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GESTATIONAL CONDITIONS
1. HYPEREMESSIS GRAVIDARUM
• Hyperemesis gravidarum is severe and unremitting nausea or vomiting associated with
pregnancy that can persist past the first trimester.
• In contrast, morning sickness is transient nausea or vomiting that generally occurs during only the
first trimester
• The exact cause of hyperemesis gravidarum is unknown, but it's linked to trophoblastic activity and
gonadotropin production, which may indicate multiple gestation or molar pregnancy.
• It can be prolonged or exacerbated by vitamin B1 or B6 deficiencies.
• Patients are often treated on an outpatient basis with oral medications, home intravenous (IV)
infusion therapy to replace fluids and electrolytes, or total parenteral nutrition
• Approximately 1% of women who develop hyperemesis gravidarum require multiple hospitalizations.

ASSESSMENT FINDINGS:
❖ The first priority of care is to determine severity of the nausea and vomiting problem
in patients who can no longer retain solids or liquids as well as the degree of
dehydration and weight loss.
❖ Laboratory studies are prescribed to identify electrolyte imbalances.
❖ Patients may exhibit a low-grade fever, increased pulse rate, decreased blood
pressure, weakness, dry skin, cracked lips, and poor skin turgor.
❖ Patients may appear extremely fatigued and listless with a possible loss of 5%-10% of
total body weight, be constipated as a result of dehydration, and have a markedly
decreased urinary output
❖ GI motility is reduced because of increased progesterone and decreased motilin levels.

NOTE: “Normal” nausea and vomiting of pregnancy usually has an onset between 4 and 6 wk, peaks at about the
12th wk, and resolves between 16 to 20 wk. Hyperemesis usually begins in the first trimester but may extend
throughout the entire pregnancy.

Physical Examination

Integumentary ■ Dry mucous membranes and lips

■ Pale, dry skin with decreased ■ Sunken eyes
turgor ■ Jaundice

Cardiovascular ■ Vertigo
■ Tachycardia ■ Syncope
■ Hypotension

Gastrointestinal
■ Fruity breath
■ Severe nausea
■ Marked emesis
■ Mucosal bleeding
■ Ptyalism (drooling associated with excess saliva production)
■ Weight aberration (failure to gain weight or actual weight loss)

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Neurologic ■ Somnolence
■ Low-grade fever ■ Polyneuritis or peripheral
■ Lethargy neuropathy
■ Confusion

Renal and urinary

■ Oliguria
■ Ketonuria

Diagnostic studies
■ Potassium, sodium, chloride, and protein levels are decreased due to losses from vomiting.
■ Blood urea nitrogen, nonprotein nitrogen, and uric acid levels are increased due to renal
compromise and hemoconcentration.
■ Hemoglobin (Hb) level and hematocrit (HCT) are increased due to hemoconcentration.
■ Urinalysis reveals ketones and, possibly, protein; urine specific gravity increases.
■ Vitamin B1 and B6 levels are decreased due to impaired intake.

Nursing care plan

Nursing diagnosis Nursing priorities

Imbalanced nutrition: Less than body ■ Monitor the patient for effects of nausea and
requirements related to nausea, emesis, vomiting that are unresponsive to nonmedical
and subsequent inconsistent or treatment, and initiate treatment before severe
insufficient food intake complications can occur.
Deficient fluid volume related to ■ Observe for signs of dehydration and provide
protracted emesis replacement fluids and electrolytes as needed.
Fear related to hospitalization and ■ Provide the patient with information to fight fears
pregnancy outcome and offer support.
Acute pain related to repeated episodes ■ Prevent vomiting when possible, or decrease the
of vomiting frequency and severity of episodes.
Other potential nursing diagnoses: Constipation related to inadequate food intake ■ Impaired
home maintenance related to debilitating emesis ■ Disturbed sensory perception (gustatory)
related to persistent emesis

2. Gestational trophoblastic disease is the degeneration and abnormal proliferation of the

trophoblastic villi. The cells become filled with clear fluid, giving them the appearance of grape-like
vesicles.

Pathophysiology
• Fertilization occurs as the sperm enters the ovum. In instances of a partial mole, two sperms
might fertilize a single ovum.
• Reduction division or meiosis was not able to occur in a partial mole. In a complete mole, the
chromosome undergoes duplication.
• The embryo fails to develop completely. There are 69 chromosomes that develop for the partial
mole, and 46 chromosomes for the complete mole.
• The trophoblastic villi start to proliferate rapidly and become fluid-filled grape-like vesicles.
Risk Factors
❖ This incidence happens in 1 of every 1, 500 pregnancies. There are risk factors that could precipitate
the formation of hydatidiform mole, and they are as follows:

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• Low protein intake. Women with low protein intake have a possibility of developing a
hydatidiform mole because protein is needed for the development of the trophoblastic villi.
• Women older than 35 years old. Being pregnant beyond 35 years old presents a lot of risky
conditions like H-mole.
• Asian women. Asians have a higher chance of acquiring this disease because of their genetic
formation.
• Women with a blood group of A who marry men with blood group O. these blood groups,
when combined together, results in unfavorable conditions like H-mole.

Signs and Symptoms

These signs and symptoms, if noticed in a pregnant woman, might indicate a possibility of gestational
trophoblastic disease.
• Uterus expands faster than normal. Because the trophoblast cells proliferate abnormally, it
does so in such a rapid pace that the uterus reaches its growth landmarks before the usual time.
• A very high serum or urine test for hCg. Trophoblast cells produce hCg, and they are produced
in large amounts because the trophoblast cells are growing rapidly.
• Vaginal bleeding. When the H-mole is still not identified at the 16th week of pregnancy, it will
identify itself through vaginal bleeding accompanied by clear fluid filled vesicles.

Diagnostic Tests
Diagnostic tests are ordered to check for a presence that might indicate a positive gestational
trophoblastic disease.
• Pregnancy test. This may not be able to detect specifically the H-mole, but this will confirm if the
woman is pregnant or not.
• Urine test or serum for hCg. A very high result for hCg might indicate the presence of an H-mole.
• Ultrasound. An ultrasound will show a dense growth of grape-like vesicles with a snowflake
pattern, filled with clear fluid instead of an embryo.

Medical Management
The physician would order medications and other interventions that would ensure the safety of the
woman during this complicated period.
• Methotrexate. Physicians may order a prophylactic course of methotrexate, which attacks
rapidly growing cells like the abnormally growing trophoblastic cells.
• Dactinomycin. This is ordered by the physician once metastasis occurs.

Surgical Management
Upon identification of the trophoblastic disease, the physician would schedule a surgical intervention to
remove it from the uterus of the woman.
• Suction curettage. This is the ideal management of gestational trophoblastic disease, to
evacuate the mole inside the woman’s uterus and avoid any further complications if it stays
longer inside the reproductive system

Nursing Management
Nurses must also take action during the critical stages of the pregnancy. We must be able to function on
our own while waiting for any orders from the physician.
Nursing Assessment
• Assess the abdominal girth of the pregnant woman to check if it is within the usual landmark of
pregnancy.
• Assess for signs and symptoms of pregnancy induced hypertension, because for a woman with
H-mole, they occur earlier than the 20th week of pregnancy.

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• Instruct the woman to save all perineal pads containing any clots or tissue that has passed out of
her during bleeding.

Nursing Diagnosis
• Grieving related to loss of pregnancy as evidenced by anger and social detachment.

Nursing Interventions
• Measure abdominal girth and fundal height to establish baseline data regarding the growth of
the uterus.
• Assist patient in obtaining a urine specimen for urine test of hCg.
• Save all pads used by the woman during bleeding to check for clots and tissues she may have
discharged.
• Provide your patient with an open environment and a trusting relationship so she would be
encouraged to express her feelings.
• Honestly answer the patient’s questions to foster a trusting relationship between nurse and
client.
• Provide an assurance that it is not her own fault that this happened to her to lessen her sense of
guilt and self-blame.

Evaluation
• Patient must be able to express her feelings effectively.
• Patient must acknowledge the situation and seek for appropriate help.

ANOMALIES OF THE PLACENTA

Placenta Succenturiata
• The normal placenta weighs approximately 500 g and is 15 to 20 cm in diameter and 1.5 to 3.0 cm
thick.
• Placenta succenturiata is a placenta that has one or more accessory lobes connected to the main
placenta by the blood vessels.
• This is not a fetal abnormality; however, it must be recognized upon assessment after birth.
• The small lobes may be retained in the uterus after birth leading to severe maternal
hemorrhage.
• If you look closer at the placenta, it may appear torn at the edge or torn blood vessels extend
beyond the edge of the placenta.
• Remaining lobes are removed from the uterus manually to prevent maternal hemorrhage as a
result of poor uterine contraction.

Placenta Circumvallata
• Normally, the chorion membrane begins at the edge of the placenta and spreads to cover the
fetus.
• The fetal side of the placenta is not usually covered by the chorion.
• In placenta circumvallata, the fetal side of the placenta is covered with chorion.
• The umbilical cord enters the placenta at the usual midpoint, and large vessels spread out from
there.
• They end abruptly at the point where the chorion folds back into the surface.
• In placenta marginata, the fold of the chorion reaches just to the edge of the placenta.

Placenta Accreta
• Placenta accreta refers to an unusually deep attachment of the placenta to the uterine
myometrium that the placenta will not loosen and deliver.

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• Never attempt to remove it because it might lead to extreme hemorrhage because of its deep
attachment.
• Hysterectomy or treatment with methotrexate to destroy the still-attached tissue is the
recommended treatment of choice.

Battledore Placenta
• Battledore placenta refers to the cord that is inserted marginally rather than centrally.
• This is a rare anomaly and it has no known clinical significance.

Velamentous Insertion of the Cord

• Velamentous insertion of the cord occurs when the cord, instead of entering the placenta
directly, separates into small vessels that reach the placenta by spreading across a fold of
amnion.
• This is most commonly found with multiple gestations.
• It can be associated with fetal anomalies, so an infant born with this type of placenta must be
examined carefully.

Vasa Previa
• The umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver
before the fetus.
• The vessels may tear with cervical dilatation, just as the placenta previa may tear.
• Ensure that you can identify the structures before inserting any instrument to prevent accidental
tearing of a vasa previa which could end in sudden fetal blood loss.
• With either placenta previa or vasa previa, there is sudden , painless bleeding that occurs with
the beginning of cervical dilatation.
• Vasa previa can be confirmed by ultrasound.
• If vasa previa is confirmed, the infant needs to be born via cesarean delivery.

ABRUPTIO PLACENTA
Definition
• Abruptio placentae (also known as placental abruption) is the premature separation of the
placenta that occurs late in the pregnancy.
Pathophysiology
• The placenta has implanted in the correct location.
• For some unknown reasons, it suddenly begins to separate, causing bleeding.
• This separation would occur late in pregnancy, and accounts for 10% of perinatal deaths.

Risk Factors
The following are the risk factors that surround abruption placenta and these should be made known to all
pregnant mothers to avoid development of this fatal condition.

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• High parity. A woman who has given birth multiple times predisposes herself to abruptio
placentae.
• Short umbilical cord. A short umbilical cord could cause the separation of the placenta especially
if trauma occurs.
• Advanced maternal age. Women over the age of 35 years old have higher risk of acquiring
abruptio placentae.
• Direct trauma. Any trauma to the abdomen could cause a separation of the placenta.
• Chorioamnionitis. This is an infection of the fetal membranes and fluid that could predispose the
woman to premature placental separation.
Types
The types of abruption placenta are measured according to the degree of placental separation that has
occurred.
• Grade 0. No indication of placental separation and diagnosis of slight separation is made after
birth.
• Grade 1. There is minimal separation which causes vaginal bleeding, but no changes in fetal vital
signs occur.
• Grade 2. Moderate separation occurs and fetal distress is already evident. The uterus is also hard
and painful upon palpation.
• Grade 3. Extreme separation; maternal shock and fetal death is imminent if no interventions are
done.
Signs and Symptoms
The signs and symptoms of abruption placenta must be monitored and detected early before it progresses
to a critical stage.
• Sharp, stabbing pain. A woman may experience the pain on the upper uterine fundus as initial
separation occurs.
• Heavy bleeding. This usually happens after the separation of the placenta. External bleeding will
only occur if the placenta separates first from the edges. Internal bleeding will occur if placenta
separates from the center because blood would pool under it.
• Uterus is tense and rigid. Most often called as Couvelaire uterus, it appears as a board-like, hard
uterus without any bleeding.
Diagnostic Tests
These diagnostic procedures would be enforced by the physician to finally diagnose the presence of
abruption placenta.
• Hemoglobin level and fibrinogen level. These tests are performed to rule out disseminated
intravascular coagulation.
Medical Management
To avoid a worsening condition, these medical procedures are implemented for both the mother and the
fetus.
• Intravenous therapy. Once the woman starts to bleed, the physician would order a large gauge
catheter to replace the fluid losses.
• Oxygen inhalation. Delivered via face mask, this would prevent fetal anoxia.
• Fibrinogen determination. This test would be taken several times before birth to detect DIC.
Surgical Management
Once the condition has reached a stage that mightily endangers the life of both patients, then surgical
management is put into action.
• Cesarean delivery. If birth is imminent, it is safest to deliver the baby via caesarean delivery.
• Hysterectomy. The worst outcome would be for the woman to develop DIC, and to prevent
exsanguinations, hysterectomy must be performed.

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Nursing Management
A vital role is also upheld by the nurses during this situation. Their accurate assessment would be one of
the baseline data for all health care providers to plot the care plan for the patient.
Nursing Assessment
• Assess for signs of shock, especially when heavy bleeding occurs.
• Assess if the bleeding is external or internal.
• Monitor contractions if separation occurs during labor.
• Obtain baseline vital signs.
• Assess for the time the bleeding began, the amount and kind of bleeding, and interventions
done when bleeding occurred if it started before admission.
• Assess for the quality of pain.
Nursing Diagnosis
• Deficient fluid volume related to bleeding during premature placental separation.
Nursing Interventions
• Place the woman in a lateral, not supine position to avoid pressure in the vena cava.
• Monitor fetal heart sounds.
• Monitor maternal vital signs to establish baseline data.
• Avoid performing any vaginal or abdominal examinations to prevent further injury to the
placenta.
Evaluation
• Maternal vital signs are all within the normal range, especially the blood pressure.
• Urine output should be more than 30mL/hr.
• No bleeding or minimal amount of bleeding observed.
• Uterus is not tense and rigid.
• Fetal heart sounds are within the normal range.

PLACENTA PREVIA
Definition
• Placenta previa is a condition wherein the placenta of a pregnant woman is implanted
abnormally in the uterus. It accounts for the most incidents of bleeding in the third trimester of
pregnancy.
Pathophysiology
• The placenta implants on the lower part of the uterus.
• The lower uterine segment separates from the upper segment as the cervix starts to dilate.
• The placenta is unable to stretch and accommodate the shape of the cervix, resulting in
bleeding.
Risk Factors
Placenta previa is dangerous if not detected early. However, it is also highly preventable once you get to
know the risk factors.
• Advanced maternal age. Women who are over the age of 35 years old are at an increased risk of
developing placenta previa.
• Multiple gestations. The uterus which has accommodated more than one fetus has an increased
risk for placenta previa.
• Increased parity. Women who have given birth to a lot of children have an increased chance of
having placenta previa.
• Past caesarean births. Giving birth via caesarean delivery predisposes the woman to placenta
previa on her next childbearing.
• Past uterine curettage. Scars from a past curettage can affect the implantation of the uterus
and lead to placenta previa.

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Types
These types of placenta previa are classified according to the degree of the opening that is covered by the
placenta.

• Low lying placenta. The placenta implants in the lower portion instead of the upper portion of
the uterus.
• Marginal implantation. The placenta’s edge is nearing the cervical os.
• Partial placenta previa. A portion of the cervical os is already covered by the placenta.
• Total placenta previa. The placenta occludes the entire cervical os.
Signs and Symptoms
The following signs and symptoms for placenta previa must be detected immediately by the health care
providers to avoid risking the life of the fetus.
• Bright red bleeding. When the placenta is unable to stretch to accommodate the shape of the
cervix, bleeding will occur suddenly that could frighten the woman.
• Painless. Bleeding in placenta previa is not painless and may also stop as abruptly as it had
begun.
Diagnostic Tests
To diagnose placenta previa, the patient must undergo the following diagnostic procedure.
• Ultrasound. Early detection of placenta previa is always possible through ultrasonography. It is
the most common and initial diagnostic test that could confirm the diagnosis.
Medical Management
Medical interventions are necessary to ensure that the safety of both mother and fetus are still intact.
• Intravenous therapy. This would be prescribed by the physician to replace the blood that was
lost during bleeding.
• Avoid vaginal examinations. This may initiate hemorrhage that is fatal for both the mother and
the baby.
• Attach external monitoring equipment. To monitor the uterine contractions and record fetal
heart sounds, an external equipment is preferred than the internal monitoring equipment.
Surgical Management
Surgical interventions are carried out once the condition of both the mother and the fetus has reached a
critical stage and their lives are exposed to undeniable danger.
• Cesarean delivery. Although the best way to deliver a baby is through normal delivery, if the
placenta has obstructed more than 30% of the cervical os it would be hard for the fetus to get
past the placenta through normal delivery. Cesarean birth is then recommended by the
physician.
Nursing Management
Nurses also play a major role in the care of a woman with placenta previa. They are also entrusted with the
outcome of the lives of both the mother and the child.

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Nursing Assessment
• Assess baseline vital signs especially the blood pressure. The physician would order monitoring
of the blood pressure every 5-15 minutes.
• Assess fetal heart sounds to monitor the wellbeing of the fetus.
• Monitor uterine contractions to establish the progress of labor of the mother.
• Weigh perineal pads used during bleeding to calculate the amount of blood lost.
• Assist the woman in a side lying position when bleeding occurs.
Nursing Diagnosis
• Fear related to outcome of pregnancy due to bleeding.

Nursing Interventions
• Assess fetal heart sounds so the mother would be aware of the health of her baby.
• Allow the mother to vent out her feelings to lessen her emotional stress.
• Assess any bleeding or spotting that might occur to give adequate measures.
• Answer the mother’s questions honestly to establish a trusting environment.
• Include the mother in the planning of the care plan for both the mother and the baby.
Evaluation
• Woman is able to discuss her concerns with the health care providers.
• States that hearing the fetal heartbeat assures her of the baby’s safety.

INCOMPETENT CERVIX
Definition
• Incompetent cervix is a condition that refers to the inability of the cervix to hold the fetus any
longer until term because it has dilated prematurely.
Pathophysiology
1. When the fetus reaches its 20th week, it starts to become heavy and gain fats.
2. The mother’s cervix is weak, and it could not hold the fetus’ weight anymore as it slowly starts
to dilate.
3. This would cause the appearance of a show, a pink-tinged vaginal discharge.
4. Then, the membranes would rupture and amniotic fluid would be discharged.
5. Uterine contractions would start followed by a short labor, then the birth of the fetus.
Risk Factors
The causes of incompetent cervix are somehow difficult to explain, but it is believed to be associated with
the following:
• Increased maternal age. The muscles around the cervix start to slowly lose its elasticity because
of increasing age, and could contribute to the weakening of the cervix.
• Congenital structural defects. There are defects might contribute to the cervix’ incapability of
holding in the fetus.
• Trauma to the cervix. Any trauma experienced by the cervix could weaken the muscles
surrounding it, thus leading to its premature dilation.
Signs and Symptoms
The signs and symptoms of every danger to a pregnancy must be reviewed by the health care provider to
the woman on her clinic visit. This could give her ideas on how to further take great caution of her
pregnancy.
• Show. This is a pink-tinged vaginal fluid that is discharged from the vaginal opening as a sign that
the cervix has dilated.
• Increased pelvic pressure. The fetus is already descending, causing a pressure felt by the mother
on her pelvis.
• Cervical dilation. Upon inspection of the physician, the cervix would show dilation.

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Diagnostic Tests
There are few diagnostic tests that could detect an incompetent cervix before it usually happens. It is
usually diagnosed after the pregnancy has already been lost.
• Ultrasound. This is the only test that the physician could order if an incompetent cervix is already
suspected.
Medical Management
Medical management by the physician would not include any medications that could hinder the dilation of
the cervix. Surgical procedures are immediately enforced to prevent compromising the pregnancy.

Surgical Management
There are two types of surgical management for incompetent cervix:
• McDonald’s Cervical Cerclage. Nylon sutures are placed horizontally and vertically across the
cervix. They are pulled back together until the cervical canal is only a few millimeters in
diameter.
• Shirodkar Cervical Cerclage. Sterile tape is used for this technique, where it is threaded in a
purse-string manner under the submucous layer of the cervix. Then, it is sutured in place so it
would close the cervix
• These sutures are removed on the 37th or 38th week of pregnancy for the fetus to be born
vaginally.

Nursing Management
As nurses, here is what we could do to help in our own way.

Nursing Assessment
• Ask the woman who is reporting for painless bleeding if she is feeling an intense pressure on her
pelvis.
• Inspect and save pads used by the woman during bleeding to determine any clots or tissues that
already passed out.
• Determine if the woman is experiencing true contractions to prepare for the birth of the fetus.

Nursing Diagnosis
• Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix.

Nursing Interventions
• Determine any factors that further contribute to the anxiety of the woman so it could be
avoided.
• Monitor vital signs to determine any physical responses of the patient that could affect her
condition.
• Convey empathy and establish a therapeutic relationship to encourage client to express her
feelings.
• Provide accurate information about the situation to help client back into reality.

Evaluation
• Patient would appear relaxed and report that anxiety has been reduced.
• Verbalize awareness of feelings of anxiety.
• Enumerate ways to deal with anxiety.
• Use resources or support system effectively.

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PREGNANCY INDUCED HYPERTENSION

Definition

• Pregnancy induced hypertension (PIH) is a condition wherein vasospasm occurs during

pregnancy in both the small and large arteries in the body.
• Also known as gestational hypertension.
• 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.
• Originally, it was called toxaemia because researchers pictured a toxin of some kind being
produced by the 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.

Pathophysiology

• Increased cardiac output occurs with pregnancy, and it can injure the epithelial cell of the
arteries.
• Prostaglandin, a vasodilator, may also contribute to the injury.
• Reduced responsiveness of the blood vessels to the blood pressure is lost.
• There is vasoconstriction, and blood pressure increases.

Classifications

A. 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.
B. Mild Preeclampsia
• A woman is said to be mildly preeclamptic when her blood pressure rises to 140/90 mmHg, taken
on two occasions at least six (6) hours apart.
• Systolic blood pressure greater than 30 mmHg and diastolic blood pressure greater than 15
mmHg above pregnancy values.
• In addition to 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.
C. Severe Preeclampsia
• 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 at least 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.

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• 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); thrombocytopenia and epigastric pain.
D. 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).

Risk Factors

There are certain factors that contribute to the occurrence of pregnancy induced hypertension.
• Women of color. Hypertension is most common to these women due to genetic makeup of their
race.
• Multiple pregnancies. Women who have undergone multiple pregnancies are more
compromised with hypertension.
• Primiparas who are 20 years and older. This group has an increased risk for pregnancy induced
hypertension than women who are 40 years old and above.
• Women from low socioeconomic backgrounds. These women may have a poor diet due to their
low socioeconomic background, which could contribute greatly to hypertension.
• Underlying disease. This disease might contribute to the occurrence of pregnancy induced
hypertension.

Signs and Symptoms

These signs and symptoms, once detected, would indicate pregnancy induced hypertension.
• Hypertension. An increase in the usual blood pressure of the woman is the first indicator of this
disease.
• Proteinuria. Protein leaks out during this condition and can be detected in the urine.
• Edema. Since protein has already leaked out and it is responsible for containing water inside the
vessels, edema starts to occur.
Diagnostic Tests

Diagnostic tests would be ordered by the physician to determine the presence of pregnancy induced
hypertension.
• Urinalysis. This is one of the most common diagnostic tests that determine the presence of
protein in the urine. This is usually indicative of pregnancy induced hypertension.
Medical Management

Medications and other therapies are instituted by the physician to reverse pregnancy induced
hypertension.
• Antiplatelet therapy. There is an increased tendency for platelets to cluster along the vessel
walls, so a mild antiplatelet agent is ordered by the physician.

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• Administer medications to prevent eclampsia. To avoid progression of the disease to eclampsia,

hydralazine, nifedipine, and labetalol may be prescribed to reduce hypertension.
Surgical Management
No surgical interventions are needed to manage pregnancy induced hypertension. They can be managed
by medications and interventions imposed or ordered by the health care providers.

Nursing Management

Nurses also have a role in reducing the blood pressure of the patient. These are just simple interventions
but could create a dramatic effect when applied properly.

Nursing Assessment
• Assess vital signs, especially blood pressure. An elevated blood pressure of 140/90 mmHg and
above would indicate hypertension.
• Presence of protein could be determined through urine tests.
• Assess patient for the presence of edema on the face, fingers, and upper extremities.
Nursing Diagnosis
• Ineffective tissue perfusion related to vasoconstriction of blood vessels.
Nursing Interventions
• Promote bed rest in a recumbent position to aid in the secretion of sodium.
• Promote good nutrition, since the woman has still to continue her usual pregnancy nutrition.
• Provide emotional support to establish a trusting relationship and let the woman voice out her
fears.
Evaluation
• Patient must exhibit a normal blood pressure of 120/70 mmHg.
• No presence of protein should be detected on her urine.
• Edema should be confined to the lower extremities only.

Ms. April Anne D. Balanon-Bocato GreywolfRed

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