Peer Responses – Martha
- Length: A minimum of 170 words per post, not including references
- Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
- Relate to another journal reading
The International Society for the Study of Hypertension in Pregnancy (ISSHP) defines hypertensive disorders in pregnancy as new onset hypertension after 20 weeks of gestation, affecting 10% of pregnancies, including preeclampsia, gestational hypertension, and chronic hypertension (Fox et al., 2019). Hypertensive disorders during pregnancy can significantly impact the mother and fetus’ health, increasing the risk of stroke, cardiovascular death, and long-term hypertension. Prenatal risks include intrauterine growth restriction, oligohydramnios, placental abruption, and preterm birth. Exposure to these disorders during pregnancy can lead to serious long-term consequences (Fox et al., 2019).
Risk factors for preeclampsia include hypertensive disease history, maternal diseases such as diabetes, and chronic kidney disease (Fox et al., 2019). Additional risk factors include advanced maternal age, obesity, multifetal pregnancy, or long pregnancy intervals. Preeclampsia risk can be heightened by clinical factors such as elevated blood pressure, polycystic ovarian syndrome, sleep difficulties, and infections. Obstetric history, oocyte donation, and vaginal bleeding during pregnancy increase the risk of preeclampsia (Fox et al., 2019).
Aspirin is the only medication supported by research to lower preeclampsia risk in high-risk women. Current guidelines suggest low-dose aspirin from 12 weeks gestation to delivery (Fox et al., 2019).
Preeclampsia is a condition characterized by hypertension and new-onset proteinuria under 20 weeks gestation (Dynamedex, 2024). In the absence of proteinuria, one of the following criteria must be present: thrombocytopenia, impaired liver function, severe pain, elevated liver transaminases, new renal insufficiency, pulmonary edema, headache, and visual disturbances (Dynamedex, 2024).
Preeclampsia involves dysfunctional placentation, systemic inflammation, and oxidative stress (Fox et al., para. 12, 2019). It causes oligohydramnios, placental abruption, IGUR, preterm birth, chronic placental ischemia, and fetal distress, among adverse outcomes (Fox et al., para. 12, 2019).
The American College of Obstetricians and Gynecologists (ACOG) recommends that pregnant women with preeclampsia or hypertension undergo blood tests, including liver enzymes, electrolytes, serum creatinine, and platelet counts (Dynamedex, 2024). For women without severe features and under 37 weeks of gestation, ongoing observation, biweekly blood pressure monitoring, and weekly measurements of liver enzymes, serum creatinine, and platelet counts (Dynamedex, 2024).
Standard measures for fetal surveillance include monitoring fetal movements, biophysical profiles, cardiotocography, amniotic fluid volume assessment, ultrasound growth assessment, and ultrasound Doppler measurements (Fox et al., 2019).
Preeclampsia-related problems in the fetus are managed with antenatal corticosteroids and magnesium sulfate infusions to prevent adverse outcomes (Fox et al., 2019). The only effective treatment for preeclampsia is delivery. However, the delivery decision involves weighing the mother’s health against the fetus and gestation. Optimizing the mother’s health with antihypertensives (labetalol, nifedipine, methyldopa, or a beta-blocker) and magnesium sulfate may also benefit the fetus (Fox et al., 2019).
Patient education should include warning signs of preeclampsia, including shortness of breath, weight gain, visual changes, unrefractory headache, and nausea and vomiting in the second half of pregnancy (Roberts et al., 2023). Patients should be encouraged to exercise, maintain a healthy weight, and eat a well-balanced diet low in fat and sugar. Additionally, they should be advised to take prenatal vitamins and low-dose aspirin if indicated. Home blood pressure monitoring should be discussed in the care plan. Patients require cardiac monitoring after delivery, and yearly follow-up is recommended to evaluate for cardiovascular disorders (Roberts et al., 2023).
References
Fox, R., Kitt, J., Leeson, P., Aye, Y. L., & Lewandowski, A. J. (2019). Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. Journal of Clinical Medicine, 8(10). https://doi.org/10.3390/jcm8101625
https://doi.org/10.3390/jcm8101625
Roberts, J. M., King, T. L., Barton, J. R., Beck, S., Bernstein, I. M., Buck, T. E., Forgues-Lackie, M. A., Facco, F., Gernand, A. D., Graves, C. R., Jeyabalan, A., Hauspurg, A., Manuck, T. A., Myers, J., Powell, T. M., Sutton, E. F., Tinker, E., Tsigas, E., & Myatt, L. (2023). Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. American Journal of Obstetrics and Gynecology, 229(3), 193–213. https://doi.org/10.1016/j.ajog.2023.04.023
