MATERNAL NURSING • Lung damage as a result of poisonous gas
Complications of Hypertensive Disorders
in Pregnancy
PULMONARY EDEMA
• A buildup of fluid in your lungs.
• It’s also known as lung congestion, lung
water, and pulmonary congestion.
• When pulmonary edema occurs, fluid collects
in the numerous air sacs in the lungs, making
it difficult to breathe
ETIOLOGY
• Congestive heart failure is a common cause
of pulmonary edema. When the heart is
unable to efficiently pump blood, blood can
back up into the veins that carry blood to the
lungs. Fluid is pushed into the lungs' air
spaces (alveoli) as the pressure in these
blood vessels rises. This fluid reduces the
normal movement of oxygen through the
lungs. Shortness of breath is caused by the
combination of these two factors.
When the alveoli are flooded, two issues
arise:
✓ The bloodstream is depleted of oxygen.
✓ The body is unable to properly eliminate
carbon dioxide.
Pulmonary edema can also be caused by the
following factors:
Certain medications
• Exposed to high altitudes
• Failure of the kidneys
• Blood vessels that are narrow and bring
blood to the kidneys
or severe infection
• Serious injury
• Pneumonia
• Sepsis (blood infection)
• Exposure to certain chemicals
• Near-drowning
• Inflammation
• Trauma
EPIDEMIOLOGY
Pulmonary edema occurring during pregnancy or
in the postpartum period has a reported incidence
of 0.08%. The period of pregnancy at greatest risk
for presentation appears to be the immediate
postpartum.
In the largest case series available from a high-
volume tertiary care hospital (51 cases over10
years and 62,917 pregnancies), 39% of cases
presented in the first 24 hours following delivery.
This compares with 47% of cases diagnosed in
the entire antepartum period. Only14% of
patients in this case series developed pulmonary
edema during labor.
The most common attributable causes are:
• pre-existing cardiac disease (25.5% of
allcases)
• tocolytic use (25.5%)
• iatrogenic fluid overload (21.5%)
• preeclampsia (18%).
PATHOPHYSIOLOGY
Vasospasm in the kidney increases blood flow
resistance. Degenerative changes then develop
in the kidney glomeruli because of backpressure.
This leads to an increase the permeability of the
glomerular membrane, allowing the serum
proteins albumin and globulin to escape into the
urine. The degenerative changes also result in
decreased glomerular filtration, so there is
lowered urine output and clearance of creatinine.
If increased kidney tubular reabsorption occurs,
retention of sodium begins. As sodium retains
fluid, edema results. Edema is further increased
because, as more protein is lost, the osmotic
pressure of the circulating blood falls and fluid
diffuses from the circulatory system into the
denser interstitial spaces to equalize the
pressure. Extreme edema can lead to pulmonary
edema
 PROGNOSIS NURSING INTERVENTION
In-hospital mortality rates for patients with CPE
are difficult to assign because the causes and
severity of the disease vary considerably. In a
high-acuity setting, in-hospital death rates are as
high as 15-20%.

MYOCARDIAL INFARCTION
• associated hypotension, and a history of
frequent hospitalizations for CPE generally
increase the mortality risk

SEVERE HYPOXIA
• may result in myocardial ischemia or
infarction.

Mechanical ventilation may be required if medical

therapy is delayed or unsuccessful. Endotracheal
intubation and mechanical ventilation are
associated with their own risks, including
aspiration (during intubation), mucosal trauma
(more common with nasotracheal intubation than
with orotracheal intubation), and barotrauma.

TREATMENT AND OUTCOME

The first treatment for acute pulmonary edema is
supplemental oxygen

You usually receive oxygen through a face mask

or nasal cannula
— a flexible plastic tube with two openings that
deliver oxygen to each nostril. This should ease
some of your symptoms.
They will monitor your oxygen level closely.
Sometimes, it may be necessary to assist your
breathing with a machine such as a mechanical
ventilator or one that provides positive airway
pressure.

Depending on the severity of your condition and

thereason for your pulmonary edema, you may
also receive one or more of the following
medications:
• Diuretics
• Morphine (MS Contin, Oramorph, others).
• Blood pressure drugs
• Inotropes