PREGNANCY INDUCED HYPERTENSION

pregnancy induced hypertension
preeclampsia
eclampsia
gestational hypertension
all managements

1. Seminar on pregnancy induced hypertension - G argi shukla obg

2. INTRODUCTION Hypertension is one of the most common complication during pregnancy. Increased maternal and perinatal morbidity and mortality. It is the sign of an underlying pathology that may be pre-exiting or appears for the first time during pregnancy that is why it is also called as toxemia of pregnancy.

3. DEFINITION OF HYPERTENSION Blood pressure of 140/90 mmHg or more or an increase of 30mmhg in systolic and/or 15mmHg in diastolic blood pressure over the pre or early pregnancy level. OR HYPERTENION simply put its blood pressure , meaning the arteries in your body have an elevated blood pressure.

4. CLASSIFICATIONOF PREGNANCY INDUCED HYPERTENSION Pre-eclampsia Eclampsia Gestational hypertension

5. PRE ECLAMPSIA A multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90mmHg or more with proteinuria after the 20 th week in a previously normotensive and nonproteinuric women.

6. ETILIOGY CAUSES RISK FACTORS Primigravida Family history Placental abnormalities Obesity Pre-existing vascular diseases New paternity

7. TYPES OF PRE- ECLAMPSIA

8. DIAGNOSTIC EVALUATION History collection Urine test Blood test- serum uric acid blood urea level serum creatinine level liver enzymes Antenatal fetal monitoring- daily fetal kick count ultrasonography cardiotocography umbilical artery flow velocimetry

9. CLINICAL FEATURES MAIN FEATURES- 1. Hypertension , rise of bp above 140/90mmg. 2. Edema usually on face, hands, lower abdomen, vulva, sacral area, ankles. 3. Proteinuria is a serious sign as it involves renal involvement. 4. Presence of protein in 24 hrs urine of more than 0.3g per litre or more than 1g litre in two or more midstream specimens obtained 6hrs apart in the absence of urinary tract infection. 5. A rapid gain weight that is, more than 1Lb in week and more than 5Lb in a month.

10. SIGN AND SYMPTOMS MILD SYMPTOMS sight swelling over the ankles which persists on rising from the bed in the morning or tightness of the ring on the finger is the early manifestation of preeclampsia edema the swelling may extend to the face, abdominal wall, vulva and even the whole body. ALARMING SYMPTOMS Headache Distrurbed sleep Diminished urinary output Epigastric pain Eye symptoms

11. COMPLICATIONS OF PRE ECLAPAMSIA

12. IMMEDIATE COMPLICATIONS- MATERNAL COMPLICATIONS- During pregnancy- Eclampsia Accidental hemorrhage Oliguria and anuria Preterm labor Help syndrome- hemolytic anemia , elevated liver enzymes these are coagulation protein

13. Conti…. During labor- Eclampsia Postpartum hemorrhage During puerperium- eclampsia Shock sepsis

14. FETAL COMPLICATION Intrauterine death Intrauterine growth restriction Asphyxia Prematurity

15. REMOTE Residual hypertension(50%) Recurrent pre–eclampsia(25%) Chronic nephritis(high incidence of glomerulonephritis in women)

16. PREDICTION AND PREVENTION OF PREECLAMPSIA : Preeclampsia is not a totally preventable disease. However, some specific “high risk” factors leading to preeclampsia may be identified in an individual Screening tests for prediction and prevention of pre-eclampsia Doppler ultrasound Development of renal dysfunction Absence of end diastolic frequencies Average mean arterial pressure Maternal serum level of SFIt Fetal DNA Roll over test

17. PROPHYLACTIC MEASURES FOR PREVENTION OF PREECLAMPSIA Regular antenatal check up Antithrombotic agents Heparin or low-molecular-weight Calcium supplementation Antioxidants, vitamins E and C and nutritional supplementation with magnesium, zinc, fish oil and low-salt diet have been tried but are of limited benefits. Balanced diet rich in protein may reduce the risk

18. MANAGEMENT Objectives are: (1) To stabilize hypertension and to prevent its progression to severe preeclampsia. (2) To prevent the complications. (3) To prevent eclampsia. (4) Delivery of a healthy baby in optimal time. (5) Restoration of the health of the mother in puerperium.

19. MEDICAL AND NURSING MANGEMENT

20. CONTI….

21. ECLAMPSIA Pre-eclampsia when completed with convulsion and/or coma is called ECLAMPSIA . It is also called as “flash of lightening”. Eclampsia may occur abruptly without any warning manifestation . In majority 85% the disease is preceded by features of severe pre-eclampsia.

22. ETIOLOGY CAUSES Same as pre-eclampsia that is unknown and can be due to abnormal formation and function of the placenta. RISK FACTORS Primigravida Family history Placental abnormalities Obesity Pre-exiting vascular diseases New paternity thrombophilias

23. SIGNS AND SYMPTOMS Convulsion/fits Proteinuria Epigastric pain Vomiting Weight gain Edema(over ankle) Visual disturbance Severe headache Oliguria Loss of consciousness agitation

24. COMPLICATIONS Hazards of convulsions- Injuries-tongue bite Aspiration of vomitus. Exhaustion Acute left ventricular failure. Pulmonary edema Pneumonia Cerebral hemorrhage and hyperpyrexia

25. CONTI…. Disseminated intravascular coagulopathy Hepatic necrosis Postpartum shock Puerperal sepsis Psychosis Pulmonary embolism Abruptio placenta Eye compications

26. STAGES OF ECLAMPSIA

27. 1. Premonitory stage Unconscious Twisting of muscle of face , tongue and limbs Eye balls roll and are turned to one side and becomes fixed. Last about 30seconds.

28. 2. TONIC STAGE Tonic spasm The trunk- opisthotonus The limbs- flexed The hands- clenched Respiration arrest Cyanosis Eyeball becomes fixed Last about 30 seconds

29. 3. CLONIC STAGE All the voluntary muscles undergo alternate contraction and relaxation. Twisting starts in the face then involves one side of extremities and ultimately the whole body is involve in convulsion. Biting of the tongue. Last for 1-4 minutes

30. 4. COMA It may last for brief period or an other deep coma may persist till another convulsion. Patient appears to be in a confused after the convulsion and fails to remember the happening. It may be followed by another fit.

31. TYPES OF ECLAMPSIA

32. DIAGNOSTIC EVALUATION CBC Hematocrit value Platelets count Non stress test Serum creatinine level Cardiotocography USG Eye test Urine test

33. MANAGMENT Aim of management To control fits. To control blood pressure. To prevent complications. To deliver the fetus safely.

34. General management Hospitalization Rest Position while resting History(number of fits and nature of medication if taken from outside) Sedation and then abdominal examination Vital signs Urinary output Nutrition

35. Anticonvulsants(mgso4) Antihypertensive(hydralazine) Sedatives(diazepam) Diuretics(only used in case of pulmonary edema) Antibiotic(broad spectrum antibiotics) SPECIFIC MANAGEMENT

36. NURSING MANAGMENT It includes the care of the patient. BEFORE FIT DURING FIT AFTER FIT

37. Care before fits The doctor should be called upon. Monitor fluid balance Check vitals sign half hourly Mild sedation is given advice the patient to take high protein diet

38. After fits Give the patient calm and quiet environment after fits Avoid bright light Prevent injury by padding the cot Give o2 to the patient Give the patient semi prone position and change every 3hrs If breathing is moist then raise the foot end and give the patient inj. Atropine Clean the mouth and nostril after fit. to maintain urine output use a self retaining Do not give fluid till she may regain consciousness Record the onset of fit number of fit the length severity and time of occurrences

39. During fits Call for medical help Do not leave the patient alone Lower the head end with head turned to one side to help drainage of saliva and prevent asphyxia If denture is present remove it Put a mouth gag in the patient’s moth to prevent tongue bite Never force teeth to open by a spoon to avoid injury Do not apply force during convulsions as it may break any limbs or bone Keep the airway clear Give sedatives

40. GESTATIONAL Gestational hypertension is  blood pressure greater than or equal to 140/90 that begins during the latter half of pregnancy (typically after 20 weeks). It normally goes away after your baby is born. There is no excess protein in the urine or other signs of organ damage . It is relatively mild hypertension condition. The only potential complication of gestational hypertension is the need to induce labor, resulting in a higher rate of a c -section.

41. CONCLUSION Hypertension disorders of pregnancy are frequently seen. Recognizing the diagnostic features and understanding the management of these illness will help to decrease the associated increased maternal and neonatal morbidity and mortality.

42. BIBLIOGRAPHY Dr- shally magon-sanju sira, M idwifery and obstetrics, 2021edition, lotus publishers ,page no. 410,411,412,413,414,415,416,417,418,419,420 D.C. Dutta’s,textbook of obstetrics,new central book agency(p)ld,7th edition, page no. 241,242,243,244,245,246,247,248,249,250