Pregnancy Induced Hypertension Overview

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

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.