SECTION 4: Hypertensive Disorders — Gestational Hypertension, Preeclampsia, Eclampsia, HELLP, and Magnesium Sulfate

Definition of gestational hypertension

Blood pressure ≥140/90 after 20 weeks gestation without proteinuria.

When does BP return to normal in gestational hypertension?

Within 6 weeks postpartum.

Risk of progression from gestational hypertension to preeclampsia

25-50%.

Key assessments for gestational hypertension

Accurate BP measurement, absence of proteinuria or systemic findings, and fetal surveillance.

Nursing care for gestational hypertension

Patient education, weekly BP checks, daily kick counts, NST/BPP, and delivery at 37 weeks if stable.

Definition of preeclampsia

New-onset hypertension after 20 weeks (≥140/90) with either proteinuria or signs of organ dysfunction.

Main pathophysiologic changes in preeclampsia

Vasospasm, increased vascular permeability, and end-organ involvement.

Definition of severe preeclampsia

BP ≥160/110 with CNS changes, epigastric pain, abnormal labs, or decreased urine output.

Signs and symptoms of severe preeclampsia

Severe headache, visual changes, epigastric pain, N/V, hyperreflexia, edema.

Abnormal lab findings in preeclampsia

Increased AST/ALT, increased creatinine and uric acid, decreased platelets, proteinuria.

Cure for preeclampsia

Delivery of the infant and placenta.

Nursing care for preeclampsia

Frequent BP checks, strict I&O, Foley catheter, seizure precautions, magnesium sulfate, continuous fetal monitoring, quiet/dark environment.

Definition of eclampsia

Preeclampsia with onset of generalized seizures not caused by another condition.

When does eclampsia typically occur?

Usually in the last 10 weeks of pregnancy, but can occur postpartum.

Maternal risks associated with eclampsia

Pulmonary edema, cerebral hemorrhage, aspiration, death.

Fetal risks associated with eclampsia

Hypoxia, anoxia, prematurity.

Priority nursing action during eclamptic seizure

Protect airway, turn to side, maintain safety, administer oxygen, note seizure time.

After eclamptic seizure

Administer magnesium sulfate, monitor fetal heart rate, prepare for delivery.

Magnesium sulfate indication

Used to prevent and treat seizures in preeclampsia and eclampsia.

Magnesium sulfate therapeutic effects

CNS depressant that prevents seizures; may cause flushing, warmth, muscle weakness.

Therapeutic magnesium level

4-7 mEq/L.

Signs of magnesium sulfate toxicity

Absent DTRs, respiratory rate <12, urine output <30 mL/hr, O₂ sat <95%, hypotension, decreased LOC.

First sign of magnesium toxicity

Absent deep tendon reflexes.

Antidote for magnesium sulfate toxicity

Calcium gluconate.

Priority nursing assessments with magnesium sulfate

Monitor DTRs, RR, urine output, O₂ sat, and level of consciousness.

Does magnesium sulfate lower BP?

No—it is not an antihypertensive, it prevents seizures.

Medications used for hypertension in pregnancy

Methyldopa, labetalol, hydralazine, and magnesium sulfate.

Methyldopa route and indication

Oral; used for chronic or mild hypertension.

Labetalol route and indication

IV or PO; used for moderate to severe hypertension.

Hydralazine route and indication

IV; used for hypertensive crisis.

Definition of HELLP syndrome

Severe form of preeclampsia identified by specific lab findings: Hemolysis, Elevated Liver enzymes, and Low Platelets.

Meaning of HELLP acronym

H - Hemolysis; EL - Elevated Liver enzymes; LP - Low Platelets.

Characteristic symptoms of HELLP

Epigastric or RUQ pain, N/V, malaise, headache, visual changes, jaundice, severe edema.

Laboratory findings in HELLP

↑ AST/ALT, ↓ platelets (<100,000), evidence of hemolysis (↑ bilirubin, ↑ LDH).

Major maternal risks with HELLP

DIC, liver rupture, pulmonary edema, renal failure, placental abruption, maternal/fetal death.

Management of HELLP

Hospitalization in L&D or ICU, magnesium sulfate, monitor fluids, induction of labor (delivery = cure), avoid C-section if possible.

Why avoid C-section in HELLP?

Increased risk of bleeding due to low platelets.