Prgnancy induced hypertension

fiveofpeep · Feb 16, 2009

increase of what? bp? proteinuria?

afi06 · Feb 16, 2009

Am sorry,my questions are:

1) why is there increased edema in patients with PIH?

2) why is c-section not recommended in patients with PIH?

erjunkie8 · Feb 16, 2009

Hypertension is very hard on the kidney's. The increased edema is from the fluid shift and overworked kidney's not able to work as fast as they need to. PIH can lead to many other emergencies in which an early c-section is the result. PIH is another term for toxemia and that in turn can cause the mother to develop eclampsia.

The whole protein in the urine thing is a result from the increase in fluid. The protein spills into the urine since there is more volume and more pressure. Protein in the urine, high blood pressure and obvious edema are signs of PIH. It can be tricky though since it seems that most women have swollen ankles and looks more bloated towards the end of the pregnancy. That is becasue of the return circulation slowing down due to baby putting pressure on the organs that are involved in the circulatory system. For example, the liver is the one that returns it back to the heart. It filters it in and out. Liver working too hard = increased protein = protein in blood = protein in urine. Got it?

A cardinal sign of a patient who is pre-eclampsia is her blood pressure. PIH is more common in twin pregnancies, pre existing hypertension, diabetes and previous PIH in other pregnancies. Keep in mind that a BP of 140/90 can mean that the pt has PIH. For you and me we may run that high just from our diet and stress of being students. (we all know that students eat well balanced meals, work out and are never overwhelpmed, yeah right!!). Watch BP trends. PIH has a slow progression initially.

I am not sure what you mean by why a C-section is not recommended. PIH will resolve once the patient delivers. It is the only true cure. Many times a physician will attempt to place the patient on Mag Sulfate to decrease uterine contractility. Mag relaxes the muscles so the pt may appear to be lethargic. It just depends on where the patient is in her pregnancy and the viability of the fetus. Too early of a delivery increases mortality. A physician may place pt on dietary fluid restrictions, low salt intake and worst case complete bed rest with no physical activity.

PIH can be very dangerous. You have to evaluate trends in blood pressure and also check reflexes. Hyperreflexia is a sign that the patient may become pre eclampsia. PIH is slow progressing but in certain events can come on rapidly. The edema gets to be so much that the pt suffers from cerebral edema resulting in seizures. Mag sulfate! That is the key medication in this condition.

End result if pt is not a term pregnacy you would want a c-section and reverse the magnesium with calcium gluconate (after the delivery). That is the only way to save baby and mother. I believe and what I know for a fact that having hypertention prior to getting pregnant increases your odds significantly!! Having diabetes prior to gestation is another factor that plays into the PIH problem. PIH is a multitude of problems and can not be pin pointed by one or two causes. The main thing with this is to know what you have to do to treat the pt to prevent the overall emergency!! Women who are very overweight prior to getting pregnant run a higher risk for PIH. Good health prior to conception is good nursing teaching for any one working in an OB clinic.

(just so you know I am a new GN, however have done my practicum and have been hired as a L&D nurse. I worked in the Emergency Department for 10+ years and have seen the devistating effects of mortality full blown eclampsia can do to baby and mama when PIH goes untreated.)

Hope that helps...

erjunkie8 · Feb 16, 2009

and sorry.. I always write a lot. I like to explain it since it helps me too... hope it wasn't too much.