Pregnancy Induced Hypertention
Pregnanncy induced hypertantion (PIH) is spasm of arterial vessels
during pregnancy manifested by hypertantion, edema, and albuminuria
It remains obscure. It only occurs after 20 weeks of gestation &is
uncommon before the 30 weeks.
Whilst cardiac out put appears to decrease as preeclampsia worsens,
generalized vasoconstriction occurs when it affects much of the physiological
activity of the tissues with in the body.
Capillary permeability increases and the fluid which escapes contribute
to the oedema with in the tissues. The presence of excessive fluid retention
producing generalized oedema.
The uterus is also affected, particularly the vessels supplying the
placental bed. Vasoconstriction and DIC reduce the uterine blood flow and
vascular lesions occur in the placental bed. Placental abruption can be the
The liver is affected in sever cases where intracapsular hemorrhages and
necrosis occur. Oedema of the liver cells produces epigastric pain and impaired
liver function may result in jaundice.
The brain becomes oedematous and this, in conjuction with D/C, can
produce thrombosis and necrosis of the blood vessel walls resulting in
The lungs become congested with fluid in severe cases oxygen is impaired
and cyanosis occurs.
Symptoms are rarely experienced by the mother until the disease has arrived
at an advanced state. It is possible to identify the onset by the following
which are known as the cardinal signs.
Blood pressure – A rise of 15-20 mmHg above the
normaldiastolic pressure or an increase above 90 mmHg on two occasions.
Proteinuria in the absence of urinary tract
infection isindicative of renal damage. The amount of protein in the urine is
frequently taken as an index of the severity of pre eclampsia.
Oedema It may appear rather suddenly
and be associatedwith a rapid rate of weight gain. Generalized oedema is
significant and be classified as occult or clinical. Occult oedema may be
suspected if there is a marked increase in weight. Clinical oedema may be mild
or sever in nature and the severity is related to the worsening of the pre-eclampsia.
The oedema pits on pressure and may be found in:
Feet, ankles and pre-tibial region
The hands –it may be noticed by that the mother’s rings are tight.
The lower abdomen
Facial oedema – may be mild resulting in puffiness of the eye lids In
the presence of two of the cardinal signs a provisional diagnosis of pre
eclampsia may be made. Proteinaria is considered to be the most serious
Mild – is diagnosed when, after
resting, the mother’s diastolicblood pressure rises 15-20 mmhg above the basal
blood pressure recorded in early pregnancy or when the diastolic blood pressure
rises above 90 mmHg. Oedema of the feet, ankles and pretibial region may be
Moderate – Preeclampsia is usually diagnosed
when there isa marked rise in the systemic and diastolic pressure, when
proteinuria is present in the absence of a urinary tract infection and when
there is evidence of a more generalized edema.
Severe – Preeclampsia is diagnosed when
the blood pressureexceeds 170/110mmhg, when there is an increase in the protein
uria and where oedema is marked. The mother may complain of frontal head aches
and visual disturbances.
The condition may worsen and eclampsia may occur
Placenta abruption may occur with all the complications
Hematological disturbance can occur and the kidneys lungs, heart and
liver may be seriously damaged.
The capillaries with in the fundus of the eye may be irreparably damaged
and blindness can occur.
Reduced placental function can result in low birth weight.
There is an increased incidence of hypoxia in both the antenatal and
Placental abruption, if minor, will contribute to fetal hypoxia, if
major, intra uterine death will occur.
Depending up on the severity of the disease a
mother may be admitted to the hospital. Treatment is symptomatic because the
cause of pre eclampsia is unknown.
Diet: As for any pregnant woman a diet
rich in protein, fiberand vitamin may be recommended fluid should be
Weight: Should be estimated and recorded
twice weekly if themother is ambulant and oedema should be observed daily. Urine: should be tested for protein and
Fluid intake and out put should be continuously measured. Blood pressure is ascertained 4-
hourly in moderate preeclampsia but will be taken 2 hourly or more frequently
if the mother is severely affected.
Abdominal examination will be carried out, any
discomfort,tenderness or pain experienced by the mother should be recorded and
reported immediately. The fetal heart rate and fetal wellbeing is also
recorded. Sedation – may be
The nurse/midwife should remain with the mother throughout the course of
labour. Preeclampsia can suddenly worsen at any time and it is essential to
document the presence of oedema, the blood pressure, and urinary out put.
Positioning the mother on her left side will prevent supine hypo tension.
Care of the bladder is essential and the mother should be encouraged to
void urine regularly.
When the second stage commences the obstetrician and pediatrician should
be notified. The latter will be present at the delivery in case the baby
Occasionally a short second stage is prescribed and in this instance the
obstetrician will perform a forceps (vacuum) delivery.
The blood pressure will be recorded after delivery and at least 4-hourly
for 24 hours. If protein uria has been present the urine should be tested once
or twice daily until it is clear and urinary out put should be recorded.
Postnatal care will be as need strict follow up especially first 24-48
The nurse must be vigilant in monitoring the maternal condition and be
alert to the following signs and symptoms which signal the onset of eclampsia:
A sharp rise in blood pressure
Diminished urinary out put (oliguria)
Increase in protein uria
Head ache which is usually sever, persistent and frontal or occipital in
Drowsiness or confusion
Visual disturbances such as blurring of vosion or flashing lights due to
Nausea and vomiting
The midwife/nurse who observed any one of these signs in a woman with
pre-eclampsia must make a full examination in order to establish if other are
present and report for urgent action.
Eclampsia is rarely seen. Usually pregnancy induced hypertension is
diagnosed and treatment is instituted in order to prevent eclampsia. The
incidence of eclampsia is approximately 1 in 1500 pregnancies and of these
about 20% occurs in the antenatal period, 25% occur intrapartum and 35% with in
the first few hours after delivery. Eclampsia is characterized by convulsions
The mother is restless and rapid eye movements can be noted.
The head may be drawn to one side and twitching of the facial muscles
The mother has no perception of the impending fit and shows altered
The muscles of the mother’s body go into spasm and become rigid and her
back may become arched.
Her teeth will become tightly clenched and her eyes staring
Violent contraction and intermittent relaxation of the mother’s muscles
produces conversions movements
Salivation increases and foaming at the mouth occurs.
The mother’s face becomes congested and bloated and the features become
She is unconscious, her breathing detorous and her pulse full and
bounding. -Gradually the convulsion subsides.
Stertorous breathing continues and coma may persist for minutes or
Further convulsions may occur before the mother regains consciousness.
Clear and maintain the mother’s air way (suction)
Administer oxygen and prevent severe hypoxia
Prevent the mother from being insured during the clonic stage.
Monitor vital signs
Intravenous therapy will be commenced to maintain adequate hydration.
The regimen will be prescribed according to the mother’s needs and ketoacidosis
must be prevented. Dextrose 5% will be used for intravenous drug
Sedatives to control convulsion
Where the hypertension is sever and requires rapid reduction,
intravenous hydrallazine may be given.
The volume of urine and the albumin uria need to be monitored.
Monitor intake and output
Avoid disturbance (noise, light, etc)
Keep emergency drugs ready
Control blood pressure
Deliver the baby
Cerebral: hemorrhage, thrombosis and
Renal: acute renal failure
Hepatic: liver necrosis
Cardiac; myocardial failure
Respiratory: asphyxia, pulmonary oedama,
Visual: temporary blindness
Injuries: bitten tongue, fractures
Fetal: hypoxia and still birth