Pregnancy Induced Hypertension (PIH)

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Pre-eclampsia and eclampsia are two categories of pregnancy induced hypertension. The HELLP syndrome is a severe sequel of pregnancy induced hypertension. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Classifications Pre-eclampsia. Severe pre-eclampsia. Eclampsia. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Incidence 5-7% of all pregnancies. If a woman has chronic hypertension, she has a 25 to 35% risk of developing PIH 19/09/2018 06:50 م Dr/ Hanan Elsayed

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Factors that Develop During Pregnancy and Increase the Risk of Developing PIH Diabetes mellitus. Multiple gestation. Gestational trophoplastic disease. Hydramnios. Renal infections 19/09/2018 06:50 م Dr/ Hanan Elsayed

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

Severe pre-eclampsia Blood pressure:160/110 Proteinuria 5 g in 24 hour urine collection Oliguria: less than 700 to 800 ml in 24 hours or <30 ml/hr. Hypereflexia Visual disturbances Headache, blurred vision Pulmonary edema or cyanosis. Epigastric pain 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

HELLP syndrome Occurs in 2-12 % of cases H : Hemolysis EL : elevated liver enzymes LP: low platelets 19/09/2018 06:50 م Dr/ Hanan Elsayed

Eclamptic fit may occur: Ante partum (65%) with best prognosis Intrapartum (20%) Postpartum (15%)with bad prognosis which indicated excessive pathological damage 19/09/2018 06:50 م Dr/ Hanan Elsayed

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(ز More than 10 fit. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Complications of the Epileptic Fit Biting of the tongue. Suffocation. Heart failure. Cerebral hemorrhage. Accidental hemorrhage. Bronchopneumonia 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

Treatment Expectant treatment Control hypertension Prevent and control convulsion Treatment of eclampsia Termination of pregnancy 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Etiology Insulin deficiency may be caused by: ◘ Damage to beta cells in the pancreas. ◘ Increased insulin ruirement as in obesity and pregnancy 19/09/2018 06:50 م Dr/ Hanan Elsayed

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Symptoms of Diabetes Mellitus Excessive thirst and hunger. Frequent urination. Blurred vision. Weight loss. Recurrent infections 19/09/2018 06:50 م Dr/ Hanan Elsayed

Influence of Diabetes on Pregnancy Outcome During pregnancy: Mother: ► Abortion. ► Pre-eclampsia. ► Polyhydramnios. ► Incidence of cesarean section. Fetus: ► IUGR. ► IUFD. ► Congenital anomalies. ► Abnormal presentation. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Postpartum hemorrhage. Infection. Postpartum hemorrhage. During labor: Mother: ► Obstructed labor. Fetus: ► Prematurity. ► Neonatal hypoglycemia. ► Respiratory distress. ► Macrosomia. 19/09/2018 06:50 م Dr/ Hanan Elsayed

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. 19/09/2018 06:50 م Dr/ Hanan Elsayed

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 19/09/2018 06:50 م Dr/ Hanan Elsayed

Causes Unknown . May be associated with multiple pregnancy and hydatoform mole. 19/09/2018 06:50 م Dr/ Hanan Elsayed

Role of Nurse Preventive Management Hospitalization 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 19/09/2018 06:50 م Dr/ Hanan Elsayed