This further complicates things because it decreases blood volume. Lesions of the plexus are asymmetric with sensorimotor involvement of multiple nerves in one extremity. The oxygen deprived placenta does not like this and becomes stressed out so it releases substances into moms circulation in hopes of increasing blood flow to it. The neuropathies must be further characterized by onset and chronicity of symptoms, the pattern and extent of involvement, and the type of nerve fibers involved (i.e., sensory, motor, or autonomic). Disclaimer. A potential limitation of electrodiagnostic studies is that they are able to test only the large, myelinated nerve fibers. Clonus is graded as grade 4+. Aqu encontrar todo lo que necesita saber sobre cmo tomarse la presin arterial en casa. The term peripheral neuropathy is usually used to describe symmetric and universal damage to adjacent nerves. A physical examination may be performed, as well as a test of the deep tendon reflexes. Adverse pregnancy outcomes related to severe preeclampsia are caused primarily by the need for preterm delivery. Abnormal placental implantation (defects in trophoblasts and spiral arterioles), Angiogenic factors (increased sFlt-1, decreased placental growth factor levels), Cardiovascular maladaptation and vasoconstriction, Genetic predisposition (maternal, paternal, thrombophilias), Immunologic intolerance between fetoplacental and maternal tissue, Vascular endothelial damage or dysfunction, Preeclampsia in a previous pregnancy (particularly if severe or before 32 weeks of gestation), Blood pressure 160 mm Hg systolic or 110 mm Hg diastolic on two occasions at least six hours apart during bed rest, Proteinuria 5 g in a 24-hour urine specimen or 3+ or greater on two random urine specimens collected at least four hours apart. The height adjusted Treflex was abnormal in 25 (96%) cases, including 6 of 7 patients with brisk or normal reflexes on clinical testing. Acute Fatty Liver of Pregnancy (AFLP) is a relatively rare disorder that happens only during human pregnancy. As the nurse, you want to watch out for the following measurements: How is preeclampsia different than gestational hypertension? An official website of the United States government. Loss of sensation (including vibration, proprioception, temperature, and pinprick sensations) in distal extremities suggests peripheral neuropathy, as does a distal-to-proximal gradient of reflex elicitation. Dr. Judah Lindenberg answered 22 years experience 0-4: Deep tendon reflexes, of which the knee-jerk is the best known, are spinal reflexes triggered by hitting certain tendons. A maternal blood pressure measurement of 140/90 mm Hg or greater on two occasions before 20 weeks of gestation indicates chronic hypertension. Preeclampsia can stress fetus. Methods. When these reflexes are disrupted, hyperreflexia (disease induced) or. The former is usually achieved by eliminating offending agents, such as toxins or medications; correcting a nutritional deficiency; or treating the underlying disease (e.g., corticosteroid therapy for immune-mediated neuropathy).8 These steps are important to halt the progression of neuropathy, and they may improve symptoms. It is our collective voice that reduces isolation for others, raises awareness and improves healthcare practices. Hyperreflexia refers to hyperactive or repeating (clonic) reflexes. HELLP Syndrome: hemolysis (rupture of RBCs), elevated liver enzymes, low platelets. A deep tendon reflex reflects the function of a part of the nervous system that travels to and from the spinal cord. When the reflexes are absent try eliciting it after re-enforcing (Jendrassik maneuver0, by asking the patient to interlock and pull flexed fingers. The acronym HELLP describes a variant of severe preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelet count.31 HELLP syndrome occurs in up to 20 percent of pregnancies complicated by severe preeclampsia.32 The clinical presentation of HELLP syndrome is variable; 12 to 18 percent of affected women are normotensive and 13 percent do not have proteinuria.33 At diagnosis, 30 percent of women are postpartum, 18 percent are term, and 52 percent are preterm.32 Common presenting complaints are right upper quadrant or epigastric pain, nausea, and vomiting. Monitor urine output closely: concerned if <30cc/hr, Foley, I+0 An accurate weight is vital for a proper diagnosis. Should you record a reading of 2+ or greater at home, call your healthcare provider that very same day. Hypertensive disorders represent the most common medical complication of pregnancy, affecting 6 to 8 percent of gestations in the United States.1 In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension.1, Chronic hypertension is defined as a blood pressure measurement of 140/90 mm Hg or more on two occasions before 20 weeks of gestation or persisting beyond 12 weeks postpartum.1 Treatment of mild to moderate chronic hypertension neither benefits the fetus nor prevents preeclampsia.24 Excessively lowering blood pressure may result in decreased placental perfusion and adverse perinatal outcomes.5 When a patient's blood pressure is persistently greater than 150 to 180/100 to 110 mm Hg, pharmacologic treatment is needed to prevent maternal end-organ damage.1,2,4,6, Methyldopa (Aldomet; brand no longer available in the United States), labetalol, and nifedipine (Procardia) are oral agents commonly used to treat chronic hypertension in pregnancy. Treatment should address the underlying disease process, correct any nutritional deficiencies, and provide symptomatic treatment. PG, Tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdominal pain that started suddenly about 1 hour ago and has not subsided. 2+ = a brisk response; normal. Magnesium sulfate is the treatment of choice for women with preeclampsia to prevent eclamptic seizures (NNT = 100) and placental abruption (NNT = 100). High blood pressure is an important sign of preeclampsia. If you think your face is getting excessively puffy, find a picture of yourself from just before pregnancy to share with your healthcare provider. Initial evaluation of a patient with peripheral neuropathy should include a complete blood count, comprehensive metabolic profile, and measurement of erythrocyte sedimentation rate and fasting blood glucose, vitamin B. Electrodiagnostic studies are recommended if symptoms persist and if the diagnosis remains unclear after initial diagnostic testing and a careful history and physical examination. The most common treatable causes include diabetes mellitus, hypothyroidism, and nutritional deficiencies. It usually indicates a disease that involves one or more of the components of the two-neuron reflex arc itself. please help im his mother? Given that preeclampsia is a complex disease, women will develop it for different reasons. Tiny clots form in the tiny blood vessels blocking blood flow to the organs and causing ischemia These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways. Eating a healthy, balanced diet, including fresh raw fruit and vegetables, your prenatal vitamin, and a folic acid supplement is important for all pregnancies. Proper technique of reflexes examination and experience play a major role in eliciting and categorizing deep tendon reflexes. Would you like email updates of new search results? Therefore, water will leave the intravascular area and shift to the interstitial tissue and cause swelling. official website and that any information you provide is encrypted Please note that home monitors are not always as accurate as those used in clinics or hospitals. Patient information: See a related handout on high blood pressure during pregnancy. The peripheral nerves consist of bundles of long neuronal axons as they exit the central nervous system (CNS). ), To check for ankle clonus: quickly dorsiflex the patients foot (point toes upward) and see responseif positive (clonus) foot will start to bounce back and forth (it attempts to plantarflex) >3 bounces or more is positive, eclampsiaearly may see facial twitching, changes in neuro status, followed by full body tonic-clonic seizure (contraction and stiffening of body followed by jerking of muscles), Stay with patient and get help, dont restrain patient, get on left side (helps prevent aspiration, opens airway, and helps with blood flow to placenta), oxygen 8 to 10 L, monitor baby, timing and characteristics of seizure, may need medication and delivery of babydelivery of baby tends to be the treatment to help but can have seizures after delivery), watch salt intake (sodium levels can increase due to renal dysfunction and start to keep sodium in the blood). Edema monitoring (watch for and educate mother about this): Calcium gluconate: antidote for magnesium sulfate toxicitybe sure to have it handy, Left side-lying position (helps prevent placenta ischemia and increases blood flow to baby), bed rest/limit stimulation, fetal heart rate monitoring (report decrease in fetal activity), Assess for seizure activity eclampsia: there is a risk during and after labor (up to 48 hours), Magnesium sulfate administered to prevent seizures during and after labor (risk for seizures up to 48 hours after delivery), Protein-rich diet (remember there may be low protein in blood due to proteinuriaprotein leaks into the urine and leaves blood), I & Os: strict monitoring (may need Foley catheter), abnormal sign: low urinary output less than 30 cc/hr (kidneys arent being perfused very well), Antihypertensives (labetalol, hydralazine), Test your knowledge: Preeclampsia NCLEX Questions, Gestational Hypertension and Preeclampsia. See permissionsforcopyrightquestions and/or permission requests. Triceps, biceps, patellar (k. Read More Copyright 1990, Butterworth Publishers, a division of Reed Publishing. National Library of Medicine A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The spiral arteries of the uterus play an important role in providing blood flow to the growing placenta and baby. Unexplained pain. Life threatening , associated with severe preeclampsia Electrodiagnostic studies are recommended if the diagnosis remains unclear after initial diagnostic testing and a careful history and physical examination.4,5 There are two primary types of electrodiagnostic studies: nerve conduction studies and electromyography (EMG). In normotensive pregnant women the patellar reflex was cross-sectionally recorded using SEMG at four time points during the following gestational age periods: 12-14 weeks, 26-28 weeks, 32-34 weeks, 36-40 gestational weeks and 6-8 weeks postpartum. Delivery At 15 mEq/L, signs of abnormal conductivity surface as SA/AV node block. Fetal growth may be assessed by serial fundal height measurements supplemented by ultrasonography every four weeks starting at 28 weeks of gestation.4, Gestational hypertension has replaced the term pregnancy-induced hypertension to describe women who develop hypertension without proteinuria after 20 weeks of gestation.1 Gestational hypertension is a provisional diagnosis that includes women eventually diagnosed with preeclampsia or chronic hypertension, as well as women retrospectively diagnosed with transient hypertension of pregnancy. Urine output should be greater than 30 mL per hour44 and intravenous fluids limited to 100 mL per hour.35,44, Delivery Decisions in Severe Preeclampsia. Decisions regarding the timing and mode of delivery are based on a combination of maternal and fetal factors. Also, watch for Stomach and Right Shoulder Pain (above) and mention this symptom to your health care provider. You should also put your feet up every day, but avoid sitting for extended periods of time. +4= Hyperactive reflex; clonus may also be present, +1 Minimal edema of lower extremities In other disorders, such as acute inflammatory demyelinating disorder (i.e., Guillain-Barr syndrome) and chronic inflammatory demyelinating polyneuropathy, weakness rather than sensory loss typically predominates and may be the earliest sign of the disease. During pregnancy, a rise in the lower number (diastolic) of 15 degrees or more, or a rise in the upper number (systolic) of 30 degrees or more can also be a cause for concern. With preeclampsia, the blood pressure is usually normal at the beginning of the pregnancy, but around 20 weeks gestation it starts to elevate. Classic sign: right upper quadrant pain, also N&V and severe edema, jaundice (look at eyes too for signs of jaundice) This will assess for worsening effects of preeclampsia. Sural and superficial peroneal nerves are preferred for biopsy. +1= Reflexes present, hypoactive Is a change in your deep tendon reflex history an ominous sign? Normally, the bicep muscle will immediately contract. Damaged blood vessels allow more water to leak into and stay in your body's tissue and not to pass through the kidneys to be excreted. As a result, patient awareness of the warning signs is one of the most important tools we have to successfully help women receive the care they need. If you have tried taking over-the-counter medication without relief, if the headache is very painful, you have light sensitivity, or if your headache is accompanied by vision changes (please read the section below on "Changes in Vision") call your provider immediately and ask to see him/her that day. In disorders that cause acute peripheral neuropathy, such as those produced by toxic exposures, patients may present with similar but more fulminant symptoms, and pain predominates; symptoms also typically have a faster progression. Monitor maternal serum magnesium levels (therapeutic levels 4-8 mg/dl) A postictal phase may follow with confusion, agitation, and combativeness. Deep reflexes include patellar, Achilles, plantar, triceps, and biceps reflexes. Share your log with your healthcare provider at each visit and notify her immediately if you find any significant rise between visits. Deep tendon reflexes, magnesium, and calcium: assessments and implications The perinatal nurse, in collaboration with physicians, can use deep tendon reflexes as a powerful tool in determining the need to start, adjust, or stop magnesium infusion. Join the nursing revolution. RECAP: Youre assessing for new onset of hypertension (>140/90most likely to start occurring at 20 weeks and onward), protein in the urine proteinuria, signs and symptoms of organ injury. Vision changes are one of the most serious symptoms of preeclampsia. The diagnosis requires careful clinical assessment, judicious laboratory testing, and electrodiagnostic studies or nerve biopsy if the diagnosis remains unclear. If this pain accompanies one or more of the other symptoms, you should call your health care provider immediately. Here is everything you need to know about taking your blood pressure at home. The fetal heart rate was 132 beats per minute. However, we urge caution when considering diets designed for weight-loss or claiming to prevent preeclampsia that encourage large amounts of protein. The clonus test is a type of reflex test. Unless you're one of a lucky few, you may notice a little extra puffiness in your feet (good luck fitting into your pre-pregnancy shoes!). DIC allows excess bleeding from any vulnerable site: incisions, IV site, gums, nose, urine, ecchymoses Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. You can buy your own blood pressure monitor at most pharmacies, and some of these stores have a monitor available for your use, though they aren't always reliable. Support patient and family. In: StatPearls [Internet]. Clonus is the highest degree of hyperreflexia. The National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy has defined four categories of hypertension in pregnancy: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. Can brisk reflexes all tendon groups (symmetric) with 2-3 beats of clonus bilaterally be normal? what makes me kick so hard when they test deep tendon reflex? 2 1 the nurse should check the clients patellar. The evaluation of a patient with peripheral neuropathy starts with simple blood tests, including a complete blood count, comprehensive metabolic profile, and measurement of erythrocyte sedimentation rate and fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels5 (Figure 1). Did you discuss this with your doctor at the time of exam? Therefore, eclampsia causes seizure activity, which can lead to coma and death. Antihypertensive agents, Risk factors for DIC: Abruptio placenta, Severe preeclampsia, HELLP syndrome, Maternal sepsis, Amniotic fluid embolism, Prolonged retention of dead fetus, Molar pregnancy Vital signs are normal. . However, its important to note that this condition can present during the postpartum period (this is after delivery of the baby). Decreased platelets (leading the DIC), hemolysis (rupture of red blood cells)leading to HELLP Syndrome: the damaged endothelial cells cause red blood cells to rupture and it causes the body to want to repair the cellsso platelets start to congregate at these cells (note in severe cases there are many damaged endothelial cells in the body so that requires a lot of platelets)this depletes the platelet stores and cause micro-clot development with the vessels, which decreases perfusion even more. The cerebral cortex and a number of brainstem nuclei exert influence over the sensory input of the muscle spindles by means of the gamma motoneurons that are located in the anterior horn; these neurons supply a set of muscle fibers that control the length of the muscle spindle itself. Edema (eyes, face, extremities, pulmonary edema, increase weight gain, cerebral edema): the increase in permeability of the endothelial cells causes protein to escape the vessel. Severe preeclampsia condition can lead to: To help us take everything we learned about the patho and signs and symptoms and incorporate it with the nursing interventions and treatment, lets remember the word: Proteinuria monitoring: check urine for protein at every prenatal visit (some women may be taught to do this at home with a dipstick test): Reflexes hyperactive (deep tendon reflexespatellar and bicep), Evaluate blood pressure for hypertension: monitored at every prenatal visit and educate mother to monitor at home. The patellar tendon reflex is an involuntary reflex arc that occurs in response to rapid stretching of the tendon. By convention the deep tendon reflexes are graded as follows: 0 = no response; always abnormal. Doctors typically provide answers within 24 hours. Copyright 2023 American Academy of Family Physicians. Biceps Reflex Muscle involved: biceps brachii Nerve supply: musculocutaneous Segmental innervation: C5-C6 Brachioradialis Reflex Muscle involved: brachioradialis Nerve supply: radial Segmental innervation: C5-C6 Triceps Reflex Peripheral neuropathy has a variety of systemic, metabolic, and toxic causes. 2 1 The nurse should check the clients patellar reflexes The most common way to. Copyright 2023 RegisteredNurseRN.com. Retrieved 19 March 2020, from https://www.preeclampsia.org/the-news/1-latest-news/299-new-guidelines-in-preeclampsia-diagnosis-and-care-include-revised-definition-of-preeclampsia, Phipps, E., Prasanna, D., Brima, W., & Jim, B. Bookshelf Copyright 2008 by the American Academy of Family Physicians. Pregnancy is a confusing time. A medical professional skilled in performing intubations should be immediately available.53 Close observation, soft padding, and use of side rails on the bed may help prevent trauma from falls or violent seizure activity. They are used with caution. Initial management of an eclamptic seizure includes protecting the airway and minimizing the risk of aspiration by placing the woman on her left side, suctioning her mouth, and administering oxygen. CNS lesions may be associated with other features, such as speech difficulty, double vision, ataxia, cranial nerve involvement, or, in cases of myelopathy, impairment of bowel and bladder functions. In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle. People's deep tendon reflexes are widely variable. There are five deep tendon reflexes and a number of superficial and visceral reflexes covered here. Federal government websites often end in .gov or .mil. School Irvine Valley College; Course Title NUR 120; Uploaded By neilpatel315. Weight gain of more than 3-5 pounds in a week may be an indicator of preeclampsia. Monitor vital signs and FHR. Common vision changes include sensations of flashing lights, auras, light sensitivity, or blurry vision or spots. PMC https://doi.org/10.2215/CJN.12081115. Prevention of injury from seizures, Non-stress test Monitor respirations closely: concerned if <12/minute Hyporeflexia is an absent or diminished response to tapping. Eliciting the deep tendon reflexes is a vital component of medical assessments in general practice (where 9% of medical problems are believed to be neurological in origin 1) and in hospital (where 10-20% of admissions have a primary neurological problem 2).Reflex testing contributes to accurate bedside diagnosis in many cases of neuromuscular disease, providing localising diagnostic . What is normal for deep tendon reflexes? The increased glomerular filtration rate of pregnancy lowers serum creatinine, and levels greater than 0.9 mg per dL (80 mol per L) are abnormal in pregnancy. They may be associated with central nervous system irritation or be an indication of swelling of the brain (cerebral edema). Biophysical profile The presence of neuropathic symptoms, decreased ankle reflexes, and decreased distal sensations, regardless of distal muscle weakness and atrophy, makes the diagnosis of peripheral neuropathy likely.4 The isolated presence of neuropathic symptoms or decreased ankle reflexes is less valuable for diagnosis. It was the beginning of my last year of undergrad when I found out I was pregnant. Call your health professional immediately. Lesions of the peripheral nerve roots are typically asymmetric, follow a dermatomal pattern of sensory symptoms, and may have . In non-pregnant normotensive women the patellar reflex was recorded once. Maintain a safe environment: padded side rails 1+ = a slight but definitely present response; may or may not be normal. What happens to the patellar tendon reflex after running on the spot and why does this happen? For accuracy, blood pressure readings should be taken in the sitting position, with the cuff positioned on the left arm at the level of the heart. Excessive dietary protein may cause problems in women with underlying kidney disease. Morning sickness should disappear after the first trimester and the sudden appearance of nausea and vomiting after mid pregnancy may be linked to preeclampsia. The influence of increased muscle spindle sensitivity on Achilles tendon jerk and H-reflex in relaxed human subjects. This content is owned by the AAFP. What should the nurse do next? On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. The aroused receptors initiate the reflex arc, causing the muscle to move. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Otherwise, a 6-g loading dose is given intravenously over 15 to 20 minutes, followed by maintenance infusion of 2 g per hour. Tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord Hyperreflexia is seen with pre-eclampsia Brisk reflexes are the result of an irritable cortex and indicate central nervous system . A more recent article on hypertensive disorders of pregnancy is available. By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. My son has brisk deep tendon reflex and thinks he has brain cancer. Deep tendon reflexes should be graded on a scale of 0-4 as follows: 0 = absent despite reinforcement 1 = present only with reinforcement 2 = normal 3 = increased but normal This content is owned by the AAFP. 8600 Rockville Pike Why do you assess deep tendon reflexes in pregnancy? By using our website, you consent to our use of cookies. Upper abdominal pain and increase in liver enzymes (AST and ALT): the liver is affected due to decrease perfusion and swelling. Once the lesion has been localized to peripheral nerves, the next step is to find the etiology and exclude potentially treatable causes, such as acquired toxic, nutritional, inflammatory, or immune-mediated demyelinating disorders. HEND AZHARY, MD, MUHAMMAD U. FAROOQ, MD, MINAL BHANUSHALI, MD, ARSHAD MAJID, MD, AND MOUNZER Y. KASSAB, MD. Preeclampsia is the development of new-onset hypertension with proteinuria after 20 weeks of gestation. For women with mild preeclampsia, delivery is generally not indicated until 37 to 38 weeks of gestation and should occur by 40 weeks. Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia. Know your blood pressure prior to pregnancy, especially if it's normally considered low. Any of the following associated signs and symptoms: Abnormal peripheral blood smear (evidence of damaged erythrocytes, such as schistocytes and burr cells), Serum bilirubin 1.2 mg per dL (21 mol per L), Obtain laboratory tests weekly: CBC, platelet count, ALT, AST, LDH, uric acid, creatinine, Assess for proteinuria: screen with dipstick or spot protein/creatinine ratio and obtain periodic 24-hour urine collections, Measure amniotic fluid index once or twice weekly, Biophysical profile may be done weekly in place of one of the twice-weekly nonstress tests and amniotic fluid index, Perform ultrasonography for fetal growth every three to four weeks. What is the definition or description of: hyperactive deep tendon reflexes? Preeclampsia and eclampsia are complications of pregnancy. Though the Centers for Disease Control and Prevention (CDC) have recently lifted many of the recommended COVID restrictions, COVID-19 infection increases risk of developing life-threatening hypert Pregnancy is an ideal time to get familiar with your blood pressure. A 24-hour determination is most accurate because urine dipsticks can be affected by variable excretion, maternal dehydration, and bacteriuria.7 A random urine protein/creatinine ratio of less than 0.21 indicates that significant proteinuria is unlikely with a negative predictive value of 83 percent; however, confirmatory 24-hour urine protein determination is recommended.30 Generalized edema (affecting the face and hands) is often present in patients with preeclampsia but is not a diagnostic criterion.1, Severe Preeclampsia. Inappropriate coagulation occurs in the microcirculation Enter your email address below and hit "Submit" to receive free email updates and nursing tips. Normal pregnancy: vascular volume and cardiac output increase significantly, Kidneys: reduced renal bld flow: glomerular damage, loss of protein from kidneys causes edema and increased viscosity of the bld (rise in hematocrit), Preeclampsia in previous pregnancy or family history, Magnesium sulfate: Drug of choice to prevent eclamptic seizures, may have a secondary effect of dec. BP, but that is not the main action, Nursing care: After the convulsion has ended and the patient is stabilized, plans should be made for prompt delivery. Deep tendon reflexes are usually brisk, and muscle tone is spastic. This website provides entertainment value only, not medical advice or nursing protocols. The deep tendon reflexes were normal. Reflex Exam (Deep Tendon Reflexes) The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions. These cells can be found lining the inside of blood vessels throughout the body and organs. I need your help please? We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most commonly followed variables. With preeclampsia, the blood pressure is usually normal at the beginning of the pregnancy, but around 20 weeks gestation it starts to elevate. The most common treatable causes are diabetes, hypothyroidism, and nutritional deficiencies. Table 1 lists proposed etiologies and risk factors for preeclampsia.7,1221 Prevention through routine supplementation with calcium, magnesium, omega-3 fatty acids, or antioxidant vitamins is ineffective.2225 Calcium supplementation reduces the risk of developing preeclampsia in high-risk women and those with low dietary calcium intakes.26, Low-dose aspirin (75 to 81 mg per day) is effective for women at increased risk of preeclampsia.