This is a
condition in which the blood pressure is raised much above the normal level
before the onset of pregnancy. The diagnosis is made either very early in pregnancy
or in the non-pregnancy state. The diagnosis is difficult because there are
other conditions which bring about elevated blood pressure e.g. pre-eclampsia
and chronic nephritis.
a blood pressure of 140/90mMHg is regarded as hypertension but a midwife should
not have a fixed figure. Any sharp rise in blood pressure e.g. from 100/60 –
130 /80mmttg should be taken serious even if the level of 140/90 is not yet
asymptomatic and is only discoveredon routine physical examination
symptoms are present, they present as:
Throbbing occipital headache or migraine.
Weakness, dizziness, visual disturbance.
Later Signs: It affects the target organs i.e.
eyes, kidneys andbrain.
pressure is very high, the patient may develop albuminuria and frank
pre-eclampsia may set in.
A very high blood pressure causes cerebral
Later in pregnancy, it may cause concealed
accidental hemorrhage (Abruptio placenta) which may lead to renal
On fetus, there is higher incidence of abortion,
intrauterine death and premature labor.
Generally there is increased maternal morbidity
Sedatives – to relax the patient sodium Amytal 200m
Hypotensive drugs – reserpine 0.5 – 0.75mg dly, Gua
nethidine 10-25mg dly, Methyldopa 250mg tds
with this condition should not carry pregnancy beyond term. In mild-moderate
cases, surgical induction is done (artificial rupture of membrane) at 38-40wks.
In severe cases, labour is induced to avoid eclampsia.
Nursing: Ensure bed rest and adequate
Observation: Blood pressure is checked at
least twice daily and insevere cases, 4 hourly or 2 hourly. Diet -Low Sodium intake and low alcohol
Exercise – Plan daily exercise to maintain
weight, lifting iscontraindicated.