Introduction:

Pregnancy Induced Hypertension (PIH) is a condition in which vasospasms

occur during pregnancy in both small and large arteries. Signs of hypertension,
proteinuria, and edema develop. It is unique to pregnancy and occurs in 5% to 7%
of pregnancies in the united states. Despite years of research, the cause of the
disorder is still unknown. Originally it was called toxemia because researchers
pictured a toxin of some kind being produced by a women in response to foreign
protein of the growing fetus, the toxin leading to the topical symptoms. No such
toxins have ever been identified.
A condition separate from chronic hypertension, PIH tends to occur most frequently
in women of color or with a multiple pregnancy; primiparas are younger than 20
years of age or older than 40 years, women from low socio economic backgrounds,
those who have an underlying disease such as heart disease, diabetes with vessel
or renal involvement and essential hypertension.
PIH is classified as gestational hypertension, mild preeclampsia, severe
preeclampsia and eclampsia, depending on how far development advances.
Gestational hypertension when develops an elevated blood pressure but has no
proteinuria or edema. Perinatal mortality is not increased with simple gestational
hypertension, so no drug therapy is necessary; and blood pressure returns to
normal after birth. Mild preeclampsia when blood pressure rises to 140/90 mmHg or
systolic pressure elevated 15 mmHg above pregnancy level; mild edema in upper
extremities or face. Severe preeclampsia when blood pressure has risen to 160
mmHg systolic and 110 mmHg diastolic; proteinuria; pulmonary or cardiac
involvement; extensive peripheral edema; hepatic dysfunction; theombocytopenia.
Eclampsia is the most severe classification of PIH and seizure or coma Accompanied
by s/s of preeclampsia. Any woman who falls into one of the high-risk categories for
PIH should be observed carefully for symptoms at prenatal visits. She needs
instructions about what symptoms to watch for so she can alert her clinician if
additional symptoms occur between visits.
Clinical Manifestations:
A. Mild Preeclampsia

BP of 140/90

1+ to 2+ proteinuria on random

weight gain of 2 lbs per week on the 2nd trimester and 1 lb per week on the
3rd trimester

Slight edema in upper extremities and face

B. Severe Preeclampsia

BP of 160/110

3-4+ protenuria on random

Oliguria (less than 500 ml/24 hrs)

Cerebral or visual disturbances

Epigastric pain

Pulmonary edema

Peripheral edema

Hepatic dysfunction

C. Eclampsia is an extension of preeclampsia and is characterized by the client

experiencing seizures.

Diagnostic Evaluation:
1. Based on the presenting symptoms. Often the disease process has been
developing and affecting the renal and vascular system
2. Frequently a sudden weight gain will occur, of 2 lb. or more in 1 week, or 6 lb.
or more within 1 month. This often occurs before the edema is present.
Medical Treatment and Evaluation:
1. Magnesium Sulfate (Pregnancy risk category B)
muscle relaxant, prevent seizures
loading dose 4-6g, maintenance dose 1-2g/h IV
infuse IV dose slowly over 15-30 min.
Always administer as a piggy back infusion.
Assess PR, urine output, DTR, and clonus every hour.
Observe for CNS depression and hypotonia in infant at birth.
2. Hydrazaline (Apresoline) Pregnancy risk category C
anti hypertensive (peripheral vasodilator) use to decrease hypertension
5-10mg/IV
Administer slowly to avoid sudden fall of BP
Maintain diastolic pressure over 90 mmHg to ensure adequate placental
filling.
3. Diazepam (Valium) Pregnancy risk category D
halt seizures
5-10mg/IV

administer slowly. Dose may be repeated every 10-15 min. (up to 30mg/hr)
Observe for respiratory depression for both mother and infant at birth.
4. Calcium Gluconate (Pregnancy risk category C)
antidote for Magnesium Sulfate
1g/IV (10 mL of a 10% solution)
have prepared at bed side when administering Magnesium Sulfate
administer at 5mL/min.
Complications of PIH:
1. Intrauterine growth restriction (IUGR) an abnormally restricted symmetric or
asymmetric growth of fetus
2. Oligohydramnios abnormally low volume of amniotic fluid
3. Risk of placental abruption premature separation of a normally situated
placenta from the wall of uterus
4. Risk of preterm delivery (often iatrogenic) delivery before 37 weeks of
gestation
5. Coagulopathy
6. Stillbirth
7. Seizures
8. Coma
9. Renal failure
10.Maternal hepatic damage
11.Hemolysis
12.Elevated liver enzymes levels
13.Low platelet count (HELLP syndrome)