Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Management of Pre-Eclampsia

Pre-eclampsia is a pregnancy-related hypertensive disorder with maternal or fetal risk. Management confirms blood pressure and symptoms, assesses proteinuria and organ involvement, monitors mother and fetus, controls severe features, and plans timely delivery or referral.

Purpose

  • Prevent progression to severe disease, eclampsia, stroke, and organ injury
  • Assess maternal and fetal wellbeing
  • Coordinate monitoring, treatment, referral, and birth planning

Indications

  • New hypertension after the relevant gestation with proteinuria or other features
  • Headache, visual symptoms, epigastric or right-upper-quadrant pain, oedema with illness, or abnormal tests
  • Fetal growth or wellbeing concern associated with hypertension

Equipment

  • Validated blood-pressure apparatus and appropriate cuff
  • Urine protein testing and laboratory supplies
  • Maternal and fetal monitoring equipment
  • Medication, IV, oxygen, seizure, and referral equipment
  • Antenatal and observation records

Preparation

  • Review local hypertensive-disorder protocol and ensure emergency seizure and referral equipment.
  • Arrange laboratory and fetal assessment promptly.

Procedure steps

  • Confirm blood pressure with correct cuff, position, repeat measurement as indicated, and assess symptoms.
  • Ask about headache, visual disturbance, epigastric pain, breathlessness, nausea, reduced urine, fetal movement, and seizures.
  • Assess urine protein, blood count, platelets, renal and liver function, and other tests according to policy.
  • Assess fetal growth, movement, heart rate, presentation, and wellbeing using appropriate methods.
  • Classify severity and commence prescribed antihypertensive, seizure prophylaxis, corticosteroid, or other treatment when indicated.
  • Monitor blood pressure, neurological status, urine output, reflexes when relevant, symptoms, fluid balance, and fetal status.
  • Avoid fluid overload and communicate with obstetric, anaesthetic, neonatal, and laboratory teams.
  • Plan surveillance, admission, referral, or delivery according to gestation, severity, response, and fetal condition.
  • Teach the woman and family danger signs and the need for adherence and follow-up.
  • Document findings, classification, treatment, education, communication, and plan.

Precautions

  • Severe headache, visual symptoms, epigastric pain, clonus, seizures, pulmonary oedema, severe hypertension, or fetal compromise is an emergency.
  • Use correct blood-pressure technique and do not rely on oedema alone.
  • Avoid excessive fluids and monitor urine output.
  • Do not stop prescribed treatment without review.

Aftercare

  • Continue surveillance after blood pressure improves because risk can persist.
  • Arrange postnatal blood-pressure and cardiovascular follow-up.

Nursing considerations

  • Use maternal and fetal assessment together and communicate trends.
  • Support informed decisions about admission, referral, and birth.

Patient education

  • Take medicines and attend monitoring; report headache, visual change, epigastric pain, breathlessness, reduced urine, seizures, or reduced fetal movement immediately.
  • Explain that pre-eclampsia can worsen or continue after birth.

Documentation

  • Record blood pressure trends, symptoms, urine, labs, fetal findings, medications, fluid balance, education, referrals, and plan.
  • Document severity and response.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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