Pregnancy Induced Hypertension PIH Dr Hanan Elsayed Pregnancy

Pregnancy Induced Hypertension (PIH) Dr/ Hanan Elsayed

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. 10/31/2021 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. 10/31/2021 Dr/ Hanan Elsayed

Classifications • Pre-eclampsia. • Severe pre-eclampsia. • Eclampsia. 10/31/2021 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 10/31/2021 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 • 10/31/2021 • • • Low socioeconomic status. Diabetes mellitus. Obesity. Malnutrition. Age (under 17 or over 35 years old). • Underweight or overweight. 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 10/31/2021 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. 10/31/2021 • Fetal growth retardation, hypoxia and death. • Preterm labor. • Coagulation failure. • Spontaneous abortion. • Prematurity. Dr/ Hanan Elsayed

Pre-eclampsia: • Hypertension: 140/90 • Proteinuria: 300 mg or more in 24 h • Edema: greater than I pitting edema after 12 hour bed rest or weight gain of 2. 3 kg or more in one week or both after 20 week of gestation 10/31/2021 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 10/31/2021 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 -2 minute) 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 10/31/2021 Dr/ Hanan Elsayed

HELLP syndrome Occurs in 2 -12 % of cases • H : Hemolysis • EL : elevated liver enzymes • LP: low platelets 10/31/2021 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 10/31/2021 Dr/ Hanan Elsayed

Criteria for severity of eclampsia • Coma more than 6 hours. • Temperature more than 39 c. (indicate pneumonia • Systolic blood pressure more than 200 mmhg. (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. 10/31/2021 Dr/ Hanan Elsayed

Complications of the Epileptic Fit • • • Biting of the tongue. Suffocation. Heart failure. Cerebral hemorrhage. Accidental hemorrhage. Bronchopneumonia 10/31/2021 Dr/ Hanan Elsayed

Investigations • Urine : 24 h urine , protinuria • Kidney function (serum creatinine, urea, uric acid • Liver function bilirubin and enzymes • Blood picture, hematoicreate • Coagulation profile (bleeding and clotting time 10/31/2021 • Fundus examination (retinal or hemorrhage • CT to detect cerebral hemorrhage • Ultrasound (gestational age , fetal life, IUGR , IUFD, retroplacenta hematoma 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. 10/31/2021 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 10/31/2021 Dr/ Hanan Elsayed

Treatment • • • Expectant treatment Control hypertension Prevent and control convulsion Treatment of eclampsia Termination of pregnancy 10/31/2021 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 10/31/2021 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 10/31/2021 Dr/ Hanan Elsayed

Prevent and control convulsion • Magnesium sulfate (Mgso 4) it is drug of choice it cause CNS depression , it can given IV or IM Antidote 10 ml of 10% calcium gluconate 10/31/2021 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. 10/31/2021 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 10/31/2021 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. 10/31/2021 Dr/ Hanan Elsayed

Symptoms of Diabetes Mellitus • • • Excessive thirst and hunger. Frequent urination. Blurred vision. Weight loss. Recurrent infections 10/31/2021 Dr/ Hanan Elsayed

Influence of Diabetes on Pregnancy Outcome During pregnancy: Mother: ► Abortion. ► Pre-eclampsia. ► Polyhydramnios. ► Incidence of cesarean section. 10/31/2021 Fetus: ► IUGR. ► IUFD. ► Congenital anomalies. ► Abnormal presentation. Dr/ Hanan Elsayed

During labor: Mother: ► Obstructed labor. Fetus: ► Prematurity. ► Neonatal hypoglycemia. ► Respiratory distress. ► Macrosomia. 10/31/2021 Postpartum: Infection. Postpartum hemorrhage. 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. 10/31/2021 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 10/31/2021 Dr/ Hanan Elsayed

Causes • Unknown. • May be associated with multiple pregnancy and hydatoform mole. 10/31/2021 Dr/ Hanan Elsayed

Role of Nurse Preventive 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 10/31/2021 Dr/ Hanan Elsayed