hypertension in pregnancy Flashcards
Hypertension (HTN)
140/90
A systolic pressure greater than or equal to 140 mmHg
A diastolic pressure greater than or equal to 90 mmHg
systolic
the force the blood exerts on arterial walls as the heart contracts and sends blood to periphery
diastolic
the residual pressure exerted on the arteries as the heart relaxes between beats
Dx as:
essential HTN
hypertension due to a genetic cause
Dx as:
secondary HTN
hypertension due to an underlying medical condition
maybe a renal, neurological, endocrine origin
Hypertension can increase the risk for the following:
- heart disease
- stroke
- TIA
- renal failure
- MI
Hypertensive disorders are not very common complication in pregnancy. True or false.
False.
Hypertensive disorders in pregnancy are one of the most common disorders in pregnancy affecting 10% of women
HTN is he 2nd leading cause of maternal death
incidence has increased has increased more than 50% over 30 years
d/t western diet and process foods
Four categories of Hypertension in pregnancy
- Chronic HTN
- Gestational HTN
- Chronic HTN w/ Superimposed Preeclampsia
- Preeclampsia
chronic hypertension
- dx of HTN prior to conception
or - dx prior to 20 weeks gestation
BP greater or equal to 140/90
gestational hypertension
- dx with HTN **after 20 weeks **gestation without any other signs/symptoms of preeclampsia
BP greater than or equal to 140/90
-
Chronic Hypertension with Superimposed Preeclampsia
- dx with HTN prior to 20 weeks gestation
and then…
-develop proteinuria after 20 weeks
~dx with HTN and proteinuria prior to 20
weeks gestation and then…
-develop a sudden exacerbation of HTN
&/OR
-have sudden onset of ‘typical’ preeclamptic
manifestations (↑ liver enzymes, ↓ platelets,
RUQ pain, HA, vision changes pulmonary edema,
renal insufficiency)
&/OR
-have sudden, substantially increased protein
excretion
preeclampsia
- Hypertensive, multisystem disorder of unknown etiology in pregnancy
- Pregnancy specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation
-
new onset of HTN after 20 weeks of gestation with…
- ******* with 2 BPs greater than or equal to 140/90 mmHg taken at least 4 hours apart *
&/or
- proteinuria ** greater than or equal to 3 grams over 24 hours **
&/or
- new onset systemic disease symptoms
diagnosing considerations for preeclampsia
- disease presentation varies with timing of symptoms onset
-proteinuria is no longer an absolute criteria
risk factors of preeclampsia & eclampsia
- nulliparity
- younger than 20 or older than 35
- obese
- african american
- multiple gestation
- hx of preeclampsia or eclampsia
- family hx of preeclampsia
- pre-pregnancy CHTN, kidney disease, lupus, diabetes
- gestaional diabetes
Early-Onset Preeclampsia
- symptom onset prior to 34 weeks
- associated with increase severity of disease
- poor placentation (formation, structure, placement)
- see abnormal uterine artery dopplers and increase incidence of IUGR & preterm birth
Late-onset Preeclampsia
- symptom onset after 34 weeks
- more favorable maternal/fetal outcomes
- possinly triggered by abnormal imune response
New-Onset Postpartum Preeclampsia
- symptom onset up to 8 weeks PP
- different & complicated clinical presentation
- unknown etiology if nothing present during the pregnancy
A women is can be diagnosed with mild preeclampsia, what does nurse know is incorrect about the statement.
The nurse knows that mild preeclampsia is an old diagnostic term. There is no in between, a patient either does or doesn’t have preeclampsia.
The term subjectively undermineded the disease’s progression potential.
Risk factors for Preeclampsia & Eclampsia
- nulliparity
- younger than 20 or older than 35
- obesity
- African American
- Multiple gestation
- family hx of preeclampsia
- pre pregnancy -> CHTN, kidney disease, lupus, diabetes
- hx of preeclampsia or eclapsia
- gestational diabetes
normal physiology
- generalized vasodilated state, in early pregnancy
- (BP returns to pre-pregnant levels at term) - decreased peripheral vascular resistance and BP
- increased blood volume, cardiac output, and renal blood flow
when does pahology of the disease begin?
at conception
1st stage
placental abnormalities
