PREGNANCY INDUCED HYPERTENSION (PIH) NURSING MANAGEMENT DEFINITION Pregnancy Induced Hypertension: is a form of high blood pressure in pregnancy. It occurs in about 5 percent to 8 percent of all pregnancies. It is a condition in which vasospasm occurs during pregnancy in both small and large arteries. With high blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta. It occurs in about 5 percent to 8 percent of all pregnancies. Originally, it was called toxaemia because researchers pictured a toxin of some kind being produced by woman in response to the foreign protein of the growing fetus, the toxin leading to the typical symptoms. No such toxin has ever been identified. CAUSES Possible causes may include: Insufficient blood flow to the uterus Damage to the blood vessels A problem with the immune system Poor diet Genes RISK FACTORS Preeclampsia develops only during pregnancy. Risk factors include: History of preeclampsia -A personal or family history of preeclampsia increases the risk of developing the condition. First pregnancy – The risk of developing preeclampsia is highest during the first pregnancy or the first pregnancy with a new partner. Age – The risk of preeclampsia is higher for pregnant women who are older than age 35. Obesity – The risk of preeclampsia is higher if the pregnant woman is obese. Multiple pregnancies – Preeclampsia is more common in women who are carrying twins, triplets or other multiples. Gestational diabetes – Women who develop gestational diabetes have a higher risk of developing preeclampsia as the pregnancy progresses. History of certain conditions – Having certain conditions before becoming pregnant such as chronic high blood pressure, diabetes, kidney disease or lupus. Signs and Symptoms (Signs and symptoms of PIH. Source: pennmedicine.org) Hypertension -Elevated blood pressure Proteinuria – presence of excess protein in the urine after 20 weeks of pregnancy. Other signs and symptoms of Preeclampsia, which can develop gradually or strike suddenly, often in the last few weeks of pregnancy, may include: Severe headaches Changes in vision, including temporary loss of vision, blurred vision or light sensitivity Upper abdominal pain, usually under the ribs on the right side Nausea or vomiting Dizziness Decreased urine output Agitation Sudden weight gain, typically more than 2 pounds a week Edema – swelling particularly in the face and hands, often accompanies preeclampsia as well. Swelling isn’t considered a reliable sign of preeclampsia, however, because it also occurs in many normal pregnancies. CLASSIFICATIONS 1. Gestational Hypertension A woman is said to have Gestational Hypertension when she develops an elevated blood pressure (140/90 mmHg) but has no proteinuria or edema. Perinatal mortality is not increased with simple gestational hypertension, so no drug therapy is necessary. Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater than 15 mmHg above pregnancy values. No edema, no proteinuria and blood pressure returns to normal after birth. 2. Mild Pre-eclampsia A woman is said to be mildly pre-eclamptic when her blood pressure rises to 140/90 mmHg, taken on two occasions atleast 6 hours apart. Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater than 15 mmHg above pregnancy values. In addition to the hypertension, a woman has proteinuria (1+ or 2+ on a reagent test strip on a random sample). A weight gain of more than 2 lbs/week in the second trimester or 1 lb/week in the third trimester usually indicates abnormal tissue fluid retention. 3. Severe Pre-eclampsia A woman has passed from mild to severe preeclampsia when her blood pressure has risen to 160 mmHg systolic and 110 mmHg diastolic or above on atleast two occasions 6 hours apart at bed rest. Marked proteinuria. 3+ or 4+ on a random urine sample or more than 5 g in a 24 hour sample and extensive edema are also present. With the severe preeclampsia, the extreme edema will be noticeable as puffiness in a woman’s face and hands. It is most readily palpated over bony surfaces. The woman may manifest oliguria (altered renal function), elevated serum creatinine (more than 1.2 mg/dL); cerebral or visual disturbances (blurred vision); thrombocytophenia and epigastric pain. 4. Eclampsia This is the most severe classification of PIH. A woman has passed into this stage when cerebral edema is so acute that seizure or coma occurs. With eclampsia, the maternal mortality is high from cause such as cerebral hemorrhage, circulatory collapse or renal failure. The fetal prognosis in eclampsia is poor because of hypoxia and consequent fetal acidosis. The manifestations are the same accompanied by seizures. HELLP SYNDROME HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of physical changes including the breakdown of red blood cells, changes in the liver and low platelets (cells found in the blood that are needed to help the blood to clot in order to control bleeding). NURSING RESPONSIBILITIES A woman with mild PIH Promote bedrest Promote good condition Provide emotional support Nursing Intervention for a woman with sever PIH Support bed rest Monitor maternal and well being Monitor Fetal Well being Support a Nutritious Diet Administer medications to prevent eclampsia PREVENTION There’s no known way to prevent preeclampsia. Eating less salt or changing your activities during pregnancy doesn’t reduce the risk. The best way to take care of yourself — and your baby — is to seek early and regular prenatal care. If preeclampsia is detected early, you and your doctor can work together to prevent complications and make the best choices for you and your baby. In a preliminary 2006 study, women who took multivitamins and maintained a healthy weight before conception reduced the risk of developing preeclampsia during pregnancy by more than 70 percent compared with women of a healthy weight who didn’t take multivitamins or with women who took multivitamins but were overweight before conception. Several earlier studies suggested that specific nutritional supplements could prevent preeclampsia, but these studies haven’t stood the test of time. Although a healthy weight before pregnancy has clear benefits for both mother and baby, more research is needed to determine the preventive effects of multivitamins and other nutritional supplements.