Pregnancy Induced Hypertension

INTRODUCTION Hypertensive disease is a significant cause of maternal and fetal or neonatal morbidity and mortality. It is the commonest medical condition encountered in pregnancy and complicating approximately in all pregnancies(McKinney, Ashwill & James. (2005). pp: 25). Careful observation of this condition has identified that the incidence varies with geographical location and race. Hypertensive disorders include a variety of vascular disturbances such as gestational hypertension, pre-eclampsia, HELLP syndrome, eclampsia and chronic hypertension. Pregnancy induced hypertension (PIH) is a condition of high blood pressure during pregnancy. Your blood pressure goes up, you retain water, and protein is found in your urine. Pre-eclampsia is more severe and also associated with proteinuria. Eclampsia is very serious state in which generalized convulsions occur. The risk of getting pregnancy induced hypertension (PIH) are for first-time mom, Women whose sisters and mothers had PIH, Women carrying multiple babies; teenage mothers; and women older than age 40 and Women who had high blood pressure or kidney disease prior to pregnancy. The symptoms of Pregnancy Induced Hypertension (PIH) are the mild and severe symptoms. The mild symptoms are high blood pressure, water retention, and protein in the urine. The Severe symptoms are headaches, blurred vision, inability to tolerate bright light, fatigue, nausea/vomiting, urinating small amounts, pain in the upper right abdomen, shortness of breath, and tendency to bruise easily. Contact your doctor immediately if you experience blurred vision, severe headaches, abdominal pain, and urinating very infrequently. Pregnancy induced hypertension (PIH) can affect babies by preventing the placenta from getting enough blood. If the placenta doesn't get enough blood, your baby gets less oxygen and food. This can result in low birth weight. PATHOLOGICAL CHANGES IN PREGNANCY INDUCED HYPERTENSION Pregnancy induced hypertension decreases cardiac output as pre-eclampsia which worsens generalization of vasoconstriction which affects much of physiological activity

of tissues within the body. Capillary permeability increases and fluid which an escape contributes to the edema within tissues. In the kidney the vasospasm of arterioles results in a decreased renal blood flow and circulating plasma volume is reduced resulting in haemoconcentration. In the liver the intracapsular hemorrhages and necrosis occurs and edema of liver cells produces epigastric pain and impaired liver function may result in jaundice. In the brain the edematous occurs, in conjunction with DIC, can produce thrombosis and necrosis of the blood vessel wall resulting in CVA (Pairman, Pincombe. & Thorogood. (2006). pp: 15). In the lungs the congested is with fluid in severe cases; oxygenation is impaired and cyanosis occurs. NORMAL PHYSIOLOGICAL CHANGE IN BLOOD PRESSURE DURING PREGNANCY Early in the first trimester there is a fall in blood pressure caused by active vasodilatation, achieved through the action of local mediators such as prostacyclin and nitric oxide. This reduction in blood pressure primarily affects the diastolic pressure and a drop of 10 mm Hg is usual by 1320 weeks gestation. Blood pressure continues to fall until 2224 weeks when a nadir is reached (Bennett & Bromm. (1996). pp: 34-35). after this, there is a gradual increase in blood pressure until term when pre-pregnancy levels are attained. Immediately after delivery blood pressure usually falls, then increases over the first five postnatal days. Even women whose blood pressure was normal throughout pregnancy may experience transient hypertension in the early post partum period, perhaps reflecting a degree of vasomotor instability. Health history A patient P, a 35 year old Fijian SDA female, she is a police officer, married with a army officer and residing at nine miles Tamavua. Mrs. P parity was that she is a multigravida and primipara, her first baby was born on 5th may, 2009 in CWM was a term baby but she had a caesarean section because she was a pregnancy induced hypertension patient and it was a baby girl with a weight of 3.0kg. She was 37 weeks of gestation on 26th July, 2011 at present, her early symptoms were headache, vomiting and urinating large amount.

Through her family history her father was a diabetic person and her mother and her sister was a PIH patient during they pregnancy. Mrs. P hospital number is 520130215, her estimated date of delivery is 15th august, 2011 and her last menses date was 9th November, 2010. Her menarche was when she was 15 years old girl and her onset of movements occurred when she was on 26 weeks of gestation. Mrs. P came on her seventh clinic and was admitted due to high blood pressure which was 170/100mm Hg when she came for her clinic on the 19th July, 2011 and that time she was 36 weeks of gestation. PHYSICAL ASSESSMENT Hypertensive disorders are unlikely to be prevented; therefore early detection and appropriate management can minimize the severity of the condition. In addition to these physical assessments was also performed on Mrs. P. Firstly a comprehensive history taking at first contact is crucial, this will identify are adverse social circumstances or poverty which prevents woman from attending regular ANC, Mothers age and parity, past history of hypertensive disorders, past history of pre-eclampsia and presence of underlying medical conditions e.g. renal diseases, diabetes, SLE, and thromboembolic disorders. Diagnosis is usually based on the rise in blood pressure and the presence of proteinuria after the 20th week of gestation. Blood pressure: taken in early pregnancy and compared with all subsequent recordings. Calibrated machines should be maintained regularly or proper cuff size should not be measured immediately after a woman has experienced pain, anxiety, or a period of exercise which allow a rest period of 10 minutes before measuring BP. Urinalysis was done on every 24 hour where her urine was collected required for certain absence or presence of proteinuria/accurate assessment of protein loss. Clinical edema may be mild or severe in nature/ severity is related to the worsening of pre-eclampsia, Watch out for ankle edema in presence of proteinuria and BP. Sudden severe widespread appearance of edema suggests pre-eclampsia. Pitting edema may be found in non-

dependent areas such as face, hands, lower abdomen, vulval and sacral areas. Her urea test result was 2.8. Laboratory test was done FBC, renal function and liver function. Make a significant contribution to the assessment & diagnosis of pre-eclampsia. Her white blood count was 7.58; HGB 9.7 and PLT 251. NURSING MANAGEMENT Proper management of PIH is very important. This lowers the complication during birth and health new mothers. This includes bed rest where mothers should be nursed in bed and encouraged to adopt a sitting position or lie on her side to encourage uterine blood flow. Supine position predisposes to aortacaval compression. Bed rest is added advantage of reducing edema by improving renal circulation. Reduction in blood pressure with bed rest where pre-eclampsia is severe high dependency care should be instituted. Diet no reasons to support attempts at weight reduction or low salt diets. Diet rich in protein, fiber and vitamins may be recommended. Fluids to be encouraged in very severe preeclampsia IV therapy will be used but oral fluids may still be given. Weight should be estimated and recorded twice weekly and edema observed daily. Urine tested for protein daily or according to severity. Fluid intake and output strictly kept due to the adequate urine output signifies good renal function. Oliguria may occur if disease becomes severe. Abdominal examination carried out twice daily. Discomfort, tenderness or pain experienced to be reported to doctor. Fetal heart rate uses CTG machine for twenty minutes. Sedation if mother needs to be encouraged to rest. Kick charts maintained to monitor degree of fetal movement and serial scan to assess fetal growth. CONCLUSION To conclude, the ultimate goal of nursing care for a pregnant woman with PIH is to minimize the effects risks and complications. Hypertensive disease is a significant cause of maternal and fetal or neonatal morbidity and mortality. It is the commonest medical condition encountered in pregnancy and complicating approximately in all pregnancies. The skills gained by the mother during this phase lasts a life time. Blood pressure must be elevated on at least two occasions and measurements should be made with the woman

seated and using the appropriate cuff size. Late in the second trimester and in the third trimester, venous return may be obstructed by the gravid uterus and, if supine, blood pressure should be taken with the woman lying on her side. (Words: 1455)

Reference
Bennett. V. & Bromm. L. (1996). Myles textbook for midwives. (12th ed.). Edinburgh: Churchill Livingstone. McKinney. E., Ashwill, J. & James. S. (2005). Maternal- child nursing. (2nd ed.). St. Louis: Elsevier Saunders. Pairman. S., Pincombe. J. & Thorogood. C., (2006). Midwifery preparation for practice. Elsevier: Sydney.