ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

NCM 109 RLE

Care of Mother and Child at Risk or with Problems
(Acute and Chronic)

Case Scenario 4

PREGNANCY
INDUCED HYPERTENSION
(PIH)

Mae Arra G. Lecobu-an

BSN 2-G Group 2

Jose Maria Nelson Cortez

Clinical Instructor
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

CASE 4:
This is a case of patient E.L. 29-year-old, married, G2P1L1 37 4/7 gestation was
admitted to OB unit due to increase of BP 180/110, in two occasion, sudden onset of
severe headache and vomiting.
Upon assessment vital signs show T-37.4 ͦC, PR-84 bpm, RR-18 cpm, BP160/110 mmHg
at right arm supine. She is oriented to time and place, looks apprehensive, epigastric
pain noted, no visual disturbances, no vaginal bleeding, no known drug allergies,
positive moderate pedal and peri-orbital edema. She was given Labetalol (Trandate)
200mg PO Stat as ordered. A few hours later her BP decreases to 150/110mmHg. The
patient was advised for blood pressure stabilization and possible induction of labor.
Physical examination: Breast is normal in size and shape; Heart and lungs are normal,
abdomen is globular and distended, umbilicus is inverted, linea negra is prominent,
fundal height upon palpation corresponds to 36 weeks gestation about 34 cm., uterus
was relaxed & non tender with single life fetus in cephalic presentation, FHT is 144
bpm via doppler. DTR hyperreflexia +3 noted. 2 days PTA she complained of frontal
headache but was relieved by rest. She has a history of increase blood pressure in her
previous pregnancy but controlled which spontaneously she delivered full term. E.L. is a
housewife who loved to cook and fun of eating salty food. Her mother is known diabetic
and her father died in renal failure. E.L. started her menarche at the age 14-year-old
with 28 to 30 days regular cycle at 7 days duration of menses.
During admission Dr. Luis ordered venoclysis of PLR 1L @ 8 hrs. with side drip of D5W
500 cc + 2 ampules of Apresoline and 2 ampules of clonidine 150 mcg/1ml ampule
regulated @ 10 drops per minute to titrate for BP of 140/90mmHg. She is for BP
monitoring every 2h for 24 hours and place on bed rest.
Laboratory test requested. Result shows: Hgb 14.5g/dl; WBC 10,000 cells/mm3;
Neutrophil = 60; Lymphocytes =38; Eosinophil = 02; Hb = 9mg/dl; Platelet count =
86,000/cumm; Blood typing = “A” negative. Coagulation Profile: BT = 10 min; CT = 14
min; INR = 9.0. Biochemistry: Urea = 25 mg/dl; Creatinine = 1.1 mg/dl; Sodium = 142
mmol/dl; Potassium = 2.9 mmol/dl; Bilirubin Total = 4.76 mg/dl; Bilirubin Direct = 3.2
mg/dl; SGOT(AST) = 1837 u/l; SGPT (ALT) = 913 u/l; Total Protein = 7.2 gm/dl;
Albumin = 4.8 gm/l; LDH = 2057 iu/l; RBS = 83 mg/dl; Uric acid = 4.7 mg/dl.
Urinalysis: Reaction: Alkaline; Color = yellow; Epi cells = 16 – 18/hpf; RBC = 10 –
12/hpf; WBC = 14 – 16/hpf; Albumin = 3+. 24-hour urine protein: positive. Latest scan
at 38 1/7 weeks shows all parameters are corresponding to date. It was a singleton
fetus on longitudinal lie and cephalic presentation. Fetal heart rate is 150 and fetal
movements are seen. Amniotic fluid index is 11. Estimated fetal weight was 3.3 kg and
placenta were on anterior upper segment.
On the next day, 7:15am, Bishop’s Score was done and result was 2/13. First 3mg of
Prostin tablet was inserted into the posterior fornix. CTG was then done after 1hour.
The abdomen and cervix will be reassessing in 6hours time. Labetalol 200mg was
continued and signs and symptoms of impending eclampsia (IE) were monitored.
Six hours later, she had 2 contractions in 10 minutes and it was moderate. Her BP on
lying was 110/90 mmHg and 120/90mmHg on sitting, well controlled BP. Vaginal
examination revealed cervix dilated to 1cm, os was 3cm membrane intact and at station
-2.
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

2 hours later, the contraction was 3 in 10minutes and no leaking liquor. Vaginal
examination showed 1cm cervix, 4cm os. Artificial Rupture of Membrane (ARM) was
done. Clear liquor was noted. Patient was in active phase of labor and was sent to the
labor room for delivery. One and a half hour later, patient complained of having strong
contraction and felt the urge to bear down.IE done revealed fully dilated at 10cm.
She delivered to a baby boy weighing 2.53kg with Apgar score of 8 in 1minute and 9 in
5minutes. The patient developed first degree tear; placenta was complete weighing
590gm.
In the ward, day 1 post SVD she was alert, conscious, and comfortable and was not
pale. Her BP was 120/80mmHg which was normal and her pulse rate was 96beats per
minute. She was afebrile. Abdominal examination showed that her abdomen soft and
non-tender. The uterus was well contracted at 18weeks in size. The lochia was normal.
Breastfeeding was established and she was ambulating well. The patient can tolerate
orally and had pass urine and bowel movement.
BP was stabilized, discontinued from labetalol. She was then discharged with the Final
diagnosis of Pre – eclampsia with HELLP syndrome. She was advised to come back for
follow – up after 2 weeks. Take medications of Ferrous sulfate 1 tablet OD; Ponstan 1
tablet Q8H PRN and Lactulose syrup15 ml.
 ILOILO DOCTORS’ COLLEGE
COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

I. Introduction

Hypertensive disorders of pregnancy constitute one of the leading causes of

maternal and perinatal mortality worldwide. It has been estimated that preeclampsia
complicates 2–8% of pregnancies globally. In Latin America and the Caribbean,
hypertensive disorders are responsible for almost 26% of maternal deaths, whereas
in Africa and Asia they contribute to 9% of deaths. Although maternal mortality is
much lower in high-income countries than in developing countries, 16% of maternal
deaths can be attributed to hypertensive disorders.
Pregnancy Induced Hypertension or (PIH) is a form of high blood pressure that
occurs in pregnancy. About 7 to 10 percent of pregnancies have experienced PIH.
Pregnancy-induced hypertension is called gestational hypertension but it was
originally called toxaemia.
It is a condition wherein vasospasm occur during pregnancy in both small or
large arteries in the body, with high blood pressure there is an increase in the
resistance of blood vessels. This can result to a hindrance in the blood flow in many
different organ systems of the mother that includes the liver, kidney, brain, uterus
and placenta.
In Pregnancy Induced Hypertension there is an increase in cardiac output that
happens in pregnancy that the injure the epithelial cells of the arteries. The
prostaglandins, a vasodilator may also contribute to the injury. When there is a
vasoconstriction the blood pressure increases. and reduce the responsiveness of the
blood vessels to the blood pressure is loss.
There are different classifications such as: Gestational Hypertension, Mild
Preeclampsia, Severe Preeclampsia, Eclampsia, and HELLP Syndrome.
Hypertension, proteinuria and edema are the signs and symptoms of a
pregnancy induced hypertension and women with color, multiparous women,
primiparas 20yrs and older, women with low socioeconomic status and women with
underlying disease are at risk of pregnancy induced hypertension.

II. Objectives
At the end of this case presentation, the participants and the audiences will
be educated about the disorder Pregnancy Induced Hypertension (PIH)

III. Nursing Health History

IV. Physical Examination

V. Anatomy and Physiology

VI. Diagnostic and Laboratory

VII. Drug Study

VIII. Nursing Care Plan

IX. Discharge Plan/Health Teaching