HYPERTENSIVE DISORDERS OF PREGNANCY

GESTATIONAL HYPERTENSION DEFINITION Gestational hypertension is a sustained rise of blood pressure to 149/90 mmhg or more on at least two ocassions , 4 or more hours apart beyond the 20th week of pregnancy or during the first 24 hours after the delivery in a previously normotensive women.

The hypertension may be a stress response. ESSENTIAL FEATURES OF THIS CONDITION ARE Absence of any evidence for the underlying cause of hypertension. Unassociated with other evidence of pre eclampsia such as edema or proteinuria. The blood pressure returns to normal within 10 days following delivery. The hypertension may be a stress response.

CHRONIC HYPERTENSION IN PREGNANCY DEFINITION Chronic hypertensive disease is defined as the presence of hypertension of any cause before the 20th week of pregnancy in the absence of hydatidiform mole or is present long after delivery.

CAUSES 1. Essential hypertension. 2. Secondary to existing problem. Renal diseases Systemic lupus erythematous Cushing’s syndrome Pheochromocytoma

DIAGNOSIS BP Recording Family and personal history Older and parous women Physical examination reveals long term effect of hypertension

ESSENTIAL HYPERTENSION DIAGNOSTIC CRITERIA 1.Rise in Bp before 20th week of pregnancy 2.Persistence of blood pressure even after delivery 3.Common in multiparous and elderly 4.Presence of pre pregnant hypertension 5.Family history 6.Presence of hypertensive retinopathy

EFFECTS OF PREGNANCY ON THE DISEASE Mild fall in pregnancy in the mid pregnancy. BP tends to rise progressively as pregnancy advances. It can superimpose by pre eclampsia. Malignant hypertension. Permanent deterioration following delivery.

RISK TO MOTHER AND FETUS Growth retarded babies. Perinatal loss.

MANAGEMENT MILD CASE REST SEDATIVE FREQUENT CHECK UP LOW SALT DIET

RX PROTOCOL FOR PRE ECLAMPSIA IN SEVERE CASE HOSPITALIZATION RX PROTOCOL FOR PRE ECLAMPSIA INDUCTION OF LABOUR WAIT FOR SPO.LABOUR ANTI HYPERTENSIVES

NURSING PROCESS FOR PIH ASSESSMENT 1.Edema 2.Proteinuria 3.Weight gain 4.Blood pressure 5.Other symptoms 6.Age and parity 7.Predisposing factors

NURSING DIAGNOSIS 1.Risk for injury 2.Risk for infection 3.Ineffective airway clearance 4.Actual/Risk for aspiration 5.Anxiety 6.Anticipatory grieving 7.Altered family process 8.Actual/Risk for altered parenting 9.Health seeking behaviour

PLANNING 1.Prevent progression of PIH to convulsion. 2.Monitor maternal and fetal well being. 3.Provide counselling and support. 4.Provide health education.

IMPLEMENTATION 1.Facilitate early prenatal care. 2.Assess physical parameters. 3.Provide diet instructions. 4.Instruct regarding medications. 5.Facilitate hospitalization,if required. 6.Promote bed rest ,rest on left side and quiet environment. 7.Prevent convulsion.

EVALUATION Ensure that the expectant woman: 1.Complies with treatment regimen. 2.Does not develop eclampsia. 3.Progress to labour with out further complication. 4.Verbalise support and increase coping ability. 5.Verbalise self care measures.

EVALUATION Ensure that the expectant woman: 1.Complies with treatment regimen. 2.Does not develop eclampsia. 3.Progress to labour with out further complication. 4.Verbalise support and increase coping ability. 5.Verbalise self care measures.

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