Preeclampsia: Home Blood Pressure Monitoring, Severe Features, and Postpartum Warning Signs

Who needs this teaching

Pregnant clients after 20 weeks of gestation, and every client in the first 6 weeks after birth, with the support person. Preeclampsia is a multisystem disorder of endothelial dysfunction and vasospasm. It reduces placental perfusion and damages the kidneys, liver, brain, and coagulation system.

The priority teaching points

1. What preeclampsia is. Preeclampsia is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher on 2 occasions at least 4 hours apart after 20 weeks, with proteinuria or end-organ dysfunction. Severe features include a systolic pressure of 160 or higher or a diastolic pressure of 110 or higher, platelets below 100,000/microL, elevated liver enzymes, serum creatinine above 1.1 mg/dL, pulmonary edema, and new cerebral or visual symptoms. Birth is the definitive treatment.
2. Low-dose aspirin. High risk factors are prior preeclampsia, multifetal gestation, chronic hypertension, pregestational diabetes, kidney disease, and autoimmune disease. For these clients, and for clients with more than one moderate risk factor, low-dose aspirin 81 mg daily is prescribed from 12 to 28 weeks (ideally before 16 weeks) and continued until birth.
3. Home blood pressure checks. When advised, use a validated upper-arm monitor after 5 minutes of seated rest, with the arm at heart level. Record each reading. Report a systolic reading of 140 or higher or a diastolic reading of 90 or higher the same day. A systolic reading of 160 or higher or a diastolic reading of 110 or higher requires immediate evaluation in labor and delivery or the emergency department.
4. Severe features the client reports. The client reports a severe headache not relieved by acetaminophen, visual disturbances (scotomata, which are spots in the vision, or blurring), right upper quadrant or epigastric pain, sudden edema of the face or hands, shortness of breath, and new nausea or vomiting in late pregnancy. These indicate cerebral, hepatic, or pulmonary involvement. Go to labor and delivery or the emergency department now.
5. Fetal well-being. Count fetal movements daily and report a decrease immediately. Keep scheduled nonstress tests, growth ultrasounds, and laboratory tests. Preeclampsia causes fetal growth restriction.
6. After birth. Preeclampsia develops or worsens up to 6 weeks after birth, most often within the first week. Continue home blood pressure checks and prescribed antihypertensives. Keep the blood pressure visit within 7 to 10 days after birth, or within 72 hours with severe hypertension. Preeclampsia increases lifelong cardiovascular risk; schedule yearly blood pressure, lipid, and glucose checks.

Red flags the client reports

Teach-back questions

• "Which blood pressure numbers mean you call today?"
• "Which numbers mean you go to the hospital now?"
• "Show me how you sit to check your blood pressure."
• "Which headache means you go to labor and delivery?"
• "How long after birth will you watch for these signs?"

Teaching tips

• Write the client's call and emergency blood pressure numbers on the handout.
• Observe a return demonstration with the client's own monitor.
• Repeat the warning signs at postpartum discharge.

Read more on NCLEXPace

• Preeclampsia vs HELLP on the NCLEX: Findings and First Actions
• Cord Prolapse, Abruption, Previa and Postpartum Hemorrhage: First Actions
• Seizure Precautions and Status Epilepticus: What Never to Do

Sources

• American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin No. 222. Obstet Gynecol. 2020;135(6):e237-e260.
• American College of Obstetricians and Gynecologists. Low-Dose Aspirin Use During Pregnancy: ACOG Committee Opinion No. 743. Obstet Gynecol. 2018;132(1):e44-e52.
• American College of Obstetricians and Gynecologists. Clinical Guidelines for the Management of Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period: ACOG Committee Opinion No. 767. Obstet Gynecol. 2019;133(2):e174-e180.
• American College of Obstetricians and Gynecologists. Optimizing Postpartum Care: ACOG Committee Opinion No. 736. Obstet Gynecol. 2018;131(5):e140-e150.