KING GEORGE MEDICAL UNIVERSITY

COLLEGE OF NURSING

LESSON PLAN ON - “PRE-ECLAMPSIA”

SUBMITTED TO: - SUBMIITED BY: -

MRS. PRIYANKA MR.SUNNY KUMAR PATHROL
CLINICAL INSTRUCTOR M.SC.(N) 2ND YEAR
KGMC COLLEGE OF NURSING KGMC, COLLEGE OF NURSING
 LESSON PLAN ON TOPIC – “PRE-ECLAMPSIA”
SUBJECT Obstetrics & Gynecology

UNIT UNIT- IV

TOPIC “PRE-ECLAMPSIA”

GROUP M.Sc. nursing 2nd year

PLACE Msc 2nd year class, KGMU LKO

DATE & TIME 9-1-2023

TEACHING METHOD Lecture Cum Demonstration

AV AIDS/INSTRUCTIONAL PowerPoint Presentation, Charts, Whiteboard.

AIDS

STUDENT PRE- Before the lecture student must be able to recall “Pre-Eclampsia”.
REQUISITES

GERAL OBJECTIVE At the end of the class student will be able understand the theory& procedure of the topic“Pre-Eclampsia”.

SPECIFIC OBJECTIVE At the end of the class the student will be able to -
1) To define the terminologies and give introduction of the topic.
2) To give the classification of gestational hypertensive disorders in detail.
3) To define the pregnancy induced hypertension, pre-eclampsia, explain in detail.
4) To discuss the incidence of pre- eclampsia, explain in detail.
5) To discuss the risk factor for pre-eclampsia in detail.
6) To discuss the etiologies of pre- eclampsia hypertensive, explain, in detail.
7) To discuss the clinical features of pre-eclampsia hypertensive, explain, in detail.
 8) To discuss the investigations in pre- eclampsia in detail.
9) To discuss the complications of pre-eclampsia in detail.
10) To discuss the management of pre-eclampsia in detail.
11) To discuss the research articles in detail.
12) To give the conclusion related to pre-eclampsia in detail.

REVIEW OF PREVIOUS Students are having previous knowledge regardingthe “Preeclampsia”.

CLASS
INTRODUCTION (1 MIN) Good Morning/Good afternoon ma’am, today we are going to discuss about“Preeclampsia”.”.

S.NO. TIME SPECIFIC CONTENT TEACHING EVALUATION

OBJECTIVE LEARNING
ACTIVITY
1 2 min To define the TERMINOLOGY T: Recalling the What do define the
terminologies and content verbally by terminologies and
give introduction of  Hypertension:BP ≥140/90 mm Hg measured two using PowerPoint introduction of the
the topic. times with at least 6-hour interval presentation as an topic?
 Proteinuria:Urinary excretion of ≥0.3 g protein/24 AV aid.
hours specimen or 0.1 g/L S: students will
 Gestational hypertension:BP ≥140/90 mm Hg for listen carefully and
the first time in pregnancy after 20 weeks, without respond
proteinuria accordingly.
 Preeclampsia: Gestational hypertension with
proteinuria
 Eclampsia:Women with preeclampsia complicated
with grand mal seizures and/or coma
 HELLP syndrome:
 Hemolysis (H)
 Elevated liver enzymes (EL)
 Low platelet count (LP)

INTRODUCTION

Hypertension is one of the most common disorders

of pregnancy and contributes significantly to the
maternal and perinatal morbidity.Hypertension
 may appear for the first-time during pregnancy as a
direct result of the gravid state or a sign of
underlying pathology, which maybe pre-existing.

Hypertension: An absolute rise of blood pressure

of at least 140/90 mm Hg, if the previous blood
pressure is not known or a rise in systolic pressure
of at least 30 mm Hg, or a rise in diastolic pressure
of at least 15 mm Hg over the previously known
blood pressure is called pregnancy-induced
hypertension.

2 5 min To give the CLASSIFICATION OF GESTATIONAL T: Recalling the How do youthe

classification of HYPERTENSIVE DISORDERS: content verbally by classify the
gestational
PREGNANCY-INDUCED HYPERTENSION using PowerPoint gestationalhyperten
hypertensive presentation as an sivedisorders?
disorders in detail. (PIH) AV aid.
S: students will
 Transient hypertension: Development of mild
listen carefully and
hypertension during pregnancy in previously
respond
normotensive patient without proteinuria or
accordingly.
pathologic edema.
 Gestational proteinuria: Development of
proteinuria after 20 wks of gestation in previously
nonproteinuric patient without hypertension
 Preeclampsia: Development of hypertension and
proteinuria in previously normotensive patient after
20 wks of gestation or in early postpartum period;
in presence of trophoblastic disease it can develop
before 20 wks of gestation
 Eclampsia: Development of convulsions or coma
in preeclamptic patient
 CHRONIC HYPERTENSIVE DISORDERS

 Chronic hypertension: Hypertension and/or

proteinuria in pregnant patient with chronic
hypertension
SUPERIMPOSED PREECLAMPSIA/ECLAMPSIA:
Development of preeclampsia or eclampsia in patient with
chronic hypertension.

3 5 min To define the PRE-ECLAMPSIA T: conceptualizing Howdo you define

pregnancy induced the content the pregnancy
hypertension, pre- DEFINITION: verbally by using induced
eclampsia, explain PowerPoint hypertension, pre-
in detail. “Pregnancy-induced hypertension (PIH)” is defined as presentation as an eclampsia explain
the hypertension that develops as a direct result of the AV aid for in detail?
gravid state. presentation.
It includes—(i) gestational hypertension, (ii) preeclampsia
and (iii) eclampsia. S: students will
listen carefully and
Preeclampsia is a multisystem disorder of unknown respond
aetiology characterized by development of hypertension to accordingly.
the extent of 140/90 mm of hg or more with proteinuria
induced by pregnancy after the 20thweek in a previously
normotensive and proteinuric woman. (International
society for study of hypertension in pregnancy, 1998) 

Preeclampsia is a multisystem disorder of unknown

etiology characterized by development of hypertension to
the extent of 140/90 mm Hg or more with proteinuria after
the 20th week in a previously normotensive and
nonproteinuric woman. Some amount of edema is
common in a normal pregnancy. Edema has been excluded
 from the diagnostic criteria unless it is pathological. The
preeclamptic features may appear even before the 20th
week as in cases of hydatidiform mole and acute
polyhydramnios.(D.C. DUTTA)

DIAGNOSTIC CRITERIA OF PREECLAMPSIA

Calculation based on mean arterial pressure (MAP) as:

Systolic pressure + (diastolic pressure × 2) /3 = MAP

4 1 min To discuss the INCIDENCE T: Recalling the What is the

incidence of pre- content verbally by incidence of pre-
eclampsia, explain  According to the new guidelines given by American using PowerPoint eclampsia explain
in detail. Congress Of Obstetricians and Gynaecologist (ACOG) presentation as an in detail?
in 2013. AV aid.
 In India, the incidence of preeclampsia is reported to S: students will
be 8-10%. listen carefully and
 It occurs more frequently in young primigravidae and respond
in mothers over 35yrs of age. It is known to be accordingly.
associated with hydatiform mole, multiple pregnancy
and maternal diabetes.
 The incidence in primigravidae is about 10% and in
multigravida 5%.
5 2min To discuss the risk RISK FACTORS FOR PREECLAMPSIA T: conceptualizing Whatis the risk
factor for pre- the content factor for pre-
eclampsia in detail.  Primigravida: Young or elderly (first time exposure to verbally by using eclampsia explain
chorionic villi) PowerPoint in detail?
presentation as an
 Family history: Hypertension, preeclampsia AV aid for
presentation.
  Placental abnormalities:
S: students will
 Hyperplacentosis: Excessive exposure to listen carefully and
chorionicvilli— (molar pregnancy twins, respond
diabetes) accordingly.
 Placental ischemia.
 Obesity: BMI >35 kg/m2, Insulin resistance.
 Pre-existing vascular disease.
 New paternity

6 3min To discuss ETIOLOGIES OF PREECLAMPSIA T: conceptualizing What are the

theetiologies of pre- HYPERTENSION: the content etiologies of pre-
eclampsia verbally by using eclampsia
hypertensive, 1. Genetic predisposition PowerPoint hypertensive,
explain, in detail. 2. Abnormal immunological response presentation as an explain in detail?
3. Deficient trophoblast invasion AV aid for
4. Hypo perfused placenta presentation.
5. Circulating factors
S: students will
6. Vascular endothelial cell activation
listen carefully and
7. Failure of trophoblastic invasion mediators
respond
(abnormal placentation).
accordingly.
8. Vascular endothelial damage.
9. Inflammatory mediators.
10. Immunological intolerance between maternal and
fetal tissues.
11. Coagulation abnormalities.
12. Increased oxygen free radicals.
13. Genetic pre disposition.
14. Dietary deficiency or excess.
 15. Other Factors
Abnormal lipid metabolism (results in more
oxidative stress).
Mutation of factor V Leiden increase risk.
7. 5 min To discuss the CLINICAL FEATURES T: Recalling the What are the
clinical features of content verbally by clinical
pre-eclampsia Preeclampsia frequently occurs in primigravidae (70%). It using PowerPoint manifestations of
hypertensive, is more often associated with obstetrical–medical presentation as an the pre-eclampsia?
explain, in detail. complications such as multiple pregnancy, AV aid.
polyhydramnios, pre-existing hypertension, diabetesetc. S: students will
The clinical manifestations appear usually after the 20th listen carefully and
week. respond
accordingly.
ONSET: The onset is usually insidious and the syndrome
runs a slow course. On rare occasion, however,the onset
becomes acute and follows a rapid course.

SYMPTOMS: Preeclampsia is principally a syndrome of

signs and when symptoms appear, it isusually late.

Mild symptoms: Slight swelling over the ankles which

persists on rising from the bed in the morningor tightness
of the ring on the finger is the early manifestation of
edema due to preeclampsia. Gradually,the swelling may
extend to the face, abdominal wall, vulva and even the
whole body.

Alarming symptoms: The following are the ominous

symptoms, which may be evident either singlyor in
combination. These are usually associated with acute onset
of the syndrome.
(1) Headache —either located over the occipital or frontal
region,

(2) Disturbed sleep,

(3) Diminished urinary output—Urinary output of less

than 400 mL in 24 hours is very ominous,

(4) Epigastric pain—acute pain in theepigastric region

associated with vomiting, at times coffee color, is due to
hemorrhagic gastritis or due tosubcapsular hemorrhage in
the liver,

(5) Eye symptoms—there may be blurring, scotomata,

dimness ofvision or at times complete blindness. Vision is
usually regained within 4–6 weeks following delivery.
Theeye symptoms are due to spasm of retinal vessels
(retinal infarction), occipital lobe damage
(vasogenicedema) or retinal detachment. Reattachment of
the retina occurs following subsidence of edema
andnormalization of blood pressure after delivery.

SIGNS

1. Abnormal weight gain: Abnormal weight gain within a

short span of time probably appears evenbefore the visible
edema. A rapid gain in weight of more than 5 lb a month
or more than 1 lb a weekin later months of pregnancy is
significant.

2. Rise of blood pressure: The rise of blood pressure is

usually insidious but may be abrupt. Thediastolic pressure
 usually tends to rise first followed by the systolic pressure.

3. Edema: Visible edema over the ankles on rising from

the bed in the morning is pathological. Theedema may
spread to other parts of the body in uncared cases. Sudden
and generalized edemamay indicate imminent eclampsia.

4. There is no manifestation of chronic cardiovascular or

renal pathology.

5. Pulmonary edema—due to leaky capillaries and low

oncotic pressure.

6. Abdominal examination may reveal evidences of

chronic placental insufficiency, such as scantyliquor or
growth retardation of the fetus.

Thus, the manifestations of preeclampsia usually appear in

the following order—rapid gain in weight→ visible edema
and/or hypertension → proteinuria.
8 5 min To discuss the INVESTIGATIONS T: Recalling the What are the
investigations in content verbally by investigations in
pre- eclampsia in History using PowerPoint pre- eclampsia,
detail. presentation as an explain in detail?
Physical examination AV aid.
S: students will
Urine: Proteinuria is the last feature of preeclampsia to listen carefully and
appear. It may be trace or at times copiousso that urine respond
becomes solid on boiling (10–15 g/L). There may be few accordingly.
hyaline casts, epithelial cells oreven few red cells. 24
hours urine collection for protein measurement is done.
Ophthalmoscopic examination: In severe cases there
may be retinal edema, constriction of thearterioles,
alteration of normal ratio of vein: arteriole diameter from 3
: 2 to 3 : 1 and nicking of the veinswhere crossed by the
arterioles. There may be hemorrhage.

Blood values: The blood changes are not specific and

often inconsistent. A serum uric acid level(biochemical
marker of preeclampsia) of more than 4.5 mg/dL indicates
the presence of preeclampsia.

Blood urea level remains normal or slightly raised. Serum

creatinine level may be more than 1 mg/dL.

There may be thrombocytopenia and abnormal coagulation

profile of varying degrees. Hepatic enzymelevels may be
increased.

Antenatal fetal monitoring: Antenatal fetal well-being

assessment is done by clinical examination,daily fetal kick
count, ultrasonography for fetal growth and liquor pockets,
cardiotocography, umbilicalartery flow velocimetry and
biophysical profile.

COURSE OF THE DISEASE: Preeclampsia is usually

insidious in onset and runs a slow course. Rarely,the onset
may be acute and follows a rapid course of events. The
following course of events may occur:

If detected early: With prompt and effective treatment the

preeclamptic features may subsidecompletely.
 If left untreated and uncared for:

(a) The preeclamptic features remain stationary at

varyingdegrees till delivery.

(b) Aggravation of the preeclamptic features with

appearance of symptoms ofacute fulminating preeclampsia
as mentioned earlier. This happens mostly in cases with
acute onset.

(c) Eclampsia – It may occur following acute fulminating

preeclampsia or bypassing it. In fact, eclampsia

can occur even with a blood pressure of 140/90 mm Hg.

(d) Spontaneous remission of the preeclampticfeatures—a
rare and fortunate event.
9 2 min To discuss the COMPLICATIONS OF PREECLAMPSIA T: explaining the What are the
complications of content verbally by complications of
pre-eclampsia in The complications are more likely to occur if the patients using PowerPoint pre-eclampsia,
detail. are left untreated and uncared for. as an AV aid. explain in detail?

 Immediate:  Maternal  Fetal  Remote S: students will

listen carefully and
IMMEDIATE: Maternal respond
accordingly.
 During pregnancy:
(a) Eclampsia (2%) — more in acute than in
subacute cases,
(b) Accidental haemorrhage,
(c) Oliguria and anuria,
(d) Dimness of vision and even blindness,
 (e) Preterm labor,
(f) HELLP syndrome,
(g) Cerebral haemorrhage,
(h) Acute respiratory distress syndrome (ARDS)
 During labor:
(a) Eclampsia,
(b) Postpartum haemorrhage— may be related with
coagulationfailure
 Puerperium:
(a) Eclampsia — usually occurs within 48 hours,
(b) Shock— puerperal vasomotorcollapse is
associated with reduced concentration of sodium
and chloride due to sudden fall incorticosteroid
level,
(c) Sepsis— due to increased incidence of
induction, operative interference,and low vitality.

Fetal: The fetal risk is related to the severity of

preeclampsia, duration of the disease and degree
ofproteinuria. The following hazards may occur.

(a) Intrauterine death—due to spasm of

uteroplacentalcirculation leading to accidental
haemorrhage or acute red infarction,

(b) Intrauterine growth restriction—due to chronic

placental insufficiency,

(c) Asphyxia,

(d) Prematurity—either due to spontaneous preterm

 onset of labor or due to preterm induction.

REMOTE

 Residual hypertension: It may persist even after 6

months following delivery in about 50% cases. It
ismore related to familial diathesis and underlying
thrombophilias (protein C, protein S
deficiency,antiphospholipid syndrome).
Microvascular dysfunction due to insulin resistance
isalso there.
 Recurrent preeclampsia: There is 25% chance of
preeclampsia to recur in subsequent
pregnancies.This too is related with familial
diathesis, personal predisposition with
underlyingthrombophilias.
 Chronic renal disease: There is high incidence of
glomerulonephritis in women with
preeclampsiaremote from term. This is more likely
due to pre-existent underlying renal disease.
 Risk of placental abruption for those women with
preeclampsia ranges from 5% to 20% and
womenwith HELLP syndrome, the risk of
preeclampsia in subsequent pregnancy is about
20%.

10 10 min To discuss the MANAGEMENT OF PREECLAMPSIA T: explaining the What do you

management of pre- content verbally by understand
eclampsia in detail. Hospital or home treatment: Ideally, all patients of using PowerPoint managementof pre-
preeclampsia are to be admitted in the hospitalcase of as an AV aid. eclampsia, explain
preeclampsia. However, in some centers cases of in detail?
preeclampsia are managed in the daycare unit. In the S: students will
developing countries where the prevalence of listen carefully and
preeclampsia is more andhospital facilities are meagre, respond
there is no alternative but to put the uncomplicated mild accordingly.
preeclampsia indomiciliary treatment regime. Rest, high-
protein diet are prescribed and the patient is investigated
andchecked. If the treatment fails to improve the patient is
to be admitted. It is essential that she should bewarned
against the ominous symptoms, such as headache, visual
disturbances, vomiting, epigastricpain or scanty urine.

PHARMACOLOGICAL MANAGEMENT

1. ANTIHYPERTENSIVE AGENTS
Methyl Dopa: central and peripheral anti
adrenergic action:250/500mg/tid/qid.
Labetalol: adrenoceptor antagonist (alpha and beta
blockers):250mg tid/qid.
Nifedipine: calcium channel blockers:
10-20mg/bid.
Hydralazine: vascular smooth muscle relaxant:
10-25mg bid.
2. IN HYPERTENSIVE CRISIS:
DIURETICS: The diuretics should not be used
injudiciously as they cause harm to the baby by
diminishing placental perfusion. FRUSEMIDE
(LASIX) 40 MG give orally after breakfast for
5days in a week.
3. SEDATIVES: To cut down the emotional factors
mild sedatives may be given orally as
PHINOBARBITONE 60mg or DIAZEPAM 5mg
at bed time.
 Depending on the response to the treatment, the
patients are grouped into the following:

Group A: If the duration of pregnancy is remote from

term, the patient may be discharged with advice to
attend the antenatal clinic after 1 week. These women
are not cured as majority (90%) develop recurrence. If
the patient is near term, she should be kept for a few
days till completion of 37th week. Thereafter, decision
is to be taken either to deliver her or to wait for
spontaneous onset of labor by the due date. It is not
wise to allow the pregnancy to continue beyond the
expected date.

Group B: If the pregnancy is beyond 37 completed

weeks, delivery is to be considered without delay. If
less than 37 weeks, expectant treatment may be
extended judiciously at least up to 34 weeks. Careful
maternal and fetal well-being are to be monitored
during the period.

Group C: The couple is counseled. Termination of

pregnancy (delivery) is considered irrespectiveof
duration of gestation. Seizure prophylaxis (magnesium
sulfate) should be started. Steroidtherapy is considered
if the duration of pregnancy is less than 34 weeks. It
prevents neonatal RDS,IVH and maternal
thrombocytopenia.

METHODS OF DELIVERY:

Indications: It is indeed difficult to lay down hard and fast

rules for the indications for induction.

(1) Aggravation of the preeclamptic features in spite of

medical treatment and/or appearance ofnewer symptoms
such as epigastric pain.

(2) Hypertension persists in spite of medical treatment

withpregnancy reaching 37 weeks or more.

(3) Acute fulminating preeclampsia irrespective of the

periodof gestation.

(4) Tendency of pregnancy to overrun the expected date.

Methods: If the cervix is ripe, surgical induction by low

rupture of the membranes is the methodof choice.
Oxytocin infusion may be added. If the cervix is unripe,
prostaglandin (PGE2) gel 500 µgintracervical or 1–2 mg
in the posterior fornix is inserted to make the cervix ripe
when low rupture of themembranes can be performed. In
severe preeclampsia, antihypertensive drugs should be
used duringinduction.

 Caesarean section

Indications:

(1) When an urgent termination is indicated and the cervix

is unfavourable (unripened closed).

(2) Severe preeclampsia with a tendency of prolonged

induction—delivery interval.

(3) Associated complicating factors, such as elderly

primigravidae, contracted pelvis, malpresentation, etc. The
operation should be done by an experienced surgeon with
the help of an expert anaesthetist.Epidural anaesthesia is
preferred, unless there is coagulopathy.

MANAGEMENT DURING LABOR: Blood pressure

tends to rise during labor and convulsions may occurdue to
stress hormones (intrapartum eclampsia). The patient
should be in bed.Antihypertensive drugsare given if the
blood pressure becomes high. Blood pressure and urinary
output are to be notedfrequently so as to detect imminent
eclampsia. Prophylactic MgSO4 is started when systolic
BP >160diastolic >110, MAP >125 mm Hg. Careful
monitoring of the fetal well-being is mandatory.

Labor durationis curtailed by low rupture of the

membranes in the first stage; and forceps or ventousein
second stage. Intravenous ergometrine following the
delivery of the anterior shoulder is withheldas it may cause
further rise of blood pressure. However, there is no
contraindication of syntocinon IMor slow IV and to keep
the patient under close observation for several hours.

PUERPERIUM: The patient is to be watched closely for at

least 48 hours, the period during whichconvulsions usually
occur. Antihypertensive drug treatment should be
continued if the BP is high(systolic >150 mm Hg or
diastolic >100 mm Hg). Oral nifedipine 10 mg at every 6
hours is given until BPremains below the hypertensive
levels for at least 48 hours. Oral furosemide 20 mg a day
for 5 days is alsofound to improve recovery and to reduce
the need of antihypertensive drugs in severe preeclampsia.

Magnesium sulfate (for at least 24 hours) and

antihypertensive drugs may be needed in women
withsevere hypertension and symptoms of acute fulminant
preeclampsia during the postpartum period.

The patient is to be kept in the hospital, till the blood

pressure is brought down to a safe level andproteinuria
disappears. In breastfeeding women, labetalol, nifedipine
or enalapril may used on discharge.Methyldopa is avoided
due to the risks of postpartum depression.

NURSING DIAGNOSES:

Woman Experiencing a Hypertensive Disorderin

Pregnancy

1) Anxiety related to:

• Preeclampsia and its effect on woman and infant
2) Knowledge deficit related to:
• Management (diet, medications, activity
restrictions)
3) Ineffective individual/family coping related
to:
• Woman's restricted activity and concern over a
complicated pregnancy
• Woman's inability to work outside the home
4) Powerlessness related to:
• Inability to prevent or control condition
 andoutcomes
5) Altered tissue perfusion related to:
• Hypertension
• Cyclic vasospasm
• Cerebral edema
• Haemorrhage
6) Risk for impaired gas exchange related to:
• Magnesium sulfate therapy
• Pulmonary edema
7) Risk for injury to foetus related to:
• Uteroplacental insufficiency
• Preterm birth
• Abruptio placentae
8) Adverse effects of maternal medications
Risk for injury to mother related to:
• CNS irritability secondary to cerebral edema,
vasospasm, decreased renal perfusion
• Magnesium sulfate and antihypertensive therapies
• Abruptio placentae
9) Deficient Fluid Volume
10) Decreased Cardiac Output
11) Risk for Imbalanced Nutrition: Less Than Body
Requirements
12) Deficient Knowledge

INTERVENTIONS:

1) Proteinuria monitoring:
• check urine for protein at every prenatal visit
(some women may be taught to do this at home
with a dipstick test):
• Labs to remember:
• >1+ dipstick test (if hypertension is present along
with protein in the urine the physician may order
the woman to complete a 24-hour urine)
• 24-hour urine: >300 mg
• >0.3 mg/dL creatinine to protein ratio
Other prenatal labs that may be ordered: CBC
(platelets <100,000, red blood cells or peripheral
smear to check for hemolysis, creatinine, BUN),
liver enzymes (AST or ALTif preeclampsia
suspected
2) Reflexes hyperactive (deep tendon reflex
patellar and bicep)
• Watch for exaggerated reflexes called
“hyperreflexia” like 4+
• Indicates the CNS is stressed out and at risk for a
seizures:assess neuro status, vision changes,
headaches, ankle clonus (check out the lecture to
see how to check for this)
• Magnesium Sulfate may be ordered to decrease the
risk of seizure activity: Watch for decreased or
absent reflexes because this could
indicate Magnesium Sulfate Toxicity
3) Evaluate blood pressure for hypertension:
 Monitored at every prenatal visit and educate
mother to monitor at home
 Remember hypertension criteria: >140/90 two
separate times at least 4 or 6 hours apart
4) Edema monitoring (watch for and educate mother
about this):
 weight gain of 2 lbs or more in a week and weigh
self daily
 Edema can be in the face, eyes, and extremity
 swelling
 Monitor urinary output
 Lung sounds (pulmonary edema ,short of breath)
5) Calcium gluconate: antidote for magnesium sulfate
toxicity
6) Left side-lying position (helps prevent placenta
ischemia and increases blood flow to baby), bed
rest/limit stimulation, fetal heart rate monitoring
(report decrease in fetal activity)
7) Protein-rich diet (remember there may be low
protein in blood due to proteinuria,protein leaks
into the urine and leaves blood)
 watch salt intake (sodium levels can increase due
to renal dysfunction and start to keep sodium in the
blood)

11 1 min To discuss the RESEARCH ARTICLES T: Recalling the What are the
research articles in content verbally by research articles
detail. Knowledge of pre-eclampsia in women living in using article as an you have studied of
Makole Ward, Dodoma, Tanzania AV aid. the topic pre-
S: students will eclampsia?
Pre-eclampsia is a hypertensive disorder specific to listen & read
pregnancy responsible for significant maternal morbidity carefully and
and mortality in Africa. The majority of deaths related to respond
pre-eclampsia could be avoided with timely and effective accordingly.
care. “Phase one delays” arise because of lack of
knowledge.

Pregnancy Induced Hypertension and Associated

Factors among Women Attending Delivery Service at
Mizan-Tepi University Teaching Hospital, TepiGeneral
 Hospital and GebretsadikShawo Hospital, Southwest,
Ethiopia

Disorders of pregnancy induced hypertensive are a major

health problem in the obstetric population as they are one
of the leading causes of maternal and perinatal morbidity
and mortality. The World Health Organization estimates
that at least one woman dies every seven minutes from
complications of hypertensive disorders of pregnancy. The
objective of this study is to assess pregnancy induced
hypertension and its associated factors among women
attending delivery service at Mizan-Tepi University
Teaching Hospital, Gebretsadikshawo Hospital and Tepi
General Hospital.
12 1 min To give the CONCLUSION T: explaining the What do you
conclusion related content verbally by understand by pre-
topre-eclampsia in Pre-eclampsia is a rare pregnancy-related disease with an using PowerPoint eclampsia,explain
unpredictable course that can have serious consequences as an AV aid.
detail. in detail?
for both the mother and the fetus. The treatment is simple,
S: students will
i.e., delivery. Nonetheless, induced preterm delivery
listen carefully and
requires careful weighing of both maternal and fetal risk–
respond
benefit.
accordingly.

SUMMARY:Summarized the class through questioning regarding the pre-eclampsia covered in session. (1 min)

EVALUATION:Evaluated the class through asking following questions (1 min)

1. What do define the terminologies and introduction of the topic?
 2. How do you the classify the gestational hypertensive disorders?
3. How do you define the pregnancy induced hypertension, pre-eclampsia explains in detail?
4. What is the incidence of pre- eclampsia explain in detail?
5. What is the risk factor for pre-eclampsia explain in detail?
6. What are the etiologies of pre- eclampsia hypertensive, explain in detail?
7. What are the clinical manifestations of the pre-eclampsia?
8. What are the investigations in pre- eclampsia, explain in detail?
9. What are the complications of pre-eclampsia, explain in detail?
10. What do you understand management of pre-eclampsia, explain in detail?
11. What are the research articles you have studied of the topic pre-eclampsia?
12. What do you understand by pre-eclampsia, explain in detail?
Assignment:

1. Write short note on nursing management on pre-eclampsia.

BIBLIOGRAPHY:

Book bibliography:

1. Irene M. Bobak, Deitra Leonard Lowdermilk, Margaret Duncan Jense,2008.Essentials of Maternity Nursing.Mosby.pg-644-660
2. Marshall, J. and Raynor, M., 2014. Myles' Textbook For Midwives. London: Elsevier Health Sciences UK. Pg-537
3. Macdonald, S. and Magill-Cuerden, J., 2011. Mayes' Midwifery. Edinburgh: Baillière-Tindale/Elsevier. Pg-456.
4. KonkarHiralal. Dutta’s DC Textbook Of Obstetrics.9th Edition: Jaypee Brothers Medical Publishers(P)Ltd, New Delhi India; 2017.Pg- 254
5. Basavanthappa B.T Essentials of Midwifery & Obstetrical, Jaypee Publications (New Delhi) Pg.- 637

Web bibliography:

6. US Department of Health and Human Services: http://www.womenshealth.gov/faq/depression-pregnancy.cfm

7. American Academy of Family Medicine: http://familydoctor.org/online/famdocen/home/women/pregnancy/ppd/general/379.html
8. National Institute of Mental Health: http://newsinhealth.nih.gov/2005/December2005/docs/01features_02.htm
9. AHA Journal: https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.118.313276
10. https://www.healthline.com/health/preeclampsia