PREGNANCY INDUCED HYPERTENSION (PIH)

by: Catherine Piduca RN

Pregnancy induced hypertension (PIH) is a condition of high blood pressure during pregnancy. Your blood pressure goes up, you retain water, and protein is found in your urine. It is also called toxemia or preeclampsia. The exact cause of PIH is unknown.

Risk factors for the development of Pregnancy Induced Hypertension (PIH)?

The following may increase the risk of developing PIH:

1. A first-time mom2. Women whose sisters and mothers had

PIH3. Women carrying multiple babies.4. Women who had high blood pressure or

kidney disease prior to pregnancy5. Age: <20 or >35 years of age6. Poor nutrition especially in terms of

inadequate CHON and Ca.

Pathophysiological Basis for the Clinical Manifestations of PIH

1. Vascular network does not dilate to accommodate the increasing blood volume that occurs with pregnancy.

2. Venospasm occurs increasing peripheral vascular resistance.

Classification of PIH

Is determined by the severity of the clinical findings:

1. Gestational Hypertension: Gestational hypertension is the most common form of hypertension in pregnancy. It is diagnosed if a woman’s blood pressure is higher than 140/90 in the last half of her pregnancy. No other signs or symptoms accompany this type of hypertension.

2. Preeclampsia: Preeclampsia is a more serious form of pregnancy-induced hypertension. It is diagnosed when a mother’s blood pressure is higher than 140/90 in the last 20 weeks of pregnancy, and when protein is found in urine samples.

Mild Severe

Can usually be managed as outpatient Requires hospitalization

Elevated BP: 140/90 or +30 systolic +15 diastolic mmHg in two

consecutive occasions atleast 6hrs apart as compared with Ist

trimester BP’s.

BP: 150-160/100-110 on two occasions atleast 6hr apart with

pt. at bedrest.

Edema: generalized edema that does not clear overnight, or

more significantly, facial; sudden wt gain (>44.5 lb./wk

Edema: increased;

Proteinuria: +1 in two consecutive test atleast 6h apart or

300mg/L in a 24 hour specimen

Proteinuria: > 4gm/24hr

3-4+ in spot urine

Complains of headache, visual changes, epigastric pain

Oliguria: <400-500ml urine output/24hrs

hyperreflexia

HELLP syndrome:

Hemolysis

Elevated Liver enzymes (SGOT, SGPT)

Low Platelet Count

3. Eclampsia: Eclampsia is one of the most serious forms of pregnancy-induced hypertension. It causes convulsions or coma in the late stages of pregnancies.

All cases of PIH should be considered severe and taken seriously since PIH is unpredictable and can progress rapidly. Baseline Data gathered during prenatal care is a critical factor in the early detection of signs indicative of PIH

Symptoms of Pregnancy Induced Hypertension (PIH)

A. Mild : high blood pressure, water retention, and protein in the urine.

 B. Severe : headaches, blurred vision,

inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily.

Clinical Manifestations of PIH

1. Elevated BP2. Generalized and Upper body edema3. CNS changes related to cerebral edema and venospasm4. Pulmonary edema5. Hepatic dysfunction related to venospasm and edema of

the liver.6. Renal involvement is related to diminished perfusion and

increased permeability of the glomerular membrane.7. Hemolysis and decrease in number of available platelets8. Diminished placental perfusion related to hypovolemia

and venospasm

Home Care of the Woman with Mild Preeclampsia

1. Monitor progress of PIH and fetal status

2. Encourage cooperation with treatment regimen

3. Nutrition

Hospital Care of the woman with moderate to severe preeclampsia

1. Systematic, ongoing assessment of the maternal-fetal unit to detect changes indicative of an improving or worsening condition.

2. Bed rest alternating between a left and right lateral position.

3. Seizure-precautions care

Medication Side Effects Nursing Considerations

Magnesium Sulfate Flushing, sweating

Symptoms of toxicity:

Sudden drop in BP, respirations <12/min,

urinaro output <25-30 ml/hr, decreased/absent

DTRs, toxic serum levels

CNS depressant, anticonvulsant

Monitor BP,P,R,FHR at least every 15 mins;

mgsulfata levels and DTR prior to

administration, mental status frequently, have

resuscitation equipment and calcium

gluconate/chloride (antidote) in room

Hydralazine

(apresoline)

Tachycardia, palpitations

Headache

Nausea and vomiting

Orthostatic hypotension

Vasodilator

Maintain diastolic BP 90-100mmHg for

adequate uteroplacental flow; monitor FHT and

neonatal status

Diazepam

(valium)

Risk of neonatal depression if given within 24 hr

of delivery

Sedative, anticonvulsant

Monitor FHT and neonatal status

Methyldopa

(aldomet)

May mask symptom of preeclampsia; risk of

maternal orthostatic hypotension and decreased

pulse and BP in neonate for 2-3d

Hemolytic anemia

Used for chronic HTN

Monitor maternal, fetal and neonatal vital signs

Monitor maternal mental status

Propanolol

(inderal)

Decreased heart rate, depression,

hypoglycemia

Take apical rate before giving

Monitor BP, EKG

4. PHARMAGOLOGICAL MANAGEMENT

5. Vaginal delivery, at term, is the goal- labor induction-augmentation may be rrequirred since magnesium sulfate suppresses uterine contractions

6. Postpartal care