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.
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).
What is the definition of chronic hypertension in pregnancy?
Which statements describe preeclampsia? Select all that apply.
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