Pre-eclampsia in Pregnancy
Introduction
Pre-eclampsia is a condition in pregnancy whereby the pregnant woman’s blood pressure peaks. The condition may result in complications during birth. Pre-eclampsia requires clinical diagnosis through lab tests. The condition which may first appear twenty weeks into the pregnancy might resolve in a few days or weeks. The condition may be treated by a medical professional if it is diagnosed earlier on along the pregnancy. Pathophysiology illustrates the occurrence of pre-eclampsia. There exist two types of the condition: early and late-onset. Monitoring pregnant women suffering from the pre-eclampsia condition and preventing the growth of the condition are the two physical care practices that can be carried out by a midwife. Pregnant women suffering from pre-eclampsia require close monitoring from healthcare providers. Midwifes are involved in the screening for pre-eclampsia as well as subsequent monitoring of the mother’s and fetus’ well-being. The second physical care practice aims at reducing the chances of the occurrence of pre-eclampsia. A midwife recommends the correct dosage of asprin for patients and ensures that they follow their dosages. Midwifes practice psychosocial care by informing pregnant women on the risks of the pre-eclampsia condition and engaging them in therapy. The paper discusses the pathophysiology of pre-eclampsia, and aspects of physical and psychosocial care for the condition.
Pathophysiology of Pre-eclampsia
The pathophysiology of pre-eclampsia is illustrated by an unexpected response of vessels to the placental position. The condition is common in pregnant women. Research shows that one in every twenty women suffers from pre-eclampsia (Duley et al., 2019). The pathophysiology of pre-eclampsia is unclear, which limits the implementation of interventions to treat the complication. Research shows that the condition results due to the existence of a problem in the placenta. Most scientists argue that removing the placenta after birth is the only way of treating pre-eclampsia. Currently, there exist two types of pre-eclampsia: the early and late-onset pre-eclampsia (Hutcheon, Lisonkova & Joseph, 2011). Women suffering from early-onset pre-eclampsia have been reported to have miscarriages after the first trimester. The early-onset pre-eclampsia may result in the premature rupture of membranes and impeded growth of the fetus, which may result in pre-term births. Women undergoing the late-onset pre-eclampsia may have non-communicable diseases such as cardiovascular and metabolic illness (Roberge et al., 2017). The genetic makeup of an individual may predispose them to the senescence of their placenta. The impact of maternal genetics and the factors influenced by placental placement depend on the age and the pregnancy stage.
Hypertension, proteinuria, and other symptoms are used in diagnosing patients with pre-eclampsia. Pregnant women who have a low platelets count may have pre-eclampsia (Matthiesen et al., 2015). A low platelets count shows that a person body has a reduced ability to carry out blood clotting, which points towards kidney and liver problems. Proteinuria, a condition whereby proteins are contained in urine, is a symptom of pre-eclampsia. After carrying out tests, healthcare professionals may find out that a patient who has hypertension and lacks proteinuria. The practitioners would conclude that the patient has a lot of serum creatinine (Shennan & Duhig, 2010). The serum is secreted in huge amounts because the patients are free from renal diseases. Patients who have been diagnosed with hypertension and pulmonary edema but lack proteinuria may be diagnosed with pre-eclampsia. Pregnant women who have reported high levels of hypertension and cerebral and visual symptoms but lack proteinuria would be diagnosed with pre-eclampsia.
Pregnant women with pre-eclampsia have some form of uterine malfunctioning. Complications involved with pre-eclampsia result in the inflation of the uterus. The uterus then changes its color into white. Research shows that the swelling of the uterus results in increased tension in the womb, which affects the kidneys (Steegers et al., 2010). However, research fails to explain the reason for the uterine malfunctioning. After delivery, the tension is removed, which reverses the whole system under tension. Therefore, the complication resolved after birth. Hypertension is passively transmitted from the mother to the child through vasopressors. Research shows that most diseases among adults were contracted during their fetal development process.
High blood pressure is a predisposing factor for pre-eclampsia. Most women get high blood pressure from injuries of the nerves. The visceral and vasomotor nerves release cytokines (Trogstad, Magnus & Stoltenberg, 2011). When the nerves are injured, it results in the development of denervated visceral arterioles. Having multiple fetuses in a single pregnancy, immune disorders, and obesity predisposes pregnant women for the pre-eclampsia condition. The condition is common among pregnant women over thirty-five years of age, first-time mothers, teenage mothers, and people with existing kidney disorders and people suffering from diabetes (Williams & Broughton, 2011). Severe cases of pre-eclampsia result in the breakdown of red blood cells and shortness of breath. The pregnant woman’s blood count may decline considerably due to the malfunctioning of their liver. The kidney may fail, which results in numerous renal problems. Swelling, visual issues, and presence of fluid in the lungs points towards to severity of pre-eclampsia. If pre-eclampsia is untreated by medical practitioners, the patient may experience seizures.
Physical Care
Early screening can be used to detect the illness before its progression and prevent the occurrence of similar conditions in the future. Detection of pre-eclampsia during the early stages of a pregnancy is an effective way of promoting health for both the child and mother. Research shows that ninety-five percent of pre-eclampsia conditions can be detected through imaging during the first trimester (Pettit & Brown, 2012). Early detection of pre-eclampsia reduces the probability of having complications at later stages by enabling the health care professionals to manage the condition before it progresses in complexity. Studies show that early detection of pre-eclampsia, in the first sixteen weeks, reduces the chances of developing complications by sixteen percent whereas, the probability of developing complications would be at eighty percent in case the condition was detected during the first twelve weeks of pregnancy (Henderson et al., 2014). Detecting pre-eclampsia in pregnancy during the early stages would result in a reduction in doses of asprin, which results in reduced cases of complications during pregnancy and birth. Healthcare professionals in the United Kingdom are tasked with screening for pre-eclampsia. Midwifes are expected to inform first-time mothers on the need to take tests for pre-eclampsia.
The midwife would communicate the need for the pregnant mother to control their pregnancy stages, hence taking the tests is a necessary step that has to be taken during the first trimester. The midwife plays a vital role in screening for pre-eclampsia (Bothamley & Boyle, 2008b). Urine tests may be done to determine the patients’ urine’s protein content. The midwife carries out accurate assessment and informs the patient and other professionals on the prevalence of pre-eclampsia in each patient (Magee & von Dadelszen, 2011). The midwife keeps a record of a patient’s tests, which can be used in determining their medical history. The midwife may initiate admission of a woman to enable close monitoring at the hospital, in case the well-being of the mother or the fetus is compromised. During clinical visits, the midwife screens the mother to monitor the vitals of the fetus. The midwife carries out tests to determine potential complications that may come about during the different stages of the pregnancy.
The midwife employs different strategies to impede the growth of pre-eclampsia. A variety of studies have given contradicting findings on the impact of aspirin on a pregnant woman’s body (Krishnachetty & Plaat, 2010). The information on the best time to start taking asprin and the proper dosage is unclear. Research shows that taking less amounts of asprin during the first sixteen weeks of pregnancy results in a considerable decline in the probability of contracting pre-eclampsia (Eastabrook, Brown & Sargent, 2011). Women who take less than a tenth of a gram of asprin daily within the first sixteen weeks of pregnancy reduce their chances of getting pre-eclampsia by approximately seventy percent (Steegers et al., 2010). Cutting down on the intake of the drug may reduce the severity of the condition by about ten percent. Women who are highly predisposed to pre-eclampsia should avoid or reduce their intake of aspirin in the late stages of their first trimester and the third trimester. The recommended amount of asprin consumed in different stages of pregnancy can be determined by the individual patient’s clinical history.
Midwifes introduce the pregnant women who have been diagnosed with pre-eclampsia to the medical teams. The midwife is tasked with guiding patients on the allowable amount of asprin that they can take, depending on the severity of their condition (Bothamley & Boyle, 2008a). The midwife’s role is to impart knowledge on patients. Midwifes have to understand their patients’ clinical histories, which enables them to advise the pregnant women on the maximum allowable amount of asprin that they can take during their pregnancies (Mirza & Cleary, 2009). A midwife is in charge of ensuring that patients take the recommended dosage of asprin. Midwifes can check on the compliance of patients to recommended dosages by checking up on their patients. Midwifes reach out to their patients so that they can be informed on the progress of their patients.
Psychosocial Care
Pregnant women should be given sufficient information on their diagnosis of pre-eclampsia. The women deserve to be enlightened on the risks of the condition as well as the meaning of symptoms of their condition. Studies show that informing pre-eclampsia patients about the risk of the condition results in a positive outcome (Rumbold et al., 2016). Keeping vital information from the pregnant women has been positively correlated to catastrophic outcomes. A study in which pregnant women were interviewed showed that pregnant women who lack information on their health conditions pay a steep price for their ignorance (Sibai, Dekker & Kupferminc, 2005). Healthcare professionals should, therefore, share the risks of pre-eclampsia with pregnant women during their first clinical visit (Skjaerven et al., 2005). The tests done during the universal antenatal screening should be used to give the women the required information. After the completion of the screening exercise, a midwife can share information on pre-eclampsia with their patient. The midwife could explain all the risks of the condition and suggest different interventions that can be used in treating the illness.
Therapy is an important form of support for women who have been diagnosed with pre-eclampsia. Women suffering from pre-eclampsia need support and information on effective healthcare systems that can aid them in managing their condition (North et al., 2011). Pregnant women who have been diagnosed with the condition will be encouraged to consume healthy foods, engage in physical activity, and gain a certain body weight. However, engaging in therapy is equally important. The healthcare professionals guide patients on the best practices that they should engage in during pregnancy (Smeeth & Williams, 2011). The best practices are geared towards reducing the chances of developing subsequent complications. Therapy is a best practice that can be used to improve medical care outcomes for patients. For example, the midwife could guide their patients on the correct amount of asprin to be ingested during a therapy session. The midwife will consider the patient’s medical history, family history, and stage of pregnancy to offer customized advice to their patient. According to research, pregnant women should take between one and two grams of calcium supplements daily (Smith, Waugh & Nelson-Piercy, 2013). The calcium supplements are used to maintain a healthy blood pressure level during pregnancy and eliminate risk factors of pre-eclampsia in pregnancy. Studies show that vitamins C and E do not alleviate pre-eclampsia if they are taken after the first twenty weeks of pregnancy.
Spiral arteries undergo immense changes during the first twenty weeks of pregnancy. Therefore, antioxidant vitamins taken after the first twenty weeks of pregnancy are useless since they cannot influence the transformation of spiral arteries. The midwife takes advantage of therapy sessions to perform tests on pregnant women and determine the appropriate supplements that they should take (Wang et al., 2002). A midwife has the role of advising patients on the best supplements that should be taken during their pregnancies. The midwife will understand the progress of the patients during their interactions in the therapy sessions (Lindheimer, Taler & Cunnigham, 2010). The midwife can use the therapy sessions to understand the response of their clients’ bodies to supplements, which results in the desired outcomes.
Healthcare professionals should inform patients on self-monitoring practices that can be used to determine their well-being and desired growth of their babies. Pregnant mothers across the U.K. visit clinics to undertake ultrasound screening. The tests are used in determining the well-being of their babies as well as the pre-eclampsia condition (Pre-eclampsia Community Guideline Development Group, 2004). Women could be taught on how to carry out self-monitoring. Abnormal symptoms like; abdominal pain, swelling of the hand and face, and headaches can be indicators of pre-eclampsia. Midwifes could encourage pregnant women who exhibit the signs and symptoms of pre-eclampsia to get tested for the condition. However, sharing the symptoms and signs of pre-eclampsia may have negative consequences. Pregnant women may panic about the well-being of their child hence affecting their pregnancies. The midwife should share sufficient information on self-monitoring with the patients to eliminate any cases of misconception and premature judgment. The midwife provides the family with information on self-monitoring for pre-eclampsia (Vadillo-Ortega et al., 2011). The midwife could guide the family on how to support the pregnant woman. Pregnant women should be encouraged by midwifes to go for tests in case they find possible symptoms and signs during their self-monitoring activities.
Conclusion
In conclusion, pre-eclampsia is a common condition in pregnancy. The condition results in a sharp increase in a pregnant woman’s blood pressure, which may be fatal for both the mother and child. The condition may lead to birth complication; hence, it should be detected early during the pregnancy. Pre-eclampsia can only be diagnosed clinically, through the use of medical tests such as screening and urine test. The condition appears early in the pregnancy, hence it can be detected during the tenth week of pregnancy. Pre-eclampsia can be treated by a medical practitioner in case it is detected during the early stages of pregnancy, preferably, the first trimester. Pathophysiology of pre-eclampsia illustrates the risk factors of pre-eclampsia and the process of diagnosis. There are two types of pre-eclampsia: early and late onset. The different types of pre-eclampsia result in different outcomes. Genetics, hypertension and other factors predisposes a pregnant woman to pre-eclampsia during pregnancy. A midwife could engage in physical care by assessing and monitoring pre-eclampsia patients and, preventing the growth of the condition. The midwife guides and monitors the intake of asprin for pre-eclampsia patients. Midwifes engage in psychosocial care by communicating the risks and other necessary information on the pre-eclampsia condition to patients, teaching the women on self-monitoring and engaging them in therapy. Therapy helps the midwife to have a better understanding of their patients’ medical histories, body response to medication and their compliance to the recommended practices and dosage.
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