Pregnancy Induced Hypertension (PIH)

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. 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. Dr/ Hanan Elsayed

4. Classifications • Pre-eclampsia. • Severe pre-eclampsia. • Eclampsia. 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 Dr/ Hanan Elsayed

6. 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. Prenatal Factors Increasing the Risk of PIH 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 Dr/ Hanan Elsayed

8. Abruptio placenta. Retinal detachment Acute renal failure. Cardiac failure. Cerebral hemorrhage. Maternal death. Sequelae of PIH Representing Serious Threats to Maternal and Fetal Wellbeing • Fetal growth retardation, hypoxia and death. • Preterm labor. • Coagulation failure. • Spontaneous abortion. • Prematurity. 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 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 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 Dr/ Hanan Elsayed

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

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

16. 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 Investigations 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. 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 Dr/ Hanan Elsayed

19. Treatment • Expectant treatment • Control hypertension • Prevent and control convulsion • Treatment of eclampsia • Termination of pregnancy 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 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 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 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. 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 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. Dr/ Hanan Elsayed

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

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

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

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

32. 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 Dr/ Hanan Elsayed