Pathophysiology of Hypertension in Pregnancy

Monitoring and Assessment

• Skin temperature observation is crucial for assessing capillary perfusion.
• Urine output serves as an important indicator of tissue perfusion adequacy.
• Abnormal blood pressure readings are significant for diagnosing hypertensive disorders.
• Pulse oximetry assesses oxygen uptake and delivery; low levels signify reduced oxygen availability.
• Observe for symptoms such as pallor, cyanosis, mottling, and cool or clammy skin.

Hypertensive Disorders in Pregnancy

• Hypertensive diseases during pregnancy are classified based on organ effects.
• Vasospasm leads to poor tissue perfusion and manifests in various hypertensive disorders.
• Gestational hypertension and chronic hypertension may co-occur.
• Associated risks include placental abruption, kidney failure, liver failure, preterm birth, and mortality for mother and fetus.
• Hypertensive disorders are the second leading cause of maternal deaths, following hemorrhage.

Magnesium Toxicity Monitoring

• Signs include loss of deep tendon reflexes, shortness of breath, oliguria, and decreased oxygen saturation.
• Initial side effects of IV magnesium include feelings of flush, heat, nausea, and burning at the IV site.
• A calm, quiet environment is necessary for patient well-being; avoid distressing situations.
• Follow a clear liquid diet and observe seizure precautions.
• Continuous pulse oximetry is essential for monitoring.

Postpartum Care

• Discharge education should start at admission; significant information delivery is necessary.
• Address postpartum discomforts and changes in body image; prioritize food and sleep for new mothers.
• Be aware of potential constipation; early ambulation and stool softeners may alleviate discomfort.

Urinary System Changes

• Watch for swelling and bruising around the urethra to prevent overdistention.
• Diuresis typically occurs within 12-24 hours post-delivery, with increased output for 2-5 days.
• A full bladder can displace the uterus and cause hemorrhage; adequate bladder emptying is crucial.

Vital Signs Monitoring

• Normal postpartum temperature is afebrile; an elevation could indicate dehydration.
• Significant blood pressure changes may signal bleeding or postpartum hypertension.
• Orthostatic hypotension is common in the first 48 hours.

Cardiovascular Changes

• Blood volume decreases as the body auromatically adapts postpartum.
• Expected average blood loss is 500 ml for vaginal births and 500-1000 ml for cesarean.
• Signs of deep vein thrombosis (DVT) may be indicated by Homans sign, although it is not a definitive measure.

Breastfeeding

• Initiating breastfeeding within the first hour post-birth is optimal for bonding and nutrition.
• Breastfeed on demand; newborns typically nurse every 2-3 hours.
• Monitor feeding effectiveness by the wet diaper count and stool output.

Psychological Adaptations

• The postpartum period requires adjustment and adaptation for the mother and family.
• Mothers may experience a range of emotional responses, including anxiety about caring for the newborn.
• Initial days post-birth focus on mother's self-care, but by days 2-3, mothers often seek to regain control.

Nutritional Needs Postpartum

• Nutritional intake should increase for breastfeeding mothers; inadequate calories may reduce milk volume.
• Encourage balanced meals rich in calories and continue iron supplements for 2-3 months post-delivery.

Cultural Considerations

• Be mindful of cultural practices related to postpartum care, such as rest and dietary constraints.
• Engage family members in teaching sessions, especially in cultures where extended family support is common.

Sudden Infant Death Syndrome (SIDS)

• SIDS is a leading cause of death in infants aged 1 to 12 months, often with no prior warning signs.
• SIDS is associated with brain defects governing breathing and sleep arousal; confirmed only after autopsy.
• Risk factors include preterm birth, male gender, inappropriate sleeping positions, loose bedding, and tobacco smoke exposure.