Al- Quds University ‫جامعة القدس ابو ديس‬

Faculty of Health professions Midwifery ‫كلية المهن الصحية دائرة القبالة‬

Department
‫ ابوديس‬-‫القدس‬
Jerusalem-Abu Dies

High Risk pregnancy case study

In

Ramallah Governmental Hospital

Midwife Instructor: kafa Abu Salah

Midwife Student : Aya Alnatsheh

 Introduction :

Pre-eclampsia is a serious condition that can emerge during pregnancy, characterized by

high blood pressure and organ damage. It requires close monitoring, timely intervention,
and appropriate management to prevent complications and ensure the well-being of both the
mother and the baby. Through regular prenatal care and working closely with healthcare
providers, women at risk for pre-eclampsia can receive the necessary support and
interventions to have a safe and successful pregnancy.

By choosing this case, I will learn to deal with all of this situation in all its aspects to the
mother and the fetus.

 Demographic data :

Name : R.F - G2P1

Age: 25 years Married women
Address: Ramallah
Occupation : housewife

Reason for hospitalization : this pregnant woman presented from ORC as a case of PET
(Preeclampsia is one high blood pressure (hypertension) disorder that can occur during
pregnancy. Other disorders can happen, too: Gestational hypertension is high blood pressure
that begins after 20 weeks without problems in the kidneys or other organs ).

Chief complaint:
the lady was admitted to our hospital 7/11/2023 ,as a case of PET.
complaint : a 25-year-old woman in her second pregnancy, presents to the antenatal clinic
with complaints of persistent headaches, swelling in her hands and face, and occasional
visual disturbances.

Vital signs :
Bb : 145/90 T : 36.2 p: 92 bpm

Family history & sociocultural assessment:

Her father has diabetes and her mother has hypertension

Cultural Beliefs: She said she wants family planning to be physically comfortable.

Economic situation: She says that her economic situation is good, they are middle class, and
her husband works as an accountant in a bank.

Women History:

History of allergy to medications, food environment :

There are no known drug allergies

Medical and Surgical history :

One caesarean section and free medical history.

Gynecologic history:
The patient did not suffer from any vaginal or urinary infections during pregnancy, but
before pregnancy she had a urinary tract infection and it was treated, She has no prior
gynecological problems or diseases.

Menstrual history
Family planning history : She was using the IUD method to planning pregnancy

Elimination history: About two months before this pregnancy occurred.

Past obstetrical history:

Had a previous cesarean section due to a breech presentation in her first pregnancy.

Date of Delivery GA Type of Delivery Male / Female Complication

2020 Term C/S Male No Complication

History / complication of present pregnancy

G2 P1 A0

LMP: 12/4/2023
EDD: 17/1/2024
Gestational age: 30+1 week
ANC : The patient goes to monitor the pregnancy naturally approximately every month and
a half and takes the medications prescribed during pregnancy, such as iron and folic acid.
blood group : A +
RH : positive
Hepatitis : Negative
HB:10.2
Wt gain: Before pregnancy, the patient's weight was 70kg , and during pregnancy her
weight became 85 kg, WT gain 15kg .

CTG: Fetal heart rate and contraction are normal.

Minor discomforts: moderate pain present in the lower back , suprapubic area and
bilateral Flank pain .
 History:
pregnancy has been progressing well until the past two weeks when she started
experiencing severe headaches that do not respond to over-the-counter pain relievers. She
also noticed significant swelling in her hands and face, particularly in the mornings. On a
few occasions, she had noticed blurred vision that resolved spontaneously after a short
period. she denies any history of hypertension, diabetes, or kidney disease. She has been
attending regular prenatal check-ups and all previous blood pressure measurements have
been within the normal range.

Physical Examination:
During the physical examination, blood pressure is found to be elevated at 140/95 mmHg.
Her weight gain during pregnancy is within the expected range, and her fundal height
corresponds to 30 weeks of gestation. There is generalized edema noted in her hands, face,
and lower extremities. No other abnormalities are detected on examination.

Based on symptoms, physical examination findings, and diagnostic test results, she is
diagnosed with pre-eclampsia. The persistent elevated blood pressure, presence of
proteinuria, and symptoms such as headaches, swelling, and visual disturbances indicate a
need for further management and monitoring.

Pt seen by U/S by doctor Khalid , The movement of the fetus was good, its weight matched
its age, and the water on the fetus was good, so she was admitted to the hospital to regulate
her blood pressure and monitor the condition of the mother and child.
( BP :135/91. HR: 85 T: 36,9 ) 7/11/2023.

 U/S details:
 The volume of amniotic fluid around the fetus is normal
 Cephalic
 The weight of the fetus is 2 kilograms
 Placenta is upper (normal)
 There are no problems or deformities to the fetus
 Fetal pulse Rate: 140 beat per minute.

Physical assessment and examination :

 General appearance:
The patient is fully conscious, her skin color is white, her eyes are black, her height is 165
cm, her weight is 85 kilograms, and she is 30 weeks pregnant, mild swelling in her hands
and face.

 Chest and heart:

The patient does not have heart or respiratory diseases, her breathing rate is normal, 16
breaths per minute, and pulse 80 beats per minute, but the patient has difficulty sleeping and
 feels pressure on her chest.

 Breast/ nipple exam:

The size of the breasts is normal and similar in size, The color of the nipples is dark brown
and the nipples are naturally prominent, There is some melasma on the breasts, The color of
the breasts is white and there is no pain or lumps or wounds in the breasts.

Abdomen Exam
1-inspection findings: The abdomen appears round and oval in shape and abdominal size
is normal and fundal height It is proportional with GA 30wks ,Skin appears smooth and
natural in colour, striae are clear, Linea nigra is located in the middle of the abdomen in a
clear brown colour, There are few pregnancy lines on the abdomen and stretch marks
(stria), there is hair on the abdomen, have edema and not varicose veins.

2-Palpation findings: palpate the abdomen and found that the abdomen was tight and not
tender, and there were no lumps, and the size of the abdomen was consistent with the age of
the feta’s, By palpation The lateral maneuver was set to hear the fetal heart where the back
of the fetus was palpated with both hands and it was on the left side lateral back maneuver,
By palpation, the position of the fetus was determined Longitudinal Lie Cephalic
Presentation and fetus head is not engaged, I could feel the fetus movements

3-Auscultation findings: fetal heart rate 140 is normal.

 Uterus :is normal and Anteverted position , There are no deformities or deviations in the
uterus, fibroids, etc.

 Bowel sounds : The patient said that she goes to the bathroom to defecate twice a day and
does not suffer from constipation or diarrhea

 Pelvic exam : Not Done

 Legs : The patient does not suffer from varicose veins or DVT , but she noticed swelling
and Edema in her feet

 Bladder function: The patient said that she goes to the bathroom day and night and
urinates more than 10 times a day, but she does not suffer from any urinary infections.

 Emotional status: The patient is in good health and fully prepared to receive her baby, She
is very cheerful and has no signs of stress or anger, but she is a little tired and her
psychological and emotional state is good.

Medication
 Name Dose Rout Side effect Using to
treat high blood pressure
Dizziness, and to control angina
Nifedipine 30mg Orally lightheadedness, or (chest pain). Nifedipine is
2*2 fainting may occur, in a class of medications
especially when you called calcium-channel
get up suddenly from blockers. It lowers blood
a lying or sitting pressure by relaxing the
position. These blood vessels so the heart
symptoms are more does not have to pump as
likely to occur when hard
you begin taking this
medicine, or when
the dose is increased.
This medicine may
cause fluid retention
(edema) in some
patient
Trandate 100mg Orally  dizziness, High blood pressure. High
1*2 drowsiness, tiredness; blood pressure in pregnant
 nausea, vomiting; women. Angina (chest
 sudden warmth, pains) if you already have
high blood pressure
skin redness, sweating;
 numbness; or.
dexamethasone First IM Aggression · agitation · Dexamethasone accelerates
doese anxiety · blurred vision · maturation of fetal lungs,
decrease in the amount of decrease number of
urine · dizziness · neonates with respiratory
distress syndrome and
improves survival in
preterm delivered
neonates.

 The patient was not prescribed IV treatment.

Laboratory investigation :
Urinary spescimen

Appearance Turbid Blood Trace

color Yellow Urobilinogen Normal
PH 5.0 WBC +3 (˃1000)
Specific gravity 1.025 RBC 4/ul
Protein +2

Blood

Blood test
Test Range Normal range
WBC 8 3.5-10.0
LYM 2.3 0.5-5.0
MID 0.5 0.1-1.5
GRAN 6.7 1.2-8.0
LYM % 22.1 15.0-50.0
MID% 5.9 2.0-15.0
GRA% 72.0 35.0-80.0
RBC 3.96 3.50-5.50
HGB 11.2 11.5-16.5
HCT 28.9 35.0-55.0
MCV 73.0 75.0-100.0
MCH 25.8 25.0-35.0
MCHC 35.4 31.0-38.0
PLT 301 100-400
MPV 8.6 8.0-11.0
PDW 12.3 0.1-99.9
PCT 0.26 0.01-9.99
LPCR 19.6 0.1-99.9
RDW% 13.0 11.0-16.0
RDWa 48.9 30.0-150.0

 Finding and interpretation:

pregnancy will be closely monitored to ensure the well-being of both her and the
baby. With appropriate management and regular follow-up, the healthcare team aims
to minimize the risks associated with pre-eclampsia and optimize the outcome of the
pregnancy. The plan will involve close collaboration between she, her healthcare
provider, and other members of the healthcare team to provide comprehensive care
and ensure the best possible outcome for both mother and baby.
The pressure will be monitored by toxemic chart .

Pathophysiology of the disease :

 What is preeclampsia?

Preeclampsia is a serious condition that can happen after the 20th week of pregnancy or after giving birth (called
postpartum preeclampsia). In addition to causing high blood pressure, it can cause organs, like the kidneys and
liver, to not work normally. Blood pressure is the force of blood that pushes against the walls of your arteries. High
blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too
high. Arteries are blood vessels that carry blood away from your heart to other parts of the body. Having high blood
pressure can stress your heart and cause problems during pregnancy.

Preeclampsia is a serious health problem for women around the world. Between 10 to 15 percent of maternal deaths
worldwide are caused by preeclampsia and associated complications, such as eclampsia. In the United States, it
affects between 5 to 8 percent of pregnancies, and in most cases leads to preterm birth. Preterm birth is birth that
happens too early, before 37 weeks of pregnancy.

Most women with preeclampsia have healthy babies. But if not treated, it can cause severe health problems for you
and your baby.

What are the signs and symptoms of preeclampsia?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing.
Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of preeclampsia include:

 High blood pressure with or without protein in the urine. Your provider will check these during your prenatal visit.
 Changes in vision, like blurriness, flashing lights, seeing spots or being sensitive to light
 Headache that doesn’t go away
 Nausea (feeling sick to your stomach), vomiting or dizziness
 Pain in the upper right belly area or in the shoulder
 Sudden weight gain (2 to 5 pounds in a week)
 Swelling in the legs, hands or face
 Trouble breathing

Many of these signs and symptoms are common discomforts of pregnancy. If you have even one sign or symptom,
call your provider right away. Sometimes you don't realize you have preeclampsia. Go to all your prenatal visits,
even if you feel fine. That’s the best way to detect preeclampsia.

Can taking low-dose aspirin help reduce your risk for preeclampsia and preterm birth?

For some women, yes. If your provider thinks you’re at risk for preeclampsia, low-dose aspirin may be
recommended to help prevent it. Low-dose aspirin also is called baby aspirin or 81 mg (milligrams) aspirin. Talk to
your provider to see if treatment with low-dose aspirin is right for you.

You can buy low-dose aspirin over-the-counter, or your provider can give you a prescription for it. If your provider
wants you to take low-dose aspirin to help prevent preeclampsia, take it exactly as it’s recommended. Don’t take
more or take it more often than your provider says.

If you’re at high risk for preeclampsia, your provider may want you to start taking low-dose aspirin after 12 weeks
of pregnancy. If you have diabetes or high blood pressure, your provider may ask you to take low-dose aspirin.

According to the American College of Obstetricians and Gynecologists (also called ACOG), daily low-dose aspirin
use in pregnancy has a low risk of serious complications and its use is considered safe.

Are you at risk for preeclampsia?

We don’t know for sure what causes preeclampsia, but there are some things that may make you more likely than
other women to have it. These are called risk factors. If you have even one risk factor for preeclampsia, tell your
provider.

You’re at high risk for preeclampsia If:

 You’ve had preeclampsia in a previous pregnancy. The earlier in pregnancy you had preeclampsia, the higher your
risk is to have it again. You’re also at higher risk if you had preeclampsia along with other pregnancy
complications.
 You’re pregnant with multiples (twins, triplets or more).
 You have high blood pressure, diabetes, kidney disease or an autoimmune disease like lupus or antiphospholipid
syndrome. Diabetes is when your body has too much sugar in the blood. This can damage organs, like blood
vessels, nerves, eyes and kidneys. An autoimmune disease is a health condition that happens when antibodies (cells
in the body that fight off infections) attack healthy tissue by mistake.

Other risk factors for preeclampsia:

 You’ve never had a baby before, or it’s been more than 10 years since you had a baby.
 You’re a person who has obesity. Obese means being very overweight with a body mass index (also called BMI) of
30 or higher. To find out your BMI.
 You have a family history of preeclampsia. This means that other people in your family, like your sister or mother,
have had it.
 You had complications in a previous pregnancy, like having a baby with low birthweight. Low birthweight is when
your baby is born weighing less than 5 pounds, 8 ounces.
 You had fertility treatment called in vitro fertilization (also called IVF) to help you get pregnant.
 You’re older than 35.

Some groups, such as African-American women and those who are affected by lower income, are also at higher risk
of complications like preeclampsia. Historically, in the United States, these groups have had a harder time getting
good quality health care and access to treatments that prevent illness. This has led to serious health disparities and
 unequal health outcomes. Talk to your provider about your risk factors and about what you can do to stay healthy
and reduce your chances of having a preterm birth. If your provider thinks you’re at risk of having preeclampsia,
ask if treatment with low-dose aspirin is right for you.

How can preeclampsia affect you and your baby?

Without treatment, preeclampsia can cause serious health problems for you and your baby, even death. You may
have preeclampsia and not know it, so be sure to go to all your prenatal care checkups, even if you’re feeling fine.
If you have any sign or symptom of preeclampsia, tell your provider.

Health problems for women who have preeclampsia include:

 Kidney, liver and brain damage

 Problems with how your blood clots. A blood clot is a mass or clump of blood that forms when blood changes
from a liquid to a solid. Your body normally makes blood clots to stop bleeding after a scrape or cut. Problems with
blood clots can cause serious bleeding problems.
 Eclampsia. This is a rare and life-threatening condition. It’s when a pregnant woman has seizures or a coma after
preeclampsia. A coma is when you’re unconscious for a long period of time and can't respond to voices, sounds or
activity.
 Stroke. This is when the blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot
blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open.

Pregnancy complications from preeclampsia include:

 Preterm birth. Even with treatment, you may need to give birth early to help prevent serious health problems for
you and your baby.
 Placental abruption. This is when the placenta separates from the wall of the uterus (womb) before birth. It can
separate partially or completely. If you have placental abruption, your baby may not get enough oxygen and
nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If
you have vaginal bleeding during pregnancy, tell your health care provider right away.
 Intrauterine growth restriction (also called IUGR). This is when a baby has poor growth in the womb. It can
happen when mom has high blood pressure that narrows the blood vessels in the uterus and placenta. The placenta
grows in the uterus and supplies your baby with food and oxygen through the umbilical cord. If your baby doesn’t
get enough oxygen and nutrients in the womb, he may have IUGR.
 Low birthweight

Having preeclampsia increases your risk for postpartum hemorrhage (also called PPH). PPH is heavy bleeding after
giving birth. It’s a rare condition, but if not treated, it can lead to shock and death. Shock is when your body’s
organs don’t get enough blood flow.

Having preeclampsia increases your risk for heart disease, diabetes and kidney disease later in life.

How is preeclampsia diagnosed?

To diagnose preeclampsia, your provider measures your blood pressure and tests your urine for protein at every
prenatal visit. Additional lab work evaluating your blood count, clotting factors, liver and kidney function are also
assessed.

Your provider may check your baby’s health with:

 Ultrasound. This is a prenatal test that uses sound waves and a computer screen to make a picture of your baby in
the womb. Ultrasound checks that your baby is growing at a normal rate. It also lets your provider look at the
placenta and the amount of fluid around your baby to make sure your pregnancy is healthy.
 Nonstress test. This test checks your baby’s heart rate.
 Biophysical profile. This test combines the nonstress test with an ultrasound.
 Doppler analysis. This is a sonographic test to evaluate the blood flow through the baby’s umbilical cord -- it can
provide information as to how blood flow -- which carries oxygen - is getting to your baby
 Treatment depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you
have mild preeclampsia, you need treatment to make sure it doesn’t get worse.

How is mild preeclampsia treated?

Most women with mild preeclampsia are delivered by 37 weeks of pregnancy . If you have mild preeclampsia
before 37 weeks:

 Your provider checks your blood pressure and urine regularly. It’s possible that you may need to stay in the hospital
to be monitored closely. If you’re not in the hospital, your provider may want you to have checkups once or twice a
week. You may also need to take your blood pressure at home.
 Your provider may ask you to do kick counts to track how often your baby moves. There are two ways to do kick
counts: Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your
provider. Or three times a week, track the number of times your baby moves in 1 hour. If the number changes, tell
your provider.
 If you’re at least 37 weeks pregnant and your condition is stable, your provider may recommend that you have your
baby early. This may be safer for you and your baby than staying pregnant. Your provider may give you medicine
or break your water (amniotic sac) to make labor start. This is called inducing labor.

How is severe preeclampsia treated?

If you have severe preeclampsia, you most likely stay in the hospital so your provider can closely monitor you and
your baby. Your provider may treat you with medicines called antenatal corticosteroids (also called ACS). These
medicines help speed up your baby’s lung development. You also may get medicine to control your blood pressure
and medicine to prevent seizures (called magnesium sulfate).

If your condition gets worse, it may be safer for you and your baby to give birth early. Most babies of moms with
severe preeclampsia before 34 weeks of pregnancy do better in the hospital than by staying in the womb. If you’re
at least 34 weeks pregnant, your provider may recommend that you have your baby as soon as your condition is
stable. Your provider may induce your labor, or you may have a c-section. If you’re not yet 34 weeks pregnant but
you and your baby are stable, you may be able to wait to have your baby.

If you have severe preeclampsia and HELLP syndrome, you almost always need to give birth early. HELLP
syndrome is a rare but life-threatening liver disorder. About 2 in 10 women (20 percent) with severe preeclampsia
develop HELLP syndrome. You may need medicine to control your blood pressure and prevent seizures. Some
women may need blood transfusions. A blood transfusion means you have new blood put into your body.

If you have preeclampsia, can you have a vaginal birth?

Yes. If you have preeclampsia, a vaginal birth may be better than a cesarean birth (also called c-section). A c-
section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. With
vaginal birth, there's no stress from surgery. For most women with preeclampsia, it’s safe to have an epidural to
manage labor pain as long as your blood clots normally. An epidural is pain medicine you get through a tube in
your lower back that helps numb your lower body during labor. It's the most common kind of pain relief during
labor.

What is postpartum preeclampsia?

Postpartum preeclampsia is a rare condition. It’s when you have preeclampsia after you’ve given birth. It most
often happens within 48 hours (2 days) of having a baby, but it can develop up to 6 weeks after a baby’s birth. It’s
just as dangerous as preeclampsia during pregnancy and needs immediate treatment. If not treated, it can cause life-
threatening problems, including death.

Signs and symptoms of postpartum preeclampsia are like those of preeclampsia. It can be hard for you to know if
you have signs and symptoms after pregnancy because you’re focused on caring for your baby. If you do have signs
or symptoms, tell your provider right away.
 We don’t know exactly what causes postpartum preeclampsia, but these may be possible risk factors:

 You had gestational hypertension or preeclampsia during pregnancy. Gestational hypertension is high blood
pressure that starts after 20 weeks of pregnancy and goes away after you give birth.
 You’re obese.
 You had a c-section.

Complications from postpartum preeclampsia include these life-threatening conditions:

 HELLP syndrome
 Postpartum eclampsia (seizures). This can cause permanent damage to our brain, liver and kidneys. It also can
cause coma.
 Pulmonary edema. This is when fluid fills the lungs.
 Stroke
 Thromboembolism. This is when a blood clot travels from another part of the body and blocks a blood vessel.

Your provider uses blood and urine tests to diagnose postpartum preeclampsia. Treatment can include magnesium
sulfate to prevent seizures and medicine to help lower your blood pressure. Medicine to prevent seizures also is
called anticonvulsive medicine. If you’re breastfeeding, talk to your provider to make sure these medicines are safe
for your baby.

Midwifery care plan:

Assessment Planning pt out Midwifery Rationale

comes intervention
1. Regularly monitor 1. Regular blood pressure monitoring
Monitoring and Maintain blood blood pressure helps identify any sudden spikes or
Managing Blood Pressure pressure within a according to the sustained elevation, which are common
safe range to healthcare provider's signs of pre-eclampsia. It allows for early
prevent instructions. intervention to prevent complications such
1. Assess the patient's complications.. as eclampsia or organ damage.
blood pressure 2. Ensure the patient is
regularly and document positioned comfortably 2. Providing a comfortable and supported
the readings accurately. with proper support to position promotes relaxation and reduces
2. Monitor for signs and promote relaxation anxiety, which can help obtain accurate
symptoms of worsening during blood pressure blood pressure readings.
pre-eclampsia, such as measurements.
severe headaches, 3. Stress and lack of rest can contribute to
visual disturbances, 3. Ensure the patient is elevated blood pressure levels. Educating
epigastric pain, or positioned comfortably the patient about stress reduction
changes in mental with proper support to techniques and the significance of rest
status. promote relaxation promotes self-care and helps maintain
3. Assess the patient's during blood pressure blood pressure within a safe range.
general well-being, measurements.
including their level of 4. A calm environment reduces stress
consciousness, 4. Encourage the levels, which can positively impact blood
respiratory status, and patient to maintain a pressure control. Minimizing external
presence of any edema. quiet and calm stimuli and providing a serene atmosphere
environment to promote relaxation and support the
minimize stress. patient's well-being.
Monitoring Fluid 1. Monitor intake and 1.Monitoring I&O allows for the
Balance and Urine Promote adequate output (I&O) to assess assessment of fluid balance and helps
Output fluid balance and fluid balance. Measure identify any imbalances or abnormalities.
 monitor for signs and record urine output Accurate measurement of urine output
1. Monitor intake and of worsening pre- accurately. assists in monitoring renal function and
output (I&O) to assess eclampsia. detecting worsening pre-eclampsia.
fluid balance. Measure 2. Implement measures
and record urine output to reduce edema, such 2.Elevating the legs and using
accurately. as elevating the compression stockings promote venous
2. Assess for signs of fluid patient's legs and return and reduce dependent edema. These
overload, such as providing supportive measures help alleviate discomfort and
edema, weight gain, measures like improve peripheral circulation.
and changes in lung compression
sounds. stockings.. 3.Diuretics may be prescribed to manage
3. Monitor laboratory fluid retention in patients with pre-
values, including urine eclampsia. Administering diuretics as
protein levels, to assess 3.Administer diuretics prescribed helps improve fluid balance and
kidney function and as prescribed to control symptoms associated with
proteinuria. manage fluid retention. excessive fluid retention.

4. Monitor laboratory 4.Monitoring urine protein levels helps

values, including urine assess kidney function and detect
protein levels, to assess proteinuria, which is a common sign of
kidney function and pre-eclampsia. Regular monitoring assists
proteinuria. in evaluating the severity of the condition
and guiding appropriate interventions.
Fetal Monitoring and Ensure the well- 1. Utilize continuous 1.Continuous fetal monitoring allows for
Assessment being of the fetus fetal monitoring to the assessment ofthe baby's heart rate
and detect any assess the baby's patterns and detects any signs of fetal
signs of distress or heart rate and distress or compromise. It enables prompt
1. Utilize continuous fetal
complications. detect any intervention and appropriate management.
monitoring to assess the
abnormalities.
baby's heart rate and
2. Monitor fetal 2.Monitoring fetal movements helps assess
detect any
movements and the well-being of the baby. Changes or
abnormalities.
encourage the decreased fetal activity can indicate fetal
2. Monitor fetal
patient to report distress and require further evaluation to
movements and
any changes or ensure the baby's safety and well-being.
encourage the patient to
decrease in fetal
report any changes or
activity promptly. 3.Regular ultrasounds provide valuable
decrease in fetal
3. Perform regular information about fetal growth, amniotic
activity promptly.
ultrasounds to fluid levels, and placental health.
3. Perform regular
assess fetal growth Monitoring these parameters helps identify
ultrasounds to assess
and monitor any abnormalities or complications that
fetal growth and
amniotic fluid may require intervention.
monitor amniotic fluid
levels.
levels.
4.Collaborating with the healthcare
4. Collaborate with provider is essential to ensure timely
the healthcare decision-making regarding the timing and
provider to method of delivery. Close communication
determine the facilitates the best possible outcome for
appropriate timing the mother and baby, considering the
and method of severity of pre-eclampsia and the potential
delivery if the risks involved.
condition worsens
or if the mother 5.Fetal kick counts help the patient
and baby's health actively participate in monitoring the
is at risk. baby's well-being. Educating the patient
about the importance of fetal kick counts
5. Educate the patient and providing instructions on how to
about fetal kick perform them at home promotes maternal
counts and provide engagement and early detection of any
guidance on how changes in fetal activity.
to perform them at
 home.

Teaching to the patients

When teaching patients about pre-eclampsia, it's important to provide clear and
accurate information about the condition, its signs and symptoms, potential
complications, and the importance of regular prenatal care. Here are some key points
to cover when educating patients about pre-eclampsia:
1. Definition and Overview:
 Explain that pre-eclampsia is a pregnancy-related condition
characterized by high blood pressure and the presence of protein in the
urine.
 Emphasize that pre-eclampsia typically occurs after the 20th week of
pregnancy and can affect both the mother and the baby.
2. Signs and Symptoms:
 Discuss common signs and symptoms of pre-eclampsia, such as high
blood pressure (above 140/90 mmHg), sudden swelling of the hands,
face, or feet, severe headaches, visual disturbances (e.g., blurred vision
or seeing spots), and abdominal pain.
 Encourage patients to promptly report any unusual symptoms to their
healthcare provider.
3. Risk Factors:
 Review factors that may increase the risk of developing pre-eclampsia,
such as a history of pre-eclampsia in a previous pregnancy, chronic
hypertension, obesity, advanced maternal age, multiple pregnancies
(e.g., twins or triplets), and certain medical conditions (e.g., diabetes,
kidney disease).
 Highlight the importance of discussing these risk factors with their
healthcare provider to ensure appropriate monitoring and management.
4. Prenatal Care and Monitoring:
 Stress the significance of regular prenatal visits and the importance of
attending all scheduled appointments.
 Explain that prenatal care involves monitoring blood pressure, testing
urine for protein, and assessing fetal well-being through techniques
such as ultrasound and fetal heart rate monitoring.
 Encourage patients to actively participate in their prenatal care by
following medical recommendations, adhering to a healthy lifestyle,
and reporting any concerns or symptoms promptly.
5. Complications and Potential Risks:
 Discuss potential complications of pre-eclampsia, including organ
damage (such as liver or kidney dysfunction), seizures (eclampsia),
stroke, placental abruption (separation of the placenta from the uterus),
and poor fetal growth.
 Emphasize that early detection and appropriate management can help
reduce the risks associated with pre-eclampsia.
6. Self-Care Strategies:
 Educate patients about self-care strategies to help manage pre-
eclampsia, such as maintaining a healthy diet (low in sodium and rich
 in fruits and vegetables), getting regular exercise as advised by their
healthcare provider, staying well-hydrated, and getting adequate rest.
 Discuss the importance of avoiding smoking, alcohol, and illicit drugs
during pregnancy.
7. Treatment and Management:
 Explain that the management of pre-eclampsia may involve close
monitoring, blood pressure control, medication if necessary, and
potentially early delivery of the baby in severe cases.
 Address any concerns or questions the patient may have about the
treatment plan and emphasize the need for regular follow-up with their
healthcare provider.
8. Support and Resources:
 Provide information about support resources, such as prenatal
education classes, support groups, and online communities where
patients can connect with others going through similar experiences.
 Encourage patients to reach out to their healthcare provider or
healthcare team if they have any questions, concerns, or need
additional support.

References:
Stephens, A. J., Baker, A., Barton, J. R., Chauhan, S. P., & Sibai, B. M. (2022). Clinical
findings predictive of maternal adverse outcomes with pyelonephritis. American Journal of
Obstetrics & Gynecology MFM, 4(2), 100558.