The document discusses hypertensive disorders of pregnancy. It defines hypertension in pregnancy as a group of diseases that includes pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension. It then classifies and describes the various types of hypertension seen in pregnancy. Risk factors, signs and symptoms, maternal and fetal complications, investigations, and management approaches are outlined for pre-eclampsia and eclampsia specifically.

1. Hypertensive
disorders of
pregnancy
Ms.Anbarasi.E
Msc(Nursing) II year
SCON,SIMATS.

2. DEFINITION OF HYPERTENSION
DISORDERS IN PREGNANCY
Hypertension disorders of
Pregnancy also known as
maternal Hypertensive disorders
is a group of disease that includes
Pre-eclampsia , Eclampsia,
Gestational Hypertension and
Chronic Hypertension.

3. CLASSIFICATION OF
HYPERTENSION IN PREGNANCY
1. Gestational Hypertension
2. Pre-Eclampsia
3. Eclampsia
4. Chronic Hypertension
5. Pre-Eclampsia or Eclampsia super imposed
on Chronic Hypertension

4. PRE-ECLAMPSIA –
PREGNANCY INDUCED
HYPERTENSION

5. PRE-ECLAMPSIA –PREGNANCY
INDUCED HYPERTENSION
Definition:
A multisystem disorder of unknown
aetiology characterized by development of
Hypertension to the extent of 140/90 mm hg
or more with proteinuria after the 20th week
in a previously normotensive and
nonproteinuric woman.
-D.C.Dutta

6. CLASSIFICATION OF PRE-
ECLAMPSIA
The Pre-Eclampsia is classified as
A. Primary -70%
• Pre-eclampsia
• Eclampsia
B . Secondary -30%
• Pre-eclampsia-eclampsia
superimposed on chronic
hypertension (25%)
• Pre-Eclampsia-Eclampsia
superimposed on Chronic renal
disease (5%)

7. CLASSIFICATION BASED ON
SEVERITY
1. Mild Pre-Eclampsia
2. Moderate Pre-eclampsia
3. Severe Pre-eclampsia

8. MILD-MODERATE PRE-ECLAMPSIA
• Systolic B.P 140-160 mmhg
• Diastolic B.P 90-100 mmhg
• Proteinuria upto ++
SEVERE PRE-ECLAMPSIA
• Systolic B.P >160 mmhg
• Diastolic B.P >110 mmhg
• Proteinuria upto +++ or more
• Epigastric pain

9. RISK FACTORS
• Primigravidae(Young or elderly)
• Family history of hypertension,
pre-eclampsia
• Placental abnormalities
– Hyperplacentosis: (molar pregnancy
twins, diabetes)
– Poor placentation
– Placental ischemia.
– Molar pregnancy
• Genetic disorders
• Immunological phenomenon
• Pre-existing vascular disease
• New paternity
• Thrombophilias

10. ETIOLOGY OF PRE-
ECLAMPSIA
• Placental implantation with abnormal
trophoblastic invasion of uterine
vessels
• Immunological maladaptive tolerance
between maternal, paternal
(placental),and fetal tissues
• Maternal maladaptation to
cardiovascular or inflammatory
changes of normal pregnancy
• Genetic factors

12. CLINICAL FEATURES OF PRE-
ECLAMPSIA SIGNS:
• Abnormal weight gain-
>5lb/month or 1lb/week in
later months
• Rise in blood pressure
• Edema- ankles, then
spread all over the body
• Pulmonary edema
• Abdominal examination-
chronic placental
insufficiency (scanty liquor
or IUGR)

13. MILD SYMPTOMS
• Slight 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 pre-
eclampsia oedema.
• Gradually, the swelling may extend to the
face, abdominal wall, vulva and even the
whole body

14. ALARMING SYMPTOMS
• Headache —occipital or frontal region
• Disturbed sleep
• Diminished urinary output—Urinary
output of less than 400 ml in 24 hours,
• Epigastric pain
• Eye symptoms—blurring, dimness of
vision or complete blindness.

15. INVESTIGATIONS
• Urine-proteinuria
• Opthalmoscopic examination-
retinal edema ,constriction of
arterioles
• Blood values
– BUN
– Serum creatinine
– Thrombocytopenia
– Coagulation profile
– Liver function test
• Antenatal fetal monitoring
– USG
– Fetal kick count
– Cardio tocography
– Umbilical artery flow velocimetry

16. MATERNAL COMPLICATIONS-
IMMEDIATE
• Antenatal
– Eclampsia(2%)
– Accidental haemorrhage
– Oliguria and anuria
– Dimness of vision and even
blindness
– Preterm labor
– HELLP syndrome

17. MATERNAL COMPLICATIONS-
IMMEDIATE
During labour
– Eclampsia
– Post partum
haemorrhage
During Puerperium:
– Eclampsia (usually within
48 hrs)
– Shock.
– Sepsis

18. FETAL COMPLICATIONS
• Intrauterine deaths
• Intrauterine growth
restriction
• Asphyxia
• Prematurity

19. REMOTE COMPLICATIONS
• Residual hypertension
• Recurrent preeclampsia
• Chronic renal disease
• Risk of placental abruption

20. PREVENTIVE MEASURES
• Regular antenatal check up
• Antithrombotic agents-low
dose aspirin 60 mg daily
• Calcium supplementation-
2gm/day to reduce risk of
pre eclampsia
• Anti oxidants-vitamin E & C
• Nutritional supplementation
with Magnesium,Zinc,Fish
oil, high protein and low salt
diet.

21. MANAGEMENT OF PRE-
ECLAMPSIA
OBJECTIVES
1. To stabilise 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

22. TREATMENT MODALITIES
REST
• In left-lateral position as much as possible.
• It lessen the effects of vena caval
compression.
• Increases the renal blood flow → diuresis
• Increases the uterine blood flow →
improves the placental perfusion
• Reduces the blood pressure.

23. DIET
• Should contain adequate amount of daily
protein (about 100 gm).
• Total calorie approximate 1600 cal/day.
• Usual salt intake is permitted.
• Fluids need not be restricted.

24. SEDATIVES
• To cut down emotional factor, mild
sedative may be given orally
(phenobarbitone 60mg or diazepam
5mg at bedtime is given)

25. DIURETICS
• Should not be used injudiciously as they
can harm to the baby by diminishing
placental perfusion and by electrolyte
imbalance.
• Indications for diuretics use are:
– Cardiac failure
– Pulmonary oedema
– Along with selective antihypertensive drug
therapy
– Massive oedema

26. ORAL ANTIHYPERTENSIVES
DRUGS
• Methyl dopa-250-500mg TID/QID-central
& peripheral anti-adrenergic action.
• Labetalol 250 mg TID/QID- Adrenoceptor
antagonist
• Nifedipine 10-20mg BID –Calcium channel
blockers
• Hydralazine 10-25mg BID-vascular
smooth muscle relaxant

27. PROGRESS CHART
• Blood pressure Q6H
• State of Edema & daily weight
• Fluid intake & output
• Urine examination for protein/24 hrs
• Blood examination- Hematocrit ,platelet
count, uric acid, creatinine , LFT once a
week.

28. METHODS OF TERMINATION
INDUCTION OF LABOUR
• Aggravation of the pre-
Eclamptic features in spite
of medical treatment and/or
appearance of newer
symptoms
• Hypertension persists in
spite of medical treatment
with pregnancy reaching 37
weeks or more.
• Acute fulminating pre-
eclampsia irrespective of
the period of gestation
• Post term pregnancy

29. METHODS OF TERMINATION
CAESAREAN SECTION
• Urgent termination is indicated and the
cervix is unfavourable.
• Severe pre-eclampsia
• Associated complicating factors, such as
elderly primigravidae, contracted pelvis,
malpresentation, etc

30. MANAGEMENT DURING
LABOUR
• Patient should be on bed
• Liberal sedatives
• Anti-Hypertensives drugs
• Blood pressure & urine output is monitored
• Care monitor of fetal well being
• Labour-ARM and deliver by forceps/ ventouse
• IV Ergometrine is contraindicated
• IM Oxytocin is given
• Sedation immediately-IM Morphine 15mg to
prevent postnatal Eclampsia

31. MANAGEMENT OF
PUERPERIUM
• Close monitoring for at least 48 hours
• Tab.Phenbarbitone 60mg is repeated for
effective sedation
• Anti- Hypertensive drugs is given until
diastolic pressure is below 100mmhg
• Patient is hospitalized until B.P brought
down to safe level and proteinuria
disappears

33. DEFINITION OF ECLAMPSIA
Pre-eclampsia when complicated
with generalized tonic clonic seizures
&/ or coma is called eclampsia.
D.C.DUTTA

34. PATHOPHYSIOLOGY OF
ECLAMPSIA
Since Eclampsia is a severe form of
pre-eclampsia the histopathological and
biochemical changes are similar although
intensified than those of pre eclampsia as
already described.

35. STAGES OF ECLAMPTIC
CONVULSIONS
• The Eclamptic fits are epileptiform &
consist of four stages , that are :
1).PREMONITORY STAGE :
*The patient becomes unconscious.
*There is twitching of muscles of face,
tongue & limbs.
*Eye balls or are turned to one side &
become fixed.
*This stage lasts for about 30 second.

36. 2.TONIC STAGE
*The whole body goes into a spam
called trunk opisthotonus.
*Limbs are flexed & hands
clenched.
*Respiration ceases & tongue
protrudes between the teeth.
*Cyanosis appears.
*Eyes balls become fixed.
*This stage lasts for about 30
seconds.

37. 3.CLONIC STAGE
*All the voluntary muscles undergo
alternate contraction & relaxation.
*The twitching starts in face then
involve one side of extremities &
ultimately the whole body is involved
in the convulsion.
*Biting of tongue occurs.
*Breathing is strenuous & blood stained
frothy secretions fill the mouth.
*Cyanosis gradually disappears.
*This stage lasts for 1-4 minutes.

38. 4.STAGE OF COMA
*Following the fit , the patient
passes on the stage of coma.
*It may last for a brief period or
in others deep coma persists
till another convulsion.
*On occasion, the patient
appears to be in a confused
state following the fit & fails to
remember the happenings.
*Rarely, the coma occurs without
prior convulsion

39. MANAGEMENT OF ECLAMPSIA
PRINCIPLES
• Arrest convulsion.
• Maintenance of patent airway ,
breathing & circulation.
• Oxygen administration at the rate 8-
10 L/Min.
• Terminate pregnancy.
• Ventilatory support.
• Prevention of complication.
• Hemodynimical stable.
• Prevention of life threatening
situation.
• Postpartum care

40. FIRST AID TREATMENT
• The patient , either at home
or in the health centres
should be shifted urgently
to the tertiary referral care
hospitals , because there is
no place of continuing the
treatment in such place.
• Sedation
• Maintain airway

41. NURSING MANGEMENT
• Aim to prevent serious maternal
injury from fall , to prevent aspiration
, to maintain airway & to ensure
oxygenation.
• Patient is kept in railed cot & a
tongue depressor is inserted
between teeth.
• She is kept in the lateral position to
avoid aspiration.
• Collect detailed history from the
relatives, relevant diagnosis of
eclampsia, duration of pregnancy,
number of fits & nature of medication
administered outside.

42. Cont..
• Continuous Vital signs monitoring
• Hourly urine output monitoring
• Fetal heart rate monitoring
• Fluid balance
• Antibiotic therapy

43. SPECIFIC MANAGEMENT
ANTIHYPERTENSIVE AND
SEDATIVE REGIME
1.Magnesium sulphate therapy-
IM/Prictchard Regimen-
Loading dose-4gm IV/10-15 min followed by
10gm deep IM (5gm in each buttock)
Maintenance dose-5gm IM Q4H in alternate
buttock

44. CONT..
• IV Zuspan or sibai regimen
Loading dose-4-6gm/15-
20minutes
Maintenance dose -1-2 gm/hr IV
• Lytic cocktail regimen
• Diazepam
• Phenytoin therapy
• Antihypertensive and diuretics.

45. OBSTETRICAL MANAGEMENT

46. NURSING DIAGNOSIS
• Activity intolerance related to increased
cardiac output as evidenced by edema
• INTERVENTIONS:
• Monitor daily blood pressure.
• Assist in Activity of daily living.
• Provide adequate rest.
• Avoid stress and vigourous activity.

47. NURSING DIAGNOSIS
• Deficient knowledge related to disease
condition.
• INTERVENTION:
• Explain about the disease condition to the
mother.
• Clarify the doubts about the disease condition.
• Health education to be given on anti hypertive
diet.

48. NURSING DIAGNOSIS
• Risk for decreased cardiac output related to
myocardial ischmia.
• INTERVENTIONS:
• Monitor blood levels and blood pressure
frequently.
• Provide calm and quiet environment.
• Provide anti hypertensive drugs as per order.
• Provide yoga and guided imaginary.

49. Journal references
• Pregnancy Induced Hypertension and
Associated Factors among Women Attending
Delivery Service at Mizan-Tepi University
Teaching Hospital, Tepi General Hospital and
Gebretsadik Shawo Hospital, Southwest,
Ethiopia
• Ethiop J Health Sci. 2019 Jan; 29(1): 831–840

50. • Background
• Disorders of pregnancy induced hypertensive are a major
health problem in the obstetric population as they are
one of the leading causes of maternal and perinatal
morbidity and mortality. The World Health Organization
estimates that at least one woman dies every seven
minutes from complications of hypertensive disorders of
pregnancy. The objective of this study is to assess
pregnancy induced hypertension and its associated
factors among women attending delivery service at
Mizan-Tepi University Teaching Hospital,
Gebretsadikshawo Hospital and Tepi General Hospital.

51. • Methods
• A health facility based cross-sectional study was carried
out from October 01 to November 30/2016. The total
sample size (422) was proportionally allocated to the
three hospitals. Systematic sampling technique was used
to select study participants. Variables with p-value of less
than 0.25 in binary logistic regression were entered into
the multivariable logistic regression to control
cofounding. Odds ratio with 95% confidence interval was
used. P-value less than 0.05 was considered as
statistically significant.

52. • Results
• The prevalence of pregnancy induced hypertension was
33(7.9%); of which 5(15.2%) were gestational
hypertension, 12 (36.4%) were mild preeclampsia,
15(45.5%) were severe preeclampsia and 1 (3%)
eclampsia. Positive family history of pregnancy induced
hypertension [AOR5.25 (1.39–19.86)], kidney diseases
(AOR 3.32(1.04–10.58)), having asthma [AOR 37.95(1.41–
1021)] and gestational age (AOR 0.096(0.04-.23)) were
predictors of pregnancy induced hypertension.

53. • Conclusion
• The prevalence of pregnancy induced
hypertension among women attending
delivery service was 7.9%. Having family
history of pregnancy induced hypertension,
chronic kidney diseases and gestational age
were predictors of pregnancy induced
hypertension.