Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

College of Nursing

MCN 109:
CARING FOR THE MOTHER WITH PREGNANCY- INDUCEDHYPERTENSION
(Pre-Eclampsia and Eclampsia)

 What is Pregnancy-induced or gestational hypertension?

o A vasospastic event that occurs during pregnancy.
o It usually occurs about 5-8% of all pregnancies.
o There is generalized vasospasms in both the large and small arteries in the body
affecting the perfusion of major organs including the placenta.
o Historically known as toxemia because scientists of that time believe that the growing
fetus produces some kind of toxin that is causing the hypertensive crisis. No toxin has
been found.
 Pathophysiology:
o There is no definitive pathophysiologic pathway that can singly explain how pregnancy
can induce massive vasospasms.
o One of the widely accepted explanation was the improper connection and shallow
implantation of the placental vessels in the spiral arteries thus having a negative effect
on the vasculature that connects the placenta and maternal circulation.
o With this anomaly, the endothelium is frequently injured thus invoking immunologic
response in the area.
o A cascade of immunologic secretions of cytokines, tumor-necrosis factors and
prostaglandins induce vasospasms.

CLASSIFICATIONS
1. Gestational hypertension
a. A woman is said to have Gestational Hypertension when she develops an elevated blood
pressure (140/90 mmHg) but has no proteinuria or edema.
b. Perinatal mortality is not increased with simple gestational hypertension, so no drug
therapy is necessary.
c. Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater than
15 mmHg above pregnancy values.

d. No edema, no proteinuria and blood pressure return to normal after birth.

2. Mild Pre-eclampsia
a. A woman is said to be mildly preeclamptic when her blood pressure rises to 140/90
mmHg, taken on two occasions at least six (6) hours apart.
b. Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater than
15 mmHg above pregnancy values.
c. In addition to hypertension, a woman has proteinuria (1+ or 2+ on a reagent test strip
on a random sample).
 d. A weight gain of more than 2 lbs/week in the second trimester or 1 lb/week in the third
trimester usually indicates abnormal tissue fluid retention.

3. Severe Pre-eclampsia
a. A woman has passed from mild to severe preeclampsia when her blood pressure has
risen to 160 mmHg systolic and 110 mmHg diastolic or above on at least two occasions 6
hours apart at bed rest.
b. Marked proteinuria. 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour
sample and extensive edema are also present.
c. With the severe preeclampsia, the extreme edema will be noticeable as puffiness in a
woman’s face and hands.
d. It is most readily palpated over bony surfaces. The woman may manifest oliguria
(altered renal function), elevated serum creatinine (more than 1.2 mg/dL); cerebral or
visual disturbances (blurred vision); thrombocytopenia and epigastric pain.

4. Eclampsia
a. This is the most severe classification of PIH. A woman has passed into this stage when
cerebral edema is so acute that seizure or coma occurs. With eclampsia, the maternal
mortality is high from cause such as cerebral hemorrhage, circulatory collapse or renal
failure. The fetal prognosis in eclampsia is poor because of hypoxia and consequent fetal
acidosis. The manifestations are the same accompanied by seizures.

RISK FACTORS

 Women of color. Hypertension is most common to these women due to genetic makeup of

their race.
 Multiple pregnancies. Women who have undergone multiple pregnancies are more
compromised with hypertension.
 Primiparas who are 20 years and older. This group has an increased risk for pregnancy
induced hypertension than women who are 40 years old and above.
 Women from low socioeconomic backgrounds. These women may have a poor diet due to
their low socioeconomic background, which could contribute greatly to hypertension.
 Underlying disease. This disease might contribute to the occurrence of pregnancy induced
hypertension.

SIGNS AND SYMPTOMS

1. Hypertension
2. Edema
3. Proteinuria

DIAGNOSTICS TESTS:
1. Urinalysis- used in detecting the presence of protein in the urine
2. Renal function test (creatinine and BUN)- to detect the involvement of the kidneys
3. Ultrasound- to observe fetal-wellbeing, usually done with biophysical screening or profiling
MANAGEMENT:
 The only and most definitive way to lower the blood pressure of the mother is to deliver the
baby through C-section.
 Medical or conservative management:
o Antiplatelet
 Used to decrease the aggregation of platelets in the vascular endothelium to
prevent the formation of blood clots.
 Helps in decreasing the production of prostaglandins that may have an effect in
vasoconstrictions
 Usually given at low-doses.
 Aspirin is typically the drug of choice.
o Antihypertensives
 Given to lower the blood pressure of the mother, helping in the preservation of
health of the mother and the baby.
 Example of anti-HTN used are:
 Methyldopa- the first line drug for PIH
 Nifedipine
o Magnesium sulfate
 Used in emergency setting, in controlling hypertension and seizures.
o Hydralazine
 An anti-hypertensive and potent vasodilator that is used when rapid blood
pressure reduction is needed.
o Corticosteroids
 Usually given to stimulate the maturity of the fetal lung, if the mother can carry
the fetus to term, given that BP is controlled and no other indicators of poor
outcomes are at a minimum.
 Usually given as single dose, IV or IM
 Drug-of-choice: Dexamethasone
o Unconventional drug/s:
 Calcium supplementation- helps in the prevention of PIH.
 Studies suggest that calcium can help prevent the occurrence of pre-
eclampsia in pregnant women.
 There is still no clear explanation as to how calcium can prevent pre-
eclampsia
o Low-salt diet and fluid restriction
NURSING MANAGEMENT
 Assessment
o Assess vital signs, especially blood pressure. An elevated blood pressure of 140/90
mmHg and above would indicate hypertension.
o Presence of protein could be determined through urine tests.
o Assess patient for the presence of edema on the face, fingers, and upper extremities.
 Diagnoses:
o Ineffective tissue perfusion: uteroplacental
o Deficient fluid volume (edema, third-spacing)
o Decreased cardiac output
o Risk for maternal injury
o Risk for imbalanced nutrition: less than body requirements
o Deficient knowledge
  Interventions
o Promote bed rest in a recumbent position to aid in the secretion of sodium.
o Promote good nutrition, since the woman has still to continue her usual pregnancy
nutrition.
o Provide emotional support to establish a trusting relationship and let the woman voice
out her fears.
o Administer medications as ordered. Institute BP or magnesium sulfate administration
precautions.
COMPLICATION/S:
1. Intrauterine fetal growth retardation
2. Fetal demise
3. Small for gestational age or prematurity
4. HELLP syndrome
5. Intracranial hemorrhage
6. Renal/heart failure
7. DIC
8. Death