Pregnancy-Induced Hypertension

Pregnancy-Induced Hypertension is a group of disorders characterized by the presence of hypertension beginning 20 weeks AOG or greater.
It is the 2nd cause of maternal mortality in the country (Philippines). Pregnancy-Induced Hypertension is common in those with age below 17 years or more than 35 years, protein malnutrition, pimiparity, diabetes, little or no prenatal care, low socioeconomic status, previous history of hypertension.

Basic Manifestations of Pregnancy-Induced Hypertension

• proteinuria
• edema
• hypertension

Types of Pregnancy-Induced Hypertension

1. Toxemia - pre-eclampsia and eclampsia
2. Chronic Essential Hypertension - present during non-pregnant state and combines with pre-eclampsia.


I. PRE-ECLAMPSIA

1. Mild Pre-eclampsia

• increased BP 20/15 mmHg above baseline (Roll Over Test)
• weight gain of 1 lb or more per week in last trimester
• mild generalized edema
• +1 proteinuria (<300-500>

2. Severe Pre-eclampsia

• severe hypertension, 30-40 mmHg while on bedrest
• massive anasarca and weight gain
• +4 proteinuria (5 grams/24 hrs urine collection)
• less than 400 ml output in 24 hrs
• dizziness, headache, blurring or with spots on vision, nausea and vomiting, epigastric pain, and irritabilty)

II. ECLAMPSIA

• changes from pre-eclampsia
• with tonic-clonic seizure attacks to comatose state. Pre-monitoring signs: aura, epigastric pain
• hypertensive crisis

III. HELLP

• characterized by RBC hemolysis, elevated liver enzymes and low platelet count related to severe vasospasm leading to disseminated intravascular coagulation (DIC)
• platelet and RBC transfusion often are administered, coagulation factors are monitored
• labor is induced if AOG is more than 32 weeks, cesarean if less than 32 weeks.

IV. DIC

• clinical manifestations include varying degree of bleeding from oozing to generalized hemorrhage, purpura, and petechiae as a result of overstimulation of coagulation factors
• coagulation factors are closely monitored and replaced
• treatment of underlying cause (ie. abruptio placenta, fetal death in utero, PIH) resolves its pathology
• the only cure is to end the pregnancy

Nursing Care for Pregnancy-Induced Hypertension

a) closely monitoring of maternal vital signs (esp. BP) and weight, FHR
b) bedrest most of the day; side-lying position; 8-12 hours
c) high protein (60-70 gram/day), low sodium diet, calcium (1,200 mg), magnesium, 2-6 g of zinc, vit. C and E
d) health teachings for symptoms of mild and severe pre-eclampsia
e) administration of magnesium sulfate. Corticosteroids and antihypertensives as ordered. HPN drugs are excreted in breast milk
f) drug of choice is Magnesium Sulfate (MgSO4)
- monitor for magnesium sulfate toxicity

• B - blood pressure is decreased
• U - urine output less than 30 cc/hour
• R - respiratory rate less than 12 cycles/min (1st to diminish)
• P - patellar reflex

- normal MgSO4 serum level is 1.5 - 3 mEq/L
- maintenance dose 4 - 7 mEq/L
- at 8-10 mEq/L, respiratory rate starts to diminish
- at 10-14 mEq/L, deep tendon reflex is absent

g) blood replacements
h) monitor for seizure activity and protection from injury
i) administer O2 as needed
j) prepare mother and her family for early induction of labor. Vaginal delivery is preferred over cesarean
k) health teachings on contraception

Enter your email address:

Delivered by FeedBurner