PIH- Pregnancy Induce Hypertension

- Also known as toxaemia of pregnancy

Vasospasm – increase blood flow

Vasoconstriction – compensate

3 SYMPTOMS

1. Hypertension
2. Proteinuria
3. Edema
- Rarely occurs before the 20th wks of pregnancy

CLASSIFICATIOn

1. Gestational Hypertension
= 140/90 +30 systolic +15 diastolic
Bec. BP rises after 20 wks.
2. Mild Pre eclampsia
- 140/90 +30 systolic + 15 diastolic
- - (+) proteinuria ( 3 grams of protein @ 24 hrs urine collection)
- +1,+2
- Edema = hands ( digital edema) or face ( moon face)
- Wt.Gain = 2lbs/wk in the 3rd trimester
= 1lb/wk in the 2nd trimester
3. Severe pre- eclampsia
BP=160/110 +30 diastolic
Protein +3 , +4 ( 5 gram of urine collection 24 hr)
Edema : generalized edema ( “ ANASARKA”)
Wt.gain : 2lbs/wk in the 3rd trimester
4. Late Manifestation if severe
= Oliguria
= epigastric pain – ischemia of pancrease/ liver
= nausea/ vomiting – abdominal edema
=SOB ( shortness if breath ) – pulmonary edema
= visual disturbance
=photophobia – sensitive of light > cerebral edema
= severe headache >cerebral edema
= muscle clonus – involuntary movement of the body > cerebral edema

5. Eclampsia
 - Cerebraledema – increase ICP – convulsion /seizure
- Most common cause of death of client w/ PIH
Causes of Death in Eclampsia
a.) Cerebral hemorrhage
b.) Circulatory Prolapse
c.) Kindey Failure

NOTES :
5 months age of viability – pre term
Below 5 months – therapeutic abortion
6. Tonic Clonic Convulsion
- 48 hrs per delivery

Phases

~ Premonition/ aura

Symptoms – Oliguria, epigastric pain, severe headache

~ Tonic phase

– muscle spasm ( naninigas) convulsion

- 20 secs maninigas
- Respiration will stop

~ Clonic phase

- Alternate contraction and relaxation of muscle

- Maninigas
- 60 secs.
- Respiration is irregular bec, contract relax

~ Post tictaL phase

- 1st 4 hours per convulsion

- Semi – comatose – decrease level of consciousness – increae ang senses
- Complication : abruption placenta – orient for time, person, place..

Management
Mild pre- eclampsia – home remedy

1.) Bedrest – L-side lying position

2.) Nutrition - increase CHON – bec. Of proteinuria
3.) Provide emotional support – iwasan ang stress, alcohol, smoking
4.) Note for signs of severe pre- eclampsia

Severe Pre- Eclampsia – hospitalized the client

1.) Bedrest – L – side lying

2.) Decrease environmental stimuli
- Provide proper ventilation
- Provide quiet and calm place
- Limit visitors
- Not dim light
3.) 02 sat.
4.) IVT – medication
5.) Monitor VS
6.) Monitor I and O
7.) Monitor FHT
8.) Weight monitoring – bec, of ANASARKA – lalu lala ang organs
9.) Seizure precaution
a.) 02 sat
b.) Suction machine
c.) Padded tongue depressor
d.) Medication ( MgSo4, Ca Gluconate )
10.) Nutrition – increase CHON moderate Na intake
11.) Medications
a.) MgSo4 – drug of choice
- CNS depressant
- Anti- convulsant
- Cathartic

Loading dose : 4-6g/hr / IV via piggyback ( 15-20 mins)

Maintenance dose : 1-2 g/hr

IM- gluteus maximus – 5 mins.

MgS04 toxicity

1.) Decrease RR
2.) Oliguria
 3.) Cessation / DTR – deep tendon reflex
4.) Decrease LOC – level of consciousness

Calcium Gluconate – antidote for MgS04

b.) Hydralozinc ( apresuline) > anti hypertensive
c.) Diazoxide (hyperstas) > hypotension

DIAGNOSTIC EXAMS
 Roll over test
 Urinalysis
 Amniocentesis
 Hct.ct – hemoconentration / hypovolemia
 BUN / creatinine – liver
 Non – stress test – to determine fetal distress
 Sonogram / ultrasound – to check condition of the baby
 Electrolyte monitoring

Eclampsia 1.) Airway 2.) Safety

Premonition :

1.) L-side lying position

2.) Place the tongue depressor – to prevent bitting of the tounge
3.) Raise the side rails
4.) Pad the side rails
5.) Lower the bed

Tonic- clonic phase

1.) Never leave the client unattended

Postictal
1.) Check the FHT – for the condition of the baby
2.) Check for bleeding
3.) Monitor VS
4.) Position the client
5.) Suction secretions
6.) 02 administration
7.) Diazepam ( valium) 5-10mg/IV

COMPLICATION of PIH – HELLP syndrome

H- hemolysis

E- elevated

L – liver

L-low

P-platelets