I.

Brief discussion (narrative) of the symptomatology of the

disease.

Hypertension is a common medical disorder that affects 20–30% of adults in the United
States and complicates as many as 5–8% of all pregnancies. Hypertensive disorders of pregnancy
rank among the leading causes of maternal morbidity and mortality. Approximately 15% of
maternal deaths are attributable to hypertension, making it the second leading cause of maternal
mortality in the United States. Severe hypertension increases the mother's risk of heart attack,
cardiac failure, cerebral vascular accidents, and renal failure. The fetus and neonate also are at
increased risk from complications such as poor placental transfer of oxygen, fetal growth
restriction, preterm birth, placental abruption, stillbirth, and neonatal death.

Pregnancy-induced hypertension is high blood pressure that occurs during pregnancy.

Medical professionals also refer to the condition as gestational hypertension. In some
cases, hypertension during pregnancy can lead to a more dangerous condition known as
preeclampsia. Preeclampsia is a condition that usually starts after the 20th week of
pregnancy and is due to increased blood pressure and protein in the urine. Preeclampsia
affects the placenta, and it can affect the mother's kidney, liver, and brain. Preeclampsia
is a major cause of fetal complications, which include low birth weight, premature birth,
and stillbirth.

The effects of high blood pressure range from mild to severe. High blood pressure can
harm the mother's kidneys and other organs, and it can cause low birth weight and early
delivery. In the most serious cases, the mother develops preeclampsia - or "toxemia of
pregnancy"--which can threaten the lives of both the mother and the fetus. According to
the National High Blood Pressure Education Program (NHBPEP), preeclampsia does not in
general increase a woman's risk for developing chronic hypertension or other heart-
related problems.

However, high blood pressure in pregnancy may not cause signs or symptoms. If
protein is present in the mother's urine, then preeclampsia is present. Other symptoms
that can be associated with preeclampsia include persistent headaches, blurred vision,
sensitivity to light, and abdominal pain.

II. Put check (/) if the signs and symptoms are present or absent
in the client.

Signs and Symptoms Present Absent Implication

 Blurred Vision √ There is a reported incidence
and observed blurred vision
experienced by the client.
 Fatigue √ There is a reported fatigue on
the client subjective data.

● Headache √ There is a reported incidence

and observed blurred vision
experienced by the client.
● Nausea √ Nausea was experienced as
reported by the client.
 HighBlood pressure √ Base on the recorded vital signs
of the patient ,her blood
pressure is 140/90 mmHg and in
that (stage 2 hypertension): She
is probably need medication. At
this level, the doctor is likely to
prescribe medicine now to get
your blood pressure under
control.

 Swelling in √ There is a reported incidence

extremities and objective data regarding
swelling in extremities.
● Weight gain √ There is a reported excessive
weight gain of 1.5 lbs per week
was noted.
 PROGNOSIS

If treated:

Magnesium sulfate is used to prevent eclamptic seizures in

women with preeclampsia at highest risk for them. When eclamptic
seizures occur, magnesium sulfate will be started (for those not on it
already) or given again (for those in whom seizures have occurred in
spite of initial treatment) in an effort to prevent recurrent seizures.
Other medications, such as lorazepam (Ativan), may be used to stop
("break") a seizure in progress. Many, but not all, doctors will also
treat every preeclamptic patient with magnesium sulfate during labor,
even when the disease appears mild. Magnesium treatment is
generally continued for 24-48 hours after the last seizure. You may
receive magnesium sulfate in an intensive care unit or a labor and
delivery unit. While magnesium is given you will be observed closely,
receive intravenous fluids, and may have a catheter placed in your
bladder to measure urine output.

If not treated:

In the developed world, eclampsia is rare and usually

treatable if appropriate intervention is promptly sought. Left
untreated, eclamptic seizures can result in coma, brain damage, and
possibly maternal or infant death. These seizures usually happen in
women who have severe preeclampsia, though they can occur with
preeclampsia. Eclampsia also can happen soon after a woman gives
birth. Approximately 30% to 50% of patients with eclampsia also
have the HELLP syndrome.

References:
1. Witlin AG, Sibai BM. Magnesium sulfate therapy in preeclampsia and eclampsia. Obstet
Gynecol. 1998;92:883–9.

2. Samadi AR, Mayberry RM, Zaidi AA, Pleasant JC, McGhee N Jr, Rice RJ. Maternal
hypertension and associated pregnancy complications among African-American and
other women in the United States. Obstet Gynecol. 1996;87:557–63.

3. Mackay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and
eclampsia. Obstet Gynecol.

4. ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and

management of preeclampsia and eclampsia. No. 33, January 2002. American
College of Obstetricians and Gynecologists. Obstet Gynecol.

5. Report of the National High Blood Pressure Education Program Working Group on High
Blood Pressure in Pregnancy. Am J Obstet Gynecol.

6. Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become
preeclampsia?. Br J Obstet Gynaecol.

7. Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol.

8. Dekker G, Sibai B. Primary, secondary, and tertiary prevention of preeclampsia.

9. Postovit LM, Adams MA, Graham CH. Does nitric oxide play a role in the aetiology of
preeclampsia?. Placenta. 2001;22(suppl A);S51–5.

10. Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts.
Am J Obstet Gynecol.

11. Roberts JM, Cooper DW. Pathogenesis and genetics of pre–eclampsia. Lancet.

12. Sibai BM, Ramadan MK, Chari RS, Friedman SA. Pregnancies complicated by HELLP
syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent
pregnancy outcome and long-term prognosis. Am J Obstet Gynecol.

13. Padden MO. HELLP syndrome: recognition and perinatal management. Am Fam
Physician.

14. Lim KH, Friedman SA, Ecker JL, Kao L, Kilpatrick SJ. The clinical utility of serum uric acid
measurements in hypertensive diseases of pregnancy. Am J Obstet Gynecol.