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UNIT3 - HYPERTENSIVE DISORDERS IN PREGNANCY - Coggle Diagram
UNIT3 - HYPERTENSIVE DISORDERS IN PREGNANCY
DEFINITION
HTN is diagnosed in pregnancy if systolic BP >140 mmHg and/or diastolic BP >90 mmHg preferably on 2 separate occassions or atleast 15 mins apart
CLASSIFICATION
GESTATIONAL HYPERTENSION
blood pressure elevation after 20 weeks of pregnancy that is not accompanied by protienuria
PREECLAMPSIA
a systolic blood pressure of 140 mmHg or greater or a distolic blood pressure of 90 mmHg or greater occurring after 20 weeks of pregnancy that is accompanied by significant protienuria
ECLAMPSIA
progression of preeclampsia to generelize seizures that cannot be attributed to other causes
CHRONIC HYPERTENSION
the elevated blood pressure was known to exist before pregnancy or before 20 weeks of gestation
RISK FACTORS
first pregnancy
pre-eclamptic pregnancy
age > 35 years
anemia
Obesity
DM
Multifetal pregnancy
GESTATIONAL HYPERTENSION
Gestational hypertension is defined as sustained hypertension detected after 20th week of pregnancy in a previously normotensive woman without the evidence of protienuria
if gestational HTN persists after birth, chronic hypertension is diagnosed
TREATMENT
The aim is maintaining blood pressure of 140-150/90-100 mmHg
no treatment with antihypertensives for mild range pressures
all preeclampsia pts should recieve 75mg of aspirin daily and calcium supplimentation
SBP >170mmHg or DBP > 110 mmHg in a pregnant woman is an emergency and hospitalization is recommended
induction of delivery is recommended in gestational HTN with protienuria with adverse condition
In severe HTN, drug treatment with IV labetalol or oral methyldopa or nifedipine is recommended
PRE-ECLAMPSIA
major cause of intrauterine fetal growth restriction
SIGNS INCLUDE:
HTN
protienuria
thrombocytopenia
impaired liver function test
renal insufficiency
pulmonary edema
cerebral or visual symptoms
MANAGEMENT
AIM : to stop the disorder's progression and ensure fetal survival
THERAPY INCLUDES:
Complete bed rest in the prefered left lateral recumbent position to enhance venous return
administration of antihypertensive drugs
administration of magnesium sulphate to promote diuresis, reduce blood pressure and prevent seizures
if fetal life is endangered, cesarean labor
ECLAMPSIA
refers to the pre-eclamptic patient who progresses to ave generelized tonic-clonic seizures
MANAGEMENT
magnesium sulfate is the drug of choice to control eclamptic seizures
furosemide may be administered if pulmonary edema develops
administration of oxygen via a face mask at 8 to 10 L/min improves maternal and fetal oxygenation
urine output should be assessed hourly, and if output drops below 30 mL/hr, renal failure should be suspected monitored for ruptured membranes, signs of labor and abruptio placentae
CHRONIC HYPERTENSION
AIM: to ensure a healthy and safe pregnancy, if possible till term
dietitian should be consulted for appropriate diet and weight gain
adequate intake of protien helps to counteract the protien lost in urine
reduced salt intake
regular fetal surveillance by biophysical profile and kick counts
growth monitoring of fetus
pts with chronic HTN on medications can continue medication if safe. If not safe, shift to alternate group of medication
NURSING CARE
limit activity and promote rest in lateral recumbent position
raise siderails for safety if on magnesium sulphate
assess level of consciousness, deep tendon reflexes and presence of clonus
prepare administration of antihypertensive medication for blood pressure elevation
maintain accurate intake and output chart
closely monitor edema presence, location and degree
monitor for report of headache not relieved by pharmacologic therapy or visual disturbances