PREGNANCY INDUCED HYPERTENSION

 

What is preeclampsia?

Preeclampsia as a medical diagnosis is defined as new-onset hypertension (> 140/90 mm Hg) and proteinuria OR end-organ damage after 20 weeks gestation.

What causes preeclampsia (risk factors)?

Preeclampsia is believed to be caused by a combination of genetic, dietary, vascular, and immune factors. The exact cause is unknown. 

Risk factors for developing preeclampsia include: 

• Family history
• Genetic/epigenetic predisposition
• Nulliparity
• Multiple gestation
• Maternal age > 35
• BMI > 30
• Pre-existing HTN
• Diabetes
• Chronic kidney disease
• First baby with a new partner
• Assisted reproductive technology

How to prevent preeclampsia

Here are some key strategies:

• Education: Ensure that clients understand risk factors for preeclampsia as well as the importance of prenatal care.
• Monitoring: Regularly monitor blood pressure, urine protein levels, and report any sudden changes to a healthcare provider. Look out for signs and symptoms of preeclampsia such as persistent headaches, vision changes, upper abdominal pain, and sudden weight gain.
• Advocacy: Support and encourage clients to maintain a healthy lifestyle, including a balanced diet, regular physical activity, and avoiding substances like alcohol and tobacco.
• Medication management: For high-risk clients, low-dose aspirin may be recommended after the first trimester to help prevent preeclampsia. Ensure clients understand the medication regimen if prescribed.
• Early detection: Encourage regular prenatal visits to detect any issues as early as possible.

Preeclampsia progression: how quickly can it develop?

Preeclampsia can develop quite rapidly.

It typically occurs after the 20th week of pregnancy, but it can also develop in the late second trimester or even postpartum. Once signs and symptoms begin to manifest, preeclampsia can progress from mild to severe within a matter of days or weeks. In some rare and severe cases, it can progress to full-blown eclampsia (seizures caused by preeclampsia) within a very short time frame. 

Preeclampsia generally starts with an improperly developed placenta, which can lead to placental ischemia. The body then responds by releasing substances into the bloodstream that can lead to systemic inflammation, blood vessel damage, and endothelial dysfunction, contributing to high blood pressure.

What are signs of preeclampsia?

The disease may begin with mild symptoms:

• Slight increase in blood pressure
• Protein in the urine
• Swelling in the hands and face
• Rapid weight gain due to fluid retention
• Sometimes headache, changes in vision, or upper abdominal pain

If not properly managed, preeclampsia can progress to severe preeclampsia, characterized by:

• More significant increases in blood pressure
• More protein in the urine
• Potentially severe headaches
• Blurred vision
• Impaired liver function
• Shortness of breath due to fluid in the lungs
• Decreased urine output
• Platelet count changes

In extreme cases, preeclampsia can progress to eclampsia, a serious condition that can cause seizures and is a major cause of maternal and fetal morbidity and mortality.

Preeclampsia nursing diagnoses

Potential nursing diagnoses related to preeclampsia may include:

• Anxiety: provide emotional support and concise information 
• Powerlessness
• Risk for imbalanced fluid volume: risk factors are hypertension, altered kidney function; regular assessments for input/output, weight, and signs of fluid overload, if prescribed, administer diuretics 
• Risk for maternal injury: prevent by providing safe environment in case of seizures or stroke secondary to severe preeclampsia/eclampsia; monitor neurologic status 
• Risk for unstable blood pressure

Diagnostic lab values of preeclampsia

• Proteinuria: > 300 mg/24h, protein/creatinine ration > 0.3, dipstick 1 + persistent
• Thrombocytopenia: platelets < 100,000/µL
• Renal insufficiency: creatinine > 1.1 mg/dL or doubling of baseline
• Liver involvement: serum transaminase levels twice normal

How is preeclampsia managed during pregnancy?

Preeclampsia is managed by maintaining normal blood pressure with IV anti-hypertensive medication as ordered and administering IV magnesium sulfate for seizure prophylaxis. The timing of delivery is determined by the severity of presentation and gestational age. The condition typically resolves with the birth of placenta.

Nursing interventions that can help prevent end-organ damage in patients with preeclampsia

Nursing interventions that can help prevent end-organ damage in patients with preeclampsia include: 

• Monitoring blood pressure and reporting elevations to the provider
• Evaluating deep tendon reflexes per protocol
• Assessing presence/progression of symptoms
• Administering medications as ordered
• Educating clients regarding condition/plan
• Assisting in preparation for birth, if indicated

Potential complications associated with preeclampsia

Potential complications associated with preeclampsia include: 

• Eclampsia (tonic clonic seizures resulting from altered cerebral blood flow)
• HELLP syndrome (hemolysis, elevated liver enzymes, low platelets): can lead to uncontrolled bleeding and DIC
• Reduced blood flow to vital organs
• Glomerular damage
• Fetal distress and growth restriction
• RUQ pain
• New-onset N/V
• Epigastric pain
• Coagulopathies 
• Placental syncytial stress and placental abruption 
• Pulmonary edema

CASHLESS HOSPITALISATION

 

    The introduction of cashless hospitalisation in insurance policies has helped people not to worry about cash while admitting their close ones in a hospital. With the help of this facility, patients can undergo any necessary treatment without the worry of direct payment.                   In case of cashless claims, the insurer settles all bills (if it does not exceed a sum insured amount) directly through coordination with the hospital without involving the policyholder. 

 

Types of Cashless Hospitalisation

In India, there are three types of cashless hospitalisation facilities available:

1. Individual Cashless Medical Insurance Policy

    Under this particular insurance policy, only the insured person can seek cashless benefits on seeking treatment from a network hospital.

2. Family Floater Cashless Health Insurance Policy

    Individuals can cover themselves alongside their family members under a single health insurance policy. The cashless benefits are available to all the family members covered under this single plan.

3. Cashless Health Insurance Policy for Senior Citizens

    This plan offers cashless benefits to senior citizen policyholders. The plan typically covers ambulance charges, hospital expenses, and various pre-existing ailments subject to policy terms and conditions.

Cashless Hospitalisation Benefits

The benefits of cashless hospitalisation are manifold. These include:

1. Policyholders can do away with the hassle of arranging for funds during an emergency. Medical emergencies put a lot of emotional toll on individuals and their families. Cashless claims relieve policyholders from the financial burden of paying cash upfront to seek treatment.
2. With most insurance providers shifting their operations to the digital platform, raising cashless claims have become hassle-free.
3. Leading insurance providers  have over 10,000 network hospitals across the country in India. This has made seeking such facilities much easier.

How does a Cashless Hospitalisation Function?

Health Insurance providers have an association with various private and Government hospitals in India. These firms first check the quality of services offered by these hospitals and then negotiate on prices before tying up. 

These hospitals are known as network hospitals. On getting admitted to one of these hospitals, the expenses incurred in due course of seeking treatment are directly settled by an insurer. 

1. Planned Hospitalisation 

In this case, policyholders are aware of their hospitalisation in the upcoming days. In such a situation, follow the below-mentioned cashless hospitalisation process:

1. First, check your policy or call the toll-free number to find a nearby network hospital.
2. After shortlisting a network hospital, take a policy card to the hospital and get a pre-authorisation form. It is also possible to download a pre-authorisation form from the TPA (Third Party Administrator)’s website.
3. A policyholder will have to fill the first part of the form, while a physician will fill the other part.
4. Now, submit your form to the insurance desk.
5. After that, the form will get faxed to the TPA.
6. A TPA will approve or reject your form.
7. In case of approval, the TPA will send an authorisation letter mentioning a sanctioned amount.

2. Emergency Hospitalisation

To claim this facility, follow these steps prior to the cashless hospitalisation process:

1. First, show your health insurance card at the hospital.
2. The insurance desk will provide a pre-authorisation form. Fill it up and submit it.
3. If you cannot wait for TPA approval, pay your bills to reimburse them later.
4. During a medical emergency, a TPA processes claims within 6 hours.

Cashless Healthcare Plan Exclusions

There are, however, a few facilities that are not covered under cashless healthcare plans. A few of these are as follows:

• Ambulance charges
• Visitor or attendant fees
• Service charges
• Oxygen mask charges, nebuliser expenses, diaper expenses, etc.
• Toiletries expenses
• Documentation expenses
• Injuries caused due to terrorism, drug abuse, or alcohol

Reasons for Claim Rejection

Cashless claims can sometimes get rejected, barring an insured person from seeking treatment. Following are a few instances wherein a cashless claim can get rejected:

• If your ailment does not fall under your policy coverage
• In case your sum insured amount limit has been exhausted
• On account of inadequate information on the pre-authorisation form
• If the information provided is not sufficient
• Delay in informing your TPA about hospitalisation

However, there is a judgment from the Bombay High Court that TPAs will not reject or partially disallow claims. The onus lies entirely on the insurer. Previously, TPAs got paid incentives to deny any claim. But with this judgment, an insured will now get penalised with regards to claims.

Things to Remember before Purchasing a Cashless Health Plan

There are a few pointers that you must remember before choosing any health plan. Check them below:

1. This benefit is only available at network hospitals.
2. Only your hospital can justify your treatment.
3. Keep a copy (photocopy) of all bills, reports, claim forms, discharge papers, and other documents.
4. Make sure to read the fine print before purchasing.

Check the sum insured amount before buying cashless health insurance. A policyholder must pay any excess amount of expenses breaching the limit