This document discusses hypertensive disorders in pregnancy. It covers the significance, incidence, classification, pathophysiology, risk factors, care management, and key points regarding preeclampsia, eclampsia, gestational hypertension, and chronic hypertension. Specifically, it notes that hypertensive disorders complicate 5-10% of pregnancies, with preeclampsia occurring in 3-7% of pregnancies. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. Care management involves monitoring, activity restriction, medications like magnesium sulfate, and delivery once the condition is severe.

1. Slide 1Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 27Chapter 27
Hypertensive DisordersHypertensive Disorders
in Pregnancyin Pregnancy

2. Slide 2Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Significance and IncidenceSignificance and Incidence
 Hypertensive disordersHypertensive disorders
 5% to 10% of all pregnancies5% to 10% of all pregnancies
 PreeclampsiaPreeclampsia
• Complicates 3% to 7% of all pregnanciesComplicates 3% to 7% of all pregnancies
 Predispose the woman to serious complicationsPredispose the woman to serious complications
 Pregnancy associated hypertension accounts forPregnancy associated hypertension accounts for
10%-15% of maternal deaths worldwide10%-15% of maternal deaths worldwide

3. Slide 3Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
ClassificationClassification
Gestational Hypertensive DisordersGestational Hypertensive Disorders
 Gestational hypertensionGestational hypertension
 Onset of hypertension without proteinuria afterOnset of hypertension without proteinuria after
week 20 of pregnancyweek 20 of pregnancy
 PreeclampsiaPreeclampsia
 Pregnancy-specific syndrome in whichPregnancy-specific syndrome in which
hypertension develops after 20 weeks of gestationhypertension develops after 20 weeks of gestation
in a previously normotensive womanin a previously normotensive woman
 Catagorized as Mild or SevereCatagorized as Mild or Severe

4. Slide 4Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
ClassificationClassification
Gestational Hypertensive DisordersGestational Hypertensive Disorders
Mild PreeclampsiaMild Preeclampsia
Severe PreeclampsiaSevere Preeclampsia

5. Slide 5Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
 EclampsiaEclampsia
 Onset of seizure activity or coma in a womanOnset of seizure activity or coma in a woman
diagnosed with preeclampsiadiagnosed with preeclampsia

6. Slide 6Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
ClassificationClassification
Chronic Hypertensive DisordersChronic Hypertensive Disorders
 Chronic hypertensionChronic hypertension
 Hypertension present before pregnancy orHypertension present before pregnancy or
diagnosed before week 20 of gestationdiagnosed before week 20 of gestation
 Chronic hypertension with superimposedChronic hypertension with superimposed
preeclampsiapreeclampsia
 Women with chronic hypertension may acquireWomen with chronic hypertension may acquire
preeclampsia or eclampsiapreeclampsia or eclampsia

7. Slide 7Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
PreeclampsiaPreeclampsia
 EtiologyEtiology
 Signs and symptoms developSigns and symptoms develop
during pregnancy and disappear after birthduring pregnancy and disappear after birth
 Risk factorsRisk factors

8. Slide 8Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
PreeclampsiaPreeclampsia
 PathophysiologyPathophysiology
 Disruptions in placental perfusionDisruptions in placental perfusion
and endothelial cell dysfunctionand endothelial cell dysfunction
 Inadequate vascular remodeling in uterusInadequate vascular remodeling in uterus
 Placental ischemia causes cell dysfunction. ThisPlacental ischemia causes cell dysfunction. This
in turn causes generalized vasospasm whichin turn causes generalized vasospasm which
results in poor tissue perfusion in all organs,results in poor tissue perfusion in all organs,
increased resistance and B/P, and increased cellincreased resistance and B/P, and increased cell
permeability= less plasma volumepermeability= less plasma volume
 Reduced function in maternal organs (kidneys,Reduced function in maternal organs (kidneys,
liver, brain)liver, brain)

9. Slide 9Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
PreeclampsiaPreeclampsia
 Reduced function in placenta contributes toReduced function in placenta contributes to
iincreased incidence of placental abruption,ncreased incidence of placental abruption,
premature birth, early aging of placenta, restrictionpremature birth, early aging of placenta, restriction
of fetal growthof fetal growth
 HELLP syndromeHELLP syndrome
 Laboratory diagnosis for a variant of severeLaboratory diagnosis for a variant of severe
preeclampsia that involves hepatic dysfunctionpreeclampsia that involves hepatic dysfunction
 Diagnosis associated with increased risk forDiagnosis associated with increased risk for
adverse perinatal outcomesadverse perinatal outcomes

10. Slide 10Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Care ManagementCare Management
Identifying and AssessingIdentifying and Assessing
 Mild Preeclampsia: Assessment and homeMild Preeclampsia: Assessment and home
carecare
 Health history for risk factorsHealth history for risk factors
 Monitoring B/PMonitoring B/P
 Dependent edema/Pitting edemaDependent edema/Pitting edema
 Deep tendon reflexes (DTRs)Deep tendon reflexes (DTRs)
 Lab tests/biophysical monitoringLab tests/biophysical monitoring
 Activity restrictionActivity restriction
 DietDiet

11. Slide 11Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Slide 12Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Care ManagementCare Management
Hospital ManagementHospital Management
 Severe Preeclampsia: Hospital CareSevere Preeclampsia: Hospital Care
 Bedrest, side rails up, quiet roomBedrest, side rails up, quiet room
 Fetal monitoringFetal monitoring
 Magnesium sulfate- administered IVMagnesium sulfate- administered IV
 Control of blood pressure-antihypertensiveControl of blood pressure-antihypertensive
medicationsmedications
 Eclampsia- immediate care during convulsion-Eclampsia- immediate care during convulsion-
ensure a patent airway and prevent aspirationensure a patent airway and prevent aspiration

14. Care Management
 Postpartum Nursing Care
 Symptoms of preeclampsia or eclampsia resolve
usually within 48 hours
 Careful assessment of
• vital signs
• intake and output
• DTR’s
• level of consciousness
• uterine tone/ lochia flow- boggy uterus and
heavy lochia flow due to magnesium sulfate

15. Slide 15Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chronic HypertensionChronic Hypertension
 Affects 4%-5% of all pregnanciesAffects 4%-5% of all pregnancies
 Associated with increased incidence of:Associated with increased incidence of:
 Postpartum complications include:Postpartum complications include:
 Pulmonary edemaPulmonary edema
 Renal failureRenal failure
 Heart failureHeart failure
 EncephalopathyEncephalopathy

16. ATI QuestionATI Question
 A client with preeclampsia is receiving IVA client with preeclampsia is receiving IV
magnesium sulfate. Which of the followingmagnesium sulfate. Which of the following
should the nurse include in the plan of care?should the nurse include in the plan of care?
(select all that apply)(select all that apply)
a.a. Keep calcium gluconate at the bedsideKeep calcium gluconate at the bedside
b.b. Maintain lights at dim settingMaintain lights at dim setting
c.c. Have side rails up at all timesHave side rails up at all times
d.d. Keep a padded tongue blade at the bedsideKeep a padded tongue blade at the bedside
e.e. Encourage intake of clear fluidsEncourage intake of clear fluids

17. Slide 17Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 Hypertensive disorders during pregnancy areHypertensive disorders during pregnancy are
a leading cause of worldwide infant anda leading cause of worldwide infant and
maternal morbidity and mortalitymaternal morbidity and mortality
 Cause of preeclampsia unknown, and thereCause of preeclampsia unknown, and there
are no known reliable tests for predictingare no known reliable tests for predicting
which women are at risk for preeclampsiawhich women are at risk for preeclampsia
 Preeclampsia is a multisystem disease ratherPreeclampsia is a multisystem disease rather
than only an increase in BPthan only an increase in BP

18. Slide 18Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 Failure of trophoblastic invasion of spiralFailure of trophoblastic invasion of spiral
arterioles is proposed as triggeringarterioles is proposed as triggering
mechanism that leads to vasospasm andmechanism that leads to vasospasm and
organ ischemiaorgan ischemia
 Cure is delivery of fetus and placentaCure is delivery of fetus and placenta
 Pathologic changes of preeclampsia,Pathologic changes of preeclampsia,
involving every organ system in the body, areinvolving every organ system in the body, are
present long before clinical manifestationspresent long before clinical manifestations
are evidentare evident

19. Slide 19Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 Historic risk factors are associated with aHistoric risk factors are associated with a
higher incidence of preeclampsiahigher incidence of preeclampsia
 First pregnancy or pregnancy of new geneticFirst pregnancy or pregnancy of new genetic
makeupmakeup
 History of vascular diseaseHistory of vascular disease
 Multiple gestationMultiple gestation
 Progression of hypertensive disorders duringProgression of hypertensive disorders during
pregnancy is unpredictablepregnancy is unpredictable
 Mild hypertension must be taken seriously andMild hypertension must be taken seriously and
managed as for preeclampsiamanaged as for preeclampsia

20. Slide 20Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 Once preeclampsia clinically evidentOnce preeclampsia clinically evident
 Therapeutic intervention is palliative: bed rest, dietTherapeutic intervention is palliative: bed rest, diet
 May slow progression of disease and allowMay slow progression of disease and allow
pregnancy to continuepregnancy to continue

21. Slide 21Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 Home care management an option only forHome care management an option only for
womenwomen
 Whose condition is stableWhose condition is stable
 Who are able to comply with medical regimenWho are able to comply with medical regimen
 Reliably perform self-monitoringReliably perform self-monitoring
 Immediately recognize and report abnormal signsImmediately recognize and report abnormal signs
and symptomsand symptoms

22. Slide 22Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 HELLP syndrome can occur in women withHELLP syndrome can occur in women with
severe preeclampsia and is considered lifesevere preeclampsia and is considered life
threateningthreatening
 Magnesium sulfate, the anticonvulsive agentMagnesium sulfate, the anticonvulsive agent
of choice for preventing eclampsia, requiresof choice for preventing eclampsia, requires
careful monitoring of reflexes, respirations,careful monitoring of reflexes, respirations,
and urinary outputand urinary output
 Antidote, calcium gluconate, should be available atAntidote, calcium gluconate, should be available at
bedsidebedside

23. Slide 23Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Key PointsKey Points
 Intent of emergency interventions forIntent of emergency interventions for
eclampsia is to:eclampsia is to:
 Prevent self-injuryPrevent self-injury
 Ensure adequate oxygenationEnsure adequate oxygenation
 Reduce aspiration riskReduce aspiration risk
 Establish seizure control with magnesium sulfateEstablish seizure control with magnesium sulfate
 Correct maternal acidemiaCorrect maternal acidemia
 Chronic hypertension in pregnancyChronic hypertension in pregnancy
associated with abruptio placentae andassociated with abruptio placentae and
superimposed preeclampsiasuperimposed preeclampsia