Preeclampsia is a dreaded and well-known health problem that complicates 2–8% of pregnancies. It’s a medical condition where a pregnant woman who previously had normal blood pressure develops high blood pressure during pregnancy, usually at the 20th week or later.
Symptoms of preeclampsia
The classic three symptoms for preeclampsia include:
• High blood pressure (hypertension)
• Edema or swelling in the extremities (hands and feet)
• Proteinuria (an abnormal amount of protein found in the urine)
The challenge for diagnosing preeclampsia is that some symptoms, such as swelling, or hard to distinguish from a normal pregnancy. Plus, some moms have no symptoms at all.
There is a laundry list of factors that increase the mom’s risk of developing preeclampsia. Some highlights from the list include obesity, diabetes, first pregnancy, a prior diagnosis of preeclampsia in the mom or a family member, and a multiple gestation pregnancy (i.e., twins, triplets, etc.).
Preeclampsia workup
When an obstetrician suspects that a mom has preeclampsia, a workup will be order which includes an analysis to look for protein; fetal ultrasound to assess the baby’s growth; blood work to assess platelets and clotting factors, as well as liver and kidney function; and a biophysical profile/nonstress test to evaluate the baby’s status.
Treatment and risks of delayed treatment
The goal with preeclampsia is to treat it medically until the baby is mature enough for safe delivery. This is a careful balancing act in many cases, including prescription medications to lower blood pressure, corticosteroids, and anti-convulsive medications (such as a magnesium sulfate) to prevent seizures.
Some OB/GYN physicians order bedrest for the patients with preeclampsia, although this has generally fallen out of favor.
If preeclampsia newly shows up for the first time into the pregnancy and the baby is large enough, the obstetrician may recommend inducing the labor to minimize risks to the mom and baby.
When this serious condition is inappropriately managed, it can cause major medical problems for the mom and unborn baby including:
• Fetal growth restriction, or abnormally slow growth of the baby before birth. This occurs because the maternal hypertension makes it tough for the baby to receive enough oxygenation and nutrition to grow at a normal rate. A low birth weight is considered less than 5 pounds, 8 ounces.
• A premature delivery of the baby (before 37 weeks into the pregnancy). Preeclampsia is the culprit behind about 15% of premature births.
• Damage to the placenta. Placental abruption is a life-threatening condition for the mom and baby. This happens when the placenta separates from the uterine wall prematurely, resulting in heavy bleeding.
• Blood disorders, including destruction of red blood cells, called hemolysis.
• Damage to vital organs.
• Stroke in the mother.
New hospital accreditation standards
There is a lot of room for improvements when it comes to hospital management of preeclampsia. That’s why the accrediting agency The Joint Commission recently announced six new elements of performance, which hospitals will need to demonstrate to keep their accreditation.
As a former hospital administrator, I can tell you that hospital leaders take accreditation standards seriously. By raising the bar, The Joint Commission will help improve preeclampsia safety in all pregnant moms.
The newly announced six elements of performance require hospitals to:
• Develop policies and procedures for accurately measuring and remeasuring maternal blood pressure. Interestingly, although taking blood pressure seems like one of the simplest tasks of a doctor or nurse, case after case, we found that this important vital sign isn’t measured correctly. New policies and procedures will also result in training and demonstration of competency in this area.
• Develop policies and procedures for managing pregnant mothers with severe hypertension or preeclampsia. This will include assembling a crash cart with emergency response medications that will be immediately available in the obstetrical, or labor and delivery unit. Additionally, policies and procedures must address when to administer magnesium sulfate for seizure prophylaxis, when to use continuous fetal monitoring, and criteria of when to consider an emergency delivery of the baby.
• Conduct education of staff members. Policies and procedures are essentially worthless if no one knows about them or follows them. Staff training will make sure labor and delivery nurses understand how preeclampsia works, the rationale and effects of crash cart medications, and overall risk to expecting or laboring moms with this condition.
• Schedule severe hypertension or preeclampsia drills in the obstetrical or labor and delivery unit.
• Perform a review of real-life hypertension and preeclampsia events and how the staff responded. This encourages an environment to learn from mistakes and improve patient care.
• Lastly, develop standardized patient and family education about preeclampsia, including discussing the importance to look for active bleeding both in the hospital and after discharge home.
If you or someone you care for has been seriously injured because of poor obstetrical, labor and delivery, or hospital care, then contact a skilled, top-rated Houston, Texas medical malpractice attorney for help in evaluating your potential case.
