Gestational Hypertension

Pregnant Mother who have Gestational Hypertension

The Threat of High Blood Pressure

Definition

It is a potentially life-threatening disorder that usually develops after the 20th week of pregnancy. It is most common in nulliparous (have not been pregnant) women. There are two categories of gestational hypertension. This are:

Preeclampsia

• Non-convulsive form of the disorder
• It develops in about 7% of pregnancies and may be mild or severe
• Marked by the onset of hypertension after 20 weeks of gestation
• The incidence is significantly higher in low socioeconomic groups

Eclampsia

• Convulsive form of the disorder
• Occurs between 24 weeks of gestation and the end of the first postpartum (after delivery) week
• Incidence increases among women who are pregnant for the first time, have multiple fetuses, and have a history of vascular disease

Currently gestational hypertension and its complications are the most common cause of maternal death in the developed countries.

The Story Behind Gestational Hypertension

There is no exact cause for this condition. The systemic peripheral spasm of the vessles can occur. It affects every organ system. There are researches that support with geographic, ethnic, racial, nutritional, immunologic, and familiar factors may contribute to preexisting vascular disease, which in turn may contribute to its occurence. The age is considered as a factor. Adolescents younger than age 19 and primiparas (first time being pregnant) older than age 35 are at higher risk.

What to look for?

The following are the common clinical manifestations of a woman who have gestational hypertension:

1. Blood pressure over 140/90 mmHg or an increase of 300mmHg systolic and 15mmHg diastolic over baseline obtained in two occasions at least 4 to 6 hours apart;
2. Increase in generalized edema associated with a sudden weight gain of more than 5 lb (2.3kg) per week;
3. Usually appears between the 20th week and 24th weeks of gestation and disappears within 42 days after the delivery;
4. A final diagnosis usually deferred until blood pressure returns to normal after delivery; if blood pressure remains elevated, chronic hypertension, either alone or superimposed on gestational hypertension, may be the cause;
5. Additional signs and symptoms with severe preeclampsia include increased blood urea nitrogen (BUN), creatinine, and uric acid levels; frontal headaches (forehead), blurred vision, nausea, vomiting, irritability, and epigastric pain.

What tests is being done?

Laboratory tests is use to determine the protein level in the urine. Proteinuria (protein in the urine) is of gestational hypertension. In preeclampsia, there is protein level in the urine that exceeds 300mg/24 hours (1+) and in eclampsia, 5g/24 hours (5+) or more.

How is it managed medically?

1. High protein diet with adequate fluid intake with restriction of excessively salty foods;
2. Bed rest in side-lying position;
3. Close observance of blood pressure, fetal heart rate, edema, proteinuria, and signs of pending eclampsia;
4. Administration of antihypertensive drugs

How it is managed at home?

When you know someone who happens to have this condition, it is best for you to advise then to monitor their vital signs especially the blood pressure regularly. The fetal heart rate must be closely monitored as well. Monitor the extent and location of the edema. Make sure to provide a quiet, darkened room until the pregnant mother's condition stabilizes and enforce absolute bed rest. Provide emotional support to the pregnant mother and her family by:

• Encourage them to verbalize their feelings;
• If the mother's condition necessitates premature deliver, point out that infants of the mother with gestational hypertension are usually small for gestational age but sometimes far better than other preterm infants of the same weight, possibly because they have developed adaptive response to stress in utero; and
• Help the mother and her family to develop effective coping strategies.

Uterine Rupture

Actual Image of Uterine Rupture

 

The Realm of Ruptured Uterus

Description

This condition usually occurs in about 1 of 1,500 births. It starts when the uterus undergoes more strain thay it is capable of sustaining and then ruptures. The impending rupture is usually preceded by a pathological retraction rin. The rupture can be complete, going through endometrium, myometrium, and peretoneum, or incomplete, leaving the peritoneum intact. The viability of the fetus depends on the extent of the rupture and the time that elapses between the rupture and abdominal extraction. A woman who have this condition will suffer from blood loss.

What Causes it?

Usually it occurs from a previous cesarean birth, such as when a vertical scar from a previous incision is present. It can also occur from hysterectomy repair. Below are the common causes of this condition:

1. Prolonged labor
2. Faulty presentation
3. Multiple gestation
4. Use of oxytocin
5. Obstructed labor
6. Traumatic maneuvers using forceps or traction

What to look for?

The indentation appearing across the abdomen over the uterus. The strong uterine contractions without any cervical dilation can also be an indication for this condition. Other clinical manifestations are:

1. Sudden, severe pain during a strong labor contraction
2. Tearing sensation
3. Cessation of uterine contraction
4. Hemorrhage
5. Signs of shock
6. Change in Abdominal contour with two distinct swellings
7. Retracted uterus
8. Extrauterine fetus
9. Absent of fetal heart sounds

How is it treated?

At the end of pregnancy the uterus is highly vascular organ making uterine rupture an immediate emergency situation, comparable to a splenic or hepatic rupture. The treatment focues on the following measures:

1. Fluid replacement
2. Intravenous administration of oxytocin to contract the uterus and minimize bleeding.
3. Cesarean birth, if possible, will be done to ensure safe birth of the fetus.
4. Manual removal of the placenta under the general anesthesia may be necessary in the event of placental-stage pathologic retraction rings.
5. It is inadvisable for a mother to conceive again after uterine rupture, unless it occured in the inactive lower segment.

How to Manage this Condition at Home?

1. If the following signs mentioned above where being manifested by the pregnant mother, it is best to contact the hospital for immediate transportation.
2. Immediately provide information to the support person and inform them about the fetal outcome, the extent of surgery, and the safety of the mother and her fetus.
3. Offer emotional support and expect them to grieve, not only for the loss of this child (if applicable) but also for the loss of having future children through pregnancies (if a hysterectomy or removal of the ovaries or tubal ligation is performed).
4. Allow them time to express their emotions without feeling threatened.

Placenta Previa

Image of Pregnant Mother with Placenta Previa

A Closer Look at Placenta Previa

Definition

This condition usually occurs when the placenta implants in the lower part of the uterine segment is encroaches on the internal cervical os. There are three types of this condition:

1. Low Implantation
 - the placenta implants in the lower uterine segment

2. Partial Placenta Previa
 - the placenta partially oclcudes the cervical os

3. Total Placenta Previa
 - the placenta totally occludes the cervical os

One of the most common causes of bleeding during the second half of pregnancy is Placenta Previa.

The Wrath Behind Placenta Previa

The exact cause is unknown. It may be linked to uterine tumors or uterine scars from surgical procedure.

There are factors that may affec the site of the placenta's attachment to the uterine wall. It includes:
 - defective vascularization of the decidua;
 - multiple pregnancy (the placenta requires a large surface for attachement);
 - previous uterine surgery;
 - multiparity;
 - advance maternal age (35 years old and above).

The lower uterine segment of the uterus fails to provide as much nourishment as the fundus. The placenta tends to spread out, seeking the blood supply it needs, becoming larger and thinner than normal. The placental villi are torn from the uterine wall as the lower uterine segment contracts and dilates in the third trimester. As the internal cervical os effaces and dilates, the uterine vessels are torn and the Uterine sinuses are expose at the placenta site and bleeding can occur.

What to look for?

The following are the signs and symptoms of a pregnant mother who are diagnosed to have placenta previa:

1. Painless, bright red vaginal bleeding (common during the 20th week of pregnancy, especially during the third trimester);
2. Scanty bleeding (earliest sign of placenta previa);
3. Palpatation may reveal a soft, nontender uterus;

What are the tests to know that I have Placenta Previa?

Diagnostic tests are done to identify if the pregnant woman have manifested the signs and symptoms of Placenta Previa. The purpose of these tests is to confirm the condition and to provide a specific medical intervention.

1. Pelvic examination under a double setup (preparations for an emergency cesarean deliver) - because of the likelihood of hemorrhage to confirm the diagnosis.
2. Laboratory studies may reveal decreased maternal hemoglobin levels because of blood loss.
3. Transvaginal ultrasound scanning is used to determine placental position.
4. Radiologic test such as femoral arteriography, retrograde catheterization, or radioisotope scanning or localization, may be done to locate the placenta.

What are the Medical Management?

• Dependent on when the first episode occured and the amount of bleeding;
• Limitation of maternal activities;
• Monitoring of relevant vital signs;
• Emotional support;
• Rectal or vaginal examination, which could stimulate uterine activity should not be performed unless equipment is available for vaginal and ceasarean delivery;
• Vaginal delivery is considered only when the bleeding is minimal and the placenta previa is marginal or when the labor is rapid;
• Immediate cesarean delivery is performed as soon as the fetus is sufficiently mature or in the case of intervening severe hemorrhage.

What are the Possible Ways to Manage Placenta Previa at Home?

1. Immediately report any signs of bleeding and abnormal symptoms that you have felt to your doctor;
2. Have someone to monitor your vital signs if active bleeding occurs. This include the blood pressure, pulse rate, respiratory rate and fetal heart rate. Record it and refer to the doctor when you have arrived the hospital;
3. Monitor the amount of bleeding (pad counts) and refer it to the doctor. This is to identify the amount of blood loss.

The Threat of Placenta Previa

Placenta previa is a critical condition that can cause postpartum hemorrhage and infection. It can also cause fetal death if there is no immediate medical intervention applied to the pregnant mother.