A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding.
A threatened abortion is suspected, and the nurse instructs the client regarding management of care.
Which statement, if made by the client, indicates a need for further education?

Choice A rationale: Primigravida

Primigravida (first-time pregnancy) is a known risk factor for preeclampsia. Studies show that nulliparous individuals (those who have never given birth before) have a higher likelihood of developing preeclampsia compared to multiparous individuals. The exact reason is not fully understood, but it is thought that immunological adaptation plays a role.

Choice B rationale: Age

Advanced maternal age (≥35 years) is a recognized risk factor for preeclampsia. This client is 36 years old, which places her in the higher-risk category. Older maternal age is associated with increased vascular dysfunction and underlying chronic conditions that predispose individuals to preeclampsia.

Choice C rationale: Type 1 diabetes mellitus

Type 1 diabetes mellitus significantly increases the risk of preeclampsia due to its impact on vascular health. Diabetes affects endothelial function and can cause chronic inflammation, both of which contribute to hypertension and proteinuria, hallmark symptoms of preeclampsia. Additionally, diabetes increases the risk of abnormal placentation, further raising the chances of hypertensive disorders in pregnancy.

Choice D rationale: Hemoglobin level

A hemoglobin level of 12.5 g/dL is within the normal range and does not contribute to an increased risk for preeclampsia. While anemia is sometimes associated with preeclampsia, a normal hemoglobin level does not raise concern in this case. Therefore, hemoglobin is not a risk factor for preeclampsia in this patient.

Rationale for Correct Condition

Preeclampsia is characterized by hypertension (≥140/90 mm Hg) and proteinuria (≥300 mg/24 hr) or signs of systemic involvement such as headache and edema. The client’s elevated BP, significant proteinuria, headache, hyperreflexia, and pitting edema strongly indicate preeclampsia. The absence of seizures rules out eclampsia, and the gestational age excludes chronic hypertension with superimposed preeclampsia.

Rationale for Correct Actions

Magnesium sulfate prevents seizures by stabilizing neuronal excitability and reducing cerebral vasospasm. It also lowers BP by promoting vascular relaxation. External fetal monitoring detects fetal distress from utero-placental insufficiency caused by preeclampsia-related hypertension and endothelial dysfunction.

Rationale for Correct Parameters

Blood pressure reflects disease progression and response to antihypertensives. Severe hypertension increases the risk of cerebral hemorrhage and placental abruption. Deep tendon reflexes indicate neurological impairment. Hyperreflexia signals worsening preeclampsia, while absent reflexes may indicate magnesium toxicity.

Rationale for Incorrect Conditions

Gestational hypertension lacks proteinuria and systemic symptoms. Chronic hypertension with superimposed preeclampsia requires a pre-existing hypertensive diagnosis. Eclampsia involves seizures, which the client has not reported.

Rationale for Incorrect Actions

Ampicillin is not indicated without infection. Rh immune globulin is unnecessary without Rh incompatibility. Anticoagulants are not first-line for preeclampsia.

Rationale for Incorrect Parameters

Temperature is not directly related to preeclampsia. Petechiae are signs of coagulopathy, not primary indicators. Pruritus is irrelevant unless liver dysfunction is suspected.

Take-Home Points

• Preeclampsia involves multisystem dysfunction with endothelial damage.
• Magnesium sulfate prevents seizures but must be monitored for toxicity.
• Differentiation from gestational hypertension is crucial for management.
• Fetal monitoring is key to detecting early signs of compromise.