1. Complication of pregnancy
Pregnancy Induced
Pregnancy(PIH)

2. Hypertensive Disorders of
Pregnancy
1. Chronic Hypertension (before pregnancy)
2. Gestational (in pregnancy) Hypertension
-
Pre-eclampsia
Severe pre-eclampsia
Eclampsia
HELLP syndrome

3. Hypertensive Disorders of
Pregnancy
• Most commonly reported disorder of
pregnancy
• May occur in 20% of all pregnancies
• One of the leading causes of maternal
morbidity and mortality worldwide

4. Pathophysiology/Etiology
1. Actual cause is unknown.
2. Theories of the etiology include the exposure to chorionic villi for the
first time, or in large amounts, along with immunologic, genetic, and
endocrine factors.
3. The disease is primarily seen in primagravidas.
4. Chronic hypertension, hydatidiform mole, multiple
gestation, polyhydramnios, and diabetes mellitus may predispose to
PIH.
5. Adolescents and women over 35 years of age are at higher risk.
6. Approximately 6% to 8% of pregnancies may be affected.
7. Vasospasms occur and result in increased resistance in vascular
flow, increasing the arterial blood pressure.
8. Increased sensitivity to angiotensin II occurs before the onset of
hypertension.
9. Hemoconcentration occurs due to the vasoconstriction or as a result
of increased vascular permeability or a combination of both.

5. Characteristics PIH
Three typical Symptoms:
• Hypertension(high blood pressure)
• Edema
• Protein urine

6. Pathophysiology:
1. Vasoconstriction
2. Vasospasm
3. Endothelial damage

7. Pathophysiology:
Damage to blood vessels
causes increased capillary
permeability and decreased
organ perfusion.

9. Clinical Manifestations
1. Hypertension, which is defined as a blood pressure of 140/90
mm Hg or greater on two occasions at least 6 hours apart
2. Proteinuria ,
3. Edema, nondependent, present after 8 to 12 hours of bed rest
,
4. Frequently, a sudden weight gain will occur, of 2 lb or more in
1 week, or 6 lb or more in 1 month. This often occurs before
the edema is present.
5. Altered level of consciousness, visual changes, headache
6. Oliguria
7. Epigastric pain, chest pressure
8. Hyperreflexia with or without clonus

10. Hypertensive Disorders of
Pregnancy
Preeclampsia
• Gestational Hypertension
PLUS
• Protein in the urine
PLUS
• Edema

11. Hypertensive Disorders of
Pregnancy
• Pre-eclampsia
Severe
Preeclampsia
PLUS one of the following:
1. Systolic BP > 160 mmHg
2. Diastolic BP > 110mmHg
3. Persistent headache, visual
changes or epigastric pain
4. Creatinine > 1.2 mg/dL
5. Platelets < 100,000
6. Increase liver function tests

12. eclampsia
• Gestational
Hypertension
PLUS
• Protein in the urine
PLUS
• Edema
PLUS
• Convulsion

13. Hypertensive Disorders of
Pregnancy
H = Hemolysis
HELLP
Syndrome
EL = Elevated
Liver
Enzymes
LP = Low Platelets

14. Hypertensive Disorders of
Pregnancy
• Risk factors
1.
2.
3.
4.
5.
6.
First pregnancy
More than one fetus
Pre-existing disease (diabetes, hypertension)
Obesity
Maternal age (< 20 years, > 40 years)
Family history

15. Diagnostic Evaluation
1. A 24-hour urine for protein of 300 mg or
greater
2. Serum BUN and creatine to evaluate
renal function
3. Sonogram, nonstress testing to evaluate
placenta and fetus

16. Management
1. Directed toward decreasing the maternal blood pressure
through the use of bed rest and antihypertensive medications
along with increase in dietary protein
2. Hospitalization and seizure
3. Medication
a. Magnesium sulfate (MgS04) may be given either IV or IM
b. Antihypertensive drug; Hydralazine (Apresoline)
* Side effects include tachycardia, palpitations, dizziness,
faintness, headache.
c. Diazepam (Valium) and amobarbital sodium (Amytal Sodium)
may be used if convulsions occur that respond to MgS04.
4. If symptoms are uncontrollable, delivery is planned.

17. Complications
1. Abruptio placentae
2. DIC(Disseminated Intravascular
Coagulation)
3. HELLP(Hemolysis, Elevated liver
enzyme, Low platelete) syndrome
4. Prematurity
5. Intrauterine growth retardation (IUGR) from
decreased placental perfusion
6. Maternal/fetal death

18. Nursing Assessment
• Assessment of mother
1. Blood pressure
2. Protein in the urine
3. Complaints of headache, liver pain,
or strange bruises or bleeding

19. Nursing Diagnoses
A. Fluid Volume Excess related to IV fluid
overload(edema)
B. Altered Tissue Perfusion, Fetal Cardiac
and Cerebral, related to altered placental
blood flow(fetal distress)
C. Risk for Injury related to convulsions
D. Anxiety related to concern for self and
fetus

20. A. Maintaining Fluid Balance
1. Control IV fluid intake using a continuous infusion
pump.
2. Monitor intake and output strictly; notify health
care provider if urine output is less than 30 mL/h.
4. Monitor hematocrit levels to evaluate intravascular
fluid status.
5. Monitor vital signs every hour.
6. Auscultate breath sounds every 2 hours and
report signs of pulmonary edema
(wheezing, crackles, shortness of
breath, increased pulse rate, increased respiratory
rate).

21. B. Promoting Adequate Tissue
Perfusion
1. Position on side, preferably the left side to
promote placental perfusion.
2. Monitor fetal activity.
3. Evaluate nonstress tests to determine
fetal status.
4. Increase protein intake to replace protein
lost through kidneys.

22. C. Preventing Injury
1. Instruct on the importance of reporting
headaches, visual changes, dizziness, and epigastric
pain.
2. Instruct to lie down on left side if symptoms are
present.
3. Keep the environment quiet and as calm as possible.
4. If hospitalized, side rails should be padded and remain
up to prevent injury if seizure occurs.
5. If hospitalized, have oxygen and suction setup, along
with a tongue blade and emergency medications
immediately available for treatment of seizures.

23. D. Decreasing Anxiety
1. Explain the disease process and treatment
plan.
2. Explain that PIH does not lead to chronic
hypertension.
3. Explain that PIH usually does not occur with
subsequent pregnancies.
4. Discuss the effects of all medications on the
mother and fetus.
5. Allow time to ask questions and discuss
feelings regarding the diagnosis and
treatment plan.

24. Patient Education/Health
Maintenance
1. Teach the woman the importance of bed rest in
helping to control symptoms.
2. Encourage the support of family and friends while
on bed rest.
3. Provide and suggest diversional activities while on
bed rest.
4. Provide information on tests and procedures to
evaluate maternal-fetal status, such as laboratory
tests, sonogram, nonstress tests.
5. Include support of the neonatal team for
discussion of fetal prognosis with the woman and
her family.

25. Evaluation
A. No evidence of pulmonary edema; urine
output adequate
B. Fetal heart rate within normal range;
reactivity present
C. No seizure activity
D. Expresses concern for self and the fetus