Pregnancy Induced Hypertension (PIH) and Preeclampsia
A. Discussion of disease/condition
1. Incidence
Pregnancy Induced Hypertension (PIH) is a multi-organ disease process that develops as a result of pregnancy and regresses in the postpartum period. It usually develops after 20 weeks of gestation in a woman who had normal blood pressure. It is defined as an elevation of systolic and diastolic pressures equal to or above 140/90 mm Hg. In clinical practice, the terms PIH and preeclampsia are used interchangeable, but in preeclampsia the woman also has protein in her urine indicating that there is renal involvement as well. The only know cure for preeclampsia is delivery of the fetus. It is a relatively common problem of pregnancy and affects about 8% of all pregnancies. (Murray, p680)
2. Risk factors
There are many factors that increase a woman's risk. Those include women who are having their first baby, those under 17 years old, women who are obese, having diabetes mellitus, chronic hypertension, or preexisting vascular disease and women with multi-fetal gestation. Also a woman is more likely to have preeclampsia if the mother or sister has the disorder. (Murray, p681)
3. Etiology and Pathophysiology
Preeclampsia is due to generalized vasospasm. In natural pregnancy, vascular volume and cardiac output increase significantly, but despite these increases, blood pressure does not rise in normal pregnancy. This is because pregnant women resistance to the effects of vasoconstrictors such as angiotension. However, in preeclampsia, peripheral vascular resistance increase because some women are sensitive to angiotension
Vasospasm decrease the diameter of blood vessels which results in endotheli...
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... p685).
When given MgSo, the nurse determines the woman's respiratory rate hourly, level of consciousness and reflexes). Urine is checked for protein every four hours. She should assess the woman's stress level and help her with ways to lessen it.
Signs that the woman is recovering from preeclampsia include urinary output of 4-6 liter/day, decreased or no protein in urine and a return of normal blood pressure within 2 weeks. (Murray, p.685)
B How does your patient fit this textbook picture?
My patient, LC, fit this textbook picture in many ways. Theses include this is her first baby, she is obese, have diabetes mellitus (on her 14th week of pregnancy). She also had protein in her urine on 10/09/03 and her BP was 145/90 and so she was diagnosed with PIH and told to stay on her bed rest at home. On 10/09/03, she was diagnosed with preeclampsia.
Mayo Clinic collaborative services educational publication. (2004). Mayo Clinic Guide to a Healthy Pregnancy. New York, NY, Harper Collins Publishers Inc.
Patient A.B. was a 26 year old female who had delivered her baby girl at 0502, approximately two hours before I assumed care of the patient with my preceptor. This was her third pregnancy and all were a cesarean delivery. Gestational age at time of delivery was forty weeks and one day. Mom was group B strep negative and required no antibiotics, blood loss was approximately 400ml and baby had Apgar score of eight and nine. The patient had a very detailed birth plan which included some details such as; staying with her baby, breastfeeding, and providing
The causes of hypertension are unknown. However; hypertension can be classified into two categories primary and secondary. Primary (essential) hypertension is increas...
Risk factors involve the child itself and the parent or caretaker. Risk factors for the child consist of male gender, history of colic, prematurity, low birth weight, drug/nicotine/alcohol exposure, or withdrawal syndrome, special needs or medically fragile and babies with poor bonding to caregivers (Meskauskas, Beaton, & Meservey, 2009, p. 326). Young parental age, unstable family environment, low soc...
The hereditary risk factors for cardiovascular disease are primarily those of which individuals are unable to control, the ones for which they are born with. These risk factors would include an individual’s sex, race, age, and genetics. One out of every five males has some form of cardiovascular disease and the same applies for females. More women than men have cardiovascular disease in this country, but this is only due to the fact that there are more women within the U.S. population (Weiss and Lonnquist, 2011). Men percentage wise are at a higher risk than women. There is a somewhat reduced probability for females to have cardiovascular disease before menopause. This is believed by medical researchers and scientists to be directly related to the natural hor...
Your genetic information determines the genes you inherit that may cause or elevate your risk of certain medical conditions. My family genogram clearly indicates the risk of developing type 2 diabetes (T2D), heart disease (HD), hypercholesterolemia (HC) and hypertension (HTN). Heart disease is indicated on both maternal and paternal side and even though T2D only shows on my paternal side, the other diseases such as HC and HTN that are on my maternal side are risk factors for developing diabetes. According to Pessoa Marinho et al. (2013), the genetic and environmental risk factors that influence T2D development are: “age, gender, ethnicity, family history, obesity, inactivity, gestational diabetes, macrosomia, hypertension, decreased high-density lipoprotein cholesterol, increased triglycerides, cardiovascular diseases, micropolycystic ovary syndrome, high blood glucose on previous testing, impaired glucose tolerance and glycated hemoglobin ≥5.7%” (Pessoa Marinho et al., 2013, p. 570). Bianco et al. (2013) states, “the maternal influence confirms the hereditary role in the diabetes pathogenesis that women with positive family history to the illness presented...
Tobacco use during pregnancy is another environmental influence. The nicotine, carbon monoxide, and many other harmful chemicals mixed together in cigarettes are very harmful to the mother and especially the unborn child. This can cut off the baby’s oxygen supply, increase the risk of
of fatty substances on the inside wall of the arteries). It is not caused by
Any woman might develop gestational diabetes during her pregnancy. However, there are certain risk factors that increase your chance of developing gestational diabetes. Those risk factors include: overweight, family history of diabetes, being of an ethnic group with an increased risk for gestational diabetes, older than twenty-five, if you have had pre-diabetes or high glucose, previously had gestational diabetes. (IHC, 2013)
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
Whereas signs and symptoms to the mother can include: rapid uterine contractions, back and abdominal pain, vaginal bleeding, and uterine tenderness. Direct causes sometimes can correlate with direct injury to abdominal wall, rapid loss or excess of amniotic fluid, the mother’s lifestyle choices, hypertension, advanced maternal age, diabetes mellitus, and prior placental abruption. Although, preventive measures for placenta abruption is uncommon, attention to ongoing medical evaluation of fetal and maternal welfare connected with consideration of risk factors, outcomes can be
Prenatal care also includes many types of secondary prevention methods for expecting mothers. Keeping records of an expecting mother’s weight and blood pressure throughout pregnancy to make sure they are within the recommended range helps catch issues early. The expecting mother can have her blood tested to check for certain genetic markers that would detect certain diseases in the fetus to include, cystic fibrosis, sickle cell anemia, and tay-sachs disease (Kirkham, Harris, & ...
“Hyperemesis gravidarum is a relatively rare coniditon, occurring in about 0.3% to 2% of all pregnancies” (Davidson, London, &Ladewig, 2012). It is described as a condition in which nausea and vomiting are so severe that they affect both the mother’s nutritional and hydration status. It is still unknown what specifically causes hyperemesis gravidarum, but it is suggested that the levels of hCG and other pregnancy hormones play a role. Signs and symptoms that the illness is in fact hyperemesis gravidarum, and not just “morning sickness”, include not being able to keep any food down, lightheadedness or fainting, electrolyte imbalances, weight loss, and dehydration. According to Davidson, London, and Ladwig, “The diagnostic criteria for hyperemesis include a history of intractable vomiting in the first half of pregnancy, dehydration, ketonuria, and a weight loss of 5% of prepregnancy weight” (Davidson, London, & Ladewig, ...
When I asked aunt Connie about her health history, she mentioned that she was diagnosed with polycystic ovarian syndrome, a condition characterized by irregular menstrual periods, excess hair growth and obesity which increase the risk of type 2 diabetes, there a possibility that this condition increased her chances of suffering from type 2 diabetes.
Rattue, Grace. "Pregnancy Later In Life Increases Risk Of Heart Attacks." Medical News Today. MediLexicon, Intl., 5 Jul. 2012. Web. 20 Nov. 2013. http://www.medicalnewstoday.com/articles/247492