Etiology

(Generally unknown)

Precipitating factors:
Predisposing factors: Kidney Disease
Age Diet and Nutrition
Family History Obesity
Nulliparity

Legends:
Impaired Trophoblastic Invasion Complications
& Symptoms
Diagnostics
Management
Incomplete Remodeling of Spiral Arteries

Deficient Blood Supply

 Placental Hypoxia and Oxidative Stress

Endothelial Dysfunction & Vasospasm

Kidney effect Liver effect Placenta effect Cardio & Lungs effect CNS effect

Epigastric/ Possible: Increase blood Severe Headaches

Oliguria Oligohydramnios Visual changes
Stomach pain pressure
Proteinuria Placental abruption Nausea and
Edema
IUGR Sudden weight vomiting
Preterm birth gain
Low birth weight Thrombocyto-penia
Dyspnea

Pregnancy Induced Hypertension

Urinalysis
Complete Blood Nursing
Count (CBC) Bed rest
Biophysical Scoring BP monitoring
Liver Function Test Weight and Urine check
24-hour Urine test IVF
Opthalmoscopy Pharmacological
  Antihypertensive drugs
Anticonvulsant drugs
  Steroids 
 
Narrative Discussion:

Pregnancy Induced Hypertension refers to one of the three conditions:

gestational hypertension, preeclampsia, eclampsia. PIH is a major cause of maternal and fetal
morbidity and mortality. Although the source or cause of this certain disease among pregnant women
is not yet fully known, there are some factors that may increase the risk in developing it. For instance,
having hypertensive family history or pre-existing conditions. In the scheming table above, any of its
factors may be predisposing or precipitating factors; all of it may precede in acquiring of PIH.

These signs and symptoms of pregnancy induced hypertension begins in the utero-placental
area and these abnormalities are the inflammatory response which starts from this area moving
toward the systemic circulation of the mother and involves the major organs like kidney, liver, heart,
central nervous system. 

The pathogenesis of this disease starts at the abnormal trophoblast invasion in the spiral
arterioles. In normal pregnancy the spiral arterioles of some of the trophoblastic cells invade the
maternal tissues, starting invading and replacing the endothelial or the muscular lining of spiral
arterioles. So once these endothelial lining and muscular lining of spiral arterioles are replaced by
these trophoblastic cells it will be remodeled from narrow dilated vessels to large dilated vessels
which will allow for a high-flow and low resistance circulation. However, in the pre-eclampsia it acts
differently these trophoblastic cells are not invading in the spiral arterioles and once they are not
entering in the endothelial and as well as muscular lining in the spiral arteriole then the vessel
remains narrow and that’s why they are less perfusing and the tissues as well as the cells of the
placental beds will remain hypoxic and ischemic.

As a result of inadequate oxygen delivery to the placenta and oxidative stress brought on by
low blood flow, events like endothelial dysfunction and systemic inflammation may occur. The brain
will be signaled to push harder to release blood even if there is a presence of vasoconstriction, which
may result into release of proteins. Fluids will then attract the released of proteins, leading to fluid
excretion which will manifest as edema and proteinuria.

In fetal complications Preterm or premature birth, low birth weight, placental abruption,
stillbirth, and fetal growth restriction are one of the complications that the fetus may experience as a
result of the mother's pre-eclampsia. The arteries supplying and transporting blood to the placenta
are impacted by this condition and because of this the fetus may not obtain enough blood, oxygen,
and nutrients and if the placenta does not receive enough blood, it could result in intrauterine growth
restriction or delayed growth of the baby which will also results in low birth weight. Another
complications that may happen is the early delivery of the baby before its due date (Preterm Birth)
and Placental abruption, in which the placenta separates from the uterine wall prior to birth. The
mother and fetus both risk death from this disorder, which can produce moderate to heavy bleeding
and lastly Stillbirth a pregnancy loss in which the fetus has already passed away before or during
delivery.

In the maternal side the symptoms include epigastric or stomach pain, presence of oliguria and
proteinuria, increase in blood pressure, dyspnea, edema that will result into sudden weight gain,
visual changes, severe headaches, end organ failure (kidneys, liver, lungs, heart, or eyes), and death
are all possible complications of pre-eclampsia. Eclampsia has the same symptoms as pre-eclampsia
but in worst case scenarios it can lead to seizures (eclampsia) which will lead then into stroke.
Moreover, the severity of pre-eclampsia will still determine the amount of organ dysfunction and the
inability to perform proper interventions may result into death.