Pregnancy Induced Hypertension

Desiree Graham

Pregnancy Induced Hypertension/ Gestational Hypertension Medical Definition

o Gestational Hypertension preferred term. o Hypertension that occurs during pregnancy. o Criteria o Hypertension that occurs after the 20th week of pregnancy o Non proteinuria hypertension of pregnancy o BP 140/90. Also BP 30 points or above clients normal systolic and 15 points above clients normal diastolic. Resolved by 12 weeks postpartum

Population
Pregnant women 20 weeks gestation and over. High risk population include: First pregnancy

Obesity
Family History African American Twin or Higher multiples

Over 35
Under age 20 History chronic RF/DM

Pathophysiology

After decades of research exact etiology is still unknown.

Theories include increased cardiac outupt and hyper dynamic vasodilation in first trimester results in damage to the endothelium.

Assessment

o BP readings o Medical o History/Identification of Risk Factors o Urine testing o Physical Assessment

http://youtu.be/rXs5IBMJgNI

Complications
o Placental abruption o Intrauterine growth restriction

o Development of Pre-Eclampasia
o Stillbirth

Nursing Diagnosis

Decreased Cardiac Output related to Increased Systemic Vascular Resistance as evidenced by Variations in Blood Pressure.

Interventions
o Observation Schedule prenatal visit every 1-2 week if GH is mild ( 140/90), weekly if severe (160/100). o Bed rest Strict regimen of bedrest, encourage lateral position. o Frequent monitoring Ultrasound & NST. o Medications o Teaching o Delivery

Medications
Small choice of antihypertensive drugs that have been evaluated in pregnant women. Many are contraindicated.
o Hydralazine

o Methyldopa

Compare/Contrast
Medication
Pros

Delivery
Pros o Only cure for GH. o Improves IUGR. Cons o Pre-maturity.

o Reduce vascular resistance to improve perfusion. o Allow for maturity of fetus. Cons o All antihypertensives are Cat C. o Risk for further complications.

Outcome
o Healthy mom without long term effects of hypertension. o Full term viable fetus.

Question
True or False

The only medical criteria of GH is with a BP of 140/90.

Answer

False . Systolic 30 points above norm and dystolic 15points also meet the criteria for GH.

Question
True or False

GH should resolve 12 weeks after birth.

Answer
True. GH should resolve within 12 weeks after birth.

References
Doenges, M. E., Moorhouse, M., & Murr, A. C. (2010). Maternity Care Plans (8th ed.). Philadelphia, PA: F.A Davis. Podymow, T., & August, P. (2008). Update on the Use of Antihypertensive Drugs in Pregnancy. Hypertension, 960-969. Retrieved from http://hyper.ahajournals.org/content/51/4/960.full Scott Ricci, S., Kyle, T., & Carman, S. (2013). Maternity And Pediatric Nursing (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.