Pregnancy Induced Hypertension

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Some complications of pregnancy only develop during the instance that the woman is pregnant, while others have already been there even before the pregnancy has started. These complications are just road blocks towards a healthy pregnancy, and we are the drivers who should carry our passengers, our patients, to safety by avoiding these roadblocks.

Definition


  • 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 toxaemia 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.

Pathophysiology


  • Increased cardiac output occurs with pregnancy, and it can injure the epithelial cell of the arteries.
  • Prostaglandin, a vasodilator, may also contribute to the injury.
  • Reduced responsiveness of the blood vessels to the blood pressure is lost.
  • There is vasoconstriction, and blood pressure increases.

Classifications


Gestational Hypertension

  • A woman is said to have Gestational Hypertension when she develops an elevated blood pressure (140/90 mmHg) but has no proteinuria or edema.
  • Perinatal mortality is not increased with simple gestational hypertension, so no drug therapy is necessary.
  • Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater than 15 mmHg above pregnancy values.
  • No edema, no proteinuria and blood pressure returns to normal after birth.

Mild Preeclampsia

  • 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 Preeclampsia

  • 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.

Eclampsia

This is the most severe classification of PIH. A woman has passed into this stage when cerebral edema is so acute that seizure or coma occurs. With eclampsia, the maternal mortality is high from cause such as cerebral hemorrhage, circulatory collapse or renal failure. The fetal prognosis in eclampsia is poor because of hypoxia and consequent fetal acidosis. The manifestations are the same accompanied by seizures.

HELLP Syndrome


Severe Preeclampsia (HELLP Syndrome) Nursing Mnemonic
HELLP Syndrome Mnemonic

HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical changes including the breakdown of red blood cells, changes in the liver and low platelets (cells found in the blood that are needed to help the blood to clot in order to control bleeding).

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Risk Factors


There are certain factors that contribute to the occurrence of pregnancy induced hypertension.

  • Women of color. Hypertension is most common to these women due to genetic makeup of their race.
  • Multiple pregnancies. Women who have undergone multiple pregnancies are more compromised with hypertension.
  • Primiparas who are 20 years and older. This group has an increased risk for pregnancy induced hypertension than women who are 40 years old and above.
  • Women from low socioeconomic backgrounds. These women may have a poor diet due to their low socioeconomic background, which could contribute greatly to hypertension.
  • Underlying disease. This disease might contribute to the occurrence of pregnancy induced hypertension.

Signs and Symptoms


These signs and symptoms, once detected, would indicate pregnancy induced hypertension.

  • Hypertension. An increase in the usual blood pressure of the woman is the first indicator of this disease.
  • Proteinuria. Protein leaks out during this condition and can be detected in the urine.
  • Edema. Since protein has already leaked out and it is responsible for containing water inside the vessels, edema starts to occur.

Diagnostic Tests


Diagnostic tests would be ordered by the physician to determine the presence of pregnancy induced hypertension.

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  • Urinalysis. This is one of the most common diagnostic tests that determine the presence of protein in the urine. This is usually indicative of pregnancy induced hypertension.

Medical Management


Medications and other therapies are instituted by the physician to reverse pregnancy induced hypertension.

  • Antiplatelet therapy. There is an increased tendency for platelets to cluster along the vessel walls, so a mild antiplatelet agent is ordered by the physician.
  • Administer medications to prevent eclampsia. To avoid progression of the disease to eclampsia, hydralazine, nifedipine, and labetalol may be prescribed to reduce hypertension.

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.

Nursing Management


Nurses also have a role in reducing the blood pressure of the patient. These are just simple interventions but could create a dramatic effect when applied properly.

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Nursing Assessment

  • Assess vital signs, especially blood pressure. An elevated blood pressure of 140/90 mmHg and above would indicate hypertension.
  • Presence of protein could be determined through urine tests.
  • Assess patient for the presence of edema on the face, fingers, and upper extremities.

Nursing Diagnosis

Nursing Interventions

  • Promote bed rest in a recumbent position to aid in the secretion of sodium.
  • Promote good nutrition, since the woman has still to continue her usual pregnancy nutrition.
  • Provide emotional support to establish a trusting relationship and let the woman voice out her fears.

Evaluation

  • Patient must exhibit a normal blood pressure of 120/70 mmHg.
  • No presence of protein should be detected on her urine.
  • Edema should be confined to the lower extremities only.

Whatever complications a pregnancy has, it always has a corresponding intervention and solution. All we need to do as health care providers is to collaborate and ensure that what we provide for the patient and her family is for their well-being, and for the well-being of the tiny life inside of her.

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