HYPERTENSIVE DISORDERS IN PREGNANCY

(PREECLAMPSIA)

Hypertension Type Symptoms

Gestational Hypertension Blood pressure is 140/90 mmHg or systolic pressure elevated 30 mmHg or
diastolic pressure elevated 15 mmHg above pregnancy level; no proteinuria or
edema; blood pressure returns to normal after birth
Preeclampsia without severe Blood pressure is 140/90 mmHg or systolic pressure elevated 30 mmHg or
features diastolic pressure elevated 15 mmHg above pregnancy level; proteinuria of 1+
to 2+ on a random sample; weight gain over 2lb/week in second trimester and
1lb/week in third trimester; mild edema in upper extremities or face
Preeclampsia with severe Blood pressure is 160/110 mmHg; proteinuria 3+ to 4+ on a random sample
features and 5g on a 24-hour sample; oliguria (500 ml or less in 24 hours or altered
renal function tests; elevated serum creatinine more than 1.2mg/dl); cerebral or
visual disturbances (headache, blurred vision); pulmonary or cardiac
involvement; extensive peripheral edema; hepatic dysfunction;
thrombocytopenia; epigastric pain
Eclampsia Either seizure or coma accompanied by signs and symptoms of preeclampsia
are present.

ASSESMENT
Vision changes, typically hypertension, proteinuria and edema are the classical signs of preeclampsia.
PATHOPHYSIOLOGIC EVENTS
The vascular spasm that occurs may be caused by the increased cardiac output required by pregnancy, which endures the endothelial cells of the
arteries and reduces the action of prostacyclin-a prostaglandin vasodilator-and excess production of thromboxane-a prostaglandin vasoconstrictor and
stimulant of platelet aggregation.

NURSING INTERVENTIONS
 Preeclampsia without severe features
-monitor antiplatelet therapy because of the increased tendency for platelets to cluster along arterial walls, a mild platelet agent, such as a low-
dose ASPIRIN, may prevent or delay the development of preeclampsia.
-promote bed rest. It is the best method of aiding increased evacuation of sodium and encouraging diuresis of edema fluid.
-promote good nutrition. Restriction of salt was advised in order to reduce edema.
-provide emotional support

 Preeclampsia with severe features

-support bed rest
-monitor maternal well-being. Take blood pressure at least every 4 hours or with a continuous monitoring device to detect any increase, which
is a warning that a woman’s condition is worsening.
-monitor fetal well-being. Single doppler auscultation at approximately 4-hour intervals is sufficient at this stage of management.
-support a nutritious intake. A woman needs a diet moderate to high in protein and moderate in sodium to compensate for the protein she is
losing in urine.
-administer medications to prevent eclampsia. A hypotensive drug such as hydralazine (Apresoline), labetalol (Normodyne), or nifedipine
may be prescribed to reduce hypertension. These drugs act to lower blood pressure by peripheral dilation and thus do not interfere with
placental circulation.

TONIC-CLONIC SEIZURES
- An eclamptic seizure is a tonic-clonic type that occurs in stages.
The tonic phase which all the muscles of the woman’s body contract. Her backaches, arms, legs stiffen, and her jaw closes so abruptly she
may bite her tongue. Respirations halt because her thoracic muscles are held in contraction.
The second clonic stage, the woman’s bladder and bowel muscles contract and relax; incontinence of urine and feces may occur. The
breathing of the patient is not effective so it remains cyanotic. It lasts up to 1 minute.
During the postictal stage, a woman cannot be roused except by painful stimuli for 1 to 4 hours.

: the priority care for a woman with a tonic-clonic seizure is to maintain a patent airway. To prevent aspiration, turn her onto her side to
allow secretions to drain from her mouth. Magnesium sulfate or diazepam may be administered intravenously as emergency measures.
Asses oxygen saturation via pulse oximeter. Administer oxygen by face mask as needed to protect fetal oxygenation.

Drugs used in preeclampsia

DRUG INDICATION DOSAGE COMMENTS
Magnesium sulfate (pregnancy Muscle relaxant; prevents Loading dose 4-6 g Infuse loading dose slowly over
risk category B) seizures Maintenance dose 1-2g/hr IV 15-30 minutes
Always administer as a
piggyback infusion
Assess respiratory rate, urine
output, deep tendon reflexes,

Hydralazine (Apresoline)
(pregnancy risk category C)
Diazepam (Valium) (pregnancy
risk category D)
Calcium gluconate (pregnancy
risk category C)
Antihypertensive (peripheral
vasodilator); used to decrease
hypertension
Halt seizures
Antidote for magnesium
intoxication
and clonus every hour.
Urine output should be over
30ml/hr and respiratory rate
over 12 breaths/min. serum
magnesium level should remain
below 7.5 mEq/l.
5-10 mg IV Administer slowly to void
sudden fall in blood pressure
Maintain diastolic pressure over
90 mmHg to ensure adequate
placental filling
5-10 mg IV Administer slowly. Dose may
be repeated q 5-10 minutes ( up
to 30 mg/hr).
1 g IV (10 ml of a 10% Have prepared at bedside as the
solution) antidote when administering
magnesium sulfate
Administer at 5 ml/min.