INTRODUCTION Pregnancy Induced Hypertension y y A condition which vasospasm occurs during pregnancy in both small and large arteries.

Also called Toxemia because researchers pictured a toxin of some kind being produced by a woman in response to the foreign protein of growing fetus.

Risk Factors y y y y y y y y Women with color Multiple Pregnancy Primiparas under 20 years or older than 40 years old Women in low socioeconomic status Hydramnios History of heart disease Daibetes Essential Hypertension

Assessment y PIH is classified as gestational hypertension, mild pre-eclampsia, severe preeclampsia, and eclampsia

Gestational Hypertension y y Elevated blood pressure (140/90 mmHg) No proteinuria or edema

Mild Pre-eclampsia y y y y Proteinuria (1+ or more;represent loss of 1g/L) Blood pressure rises to 140/90 mmHg, taken on two occasions at least 6 hours apart Edema not just the typical ankle edema of pregnancy but begins to accumulate in the upper part of the body. Weight gain over 2lbs per week

Severe Pre-eclampsia y Blood pressure rises to 160mmHg systolic and 110 mmHg diastolic or above on at least two occasions 6 hours

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Marked proteinuria, 3+ or 4+ on a random sample or more than 5g in a 24-hour sample Edema is most readily palpated over bony surfaces Reduce urine to approximately 400 to 600 mL per 24 hours Epigastric pain, nausea, vomiting Blurred vision, seeing spots Cerebral edema produced symptoms of severe headache, hyperflexia, and ankle clonus (a continued motion of the foot)

Eclampsia y y y Cerebral edema is so acute that grand-mal seizure (tonic clonic) or coma occurs. Staring, Dilated pupils Apnea

Management of Pregnancy Induced Hypertension Medical: y y Frequent blood pressures Urinalysis & Serial 24-hour urine collection i) Proteinuria is one of the diagnostic criteria for preeclampsia ii) Significant proteinuria defining preeclampsia is 300 mg or more of

protein in a 24-hour urine sample. iii) Proteinuria suggestive of preeclampsia is greater than or equal to 1+ protein on urine dipstick or 300 mg/L or more on urine dipstick. y Coagulation profile: PT and a PTT are elevated y CBC count and peripheral smear i) Thrombocytopenia <100,000 ii) Hemoconcentration may occur in severe preeclampsia y Head CT: This study is used to detect intracranial hemorrhage in selected patients with sudden severe headaches, focal neurologic deficits, or seizures with a prolonged post-ictal state. y Ultrasonography: This is used to assess the status of the fetus as well as to evaluate for growth restriction (typically asymmetrical use abdominal circumference). Aside from transabdominal ultrasonography, umbilical artery Doppler ultrasonography should be performed to assess blood flow. The value of Doppler ultrasonography in other fetal vessels has not been demonstrated.

y Cardiotocography: This is the standard fetal nonstress test and the mainstay of fetal monitoring. Although it gives continuing information about fetal well being, it has little predictive value.
Pharmacological: y y y y Magnesium Sulfate for convulsions Calcium Gluconate as an antidote Diazepam (Valium) to halt seizures Hydralazine (Aspresoline) to lower blood pressure

Surgical: y Cesarean Section during birth if both the mother and babys life is in danger

Nursing: y y y y y y y y y y y y y y y y Diet in protein (80g/day) Bedrest Administer Magnesium Sulfate for convulsions Be pepared to administer Calcium Gluconate as an antidote, if required Moderate sodium intake Monitor FHR Daily weight Monitor Deep tendon reflex Monitor LOC to note impending convulsions Left lateral position (to decrease pressure on venacava and increase general circulation) Monitor Fetal Movement Administer Diazepam as a sedative Administer Hydralazine to lower blood pressure Strict I&O Monitor breathing sound Observe for vaginal bleeding