, an incidence of 6.5 percent obstetric admissions per 1000 deliveries. This rate was almost similar to studies done by other authors2, 5, and 6. But this rate is lower compared to some other studies 3, 7. In the present study post-partum admissions accounted for 62%. Several other studies have also reported a majority of postpartum admissions 15, 16, 17, 18 Several other studies have reported a majority of antepartum admissions 12, 19 and admissions on the delivery 3,20.

Unfortunately, five to eight percent of all pregnancies are affected by preeclampsia and it is also one of the main causes of premature births and maternal deaths. As it is a multisystem disorder, therefore it also badly affects the other pre-existing maternal disorders like chronic hypertension and in such cases it is called as "superimposed preeclampsia". Moreover it can affect different organs and systems of the body, like the kidneys, circulatory system and the cardiovascular system.

. It is more likely that preeclampsia is predominantly placental or predominantly maternal. Early-onset and late-onset pre-eclampsia have different attributes and are now generally accepted as subtypes of preeclampsia (von Dadelszen, Magee and Roberts, 2003). Although early-onset pre-eclampsia is considered primarily placental, there is also evidence for a much greater risk of later life maternal cardiovascular disease (Staff et al 2013). Hence, early-onset pre-eclampsia includes both placental and maternal components (Staff et al 2013).

Preeclampsia the disease of the first pregnancies. Preeclampsia has several potential adverse outcomes for a pregnant woman and the neonate. Preeclampsia can occur anywhere after the 20th week of pregnancy. Cunningham (2010) described preeclampsia as a continuum of worsening disease. Each case of preeclampsia varies in symptoms and severity depending on the health of the pregnant woman, and usually resolves after delivery within 2-3 weeks. “Healthcare indicators are shown to be useful to assess, monitor, and improve quality of care” (Wollersheim et al., 2007). Recognizing characteristics of preeclampsia can save maternal and fetal lives.

According to Ricci (2013), “The woman will be asked to monitor her blood pressure daily (every 4 to 6 hours while awake) and report any increased readings; she will also measure the amount of protein found in urine using a dipstick and will weigh herself for any weight gain”. Patient at this point has developed mild edema at this point in the disease, but it will be important to monitor for signs and symptoms of worsening of the disease. If severe preeclampsia is noted due to ineffective interventions and treatment, then a more vigorous treatment is needed. First, the patient is admitted to the hospital because this disease may be a danger to her life and the life of the fetus. It is recommended to be admitted because nurses and healthcare professionals can monitor closely and act if something happens. The treatment depends on person by person and fetal age. “The woman in labor with severe preeclampsia typically receives oxytocin to stimulate uterine contractions and magnesium sulfate to prevent seizure activity” (Ricci, 2013, p. 628). Magnesium sulfate should be monitored to ensure it is at therapeutic levels (4 to 7 mEq/L) because high levels can lead to respiratory distress and cardiac arrest. “Delivery of the fetus and placenta remains the only definitive treatment for preeclampsia to prevent maternal and fetal complications from disease progression” (Feulner, 2015, p. 56). This will depend on many factors including the severity of the

Sensitivity: probability that the test results will be positive when the disease is present (true positive rate, expressed as a percentage); Specificity: Probability that the test results will be negative when the disease is present (true negative rate, expressed as a percentage); Positive Predictive value (PPV: probability that the disease is present when the test is positive); Negative Predictive value (NPV: probability that the disease is present when the test is negative) and accuracy is the ratio of the true positive and true negative on all patients. Result was considered significant at a P value of 400ml/24hrs). Oliguria was found in 25% of severe preeclampsia cases as shown in Table (1).

Aspirin is used in an effort to prevent preeclampsia due to its ability to correct a disproportion of thromboxane A2 and prostacyclin. However, “a large double-blind, randomized, placebo-controlled trial conducted in the United States enrolled 2539 women and found that low-dose aspirin did not significantly reduce the incidence of preeclampsia” (Townsend & Drummond, 2011, p. 247). Currently, aspirin is not recommended by the American Congress of Obstetricians and Gynecologists who are at low risk for this condition.

Mrs. Livingston needs to maintain a systolic blood pressure less than 150 mmHg, and a diastolic pressure less than 100 mmHg to prevent the risk of preeclampsia during pregnancy (Carson & Chen, 2014, p.129). For this reason, labetalol and methyldopa are the first-line drugs for pregnant women with hypertension (Carson & Chem, 2014, p. 130). For Mrs. Livingston, labetalol will replace lisinopril to control her blood pressure. Furthermore, she will tolerate labetalol better than methyldopa because of the latter’s side effects of fatigue and drug-induced lupus