Introduction and Types of Hypertensive Disorders (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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      Slides Hypertensive Disorders of Pregnancy Nursing.pdf
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      Slides Hypertensive Disorders Introduction and Types of Hypertensive Disorders.pdf
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      Reference List Maternity Nursing Care of the Childbearing Family.pdf
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    00:01 Today, we're going to talk about one of the most common complications of pregnancy.

    00:05 And it's a grouping of disorders called hypertensive disorders of pregnancy.

    00:11 Hypertensive disorders typically affect about 5% to 10% of pregnancies overall.

    00:15 And they are the leading cause of maternal mortality.

    00:19 Remember, that's maternal death.

    00:22 Therefore, different classifications of hypertensive disorders that we're going to discuss today.

    00:27 Chronic hypertension, gestational hypertension, superimposed hypertension, and preeclampsia and eclampsia.

    00:36 Let's look at chronic hypertension.

    00:39 So epidemiologically speaking, it affects up to about 8% of pregnancies worldwide.

    00:44 And the definition of chronic hypertension, the way we use it in pregnancy anyway, is blood pressure that is greater than 140/90 on two different occasions prior to 20 weeks gestation, or after 12 weeks postpartum.

    01:00 So that definition might look a little bit different than some of your other guidelines for hypertension.

    01:05 So pay attention to this particular diagnosis.

    01:09 Now, other patients who experience chronic hypertension 41% will end up delivering via cesarean, 28% will experience a preterm birth, 25 to 40% will go on to develop preeclampsia, which is different.

    01:26 21% will have a baby that ends up in the neonatal intensive care unit, 17% will experience a baby of low birth weight, and 4% will have a fetal death.

    01:38 Gestational hypertension, which is the second classification is signified by a systolic blood pressure that's greater than 140, and or a diastolic that's greater than 90 that occurs after 20 weeks gestation.

    01:51 So before 20 weeks is chronic, after 20 weeks seemingly is related to the pregnancy, and that's why it's called gestational hypertension.

    02:01 Now, in gestational hypertension, there's an absence of proteinuria or any other signs of any end organ dysfunction.

    02:09 So the only thing that's abnormal is the blood pressure.

    02:12 Now, 15% to 45% of these patients will go on to develop preeclampsia.

    02:18 So, at this point, no other symptoms except an elevated blood pressure.

    02:22 Now, the fancy word superimposed hypertension occurs with clients who have chronic hypertension, who then go on to develop preeclampsia.

    02:32 So by definition, superimposed hypertension describes the worsening of hypertension, and development of new onset proteinuria after 20 weeks.

    02:41 So it's layered on top.

    02:43 So you come in with a gift and you get another one.

    02:47 Now, let's talk about the meat of our conversation.

    02:50 And that is preeclampsia.

    02:52 So according to the ACOG guidelines, which stands for the American College of Obstetrics and Gynecology, there's an epidemiology of 2% to 8% worldwide of incidences of preeclampsia.

    03:04 16.1% of maternal deaths of patients who were pregnant are caused by preeclampsia.

    03:11 And thinking about that in a numeric way, that's 76,000 maternal deaths, 500,000 fetal deaths.

    03:19 That's a lot. That is so much.

    03:22 The definition of preeclampsia is new-onset hypertension using the 140/90 guidelines, and proteinuria or end-organ disease after 20 weeks gestation.

    03:34 So it looks like superimposed hypertension, except that a superimposed patient had chronic hypertension first.

    03:42 This client didn't have any signs of any sort of hypertension at all until after 20 weeks.

    03:48 So what's different about these guidelines? What's changed? Proteinuria is no longer required for the diagnosis.

    03:55 So a client can have any other type of symptom and still be classified as preeclamptic, and also dependent edema.

    04:02 So remember, dependent edema is gravity dependent.

    04:05 So when you get up in the morning, everything's fine, but after you've been walking around all day, or sitting in a chair, or at your computer, you begin to get edema in your lower extremities.

    04:14 That's what dependent edema is.

    About the Lecture

    The lecture Introduction and Types of Hypertensive Disorders (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Hypertensive Disorders of Pregnancy: Preeclampsia (Nursing).

    Included Quiz Questions

    1. Blood pressure of > 140/90 mm Hg on two different occasions before 20 weeks of gestation
    2. Blood pressure of > 140/90 mm Hg on two different occasions after 20 weeks postpartum
    3. Blood pressure of > 140/90 mm Hg on two different occasions after 20 weeks of gestation
    4. Blood pressure of > 140/90 mm Hg on two different occasions after two weeks postpartum
    1. New-onset hypertension that develops after 20 weeks of gestation
    2. Affects 2-8% of pregnancies globally
    3. No previous history of hypertension is required for diagnosis
    4. Chronic hypertension that develops new-onset proteinuria prior to 20 weeks gestation
    5. Presence of proteinuria and dependent edema confirm diagnosis

    Author of lecture Introduction and Types of Hypertensive Disorders (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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