Chapter 27 Flashcards
Hypertensive disorders
Gestational hypertension
Preeclampsia (only cure deliver baby)
Eclampsia (only cure deliver baby)
Chronic hypertension
Common medical complication of pregnancy
- Complicates 5% to 10% of all pregnancies
- Rate of pregnancy-related hypertension has risen steadily since 1990 for all ages and ethnic groups
hypertensive disorders are a major cause of
prenatal death and IUGR (interuterine growth retardation)
10-15% of death
predisposing factors
- Family history
- Primagravida
- Pre-existing abnormality of vascular, metabolic or endocrine systems
- Hypertension
- Molar pregnancy- don’t have viable fetus (false pregnancy)
- Twins - more Hcg
- renal disease/renal problems
Morbidity
- Placental abruption (not during 3rd stage of labor)
- Cerebral hemorrhage
- Hepatic or renal dysfunction
- DIC (diminished intrmuscular cognation
- Pulmonary edema
- Seizures
Mortality
Pregnancy-related hypertension accounts for 10% to 15% of maternal deaths worldwide
Gestational hypertension
Onset of hypertension without proteinuria after week 20 of pregnancy
Systolic BP >140, diastolic BP >90 (have to have two different readings two different days)
-bp will return to normal 6 wks after delivery
Preeclampsia
Pregnancy-specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman
-move from preeclampsa to eclampsia when pt has a seizure
Eclampsia
- Onset of seizure activity or coma in a woman with preeclampsia
- No history of preexisting pathology
- 70% of eclamptic women develop the condition while pregnant
- 30% develop eclampsia in the immediate postpartum period (can still have seizure in postpartum period especially 1st 48 hours
chronic hypertension
Hypertension present before pregnancy or diagnosed before week 20 of gestation and persists after 6 weeks postpartum
Chronic hypertension with superimposed preeclampsia
Women with chronic hypertension may acquire preeclampsia or eclampsia
Preeclampsia etiology
A condition unique to human pregnancy
Signs and symptoms develop during pregnancy and disappear after birth
Preeclampsia Common risk factors:
- Primigravidity or new partner in this pregnancy
- Extremes of maternal age 35
- Multifetal pregnancy
- Obesity
- Preexisting medical condition
Preeclampsia pathophysiology
- Current thought: poor perfusion and endothelial cell dysfunction
- Arteriolar vasospasm diminishes diameter of blood vessels, which impedes blood flow to all organs and increases BP
- Main pathogenic factor is vasospasm and reduced plasma volume
- Decreased placental perfusion contributes significantly to restriction of fetal growth (less plasma volume so part of intrauterine growth retardation)
Vascular Damage patho
Platelet aggregation
Fibrin deposits
Hemolysis of RBC’s
Decreased placental blood flow & IUGR
Hypertension patho
Decreased vascular vol. & increased extravascular vol
Obstructed blood flow to liver & kidneys
Cerebral ischemia & CNS irritability.
HELLP syndrome
-Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction: Hemolysis (H), Elevated liver, enzymes (EL)
Low platelets (LP)
-Diagnosis associated with increased risk for adverse perinatal outcomes
-Usually develops in third trimester or within 48 hours of birth
Evaluating HELLP is important so
that early and aggressive therapy is initiated to prevent maternal and neonatal mortality
Identifying and preventing preeclampsia
No reliable test or screening tool has been developed
Health assessment
Dependent edema
Pitting edema
Deep tendon reflexes (DTRs)
Mild gestational hypertension and mild preeclampsia Care Management
Goals of therapy are to ensure maternal safety and deliver a healthy newborn close to term Home care Maternal and fetal assessment Activity restriction Diet
Home Care for Mild Preeclampsia
Activity restrictions
Monitoring of fetal activity (kick counts)
Blood pressure monitoring (2-3 times a day)
Weight measurement (bc of edema)
Urinalysis for protein (1st void)
Diet without added salt
Fetal surveillance
Severe gestational hypertension and severe preeclampsia Care Management
Goals of care are to ensure maternal safety and formulate a plan for delivery
Intrapartum care
Severe gestational hypertension and severe preeclampsia - Intrapartum care -
Bed rest with side rails up
Darkened environment
Magnesium sulfate therapy
Antihypertensive medications
Severe gestational hypertension and severe preeclampsia - postpartum care -
Vital signs, DTRs, level of consciousness
30% of cases of eclampsia and HELLP syndrome occur postpartum
Unable to tolerate excessive blood loss
Severe gestational hypertension and severe preeclampsia - future health care -
Seven-fold risk of developing preeclampsia or eclampsia in a future pregnancy
Increased risk of adverse perinatal outcomes
Eclampsia-SeizuresPreventive measures
Provide quiet private room and closed door Minimize lights and noise Group assessments and care together Avoid startling disruptions Restrict visitors
Eclampsia-Seizures watch for:
Premonitory signs: persistent headache and blurred vision
Epigastric or right upper quadrant pain
Altered mental status
Convulsions appearing without warning
Protecting the woman and fetus (interventions for seizures)
- Remain with the woman
- During the clonic phase, turn the woman on her side– give MgSO4 IV push
- Ensure a patent airway
- Note the time and sequence of the convulsion
- After the seizure, insert an airway
- Suction woman’s mouth and nose
- Administer oxygen
- Observe fetal monitor patterns for signs of hypoxia
Chronic hypertension affects
4% to 5% of pregnant women
chronic hypertension Associated with increased incidence of:
Abruptio placentae
Superimposed preeclampsia
Increased perinatal mortality (IUGR, Preterm birth)
Chronic hypertension Postpartum complications include:
Pulmonary edema
Renal failure
Heart failure
Encephalopathy
Chronic hypertension
- Def: hypertension precedes pg, or before the 20th week of pg or continues after the postpartum period (i.e. 6 weeks after delivery)
- More common in older women, with obesity, DM, Black women
- More likely to develop preeclampsia
- Management: high protein diet, weigh q3 days, antihypertensive meds
Hypertensive disorders during pregnancy are a leading cause
of worldwide infant and maternal morbidity and mortality
Cause of preeclampsia is
unknown, and there are no known reliable tests for predicting which women are at risk for preeclampsia
Preeclampsia is a
multisystem disease rather than an increase in BP only
HELLP syndrome can occur
in women with severe preeclampsia and is considered life threatening
Once preeclampsia becomes clinically evident therapeutic interventions
may slow progression of the disease, allowing the pregnancy to continue
Magnesium sulfate, the anticonvulsive agent of choice for
preventing eclampsia, requires careful monitoring of reflexes, respirations, and urinary output
-Antidote, calcium gluconate, should be available at bedside
Nursing actions during a convulsion:
ensuring a patent airway and client safety
Chronic hypertension in pregnancy associated
with abruptio placenta and superimposed preeclampsia, fetal growth restrictions, and increased perinatal mortality
Women with preeclampsia have an increased risk of
adverse perinatal outcomes in a future pregnancy
