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Pregnancy-Induced Hypertension (PIH) is a condition in which vasospasm occurs during pregnancy in both small and large arteries. It is
unique to pregnancy and occurs in 5% to 7% of pregnancies ( Bailis & Witter,2007). Despite the years of research, the cause of the disorder is
still unknown it is highly correlated with the antiphospholipid syndrome or the presence of antiphospholipid antibodies (Clark, Silver &
Branch, 2007). Originally it was called toxemia because researchers pictured a toxin of some kind being produced by a woman in response to
the foreign protein of the growing fetus, the toxin leading to the typical symptoms.
Occurs mostly in women with:
Multiple pregnancy
Primiparas younger than 20 years or older than 40 years
Women fromm low socioeconomic backgrounds(perhaps because of poor nutrition)
Who have had five or more pregnancies
Who have had hydramnios (overproduction of amniotic fluid)
Or those who have an underlying disease ( diabetes, diabetes with vessel or renal involvement, essential hypertension)
ASSESSMENT:
CLASSIC SIGNS OF PIH:
Hypertension
Proteinuria
Edema
**some experienced vision changes
Of the three, HTN and proteinuria are the most significant as extensive edema occurs only after the other two are present.
Symptoms rarely occur before 20 weeks of pregnancy
CLASSIFICATION OF PIH:
Gestational Hypertension
Mild pre eclampsia
Severe pre eclampsia
Eclmapsia
TYPES AND SYMPTOMS OF PREGNANCY-INDUCED HYPERTENSION
Clients with mild pre-eclampsia can be managed at home with frequent follow-up care. Regardless of the setting, the care is similar.
If the pre-eclampsia is severe(systolic blood pressure of more than 160mmHg, diastolic blood pressure of more than 110mmHg after a
woman has been on bed rest; extensive edema; marked proteinuria [3+ to 4+]; cerebral or visual disturbances; marked hyperreflexia; or
oliguria [500ml per 24 hours or less), a woman may be admitted to a health care facility.
If the pregnancy is 36 weeks or further along or fetal lung maturity can be confirmed by amniocentesis, labor can be induced or a
cesarean birth performed to end the pregnancy at this point.
If the pregnancy is less than 36 weeks or amniocentesis reveals immature lung function, interventions will be instituted to attempt to
alleviate the severe symptoms and allow the fetus to come to term.
Support Bed Rest
With severe pre-eclampsia, most women are hospitalized so that bed rest can be enforced and a woman can be observed more
closely that she can be on home care.
Stress is another stimulus capable of increasing blood pressure and evoking seizures in a woman with severe pre-eclampsia. Be
certain the woman receives clear explanations of what is happening and what is planned. Clear explanations help her accept the
need for visitor restrictions and not to cheat on bed rest. Allow her opportunities to express her feelings about what is
happening or how bewildered he is because the few simple symptoms he noticed 2weeks ago have now developed into a
syndrome that may be lethal to her baby and possibly to herself
Tonic-Clonic Seizures
An eclamptic seizure is a tonic-clonic type that occurs in stages. After the preliminary signal or aura that something is
happening, all the muscles of the womans body contract. It lasts approximately 20 seconds. It may seem longer because a
woman may grow slightly cyanotic from the cessation of respirations.
During the second(clonic) stage, the womans bladder and bowel muscles contract and relax; incontinence of urine and
feces may occur. Although a woman begins to breathe during this stage, the breathing is not entirely effective. She may remain
cyanotic. The clonic stage of a seizure lasts up to 1 minute.
The priority for a woman with a tonic-clonic seizure is to maintain a patent airway. Administer oxygen by face mask to
protect the fetus. To prevent aspirations, turn the woman on her side to allow secretions to drain from her mouth.
The third stage of the seizure is the postictal state. During this stage, the woman is semicomatose and cannot be roused
except by painful stimuli for 1 to 4 hours. Extremely close observation is as important during the postictal stage as it was
during the first two stages, because if the seizure caused premature separation of the placenta, labor may begin during this
period but a woman will be unable to report the sensation of contractions. Also, the panful stimulus of contractions may initiate
another seizure. Keep a woman on her side so secretions can drain from her mouth. Give her nothing to eat nor drink.
Remember that with coma, hearing is the last sense lost and the first one regained, so limit conversation as she may be
able to hear even though she does not respond. Continuously assess fetal heart sounds and uterine contractions. Continue to
check for vaginal bleeding every 15 minutes.
BIRTH
If the pregnancy is more than 24 weeks along, a decision about birth will be made as soon as a womans condition stabilizes. Usually
12 to 24hours after the seizure. There is some evidence that a fetus does not continue to grow after eclampsia occurs, so terminating the
pregnancy at this point is appropriate for both mother and child.
Cesarean birth is always more hazardous for the fetus because of the association of retained lung fluid. Further, a woman with eclampsia is
not a good candidate for surgery. Because her vascular system is low in volume, she may become hypotensive with regional anesthesia, such
as an epidural block. The preferred method for birth therefore is vaginal.
NURSING INTERVENTIONS DURING THE POSTPARTUM PERIOD
Postpartum hypertension may occur up to 10 to 14days after birth, although it usually occurs no more than 48hours after birth.
Monitoring blood pressure and being alert that eclampsia can occur as late as 2 to 3 weeks post birth is essential to detect residual
hypertensive or renal disease (Cantey et al.,2007). Urge women who had an elevation of blood pressure during pregnancy to return for a
postpartum check-up to have their blood pressure evaluated to be certain it has returned to normal.