Pregnancy Induced Hypertension

Definition:
Pregnancy Induced Hypertension (PIH) is a condition in which vasospasms occur during
pregnancy in both small and large arteries. Signs of hypertension, proteinuria, and edema
develop. It is unique to pregnancy and occurs in 5% to 7% of pregnancies in the United States.
Despite years of research, the cause of the disorder is still unknown. Originally it was called
toxemia because researchers pictured a toxin of some kind being produced by a women in
response to foreign protein of the growing fetus, the toxin leading to the topical symptoms. No
such toxins have ever been identified.

Signs and symptoms:

 Increased blood pressure.

 Protein in the urine.
 edema (swelling)
 Sudden weight gain.
 Visual changes such as blurred or double vision.
 Nausea, vomiting.
 Right-sided upper abdominal pain or pain around the stomach.
 Urinating small amounts.

Treatment:
Specific treatment for pregnancy-induced hypertension will be determined by your
physician based on:

Your pregnancy, overall health and medical history

Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
The goal of treatment is to prevent the condition from becoming worse and to prevent it
from causing other complications. Treatment for pregnancy-induced hypertension (PIH)
may include:

bedrest (either at home or in the hospital may be recommended).

Hospitalization (as specialized personnel and equipment may be necessary).
 Magnesium sulfate (or other antihypertensive medications for PIH).
Fetal monitoring (to check the health of the fetus when the mother has PIH) may include:
Fetal movement counting - keeping track of fetal kicks and movements. A change in the
number or frequency may mean the fetus is under stress.
Non-stress testing - a test that measures the fetal heart rate in response to the fetus'
movements.
Biophysical profile - a test that combines nonstress test with ultrasound to observe the
fetus.
Doppler flow studies - type of ultrasound that uses sound waves to measure the flow of
blood through a blood vessel.
Continued laboratory testing of urine and blood (for changes that may signal worsening
of PIH).
Medications, called corticosteroids, that may help mature the lungs of the fetus (lung
immaturity is a major problem of premature babies).
Delivery of the baby (if treatments do not control PIH or if the fetus or mother is in
danger). Cesarean delivery may be recommended, in some cases.

Nursing management:
 Weigh patient regularly. Tell patient to record weight at home in between visits.
 Differentiate physiological and pathological edema of pregnancy. Locate and determine
degree of pitting.
 Note signs of progressive or excessive edema i.e., epigastric/RUQ pain, cerebral
symptoms, nausea, vomiting). Assess for possible eclampsia.
 Note alteration in Hct/Hb levels.
 Check on dietary intake of proteins and calories. Give information as needed.
 Monitor intake and output. Note urine color, and measure specific gravity as indicated.
 Examine clean, voided urine for protein each visit, or daily/hourly as appropriate if
hospitalized. Report readings of 2+, or greater.
 Review moderate sodium intake of up to 6 g/day. Tell patient to read food labels and
avoid foods high in sodium (e.g., bacon, luncheon meats, hot dogs, canned soups, and
potato chips).
 Educate patient and family members or significant others on home monitoring/day-care
program, as appropriate
 Pre-eclampsia

Definition:
Preeclampsia is when you have high blood pressure and possibly protein in your urine
during pregnancy or after delivery. You may also have low clotting factors (platelets) in your
blood or indicators of kidney or liver trouble.

Preeclampsia generally happens after the 20th week of pregnancy. However, in some cases it
occurs earlier, or after delivery.

Eclampsia is a severe progression of preeclampsia. With this condition, high blood pressure
results in seizures. Like preeclampsia, eclampsia occurs during pregnancy or, rarely, after
delivery.

Approximately 5 percent of all pregnant women get preeclampsia.

Signs and symptoms:

It’s important to remember that you might not notice any symptoms of preeclampsia. If you
do develop symptoms, some common ones include:

 persistent headache
 abnormal swelling in your hands and face
 sudden weight gain
 changes in your vision
 pain in the right upper abdomen
 During a physical exam, your doctor may find that your blood pressure is 140/90 mm Hg
or higher. Urine and blood tests can also show protein in your urine, abnormal liver
enzymes, and low platelet levels.

At that point, your doctor may do a non-stress test to monitor the fetus. A non-stress test is a
simple exam that measures how the fetal heart rate changes as the fetus moves. An ultrasound
may also be done to check your fluid levels and the health of the fetus.

Treatment:
The most effective treatment for preeclampsia is delivery. You're at increased risk of seizures,
placental abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of
course, if it's too early in your pregnancy, delivery may not be the best thing for your baby.

If you're diagnosed with preeclampsia, your doctor will let you know how often you'll need to
come in for prenatal visits — likely more frequently than what's typically recommended for
pregnancy. You'll also need more frequent blood tests, ultrasounds and nonstress tests than
would be expected in an uncomplicated pregnancy.
Medications
Possible treatment for preeclampsia may include:

Medications to lower blood pressure. These medications, called antihypertensives, are used to
lower your blood pressure if it's dangerously high. Blood pressure in the 140/90 millimeters of
mercury (mm Hg) range generally isn't treated.

Although there are many different types of antihypertensive medications, a number of them
aren't safe to use during pregnancy. Discuss with your doctor whether you need to use an
antihypertensive medicine in your situation to control your blood pressure.

Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid

medications can temporarily improve liver and platelet function to help prolong your pregnancy.
Corticosteroids can also help your baby's lungs become more mature in as little as 48 hours — an
important step in preparing a premature baby for life outside the womb.
Anticonvulsant medications. If your preeclampsia is severe, your doctor may prescribe an
anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.
Bed rest
Bed rest used to be routinely recommended for women with preeclampsia. But research hasn't
shown a benefit from this practice, and it can increase your risk of blood clots, as well as impact
your economic and social lives. For most women, bed rest is no longer recommended.

Hospitalization
Severe preeclampsia may require that you be hospitalized. In the hospital, your doctor may
perform regular nonstress tests or biophysical profiles to monitor your baby's well-being and
measure the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to
the baby.

Delivery
If you're diagnosed with preeclampsia near the end of your pregnancy, your doctor may
recommend inducing labor right away. The readiness of your cervix — whether it's beginning to
open (dilate), thin (efface) and soften (ripen) — also may be a factor in determining whether or
when labor will be induced.

In severe cases, it may not be possible to consider your baby's gestational age or the readiness of
your cervix. If it's not possible to wait, your doctor may induce labor or schedule a C-section
right away. During delivery, you may be given magnesium sulfate intravenously to prevent
seizures.

If you need pain-relieving medication after your delivery, ask your doctor what you should take.
NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), can
increase your blood pressure.

After delivery, it can take some time before high blood pressure and other preeclampsia
symptoms resolve.
Nursing management:

 During the admission process:

– Review the patient’s record, noting medical history and obstetric
History
– Note predisposing factors-
 Assess the following:
– Baseline BP
– Proteinuria
– Weight gain
– [Sudden excessive wt. gain is sometimes the first sign of impending
Preeclampsia. (2# or more per week in the 3rd trimester)]
 History or current complaint of headache or blurred vision
And/or severe edema of the hands, legs, feet, and face.

Eclampsia

Definition:

Eclampsia is a severe complication of preeclampsia. It’s a rare but serious condition where high
blood pressure results in seizures during pregnancy.

Seizures are periods of disturbed brain activity that can cause episodes of staring, decreased
alertness, and convulsions (violent shaking). Eclampsia affects about 1 in every 200 women with
preeclampsia. You can develop eclampsia even if you don’t have a history of seizures.

Signs and symptoms:

Because preeclampsia can lead to eclampsia, you may have symptoms of both conditions.
However, some of your symptoms may be due to other conditions, such as kidney disease or
diabetes. It’s important to tell your doctor about any conditions you have so they may rule out
other possible causes.

The following are common symptoms of preeclampsia:

 elevated blood pressure

 swelling in your face or hands
 headaches
 excessive weight gain
 nausea and vomiting
 vision problems, including episodes with loss of vision or blurry vision
Difficulty urinating
Abdominal pain, especially in the right upper abdomen
Patients with eclampsia can have the same symptoms as those noted above, or may even present
with no symptoms prior to the onset of eclampsia. The following are common symptoms of
eclampsia:

 seizures
 loss of consciousness
 agitation

Treatment:

In the past, women dealing with the complications of preeclampsia have been directed by health
experts to take low-dose aspirin daily after 12 weeks of pregnancy.

The only way to cure the symptoms of eclampsia is to deliver the baby. Allowing the pregnancy
to continue while the mother has eclampsia can result in complications.

In most cases, the symptoms of eclampsia resolve themselves within 6 weeks after the baby is
born. In rare cases, there can be permanent damage to vital organs, which is why it is so
important for women to keep their care provider informed of their symptoms.

If anyone experiences any symptoms similar to the ones listed above, it is essential to make an
appointment immediately. People should know their risk factors and make sure that they mention
them to a doctor during their first appointment so that the doctor is prepared for the possibility of
the diagnosis.

The overall goal is to have a healthy pregnancy and give birth to a happy, healthy baby. Paying
attention to health is the best way to do this.

Nursing management:

•During the admission process:

– Review the patient’s record, noting medical history and obstetric
History
– Note predisposing factors-
•Assess the following:
– Baseline BP
– Proteinuria
– Weight gain
– [Sudden excessive wt. gain is sometimes the first sign of impending
Preeclampsia. (2# or more per week in the 3rd trimester)]
•History or current complaint of headache or blurred vision
And/or severe edema of the hands, legs, feet, and face.
REFERENCE:
https://www.chw.org/medical-care/fetal-concerns-center/conditions/pregnancy-
complications/pregnancy-induced-hypertension

https://www.medicalnewstoday.com/articles/316255

https://web.mhanet.com/Detection_and_Management_Training.pdf