Case Study

 Pregnancy Induced Hypertension



By
Artyom Granovskiy 4945131
 Introduction
vThe Patient is 36 years old Thai female,
vGestational age 36+3 weeks
vDx: Pregnancy Induced Hypertension
vFocus on Gestational hypertension and its effect
on mother and fetus
vDiscus in 2 parts: Theory & Case Study

 Circulatory system

 Definition of Blood Pressure
Blood pressure is the lateral force on the walls
of an artery by the pulsing blood under
pressure front the heart. Systemic or arterial
blood pressure, the blood pressure in the
system of arteries in the body, is a good
indicator of cardiovascular health.
The peak of maximum pressure when ejection
occurs is the systolic blood pressure. When
the ventricle relax the blood remaining in the
arteries exert to minimum or diastolic
pressure. Diastolic pressure is the minimal
pressure exerted against the arterial walls at
all times

Physiology of Arterial Blood Pressure
Blood pressure reflects the interrelationships of
 1. Cardiac output
 2. Peripheral vascular resistance
 3. Blood volume
 4. Blood viscosity
 5. Artery elasticity
 Hypertension
Is the most common alteration in blood
pressure is hypertension.
Hypertension is an often asymptomatic
disorder characterized by persistently
elevated blood pressure. The diagnosis of
hypertension in adults is made when an
average of two or more diastolic readings on
at least two subsequent visits is 90 mmHg
(diastolic hypertension) or higher or when the
average of multiple systolic blood pressures
on two or more subsequent visits is
consistently higher than 135 mmHg (systolic
hypertension).
Hypertension in Pregnancy
Hypertension is the most common medical problem encountered
during pregnancy, complicating 2-3% of pregnancies.
Hypertensive disorders during pregnancy are classified into
4 categories

Chronic hypertension
Preeclampsia
Eclampsia
Gestational hypertension
 Chronic hypertension
ØChronic hypertension is defined as blood
pressure exceeding 140/90 mm Hg before
pregnancy or before 20 weeks' gestation. When
hypertension is first identified during a
woman's pregnancy and she is at less than 20
weeks' gestation, blood pressure elevations
usually represent chronic hypertension.
 Mild preeclampsia:
Preeclampsia
BP 140/90 or systolic pressure elevated 30 mm Hg or diastolic
pressure 15 mm Hg above pre pregnancy level; proteinuria
1+ to 2+; weight gain 2 kg week at third trimester; mild
edema in upper extremities or face.
 Severe preeclampsia:
BP 160/110 mm Hg; proteinuria 3+ to 4+ or 5 g in 24 hrs;

oliguria (500 cc or less in 24 hrs); altered kidney function,

serum Creatinine elevated more than 1.2 mg/dL; CNS or
visual disturbances (headache, blurred vision) pulmonary or
cardiac involvement; extensive peripheral edema; hepatic
Preeclam p sia
dysfunction; thrombocytopenia; epigastric pain.

S e izu re s o r co m a a cco m p a n ie d b y sig n s a n d sym p to m s o f

p re e cla m p sia
 Gestational hypertension
 Blood Pressure 140/90 mm Hg or systolic pressure
elevated 30 mm Hg or diastolic pressure elevated
15 mm Hg above pre pregnancy level; no
proteinuria or edema; blood pressure returns to
normal after birth.
 Case Study
 Name :
 Sex : Female
 Age : 36
 Visit to ANC clinic : 3 November 2010
 Diagnosis : PIH
 Nationality : Thai
 Language : Thai
 Religion : Buddhist
 Marital status : Married
 Occupation : N/A
 Allergic : N/A
 Education : bachelor degree
 Family disease : not applicable

Health history :


 Family history : no
 Past history: no
 Past surgery / accident: no
 Allergies / reaction : no known allergies
 Obstetrical history : The patient had her first child at 29+ weeks
gestation, with baby’s weight 1,700 gm. During second pregnancy
she had spontaneous abortion at GA around 6 months. The last
pregnancy was 3 and a half years ago.
No. Date of Abnormal Gestational age Place/ type Complication Baby’s Sex/ weight Infant remark
Preg. delivery, antepartum labor condition at health
abortion birth

1 15.03.2003 29+ Glarng Underweight Girl 1,700 Healthy NL

gm

2 2004 Around 6 Ngaung Spontaneous

months Jok abortion

3 17.03.2007 40 weeks Nopparat Girl 3,900 Healthy NL

gm
 Assessment
 Current pregnancy:
 Menstrual period every 28 days, duration 3 days
 L.M.P.
 E.D.C. November 21st, 2010 (by U/S)
 Date of quickening : at around fifth month
 Current symptoms : no have
 Physical examination
 Height: 159 cm.
 Weight before pregnancy: 60 kg
 Weight of today 79 kg
 B.P. = 160/90 mmHg
 Edema : legs and ankles
 Breasts, nipples : normal
 Abdominal examination
 Height of fundus: 3/4 above umbilicus
 Position: LOA
 Engagement: engage
 F.H.S.: present
 Vaginal examination: -
 Laboratory finding
 Anti HIV: non reactive
 Blood group: A+
 Hct: 34.4%
 Urine (protein and sugar): negative
 VDRL (RPR): non reactive
 HBSAg: negative
 GLT
 OGTT: 70, 170, 148, 134
 Diagnosis: 1. Gestational age: 36+3 weeks
 2. Fetal position: normal
 3. Gestational Hypertension
 Treatment: 1. NST: to a monitor and evaluates the fetal
heart rate with fetal movement. If they're absent, the fetus may
not be receiving enough oxygen. 2. Consulting with physician
about PIH and fetus. 3. Bed rest
 ** observing point: elderly gravida, grand multipara.
 ANC
Date weight urine B.P. head naus blur fetal leuk edema vigi cra urin G.I. height of presentation GA (week) diagnosis& next visit
ache ea r mov orrh nal mp ary syste
vissi eme ea blee syste m
on nt din m
g

examinati (mmHg fundus FHS treatment

on )

Alb/Sug.

10/06/10 75 N/N 134/74 2/3>PS - 19

17/06/10 75.7 N/N 152/8 20

9
1/07/10 76.7 =O= LOA 22

6/09/10 78.1 N/N 150/80 neg ¾>O LOA NST = R

13/10/10 78.5 142/79 4/4>O LOA 32 NST = R

27/10/10 79 160/90 3/4>O LOA 36 NST = R

 Comparing the case to the
theory
Theory Case study
Pregnancy Induced Pregnancy Induced
Hypertension Hypertension
- Cause and risk factors - Cause and risk factors
Multiparity * Multiparity
Elderly pregnancy * Elderly pregnancy
   
- Signs and symptoms - Signs and symptoms
Blood Pressure 140/90 mm Hg or systolic Elevated Blood pressure 160/90
pressure elevated 30 mm Hg or diastolic No proteinuria
pressure elevated 15 mm Hg above pre Edema at feet and ankle 1+
pregnancy level; no proteinuria or
edema; blood pressure returns to normal
after birth.

-Treatment
No treatment necessary
Rest
No restriction in sodium intake
 Nursing care plan
Nursing priorities
1. Monitor maternal, fetal, and placental status.
2. Prevent or reduce progressive fluid
accumulation and other complications.
3. Promote positive maternal/fetal outcome.
4. Provide information to enhance self-care and
therapeutic management.



 BE HEALTHY =)
 &
 THANK YOU FOR YOUR
ATTENTION !