Essay on Complex Case of Pregnancy

This essay discusses a complex case of pre-eclampsia during pregnancy, detailing the pathophysiology, nursing care, and the critical role of midwives in managing such complications. It highlights the importance of early detection and intervention in improving maternal and fetal outcomes.

Essay on a complex case of pregnancy 1
Essay on a complex case of pregnancy
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Essay on a complex case of pregnancy 2
Essay on a complex case of pregnancy
Introduction:
Perinatal care involves an important aspect of midwifery. Midwives working in a
setting of primary health care, pregnancy or birthing units, and neonatal or perinatal
care units are required to have the necessary skills and technical knowledge of
complications during pregnancy and the medical care procedures to avoid problems
pertaining to pregnancy (Aksornphusitaphong & Phupong, 2013). The primary
responsibilities of the midwife include the assessment, diagnosis, and appropriate
nursing care management of pregnant women. One of the primary and most
common complications in pregnancy is pre-eclampsia and hypertensive disorders.
Additionally, the mortality rate of mothers with hypertensive disorders is high
(Stellenberg & Ngwekazi, 2016).
Pre-eclampsia is additionally called toxaemia and is characterised by the elevation in
the levels of blood pressure in pregnant women. Pre-eclampsia is a type of
hypertensive disorder and is found to be responsible for approximately 8% mortality
in pregnant women. The complication of pre-eclampsia during pregnancy commonly
develops during the third trimester of pregnancy and is less commonly encountered
in the gestational period (English, Kenney, & McCarthy, 2015). The risk factors for
the development of pre-eclampsia during pregnancy are varied and range across
multiple elements such as nulliparity, obesity, chronic diabetes, medical history in the
family, or donation of ova (Buhimschi et al., 2014).
The current article discusses a case study of complication of pre-eclampsia during
pregnancy, the pathophysiology of the disease, midwifery and nursing care in

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pregnant women with pre-eclampsia, and the role of the midwife in pregnancy and
prenatal pre-eclampsia therapy protocol (Stellenberg & Ngwekazi, 2016).
Case-study:
Clara Turner is a 32-year-old housewife. She is a first-time mother. She current lives
with Richard Turner, her husband, in Clermont, Queensland. Clara presented to the
hospital complaining of severe pain in the abdomen, last week. Clara is a housewife
and Richard works on the family farm. Clara does not have a medical history of high
blood pressure or diabetes. Clara’s trimestral records in pregnancy show striae
gravidarum, melasma, and lineanigra. She additionally complained of headache and
nausea frequently. The patient has a medical history of hypertension on her paternal
familial side i.e. both her paternal grandmother and father had hypertension. Clara
experiences anxiety and restlessness. Her medical examination shows borderline
obesity and raised blood pressure. Clara was diagnosed with pre-eclampsia. Clara
has been rapidly putting on weight ever since her first presentation, has dizziness
and headaches frequently, and has excessive instances of nausea. Upon
examination, it was found that the urine output is decreased and her neurological
reflexes and orientation are slightly hindered.
Pre-eclampsia – pathophysiology and disease mechanism:
Pre-eclampsia belongs to the large spectrum of diseases associated with
hypertension and is commonly found in pregnant women during the third trimester of
pregnancy (Mustafa, Ahmed, Gupta, & Venuto, 2012).It has a high aetiology rate and
is one of the most common complications ofpregnancy. The pathogenesis and the
disease mechanism is relatively unknown in research. The hypertension that is found
in pregnant women with pre-eclampsia has several harmful or adverse effects on the

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foetus and the mother.The development of pre-eclampsia generally occurs during
the twentieth week of pregnancy or during the childbirth. The condition can last up to
the postpartum stage of 48 hours (Ferreira, Silveira, Silva, Souza, & Ruiz, 2016).
Pre-eclampsia is one of the broad spectrum of diseases belonging to the
pathobiology of hypertensive disorders during pregnancy (Direkvand-Moghadam et
al, 2012). The other disorders include: chronic hypertension, gestational
hypertension, and pre-eclampsia (Ferreira et al., 2016). The determination of pre-
eclampsia in pregnancy is primarily done by means of measurement of blood
pressure values. The value of 140/90 mm Hg or higher value of blood pressure
(diastolic pressure of 140 mmHg and systolic value of 90 mmHg) indicate the
presence of pre-eclampsia in pregnancy.
Pathogenesis of the disease: The physiological observations of the disease
include the presence of several significant modifications in the vascular system of
the patient (Guerrier et al., 2013).The systemic blood flow and vascular
hemodynamic characteristics are greatly altered in the disease condition(Mustafa et
al., 2012). The alterations are found in the prenatal stages. These changes may be
appreciated upon inspection and physical examination (Shegaze et al., 2016). There
are observable changes in the systolic and diastolic blood pressure
values(Direkvand-Moghadam et al, 2012). The increase in the level of diastolic
pressure is higher as compared to the diastolic pressure values. The alterations are
seen during the 20th week of pregnancy and the values may be higher than 140
mmHg. The systemic values of blood pressure and the vascular blood flow also
increase accordingly. These changes are accompanied by elevation in the levels of
cardiac output (Mustafa et al, 2012). The peak threshold value of blood pressure and

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cardiac output are reached during the 18th and the 20th week of gestation. The values
are incremented with the progress of pregnancy (Kattah & Garovic, 2013).
Additionally, there is an observable increase in the stroke volume, pulse, and heart
rate. The increase in the stroke volume and heart rate result in the increase in the
amount of blood that is pumped to the heart. The quantity of blood flow increases to
the circulations of the pulmonary and the systemic type (Guerrier et al., 2013). The
load of blood volume is necessarily increased as a consequence of the raised blood
flow rate. The vascular changes in circulation result in the increased blood volume
load leading to higher systolic and diastolic blood pressure and cardiac output.
Patients may experience palpitations and anxiety at several instances, as in the case
of Clara. The increase in the load of blood volume leads to hypertrophy in the left
ventricle of the heart. This leads to an increase in the work load on the cardiac
muscles and increased relaxation durations in the cardiac cycle (Mustafa et al.,
2012). The mean arterial pressure value is greatly reduced. Therefore, the cardiac
work load increases manifold in order to keep up with the increase in the cardiac
output. There is a substantial elevation in the volume of plasma, leading to the
increased cardiac output. This increases the capacity of circulation in the blood flow
(Kenny et al., 2014). Therefore, there is an observable level of increase in the
capacity of blood circulation along with a decline in the tone of circulation.Therefore,
during gestation, the vasculature is mostly flaccid. However, the muscle tone is
mostly rough and the reduction in the smoothness is not just limited to the
vasculature of the system. The muscle tone may be shared with the smooth muscles
present in the urinary tracts and the gastrointestinal tract.
The pathobiology of the disease and the subsequent regulation in the volume of the
blood flow can be done through hormones circulating in the blood (Lecarpentier et

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al., 2013). These hormones mainly include the system of aldosterone, renin, and
angiotensin circulating in the blood. The level of catecholamine in the blood is also
greatly enhanced during the period of gestation (Ferreira et al., 2016). The renal
perfusion and the plasma volume are greatly reduced due to the stimuli of the
physiological basis of these hormones. The pressor compounds that are infused
during pregnancy also contribute to an effect of vasoconstriction. The
pathophysiological factors of causation of hypertensive disorders and pre-eclampsia
in pregnancy include placental, renal, dietary, or immunological elements
(Lecarpentier et al., 2013). Vascular injuries resulted from immunological mediation
may also lead to the development of pre-eclampsia. The renal function and
glomerular filtration rate are greatly reduced in pregnant women with pre-eclampsia
(Kattah, & Garovic, 2013).
Role of the midwife:
The midwives working in prenatal or pregnancy units have a considerable amount of
responsibility in the identification of a plausible case of pre-eclampsia in pregnancy
(Stellenberg & Ngwekazi, 2016).The primary factors that determine the presence of
pre-eclampsia include oedema (Lecarpentier et al., 2013). This is frequently
accompanied by the presence of proteinuria.
Midwives function in a role that comprises of both medical knowledge and traditional
birthing skills. Pregnant women with gestational complications are in an extremely
vulnerable and helpless situation which needs to be taken into consideration by the
midwives. The primary intervention is to determine the measured values of blood
pressure. The symptoms of pre-eclampsia need to be monitored. The assessment
and the interpretation of the blood pressure values need to be made at immediate

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suspicion. The hyperbasric index and the ambulatory blood pressure have to be
determined (Navaratnam et al., 2013). The hyperbaric pressure is determined when
the blood pressure increase is higher than 90% of the limit of tolerance in a specific
period of time. The treatment protocol mainly involves medication for hypertension.
The diagnosis of pre-eclampsia includes a high value of blood pressure at
approximately >100 mmHg of diastolic pressure (approximately 140 mmHg),
proteinuria (> 5g in a span of 24 hours), and observable oedema of the pulmonary
kind (Stellenberg & Ngwekazi, 2016).
The management of pre-eclampsia includes a significant role of the midwife, starting
from the identification, diagnosis, treatment, and childbirth(Rowe et al, 2012). The
midwife is required to observe the tendencies and presentations of pre-eclampsia,
signs and symptoms, and diagnosis. The identification of the disease in the
gestational or prenatal phase enables the appropriate determination of the
underlying vascular and renal pathomechanism (Rowe et al., 2012). Therefore, it
enables the appropriate measure for treatment. The hormonal inconsistencies and
the treatment for the hypertensive disorder does not have any implications on the
gestational cycle or the childbirth (Tessema et al., 2015). The treatment procedure
does not cause any delays or alterations in the time of the childbirth. However, the
occurrence of elevated blood pressure levels, diastolic pressure, cardiac output, and
heart rate are common symptoms in hypertensive spectrum disorders (Tessema et
al., 2015). Therefore, the determination of proteinuria and related symptoms of pre-
eclampsia is essential in midwifery (Stellenberg & Ngwekazi, 2016).
Conclusion:

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Hypertensive spectrum of disorders and pregnancy complications are much common
across the world. The presence of pre-eclampsia as a complication in pregnancy is
one of the most common occurrences. The midwife is required to monitor the
individual presentations, the disease pathology, and symptoms. The diagnosis of the
disease in the prenatal and gestational stages enables immediate recognition and
subsequent timely treatment. The cure of hypertension or preeclampsia does not
typically occur with hypertension medication, but occurs after childbirth. Therefore,
the role of the midwife is significant during the childbirth and in the neonatal care.
The midwife is required to determine the early signs and symptoms of the health of
the pregnant woman. It is essential for the midwife to determine the specific blood
flow volume and cardiac output as signs of pre-eclampsia. Since the disease is
associated with high degrees of mortality in pregnant women and the foetus, it is
critical to meticulously perform physical examinations at the early stage along with
understanding and recording the frequency and severity of oedema, nausea, and
headache. Pre-eclampsia has a high rate of aetiology and leads to several
complications during the gestation period. The disorder is co-morbid in pregnancy
and is present until childbirth.

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References:
Aksornphusitaphong, A., &Phupong, V. (2013). Risk factors of early and late onset
preeclampsia. J ObstetGynaecol Res., 39, 627-631
Buhimschi, I.A., Nayeri, U.A., Zhao, G., et al. (2014). Protein misfolding,
congophilia, oligomerization, and defective amyloid processing in
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Direkvand-Moghadam, A., Khosravi, A., &Sayehmiri, K. (2012). Predictivefactors for
preeclampsia in pregnant women: a univariate and multivariatelogistic
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control. Risk factors and effective management of preeclampsia, 8, 7–12
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Lecarpentier, E., Tsatsaris, V., Goffinet, F., Cabrol, D., Sibai, B., et al. (2013).
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associatedfactors amongpregnant women attending antenatal care in Dessie

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