NURSING 306OB week 6 study guide.
• HYPERTENSIVE DISORDERS OF PREGNANCY!! (Know difference in definitions)
o Chronic hypertension
▪ Symptoms: Pre-existing hypertension
▪ Onset: exists prior to pregnancy
▪ Hypertension (BP >140/90) before conception or before the 20th week of gestation,
or HTN first diagnosed after 20 weeks’ gestation that persists after 12 weeks
postpartum, may put the woman at high risk of developing preeclampsia
▪ Assessment, monitoring, patient teaching, lifestyle interventions
▪ Medical management
o Gestational hypertension
▪ systolic BP >140/90 for the first time after 20 weeks, without proteinuria. Almost 50%
of women with gestational hypertension develop preeclampsia syndrome. When the
blood pressure increases appreciably, it can be a danger to the mother and the fetus.
▪ Assessment
▪ Monitoring
▪ patient teaching
▪ lifestyle interventions
• exercise 30 min a day
▪ Medical management
• Acute therapy: IV Labetalol, IV hydralazine
• Expectant therapy: Oral Labetalol, Methyldopa, Nifedipine
• Eclampsia prevention: MgSO4
▪ Contraindicated Antihypertensive drugs
• ACE inhibitors
• Angiotensin receptor antagonists
o Preeclampsia
▪ Preeclampsia is a hypertensive, multisystem disorder of pregnancy whose
etiology remains unknown.
▪ It is best described as a pregnancy-specific syndrome of reduced organ perfusion
secondary to vasospasm and endothelial activation.
,NURSING 306OB week 6 study guide.
▪ Diagnosis
▪ B/P readings
•
▪ Lab Values
• elevations in serum creatinine (72 mg/dL)
• Hematocrit levels (>35)
• Low platelet count (100,000/mm3)
• Elevated liver enzymes (AST >41 units/L, ALT >30 units/L)
▪ Basic idea of current research on pathophysiology
• Insufficient extravillous trophoblast invasion of uterine spiral arteries starting in
early pregnancy has been posited as a casual factor in the development of
preeclampsia, but little attention has been given to the uterine niche invaded
by the trophoblasts.
• Impaired or defective decidualization before and during early pregnancy
is associated with the development of severe preeclampsia
• “our current result suggest that it may be the ‘soil’ rather than (or in addition
to) the ‘seed’, which is a prime mover”
,NURSING 306OB week 6 study guide.
▪ Risk factors
• Nulliparity
• Age younger than 19 or older than 35 years
• Obesity
• Multiple gestation
• Family hx of preeclampsia
• Pre-existing hypertension or renal disease
• Previous preeclampsia or eclampsia
• Diabetes mellitus
▪ Risks to mother
• Cerebral edema/hemorrhage/stroke
• Disseminated intravascular coagulation (DIC)
• Pulmonary edema
• Congestive heart failure
• Hepatic failure
• Renal failure
• Abruptio placenta
▪ Risks to fetus
• Prematurity delivery may be indicated preterm related to deterioration
of maternal status
• Intrauterine growth restriction (IUGR) related to decrease
uteroplacental perfusion
• Low birth weight
• Fetal intolerance to labor because of decrease placental perfusion
• Still birth
▪ Assessment Findings
• Accurate assessment is essential so that early recognition of worsening
disease will allow for timely intervention that may improve maternal and
neonatal outcome.
o Elevated blood pressure: hypertension with systolic pressure 140
mmHg or greater and diastolic pressure 90 mmHg or greater
o Proteinuria 1+ or greater
o Lab values may indicate elevations in liver function tests,
diminished kidney function, and altered coagulopathies.
• HYPERTENSIVE DISORDERS OF PREGNANCY!! (Know difference in definitions)
o Chronic hypertension
▪ Symptoms: Pre-existing hypertension
▪ Onset: exists prior to pregnancy
▪ Hypertension (BP >140/90) before conception or before the 20th week of gestation,
or HTN first diagnosed after 20 weeks’ gestation that persists after 12 weeks
postpartum, may put the woman at high risk of developing preeclampsia
▪ Assessment, monitoring, patient teaching, lifestyle interventions
▪ Medical management
o Gestational hypertension
▪ systolic BP >140/90 for the first time after 20 weeks, without proteinuria. Almost 50%
of women with gestational hypertension develop preeclampsia syndrome. When the
blood pressure increases appreciably, it can be a danger to the mother and the fetus.
▪ Assessment
▪ Monitoring
▪ patient teaching
▪ lifestyle interventions
• exercise 30 min a day
▪ Medical management
• Acute therapy: IV Labetalol, IV hydralazine
• Expectant therapy: Oral Labetalol, Methyldopa, Nifedipine
• Eclampsia prevention: MgSO4
▪ Contraindicated Antihypertensive drugs
• ACE inhibitors
• Angiotensin receptor antagonists
o Preeclampsia
▪ Preeclampsia is a hypertensive, multisystem disorder of pregnancy whose
etiology remains unknown.
▪ It is best described as a pregnancy-specific syndrome of reduced organ perfusion
secondary to vasospasm and endothelial activation.
,NURSING 306OB week 6 study guide.
▪ Diagnosis
▪ B/P readings
•
▪ Lab Values
• elevations in serum creatinine (72 mg/dL)
• Hematocrit levels (>35)
• Low platelet count (100,000/mm3)
• Elevated liver enzymes (AST >41 units/L, ALT >30 units/L)
▪ Basic idea of current research on pathophysiology
• Insufficient extravillous trophoblast invasion of uterine spiral arteries starting in
early pregnancy has been posited as a casual factor in the development of
preeclampsia, but little attention has been given to the uterine niche invaded
by the trophoblasts.
• Impaired or defective decidualization before and during early pregnancy
is associated with the development of severe preeclampsia
• “our current result suggest that it may be the ‘soil’ rather than (or in addition
to) the ‘seed’, which is a prime mover”
,NURSING 306OB week 6 study guide.
▪ Risk factors
• Nulliparity
• Age younger than 19 or older than 35 years
• Obesity
• Multiple gestation
• Family hx of preeclampsia
• Pre-existing hypertension or renal disease
• Previous preeclampsia or eclampsia
• Diabetes mellitus
▪ Risks to mother
• Cerebral edema/hemorrhage/stroke
• Disseminated intravascular coagulation (DIC)
• Pulmonary edema
• Congestive heart failure
• Hepatic failure
• Renal failure
• Abruptio placenta
▪ Risks to fetus
• Prematurity delivery may be indicated preterm related to deterioration
of maternal status
• Intrauterine growth restriction (IUGR) related to decrease
uteroplacental perfusion
• Low birth weight
• Fetal intolerance to labor because of decrease placental perfusion
• Still birth
▪ Assessment Findings
• Accurate assessment is essential so that early recognition of worsening
disease will allow for timely intervention that may improve maternal and
neonatal outcome.
o Elevated blood pressure: hypertension with systolic pressure 140
mmHg or greater and diastolic pressure 90 mmHg or greater
o Proteinuria 1+ or greater
o Lab values may indicate elevations in liver function tests,
diminished kidney function, and altered coagulopathies.
