Pregnancy Induced Hypertension – Nursing Care and Management

Pregnancy-induced hypertension is a vasospastic disease that can climb from a mildly elevated pressure to seizures fast. Your work is serial blood pressures, urine protein, edema, and the danger signs (headache, visual changes, epigastric pain) so you catch the slide from gestational hypertension to preeclampsia to eclampsia before it costs the mother or the fetus.

What Is Pregnancy-Induced Hypertension?

PIH, also called gestational hypertension, is high blood pressure in pregnancy driven by vasospasm in both small and large arteries. It occurs in about 5 percent to 8 percent of pregnancies. The vasospasm raises vascular resistance and hinders blood flow to the liver, kidneys, brain, uterus, and placenta. It was once called toxaemia because researchers assumed a toxin produced in response to fetal protein caused the symptoms. No such toxin was ever found.

Pathophysiology

Cardiac output rises in pregnancy and can injure the epithelial cells of the arteries; the vasodilator prostaglandin may add to the injury. The vessels lose their normal responsiveness, vasoconstriction takes over, and blood pressure climbs.

Classifications

Gestational Hypertension

Elevated blood pressure (140/90 mmHg) with no proteinuria or edema. Perinatal mortality is not increased, so no drug therapy is needed. Look for systolic greater than 30 mmHg or diastolic greater than 15 mmHg above her pregnancy baseline. Pressure returns to normal after birth.

Mild Preeclampsia

Blood pressure of 140/90 mmHg on two occasions at least 6 hours apart, with systolic greater than 30 mmHg or diastolic greater than 15 mmHg above baseline. Add proteinuria (1+ or 2+ on a reagent strip from a random sample). A weight gain over 2 lbs/week in the second trimester or 1 lb/week in the third usually signals abnormal tissue fluid retention.

Severe Preeclampsia

She has crossed into severe disease when blood pressure reaches 160 mmHg systolic and 110 mmHg diastolic or above on at least two occasions 6 hours apart at bed rest. Expect marked proteinuria (3+ or 4+ on a random urine sample, or more than 5 g in a 24-hour sample) and extensive edema, visible as puffiness in the face and hands and most readily palpated over bony surfaces. Watch for oliguria from altered renal function, elevated serum creatinine (more than 1.2 mg/dL), cerebral or visual disturbances (blurred vision), thrombocytopenia, and epigastric pain.

Eclampsia

The most severe stage. Cerebral edema becomes acute enough to cause seizure or coma. Maternal mortality is high from cerebral hemorrhage, circulatory collapse, or renal failure, and fetal prognosis is poor from hypoxia and resulting fetal acidosis. Manifestations match severe preeclampsia, now with seizures.

HELLP Syndrome

A complication of severe preeclampsia or eclampsia: hemolysis (breakdown of red blood cells), elevated liver changes, and low platelets, leaving the blood unable to clot and control bleeding.

Risk Factors

Women of color carry higher risk. So do women with multiple pregnancies, who are more compromised by hypertension. Primiparas who are 20 years and older have increased risk compared with women who are 40 years old and above. Women from low socioeconomic backgrounds may have poor diets that contribute. Underlying disease can also drive PIH.

Signs and Symptoms

Hypertension is the first indicator, a rise above her usual pressure. Proteinuria follows as protein leaks into the urine. Edema sets in once the protein that holds water inside the vessels has leaked out.

Diagnostic Tests

Urinalysis is the common test, detecting urinary protein that points to PIH.

Medical Management

Because platelets tend to cluster along vessel walls, a mild antiplatelet agent is ordered. To keep the disease from progressing to eclampsia, hydralazine, nifedipine, and labetalol may be prescribed to reduce hypertension.

Surgical Management

No surgery is needed. PIH is managed with medications and nursing interventions.

Nursing Care Plan and Management

The nurse also drives the pressure down. The interventions are simple, but applied consistently they change outcomes: serial blood pressures, side-lying bed rest, a quiet environment, protein and urine output monitoring, and fast escalation when danger signs appear.