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23 terms

Pregnancy-Induced Hypertension

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Mild Preeclampsia
- exhibit few if any symptoms
- BP elevated to 140/90 or higher
- Proteinuria: 1g or less in 24 hr (2+ dipstick)
- generalized edema (puffy face or hands) and on dependent areas
- wt gain of more than 1.5 kg (3.3 lb)/mth in 2nd trimester
- wt gain of 0.5 kg (1.1 lb)/mth in 3rd trimester
Severe Preeclampsia
- may develop suddenly
- BP 160/110 or higher on 2 occasions at least 6 hrs apart when bedrest
- proteinuria of 5g or more found in 24-hr urine collection
- urine dipstick: 3+ to 4+ on two random samples in at least 4hrs apart
Symptoms of Severe Preeclampsia
- oliguria: 500mL or less in 24 hrs
- visual or cerebral disturbance
- cyanosis or pulmonary edema
- epigastric or right upper quadrant pain
- impaired liver function
- thrombocytopenia and or hemolysis
- intrauterine fetal growth restriction
- nausea, vomiting, irritability, hyperreflexia and retinal edema
Epigastric pain in preeclampsia
- sign of impending convulsion
- caused by increased vascular engorgement of the liver
Eclampsia
- characterized by grand mal convulsion or coma
- may occur before the onset of and during labor, or early in the postpartum period
Warning signs of mild preeclampsia
- weight gain of 1.4 kg (3lb) in 24 hrs
- weight gain of 1.8 kg (4lb) 4-day period
Management of mild preeclampsia
- usually home care
- daily BP, wt, urine protein and fetal movement monitoring
- remote nonstress tests (NSTs) twice per week
- weekly biophysical profiles
- nursing contacts varies from daily to weekly
- report worsening signs
Management of worsening preeclampsia
- bedrest on left side
- weighed daily
- evaluated for worsening edema, persistent headache, visual changes, or epigastric pain
- daily urine dipstick
- BP at least 4 times a day
- moderate to high protein diet
Moderate to high protein diet
- for severe preeclampsia to replace protein loss in urine
- 80-100 g/day or 1.5g kg-1 day-1
- moderate sodium intake, not exceed 6g/day
- no sodium restriction and no diurectics use
Fetal tests in pre-eclampsia
- more frequently done
- fetal movement record
- nonstress test
- ultrasonography every 3 or 4 weeks for serial determination of growth
- biophysical profile
- amniocentesis to determine fetal lung maturity
- doppler velocimetry beginning at 30-32 weeks of gestation to screen for fetal compromise
Hydralazine (Apresoline)
- Antihypertensives used in severe preeclampsia
- IV bolus
Methyldopa (Aldomet)
- Antihypertensives used in severe preeclampsia
- long-term control of mild to moderate HTN in pregnancy
labetalol (Normodyne, Trandate)
- Antihypertensives used in severe preeclampsia
- IV
- as effective as IV hydralazine but fewer side effects
nifedipine (Adalat, Afeditab CR, Nifediac, Nifedical & Procardia)
- Antihypertensives used in severe preeclampsia
- oral
- as effective as IV hydralazine but fewer side effects
Management of Eclampsia
- bolus of 4-6g of Ma Sulfate in 100mL NS IV over 15-30 mins to control convulsion
- antihypertensives to keep diastolic BP to 90-110 => to avoid potential reduction of uteroplacental blood flow or cerebral perfusion
- if seizure not controlled by Ma Sulfate => diazepam or amobarbital
- Dilantin => may be used to prevent seizure
- auscultate lungs to detect pulmonary edema
- Observed for circulatory and renal failure and signs of cerebral hemorrhage
- Furosemia: may be given for pulmonary edema
- Digitalis: may be given for circulatory failure
- Hourly I & O
- Signs of labor; bleeding, abd rigidity
- if comatose => position to side with side rails up
Anagelsics used in labor with eclampsia
- Meperidine (Demerol)
- Fentanyl
- pudendal block => vaginal birth
- epidural block => if adm by skilled anesthesiologist
Contraindication of spinal or epidural anesthesia in elcampsia
- presence of coagulopathy
- platelet count of 50,000/mm3
Birth position in eclampsia
- Sims' or semi-sitting position preferred
- a wedge under right buttock if lithotomy position and C-section
Assessment of proteinuria
- place an indwelling catheter
- evaluated hourly
- 3+ or 4+ urine dipstick: 5g or more of protein in 24 hrs
Diagnostics for PIH
- An increase of 30 mmHg systolic and 15 mmHg diastolic on two occasions
Indication(s) for Magnesium Toxicity
- Diminished reflexes
Indication(s) for Therapeutic magnesium level
- Slurred speech
- Decreased appetite
- and awkward movements
Treatment of choice for chronic HTN during pregnancy
- Methyldopa (Aldamet)