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Pregnancy Induced Hypertension (PIH)

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Title: Pregnancy Induced Hypertension (PIH)


1
Pregnancy Induced Hypertension (PIH)
2
  • Pregnancy induced hypertension is still one of
    the most common causes of maternal and prenatal
    mortality and morbidity. It is characterized by
    vasospasm that leads to poor perfusion of many
    vital organs including the feto/placental unit.

3
  • Pre-eclampsia and eclampsia are two
    categories of pregnancy induced hypertension. The
    HELLP syndrome is a severe sequel of pregnancy
    induced hypertension.

4
Classifications
  • Pre-eclampsia.
  • Severe pre-eclampsia.
  • Eclampsia.

5
Incidence
  • 5-7 of all pregnancies. If a woman has
    chronic hypertension, she has a 25 to 35 risk of
    developing PIH

6
Prenatal Factors Increasing the Risk of PIH
  • Primigravida.
  • Grand multigravidit.
  • Essential hypertension
  • Family history of hypertension or vascular
    disease.
  • Diagnosis of PIH in previous pregnancy
  • Low socioeconomic status.
  • Diabetes mellitus.
  • Obesity.
  • Malnutrition.
  • Age (under 17 or over 35 years old).
  • Underweight or overweight.

7
Factors that Develop During Pregnancy and
Increase the Risk of Developing PIH
  • Diabetes mellitus.
  • Multiple gestation.
  • Gestational trophoplastic disease.
  • Hydramnios.
  • Renal infections

8
Sequelae of PIH Representing Serious Threats to
Maternal and Fetal Wellbeing
  • Abruptio placenta.
  • Retinal detachment
  • Acute renal failure.
  • Cardiac failure.
  • Cerebral hemorrhage.
  • Maternal death.
  • Fetal growth retardation, hypoxia and death.
  • Preterm labor.
  • Coagulation failure.
  • Spontaneous abortion.
  • Prematurity.

9
Pre-eclampsia
  • Hypertension 140/90
  • Proteinuria 300mg or more in 24h
  • Edema greater than I pitting edema after 12 hour
    bed rest or weight gain of 2.3kg or more in one
    week or both after 20 week of gestation

10
Severe pre-eclampsia
  • Blood pressure160/110
  • Proteinuria 5 g in 24 hour urine collection
  • Oliguria less than 700 to 800 ml in 24 hours or
    lt30 ml/hr.
  • Hypereflexia
  • Visual disturbances
  • Headache, blurred vision
  • Pulmonary edema or cyanosis.
  • Epigastric pain

11
Eclampsia
  • Presence of seizures
  • Eclamptic fit pass in the following stage
  • 1- Premonitory stage (1-2 minute) eye rolled up
    with twitches of face and hands
  • 2- Tonic stage (1-2minute) generalized tonic
    spasms ,patient is cyanosed ,the tongue may
    bitten
  • 3- Clonic stage (1-2 minute) convulsion occur,
    face is red and cyanosed ,temperature rise and
    involuntary pass of urine
  • 4- coma

12
HELLP syndrome
  • Occurs in 2-12 of cases
  • H Hemolysis
  • EL elevated liver enzymes
  • LP low platelets

13
Eclamptic fit may occur
  • Ante partum (65) with best prognosis
  • Intrapartum (20)
  • Postpartum (15)with bad prognosis which
    indicated excessive pathological damage

14
Criteria for severity of eclampsia
  • Coma more than 6 hours.
  • Temperature more than 39c.(indicate pneumonia
  • Systolic blood pressure more than 200mmhg.(risk
    for cerebral he)
  • Pulse more than 120/m(acute heart failure) .
  • Anuria or oliguria( indicate renal failure)
  • Respiratory rate more 40/m (indicate pneumonia(?
  • More than 10 fit.

15
Complications of the Epileptic Fit
  • Biting of the tongue.
  • Suffocation.
  • Heart failure.
  • Cerebral hemorrhage.
  • Accidental hemorrhage.
  • Bronchopneumonia

16
Investigations
  • Urine 24h urine , protinuria
  • Kidney function (serum creatinine, urea, uric
    acid
  • Liver function bilirubin and enzymes
  • Blood picture, hematoicreate
  • Coagulation profile (bleeding and clotting time
  • Fundus examination (retinal or hemorrhage
  • CT to detect cerebral hemorrhage
  • Ultrasound (gestational age ,fetal life, IUGR
    ,IUFD, retroplacenta hematoma

17
Nursing Management of Pregnancy Induced
Hypertension (PIH)
  • Preventive measure
  • Counsel all women prior to conception regarding
    health behaviors that minimize risk of
    hypertension, e.g.
  • Correct dietary deficiencies.
  • Attain ideal pre-pregnancy weight.
  • Stop smoking.
  • Manage stress positively.
  • Alter coping style.

18
  • Receive regular antenatal care
  • Screen all patients for PIH each prenatal visit
    by evaluating blood pressure, edema, proteinuria
  • Low dose of asprine
  • Calcium supplementation
  • Magnesium supplementation
  • Antioxidants as vitamin C and E
  • Salt restriction

19
Treatment
  • Expectant treatment
  • Control hypertension
  • Prevent and control convulsion
  • Treatment of eclampsia
  • Termination of pregnancy

20
General and first aid measures
  • Isolation in single ,quite ,semi dark room
  • An efficient nurse should be present
  • The following equipment must be present
  • Airway, oxygen source ,suction apparatus
  • Bed with side ray
  • Put pt in trendlenburg position
  • Insert a catheter ,nothing by moth and fluid
    chart
  • Observation
  • 1- Vital signs
  • 2- Level of consciousness and duration of coma
  • 3- Urine out put and albumineuria
  • 4- Number of convulsion

21
Expectant treatment
  • Rest
  • Diet increase protein and carbohydrate and low
    salt
  • Sedation
  • Observation
  • Mother (BP, pulse, respiration ,protein urea
  • Investigation
  • Fetus , fetal well being as fetal movement NST
    ,Us

22
Prevent and control convulsion
  • Magnesium sulfate (Mgso4) it is drug of choice it
    cause CNS depression ,it can given IV or IM
  • Antidote 10ml of 10 calcium gluconate

23
Diabetes Mellitus
  • Definition
  • Diabetes mellitus is a chronic disease
    resulting from a relative or absolute lack of
    insulin, which is required for carbohydrate
    metabolism.
  • In diabetes mellitus, the pancreas does not
    produce sufficient amounts of insulin to allow
    necessary carbohydrate metabolism. With
    inadequate amounts of insulin, glucose cannot
    enter the cells and remains in the blood.

24
Etiology
  • Insulin deficiency may be caused by
  • ? Damage to beta cells in the pancreas.
  • ? Increased insulin ruirement as in obesity and
    pregnancy

25
Women at risk
  • Obstetric history
  • Previous macrosomia.
  • Previous unexplained still birth.
  • Poor obstetric outcome.
  • Polyhydramnios.
  • Excessive weight gain.
  • Hypertension.
  • Recurrent infection as monilial infections.
  • Present pregnancy
  • Abnormal fasting blood sugar.
  • Glucosuria.
  • Unexplained polyhydramnios.

26
Symptoms of Diabetes Mellitus
  • Excessive thirst and hunger.
  • Frequent urination.
  • Blurred vision.
  • Weight loss.
  • Recurrent infections

27
Influence of Diabetes on Pregnancy Outcome
  • During pregnancy
  • Mother
  • ? Abortion.
  • ? Pre-eclampsia.
  • ? Polyhydramnios.
  • ? Incidence of cesarean section.
  • Fetus
  • ? IUGR.
  • ? IUFD.
  • ? Congenital anomalies.
  • ? Abnormal presentation.

28
Postpartum Infection. Postpartum hemorrhage.
  • During labor
  • Mother
  • ? Obstructed labor.
  • Fetus
  • ? Prematurity.
  • ? Neonatal hypoglycemia.
  • ? Respiratory distress.
  • ? Macrosomia.

29
Nursing Intervention for Gestational Diabetes
  • Controlling serum glucose
  • Dietary adjustment
  • Insulin
  • Prevent, recognize and treat hypo- or
    hyperglycemia
  • Ultrasound assessment at 20 week of gestation.
  • Non - stress test.
  • Educate the patient regarding self-care measures
  • Activity and exercise
  • Hospitalization
  • ?From 32 week till delivery for patient with
    vascular changes.

30
Hyperemesis Gravidarum
  • Persistent and excessive vomiting in early
    pregnancy

31
Signs and symptoms
  • Dehydration ( eye appear dry , sunken).
  • Weight loss- signs of anemia.
  • Dryness or inelastic of the skin.
  • Jaundice may apparent denoting liver damage.
  • Mother breath will smell of acetone.
  • Urine will smell of acetone .bescant and dark in
    olor

32
Causes
  • Unknown .
  • May be associated with multiple pregnancy and
    hydatoform mole.

33
Role of Nurse
  • Preventive
  • Provide ante natal care and manage nausea and
    vomiting
  • Management
  • Hospitalization
  • Monitor mother and fetus
  • Record intake and output, weight and vital signs
  • Oral hygiene and Reassurance
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