Melody M.

Gatdula, RN RM LPT MAN

 HYPERTENSION
 Diastolic
BP > 90
mm Hg or more
 Diastolic BP is the point
when arterial sound
disappears
 Does not vary much
with the woman’s
emotional state
 Cuff must encircle at
least ¾ of the
circumference of the
arm.
Definition of Terms
 Hypertension
 Abnormally high blood pressure at
least 140/90, confirmed by a
minimum of 2 consecutive visits.

 Gestational Hypertension
 BP of 140/90 for the first time during
pregnancy
Definition of Terms
 Pregnancy Induced Hypertension
 HPN develops after the 20th week of
gestation to a previously normotensive
(normal BP) woman
 Includes: Pre-eclampsia, Eclampsia, GH

 Pre-Eclampsia
 BP of 140/90 develops after 20 weeks
accompanied by proteinuria.
Definition of Terms
 Eclampsia
 All s/sx of pre-eclampsia accompanied by
convulsions or coma that is not caused
by other conditions.

 Chronic Hypertension
 Presence of HPN before 20 weeks
gestation
PREGNANCY INDUCED HYPERTENSION

 A condition in which
vasospasm occurs during
pregnancy in both small and
large arteries
 Originally was called
“Toxemia”
 Cause: unknown
Risk Factors
 Primiparas younger than 20 or
older than 40
 Women from low socio-economic
background
 Grand multigravida/ multiple
pregnancy
 African-American descend
 Polyhydraminos
 Women with underlying disease
Assessment:
Classical Signs
1. Hypertension
2. Proteinuria
(Albuminuria)
3. Edema
Proteinuria
 Urine should always be checked for protein
when hypertension is found in pregnancy.
 Other causes of protein in the urine
 UTI
 Kidney disease
 Urine contaminated with blood, amniotic fluid or
vaginal discharge
 Severe anemia
 Heart Failure
Classification
 Gestational Hypertension
 Mild Pre-eclampsia
 Severe Pre-eclampsia
 Eclampsia
Gestational Hypertension
 Elevated BP of 140/90
 No proteinuria and edema
 BP returns to normal after
delivery
 Chronic HPN may develop later
in life
Preeclampsia
 High blood pressure and excess
protein in the urine after 20
weeks of pregnancy.
 Causes a moderate increase in
blood pressure.
 Can lead to serious complications
for both mother and baby
RISK FACTORS for Pre-eclampsia
Pre-eclampsia is more common in:
 Primigravid  Women with
 Diabetes
 Young teens  H Mole
 Women > 35 years  Essential or renal
 Obese hypertension
 Previous history of
 Multiple Pregnancy pre-eclampsia
 Family history of
hypertension
DANGER SIGNALS
 Massive pitting pedal
edema → (generalized
swelling)
 Severe headache
 Epigastric pain
 Vomiting
 Visual disturbance or
blurring of vision
Mild Pre-eclapsia
 BP rises more than 30mmHg systolic
pressure more than 15 mmHG
 BP = above 140/90
 +1 to +2 protenuria (300-500mg in a 24
hr urine collection)
 Weight gain over 2 lbs/wk in 2nd
trimester & 1 lb /week in the 3rd
 Mild edema in upper extremities or face
Severe Pre-eclampsia
 BP of 160 mmHg (systolic) and
110 mmHg (diastolic)
 +3 to +4 Proteinuria (5g in a 24-hr
urine collection
 Oliguria (400-600cc/24 hrs urine
output)
 Edema of the digits of the hands
and “puffiness of the face”
 Some women experience epigastric,
N&V
 Shortness of breathing
 Visual disturbances/ seeing spots
before the eyes
 Severe headache
 Marked hyperflexia
 Muscle clonus (spasm)
 Fetal mortality = 10%
Complications of Severe Pre-eclampsia

Small baby (IUGR)

Stillbirth
Abruptio Placenta
HELLP syndrome
Eclampsia
Eclampsia
 Is an extension of preeclampsia and
is characterized by the client
experiencing seizures.
 Convulsions is present due to
increase ICP
 Maternal Mortality = 20%
 Fetal mortality = 25%
 Fetal prognosis is poor
ECLAMPSIA

 Convulsions in a
woman with pre-
eclampsia
 Convulsions may
occur
 in pregnancy after 20
High incidence of
weeks AOG in labor maternal and
during the first 48 perinatal mortality.
hours postpartum.
Reducing the Risk of Eclampsia
 Pregnant women should come for
antenatal care early – take baseline BP
 Regular antenatal visits especially in the 3rd
trimester
 Measure BP at each visit and check urine
for protein if diastolic BP>90 mm Hg.
 REFER if proteinuria develops
 Counsel woman and family about danger
signals of severe pre-eclampsia
What to do when seizures occur
 Call for medical help
 As soon as possible, clear airway and or
give oxygen at 4–6 L/min.
 Position the woman on her left side to
reduce the risk of aspiration of
secretions, vomit and blood
 Stay with woman and protect her from
injury but do not restrain her
Immediately after the convulsion
 Set up IVF – run at slow rate
 Monitor BP, pulse, respiration, level of
consciousness. Record.
 Insert urinary catheter to monitor urine
output and test for protein.
 Arrange for referral
Protect mother during transport

Put mother in any flat or low surface to

prevent from falling during ambulation.
Observe proper maternal positioning
and least stimulation during transport.
Never leave alone
Tonic-Clonic Convulsion

1. Premonitory Phase
2. Tonic Phase
3. Clonic Phase
4. Postictal Phase
Premonitory Phase
 Mothernotices severe
headache, epigastric pain,
aura.
 She may experience a
premonition that “something is
happening”
Tonic Phase
 Lasts for about 20 sec
 Back arches, arms and legs
stiffens, and her jaw closes
abruptly
 Respirations will be halted due to
thoracic muscle contractions
 Woman may be slightly cyanotic
from the cessation of respiration
Clonic Phase
 Last for about a minute
 All muscles begin to contract and
relax
 Extremities flail wildly
 Irregular respirations
 Urinary and fecal incontinence may
occur
 Aspiration of saliva may occur if the
woman is not positioned correctly
Postictal Phase
 Woman is in a semi-comatose
state and cannot be aroused
except by painful stimuli for 1-
4 hrs
 Abruptio placenta may occur
Management:
Mild Pre-eclampsia
 Bed rest – Lateral recumbent
position
 Promotes diuresis and increases
sodium excretion
 Good nutrition – increase protein
intake
 Provide emotional support
Management
Severe Pre-eclampsia
 Support bedrest – Lateral
recumbent position
 Decrease environmental
stimuli
 Seizure precaution
 Diet – high protein low sodium
Monitor:
 Maternal well-being
 Fetal V/S
 Oxygen therapy
 IVF therapy
 Strict I&O
Medications
 Magnesium Sulfate
 Muscle relaxant
 Prevent convulsion
 Loading dose: 4-6g
 Maintenance dose:1-2g/IV
 Hydralazine (Apresoline)
 Anti-HPN
 5-10mg/IV
 Diazoxide (hyperstat)
 Anti-hypertensive for severe pre-
eclampsia
 Peripheral vasodilator
 1-3mg/kg
 Calcium gluconate
 Antidote for magnesium intoxication
 1g/IV (10ml of 10% solution)
Eclampsia
Management
 Maintain patent airway- turning to
her side
 Oxygen therapy
 Suction saliva – prn
 Raise side rails
 Avoid use of restraints
Administer Diazepam
(valium)
Monitor:
 Fetal well-being
 Vaginal bleeding
Diagnostic examination
 Roll-over test
 Urinalysis
 Amniocentesis
 Hct - hematocrit
 Blood Urea Nitrogen and creatinine
 Non-stress test
 Sonogram
 Electrolyte monitoring
Complication
 Maternal and fetal mortality
 Abruptio placenta
 Respiratory depression
 Chronic Hypertension
 Prematurity