Essay On A Complex Case Of Pregnancy †Free Samples For Students

Question: Discuss About The Essay On A Complex Case Of Pregnancy? Answer: 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 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. Claras 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 wa s 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 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 t hreshold value of blood pressure and 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 inc rease 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 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 r educed 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 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). Therefor e, the determination of proteinuria and related symptoms of pre-eclampsia is essential in midwifery (Stellenberg Ngwekazi, 2016). Conclusion: 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 metic ulously 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 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 preeclampsia. Science Transl Med., 6(245), 245ra292. Direkvand-Moghadam, A., Khosravi, A., Sayehmiri, K. (2012). Predictivefactors for preeclampsia in pregnant women: a univariate and multivariatelogistic regression analysis.Acta Biochim Pol, 59, 673-677 English, F.A., Kenney, L.C., McCarthy, F.P. (2015). Integrated blood pressure control. Risk factors and effective management of preeclampsia, 8, 712 Ferreira, M.B.G., Silveira, C.F., Silva, S.R., Souza, D.J., Ruiz, M.T. (2016). Nursing care for women with pre-eclampsia and/or eclampsia: integrative review. Rev Esc Enferm USP., 50(2), 320-330 Guerrier, G., Oluyide, B., Keramarou, M., Grais, R.F. (2013). Factors associatedwith severe preeclampsia and eclampsia in Jahun, Nigeria. Int J WomensHealth, 5, 509-513. Kattah, A.G.Garovic, V. (2013). The Management of Hypertension in Pregnancy. Adv Chronic Kidney Dis., 20(3), 229239 Kenny, L.C., Black, M.A., Poston, L., et al. (2014). Early pregnancy prediction of preeclampsia in nulliparous women, combining clinical risk and biomarkers: the Screening for Pregnancy Endpoints (SCOPE) international cohort study. Hypertension, 64(3), 644652. Lecarpentier, E., Tsatsaris, V., Goffinet, F., Cabrol, D., Sibai, B., et al. (2013). Riskfactors of superimposed preeclampsia in women with essential chronichypertension treated before pregnancy. Plos One, 8, e62140 Mustafa, R., Ahmed, S., Gupta, A.,Venuto, R.C. (2012). A ComprehensivConclusion: Navaratnam, K., Alfirevic, Z., Baker, P.N., et al. (2013). A multi-centre phase IIa clinical study of predictive testing for preeclampsia: improved pregnancy outcomes via early detection (IMPROvED). BMC Pregnancy Childbirth,13, 226. Rowe, R.E., Kurinczuk, J.J., Locock, L., et al. (2012). Womens experience of transfer frommidwifery unit to hospital obstetric unit during labour: A qualitative interview study.BMC Pregnancy Childbirth, 12, 129. https://dx.doi.org/10.1186/1471-2393-12-129 Stellenberg, E.L. Ngwekazi, N.L. (2016). Knowledge of midwivesabout hypertensive disordersduring pregnancy in primaryhealthcare. Afr J Prm HealthCare Fam Med, 8(1),a899. Shegaze, M., Markos, Y., Estifaons, W., Taye, I. et al. (2016). Magnitude and Associated Factors of Preeclampsia Among Pregnant Womenwho Attend Antenatal Care Service in Public Health Institutions in Arba Minch Town, Southern Ethiopia. GynecolObstet (Sunnyvale), 6(12), 1-6 Tessema, G.A., Tekeste, A., Ayele, T.A. (2015). Preeclampsia and associatedfactors amongpregnant women attending antenatal care in Dessie referralhospital, Northeast Ethiopia: a hospital-based study. BMC Pregnancy andChildbirth, 15, 73.

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