1. Pregnancy Induced Hypertension (PIH)

2. 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/ :50 م
Dr/ Hanan Elsayed

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

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

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

6. 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/ :50 م
Dr/ Hanan Elsayed

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

8. 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/ :50 م
Dr/ Hanan Elsayed

9. 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/ :50 م
Dr/ Hanan Elsayed

10. 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/ :50 م
Dr/ Hanan Elsayed

11. 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/ :50 م
Dr/ Hanan Elsayed

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

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

14. 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/ :50 م
Dr/ Hanan Elsayed

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

16. 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/ :50 م
Dr/ Hanan Elsayed

17. 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/ :50 م
Dr/ Hanan Elsayed

18. 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/ :50 م
Dr/ Hanan Elsayed

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

20. 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/ :50 م
Dr/ Hanan Elsayed

21. 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/ :50 م
Dr/ Hanan Elsayed

22. 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/ :50 م
Dr/ Hanan Elsayed

23. 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/ :50 م
Dr/ Hanan Elsayed

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

25. 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/ :50 م
Dr/ Hanan Elsayed

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

27. 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/ :50 م
Dr/ Hanan Elsayed

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

29. 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/ :50 م
Dr/ Hanan Elsayed

30. 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/ :50 م
Dr/ Hanan Elsayed

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

32. 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/ :50 م
Dr/ Hanan Elsayed