pregnancy induced hypertension preeclampsia eclampsia gestational hypertension all managements

1. Seminar on
pregnancy induced
hypertension
- Gargi 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
A. Pre-eclampsia
B. Eclampsia
C. Gestational hypertension

6. 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 20th week in a previously normotensive and nonproteinuric women.

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

8. TYPES OF
PRE-
ECLAMPSIA
MILD- proteinuria and hypertension
present (bp is less than 170/110mmhg)
MODERATE- proteinuria and
hypertension is present (bp more than
170/110mmhg)
SEVERE- proteinuria and hypertensionis
present. BP is highly increased more than
170/110mmhg and pregnancy is less than
32 weeks or with maternal complications.

9. 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

10. 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.

11. 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

12. COMPLICATI
ONS OF PRE
ECLAPAMSIA
IMMEDIATE-
MATERNAL
FETAL
REMOTE

13. 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

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

15. FETAL COMPLICATION
• Intrauterine death
• Intrauterine growth restriction
• Asphyxia
• Prematurity

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

17. 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

18. 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

19. 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.

20. MEDICAL
AND
NURSING
MANGEMENT
Epidural analgesia may be used to relief pain.
Drugs –
Antihypertension drugs(METHYDOPA)
Diuretics (TAB. LASIX/FRUSEMIDE 40MG*5DAYS)
Anticonvulsants (MAGNESIUM SULPHATE REGIMEN )
Sadatives (INJ. DIAZEPAM 5MG TDS)
Laxatives (IF CONSTIPATION THEN MILD LAXATIVE LIKE
MILK OF MAGNESIA 4TSP AT BED TIME)
Termination of pregnancy(induction, c section)

21. CONTI….
Maintain the progress chart.
Advice the relatives to keep the patient in a calm quiet glare free
room and to restrict the number of visitors.
Monitor fluid status and maintain.
Sadate the patient immediately after delivery to prevent post partum
eclampsia and to keep the patient under the close observation.
Advise the patient to take complete rest.
protein about 100g
During laborpatient should lie in the bed, blood pressure is
monitored regularly
Fetal monitorinf is done

22. 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.

23. 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

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

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

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

27. STAGES OF
ECLAMPSIA
Premonitory stage
Tonic stage
Clonic stage
Coma

28. 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.

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

30. 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

31. 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.

32. TYPES OF ECLAMPSIA
Antepartum
eclampsia :- (fits
occur before onset of
labor).
Intrapartum
eclampsia :-
(eclampsia that
occurs in labor).
Postpartum eclampsia
:- (eclampsia that
occurs after delivery).

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

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

35. General management
1. Hospitalization
2. Rest
3. Position while resting
4. History(number of fits and nature of medication if taken from outside)
5. Sedation and then abdominal examination
6. Vital signs
7. Urinary output
8. Nutrition

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

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

38. 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

39. 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

40. 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

41. 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.

42. 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.

43. BIBLIOGRAPHY
Dr- shally magon-sanju sira, Midwifery 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