Beyond the Basics: Preeclampsia and Eclampsia

     You arrive on the scene to find a 25-year-old pregnant patient complaining of sudden weight gain and a new onset of nausea, vomiting, blurred vision and headache. She tells you she noticed swelling to her hands when she was unable to remove her wedding ring. She also states that she has not been urinating as usual, but thought it was due to dehydration from vomiting. During your history, you gather that she is in her 28th week of pregnancy, has no known allergies, no pertinent past medical history, and is only taking prenatal vitamins. She had some tea and toast about four hours prior to your arrival; however, she vomited most of it up shortly after eating. She has not changed her activity throughout the pregnancy and does not recall any events that were unusual.

     Your partner obtains a set of vital signs as you continue to gather information regarding the current complaints. The BP is 152/98 mmHg, heart rate 92 bpm, respirations 22 per minute with an adequate tidal volume, and the skin is a normal color, warm and dry. Her SpO₂ reading is 97% on room air. The ECG monitor shows a normal sinus rhythm. During the physical exam, you note edema to the face and hands and a tender right upper quadrant.

     Based on the presentation, one might consider the complaints to parallel those of a normal pregnant patient. By using your critical thinking skills, this assumption becomes less likely. Weight gain occurs throughout pregnancy; it is not sudden in any one trimester. Nausea and vomiting are most likely to occur during the first trimester from hormonal changes and are less likely in the third trimester. Edema is not uncommon, especially in the third trimester, as the weight of the fetus compresses the pelvic and femoral vessels, causing impaired venous return. However, it is important to note that the edema is typically found in the lower extremities and most notably in the ankles and feet. This patient experienced a sudden onset of edema to the hands and face. Urinary frequency is common in the first trimester and returns to normal in the second trimester. In the third trimester, the large uterus compresses the bladder, once again increasing the frequency of urination. This patient experienced a decrease in urine output. The blood pressure decreases slightly during the first and second trimester, but returns to nonpregnant levels during the third trimester. This patient is presenting with a relatively elevated blood pressure. The heart rate appears to be slightly elevated, taking into consideration that a pregnant patient will experience an increase in heart rate of approximately 10 to 15 bpm. The respiratory rate is slightly elevated, but this is also expected in pregnancy.

     When you view the complaints and physical assessment findings cumulatively, there are some imperative indicators that are outside of what would be considered normal for a pregnant patient. Even though the signs and symptoms are somewhat subtle and do not overtly make one suspect an immediately life-threatening condition, there are consistent findings pointing to preeclampsia, which could be life-threatening for the fetus and mother.

     Preeclampsia develops after the 20th week of gestation and can manifest signs and symptoms up to the first few days after delivery. Preeclampsia was formerly known as toxemia of pregnancy due to the theory that a poison or toxin produced the condition. It is also frequently referred to as pregnancy-induced hypertension, since the condition is manifested by an elevated systolic and diastolic blood pressure. The terms are often used interchangeably; however, there are variations among the two.