Current concepts in preeclampsia

The purpose of this article is to review recent epidemiologic and pathophysiologic findings that advance the understanding of preeclampsia for the nurse in perinatal practice. Preeclampsia is different from other hypertensive disorders of pregnancy. Risk factors for preeclampsia and recent findings regarding normal and aberrant implantation are presented. Abnormal implantation and resulting poor placental perfusion may be the impetus for endothelial changes evidenced in preeclampsia; pathophysiology is described in relation to this event. The interaction of maternal factors, reduced placental perfusion, and endothelial cell dysfunction provides an explanation for the occurrence of preeclampsia and provides a basis for nursing practice and research. Implications for nursing care for women of childbearing age before, during, or after pregnancy may include (a) preconception or post-delivery counseling to reduce modifiable risk factors such as obesity, sedentary lifestyle, or high fat intake, (b) assessment of risk factors and increased surveillance when risk factors are present, and (c) surveillance of blood pressure changes of > 30 mmHg systolic or > 15 mmHg diastolic in advance of the third trimester of pregnancy.