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What is one of the main health issues associated with pregnancy induced hypertension?
What is one of the main health issues associated with pregnancy induced hypertension?
Which of the following statements about pregnancy induced hypertension is true?
Which of the following statements about pregnancy induced hypertension is true?
What could be a severe consequence of untreated pregnancy induced hypertension?
What could be a severe consequence of untreated pregnancy induced hypertension?
What should be considered a priority in managing pregnancy induced hypertension?
What should be considered a priority in managing pregnancy induced hypertension?
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Which group is most affected by pregnancy induced hypertension?
Which group is most affected by pregnancy induced hypertension?
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What physiological condition is primarily described in the content?
What physiological condition is primarily described in the content?
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Which of the following organs is affected by the condition described?
Which of the following organs is affected by the condition described?
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What is the result of the vasospasm indicated in the content?
What is the result of the vasospasm indicated in the content?
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What effect does vasospasm have on blood flow?
What effect does vasospasm have on blood flow?
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What can be inferred about the relationship between vasospasm and organ health?
What can be inferred about the relationship between vasospasm and organ health?
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Study Notes
Pregnancy Induced Hypertension (PIH)
- PIH is a significant cause of maternal and prenatal mortality and morbidity.
- It's characterized by vasospasm, leading to poor perfusion of vital organs, including the feto/placental unit.
Classifications of PIH
- Pre-eclampsia
- Severe pre-eclampsia
- Eclampsia
- HELLP syndrome (a severe complication)
Incidence of PIH
- Affects 5-7% of all pregnancies.
- Women with chronic hypertension have a 25-35% risk of developing PIH.
Prenatal Factors Increasing PIH Risk
- Primigravida (first pregnancy)
- Grand multigravida
- Essential hypertension
- Family history of hypertension or vascular disease
- Low socioeconomic status
- Diabetes mellitus
- Obesity
- Malnutrition
- Age (under 17 or over 35)
- Diagnosis of PIH in a previous pregnancy
- Underweight or overweight
Defining Pre-eclampsia
- Hypertension: blood pressure of 140/90 or higher
- Proteinuria: 300 mg or more of protein in a 24-hour urine collection
- Edema: significant swelling, especially after 12 hours of bed rest, or weight gain of 2.3 kg or more in one week, or both, after 20 weeks of gestation.
Severe Pre-eclampsia
- Blood pressure: 160/110
- Proteinuria: 5 grams or more in a 24-hour urine collection
- Oliguria: urine output less than 700-800 ml in 24 hours or less than 30 ml/hr.
- Hypereflexia (excessive reflexes)
- Visual disturbances
- Headache, blurred vision
- Pulmonary edema or cyanosis
- Epigastric pain
Eclampsia
- Characterized by seizures
- Four Stages of fit:
- Premonitory (1-2 minutes) - eye rolling, facial and hand twitching
- Tonic (1-2 minutes) - generalized muscle spasms, cyanosis, possible tongue biting
- Clonic (1-2 minutes)- convulsive phase, face red and cyanosed, temperature rise, urinary incontinence
- Coma
HELLP Syndrome
- Occurs in 2-12% of PIH cases
- Symptoms:
- Hemolysis (destruction of red blood cells)
- Elevated liver enzymes
- Low platelets
Eclamptic Fit Timing
- Antepartum (65%): best prognosis
- Intrapartum (20%)
- Postpartum (15%): worse prognosis; indicates extensive damage.
Criteria for Severity of Eclampsia
- Coma lasting longer than 6 hours
- Temperature exceeding 39°C
- Systolic blood pressure over 200 mmHg
- Pulse rate more than 120/minute
- Anuria or oliguria
- Respiratory rate more than 40/minute
- More than 10 seizures
Complications of Epileptic Fit
- Biting of the tongue
- Suffocation
- Heart failure
- Cerebral hemorrhage
- Accidental hemorrhage
- Bronchopneumonia
Investigations for PIH
- 24-hour urine collection (proteinuria)
- Kidney function tests (creatinine, urea, uric acid)
- Liver function tests (bilirubin + enzymes)
- Complete blood count (hematocrit)
- Coagulation profile (blood clotting)
- Fundus examination (eye exam for retinal changes)
- CT scan (for cerebral hemorrhage)
- Ultrasound (to evaluate the fetus, gestational age, and placental position)
Nursing Management of PIH - Prevention
- Counsel women pre-conception about healthy behaviors that minimize hypertension risk.
- Correct dietary deficiencies before pregnancy.
- Attain ideal pre-pregnancy body weight.
- Stop smoking.
- Manage stress effectively; consider altering coping mechanisms.
Nursing Management of PIH - Treatment
- Receive regular antenatal care.
- Screen for PIH in each visit (BP, edema, proteinuria)
- Low-dose aspirin
- Calcium supplementation
- Magnesium supplementation
- Antioxidants (vitamins C & E)
- Salt restriction
- Expectant management
- Control hypertension
- Prevent and control convulsions
- Treat eclampsia
- Possibly terminate the pregnancy
General and First Aid Measures
- Isolation in a single, quiet, semi-dark room
- Availability of trained nurses.
- Necessary equipment: airway, oxygen source, suction apparatus, bed with side rails
- Put the patient in the Trendelenburg position
- Insert a catheter; nothing by mouth
- Monitor vital signs
- Monitor level of consciousness
- Monitor urine output and albuminuria
- Monitor number of convulsions
Expectant Treatment
- Rest
- Diet high in protein and carbohydrates, low in salt
- Sedation
- Monitor mother (BP, pulse, respiration, protein urea)
- Monitor the fetus (well-being, movement, NST, Ultrasound).
Prevent and Control Convulsions
- Magnesium sulfate (MgSO₄): drug of choice; can cause CNS depression; given IV or IM
- Antidote: 10 ml of 10% calcium gluconate
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Description
This quiz covers key aspects of Pregnancy Induced Hypertension (PIH), including its classifications, incidence, and prenatal risk factors. Explore the definitions of pre-eclampsia and its implications on maternal and fetal health.
