This is an obstetric care rendered by the midwife to a pregnant woman/client with an elevated blood pressure of 140/90 mmHg and proteinuria after 20 weeks of gestation. This management is also rendered for a client with an increase systolic of 15 – 20 mmHg and diastolic of 10 mmHg with proteinuria irrespective of client’s normal blood pressure.
Aims
· Stabilise client’s blood pressure
· Prevent severe Pre-eclampsia, Imminent Eclampsia and Eclampsia
· Prevent and manage complications
· Reduce maternal and foetal morbidity and mortality
Types
· Out-Patient Management
· In-Patient Management
Requirements
· Vital signs tray
· Emergency Delivery tray
· Intravenous line tray
· Foetal monitor (manual /electronic)
· Perineal Pad
· Oxygen apparatus
· Patella Hammer
· Urine Dipsticks
· Blood and Urine sample bottles
Steps
OUT-PATIENT MANAGEMENT:
1. Establish rapport (refer steps)
2. Explain procedure to client (refer steps)
3. Explain to client the need to attend antenatal clinic and procedures involved
4. Perform a rapid evaluation of the general condition of the woman, including vital signs
5. Take history of the present and past illness from her relatives
6. Ascertain gestational age to help in proper diagnosing of pre-eclampsia
7. Perform general examination from head to toe
8. Obtain urine sample and test for protein and sugar
9. Refer client to Obstetrician when there is high blood pressure and urine protein
10. Counsel the woman and her relatives about symptoms (danger signals) of preeclampsia that require immediate attention
11. Encourage the client to eat a normal diet low in salt, fats and oils but more roughage and fluids
12. Educate and encourage client to avoid caffeinated drinks and over the counter drugs
13. Educate her to take only prescribed medications
14. Encourage additional periods of rest
15. Counsel her on these signs (blurred vision, epigastric pain, severe frontal headache) and to report immediately when notice
16. Consider hospital admission if follow-up as an out-patient is not possible or pre-eclampsia progress rapidly
17. Manage as severe pre-eclampsia if signs worsen according to WHO/GHS protocols
18. Follow-up twice a week as an out-patient if less than 37 weeks, and signs remain unchanged or normalize, monitor blood pressure, proteinuria, reflexes and foetal well-being
19. Monitor growth and condition of foetus and expedite delivery if there are signs of foetal compromise
20. Ripen the cervix if it is not favourable for easy induction when gestation is more than 37 complete weeks
21. Start ordered induction of labour when the period of gestation is more than 37 completed weeks and cervix is favourable (soft, thin, partly dilated)
22. Communicate findings to client and family
23. Emphasize the need for client to adhere to information given
24. Express appreciation of client for her cooperation
25. Record and report all information in the Maternal and Child Health Book (Manual or Electronic)
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