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Pregnancy induced HTN

1. Gestation HTN

1. Onset without proteinuria/edema after 20wks

2. Resolves after delivery

2. Preeclampsia (mild) common last 10wks

1. BP140/90 or inc 30/15

2. 1+ to 2+ proteinuria

3. After 20wks

4. Slight edema, inc wt

3. Preeclampsia (severe)

1. BP150-160/100-110

2. 3-4+ proteinuria

S/Sx

    HA

    Epigastric pain

    Inc irritability

    Sudden onset general edema

    Hemorrhage

    Pulm edema

    Hyperreflexia

    H-hemolysis

    E- elevated

    L-liver enzymes

    L-low

    P-platelet count

1. Eclampsia

1. HTN

2. Proteinuria

3. Tonic-clonic seizures->COMA!!

2. Post delivery

1. If DIC (dessiminated intravascular coagulation)- anticoagulant therapy

1. Monitor BP 48hr

Inc risk:

    Lg fetus

    >35yo, <17yo

    Mult fetuses/ hydatidiform mole

    Poor nutrition

    Hx DM, renal disease, vascular D/O

    Obese, <100lbs

N/I

    Preeclampsia (mild) @ home

        Bedrest, L lateral position

        <2g salt, mod – high protein

        QD wt, REPORT 3lb inc wt in 24hr!!!!

    Preeclampsia (severe) @ hosp

        Complete Br, L lateral position

        V/S, FHR, I&O

        Seizure precautions

        Meds (Mg sulfate, hydralazine, valium, procardia)

    Eclampsia (EMG!!!!!!!!!!!!)

        IV w/ bore needle – fluid balance

        Dec stim

        Airway and o2 in case EMG

        Meds (Mg sulfate, apresoline, valium, procardia

        Delivery of fetus- monitor fetal status

        Type and cross match bld

        Postpartum -> monitor VS and seizure precautions