Case study of

Pregnancy Induced
Hypertension

Noveno, Jamaica Leslie M.

Ma’am Virginia Jupiter RN, MAN
BSN-2A
Introduction
Pregnancy Induced Hypertension

Pregnancy induced hypertension (PIH) is a condition wherein vasospasm occurs during

pregnancy in both the small and large arteries in the body. Also known as

gestational hypertension. Pregnancy Induced Hypertension  is a form of high blood pressure in

pregnancy. It occurs in about 5 percent to 8 percent of all pregnancies. It is a condition in which

vasospasm occurs during pregnancy in both small and large arteries. With high blood pressure,

there is an increase in the resistance of blood vessels. This may hinder blood flow in many

different organ systems in the expectant mother including the liver, kidneys, brain, uterus,

and placenta. Originally, it was called toxemia because researchers pictured a toxin of some kind

being produced by the woman in response to the foreign protein of the growing fetus, the toxin

leading to the typical symptoms. No such toxin has ever been identified.

Mild PIH

A woman is said to be mildly preeclamptic when her blood pressure rises to 140/90 mmHg,

taken on two occasions at least six (6) hours apart.

 Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater

than 15 mmHg above pregnancy values.

 In addition to hypertension, a woman has proteinuria (1+ or 2+ on a reagent test strip

on a random sample).

 A weight gain of more than 2 lbs./week in the second trimester or 1 lb./week in the

third trimester usually indicates abnormal tissue fluid retention.

Severe PIH

A woman has passed from mild to severe preeclampsia when her blood pressure has risen to 160

mmHg systolic and 110 mmHg diastolic or above on at least two occasions 6 hours apart at bed

rest.

 Marked proteinuria. 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour

sample and extensive edema are also present.

 With the severe preeclampsia, the extreme edema will be noticeable as puffiness in a

woman’s face and hands.

 It is most readily palpated over bony surfaces. The woman may manifest oliguria

(altered renal function), elevated serum creatinine (more than 1.2 mg/dL); cerebral or

visual disturbances (blurred vision); thrombocytopenia and epigastric pain.

Signs and Symptoms of Placenta Accreta

 Blurred Vision

 Fatigue

 Headache

 High Blood Pressure

 Nausea

 Swelling in Extremities

 Vomiting

 Weight Gain
Definitive Diagnostic Exam

Diagnosis is often based on the increase in blood pressure levels, but other symptoms

may help establish gestational hypertension as the diagnosis. Tests for gestational

hypertension may include the following: Blood pressure measurement. Urine testing to rule out

preeclampsia.

Surgical Management

No surgical interventions are needed to manage pregnancy induced hypertension. They

can be managed by medications and interventions imposed or ordered by the health care

providers.

World Statistics

It is also estimated that pregnancy induced hypertension (PIH), one of

the hypertensive disorders of pregnancy, affects about 5 – 8 % of

all pregnant women worldwide. It is estimated that 9.1 % of maternal deaths in Africa are due

to hypertensive disorders of pregnancy.

Countries Statistics
 Hypertensive disorders of pregnancy ranked 75th in terms of DALYs and were

responsible for 6% of the burden of all maternal conditions. It was estimated that deaths due to

hypertensive disorders of pregnancy represented 13% of all maternal deaths.

Philippine Statistics

Hypertensive disorders of pregnancy account for 36.7% of all maternal deaths in

the Philippines, which is much higher than the worldwide rate of 18%

Prognosis

Hypertensive disorders in pregnancy are among the leading causes of maternal mortality,

along with thromboembolism, hemorrhage and no obstetric injuries. Between 2011 and 2013,

pregnancy-induced hypertension caused 7.4% of maternal deaths in the United

States. Furthermore, hypertension before pregnancy or during early pregnancy is associated with

a twofold increased risk of gestational diabetes mellitus. Transient hypertension of pregnancy (ie,

the development of isolated hypertension in a woman in late pregnancy without other

manifestations of preeclampsia) is associated strongly with later development of chronic

hypertension. Although maternal diastolic blood pressure (DBP) greater than 110 mm Hg is

associated with an increased risk for placental abruption and fetal growth restriction,

superimposed preeclamptic disorders cause most of the morbidity due to chronic hypertension

during pregnancy.

Patient’s Profile
Name: Avelina Flores

Age: 35 years old

Contact no: 09263052644

Address: Imus Cavite

Nationality: Filipino

Civil Status: Married

Chief complaint: Headache that doesn't go away and blurred or double vision

History of past illness

A 21-year-old pregnant woman, gravida 2 para 1, presented with hypertension and

proteinuria at 20 weeks of gestation. She had a history of pre-eclampsia in her first pregnancy

one year ago. At 20 weeks of gestation, blood pressure was found to be elevated at 145/100

mmHg during a routine antenatal clinic visit. Aside from a mild headache, she reported no other

symptoms. On physical examination, she was tachycardic with heart rate 100 beats per minute.

Body mass index was 16.9 kg/m 2 and she had no cushingoid features. Heart sounds were normal,

and there were no signs suggestive of congestive heart failure. Radial-femoral pulses were

congruent, and there were no audible renal bruits.

History of present illness

 Occasional mild headaches x 3 weeks, double vision

 Leg edema

 Fatigue
 Vitals: afebrile, HR 75 BP 140/91, sat 100% on RA

 General: NAD, pleasant, comfortable

 HEENT: moist mucous membranes

 CVS: S1S2 normal, flow murmur over LLSB

 Pulmonary: CTABL, no wheezing, no crackles

 Abdomen: gravid abdomen, soft, non-tender

 Ext: lower extremity non pitting edema to shin, 1-2+ pitting edema of foot
Anatomy and Physiology

Modifiable Risk Factors

- Body Weight

-Sodium Chloride Intake

-Alcohol intake

-Physical Activity

- Psychosocial Factors

-Socioeconomic status

-Hormonal contraceptives
Pathophysiology

Non- Modifiable Risk Factors

- Age
Pregnancy Induced Hypertension
- Sex / Gender
2
- Genetic predisposition

Abnormal cytotrophoblast invasion

Decreased uterine placental blood

flow

Placental ischemia

Placental release of cytokine factors

Endothelial dysfunction

ET TBX PGI NO ANGII Sensitivity

Renal Pressure Natriuresis

Hypertension

Drug Study
Generic Indications Mechanism of Contraindications Side Effects Nursing
Name - Action -with Considerations
-Methyldopa Hypertension  -Methyldopa active hepatic disease, -infusion until
(or high such as  drowsiness
may lower blood patient is stable.
Brand blood pressure) pressure by acute hepatitis and Monitor intake,
-Gestational  stimulating central active cirrhosis.  headache output, and daily
Name -with liver
hypertensio inhibitory alpha- weights to detect
-Aldomet disorders previously  lack of energy
n (or  adrenergic sodium and water
pregnancy- receptors, false associated with retention; voided
Dosage in induced  neurotransmission, methyldopa therapy.  weakness urine exposed to
Frequency hypertensio and/or reduction -with  air may darken
-500 mg to 2 n) and of plasma renin hypersensitivi  dizziness because of the
g in two to pre- activity. ty  breakdown
four doses. eclampsia. to any of methyldopa 
 lightheadednes
-maximum component of this or its metabolites.
recommended product. s Monitor patient for
daily dosage i -on therapy signs and
s 3 g. with monoamine symptoms of drug-
 fainting
oxidase (MAO) induced depression
inhibitors.  nausea or
vomiting

 swelling of
your hands or
feet

 weight gain

Generic Indications Mechanism of Contraindications Side Effects Nursing

Name -The FDA-approved Action -Labetalol is -Excessive tire Considerations
-Labetalol indication for -Labetalol is a contraindicated in dness. -Instruct patient
labetalol is the dual alpha (α1) people with -Tingling scalp regarding
treatment of arterial and beta (β1/β2) overt cardiac failure, or skin. compliance;
Brand hypertension which adrenergic greater-than-first- -Dizziness. do not abruptly
Name ranges from acute receptor blocker degree heart block, - withdraw
-Normodyne hypertensive crises and competes with severe bradycardia, Lightheadedness. medication in
and Trandate (urgent/emergency) other cardiogenic shock, patients with
-Upset
to stable Catecholamines severe hypotension, ischemic heart
stomach.
Dosage in chronic hypertension for binding to anyone with a history disease; IVP:
-Stuffy nose.
Frequency . these sites. of obstructive airway Administer over 2-
-Fatigue.
Labetalol is highly disease 3 minutes
- selective for including asthma, and
postsynaptic those with
alpha1- hypersensitivity to the
adrenergic, and drug.
non-selective for
beta-adrenergic
receptors.
Generic Name Indications Mechanism of Contraindications Side Effects Nursing
-Atenolol -Tenormin is Action -Tenormin is -Dizziness Considerations
indicated for the -Atenolol  contraindicated in -Tired feeling -Patients should be
Brand Name treatment of belongs to a class of sinus bradycardia, heart -Nausea cautioned to avoid
-Tenormin hypertension, to drugs known as beta- block greater than first -Slow heart rate driving or operating
lower blood blockers. It works by degree, cardiogenic -Depression machinery until the
Dosage in pressure. blocking the action of shock, and -Decreased sex response
Lowering blood certain natural overt cardiac failure. drive to atenolol is
Frequency -Impotence
pressure lowers chemicals in your known. Atenolol is
-25-50 mg/day PO the risk of fatal body, such as -Difficulty having relatively
initially; may be an orgasm
and non-fatal epinephrine, on the contraindicated in
increased to 100 -Sleep problems
cardiovascular heart and blood patients with
mg/day PO (insomnia)
events, primarily vessels. This effect Raynaud's
strokes and lowers the heart rate, -Anxiety phenomenon or
myocardial blood pressure, and -Mild shortness of peripheral vascular
infarctions. strain on the heart. breath disease because
reduced cardiac
output and the
relative increase in
alpha stimulation can
exacerbate
symptoms.
Generic Name Indications Mechanism of Contraindications Side Effects Nursing
-Hydralazine -Severe  Action -heart attack - Considerations
Essential -Although the within the last 30 days. headache. -Advise them to
Brand Name Hypertension. 10 precise mechanism of -coronary -loss of check BP at least
mg PO q6hr for action of hydralazine  artery disease. appetite weekly and report
-Apresoline 2-4 days; 25 mg is not fully (anorexia)
-stroke. significant changes.
q6hr daily for the understood, the major -low blood -nausea. Patients should weigh
Dosage in first week; effects are on the pressure. - themselves twice
Frequency increase to 50 mg cardiovascular -a condition vomiting. weekly and assess
-10 mg PO q6hr q6hr from second system. Hydralazine  with symptoms that - feet and ankles for
for 2-4 days; 25 week on; adjust apparently lowers resemble lupus. diarrhea. fluid retention. May
mg q6hr daily for dose to lowest blood pressure by -high pressure -fast occasionally cause
the first week; effective levels. exerting a peripheral within the skull. heart rate. drowsiness. Advise
increase to 50 mg - vasodilating effect -decreased -chest patient to avoid
q6hr from second Hypertension  through a direct blood volume. pain. driving or other
week on; adjust (Chronic relaxation of vascular -slow activities requiring
dose to lowest ) smooth muscle. alertness until
acetylator.
effective levels - response to
20-40 mg IM/IV; Hypertensive medication is known.
repeat as necessary Crisis.
-
Congestive Heart
Failure.

Generic Name Indications Mechanism of Contraindications Side Effects Nursing

-Nifedipine -Administration Action -Unstable angina -headache Considerations
of the drug for -Nifedipine is a pectoris (intermediary -nausea -Assess for anginal
Brand Name the treatment peripheral arterial syndrome) and the first -dizziness or pain, including
of hypertension is vasodilator which six months after a lightheadedness location, intensity,
-Adalat/ Procardia well documented acts directly on myocardial infarction.
-flushing duration, and
for patients of vascular smooth Left ventricular failure. alleviating and
Dosage in different age muscle. The binding -Known (reddening of the
Frequency groups. It is of nifedipine to hypersensitivity skin) aggravating factors.
-Initial dose: 30 to suited for single voltage-dependent reaction to nifedipine -heartburn - Assess cardiac
60 mg orally once drug therapy or and possibly and pregnancy -muscle cramps status with BP, pulse,
a day for combinations receptor-operated respiration and ECG.
with other channels in vascular
-constipation - Monitor potassium
-Maintenance
dose: 30 to 90 mg antihypertensive smooth muscle -cough and liver function
orally once a day agents. When a results in an -decreased sexual tests throughout
-Maximum dose: nifedipine inhibition of calcium ability or desire treatment
Up to 120 mg/day capsule is bitten influx through these -edema (swelling with nifedipine
in two the channels in the legs or feet)
lowering of the -weakness
blood pressure is
quickly achieved
(use for
hypertension
emergencies!).
To date it has not
been established,
whether calcium
antagonists can
reduce mortality
induced by
hypertension.