Pregnancy-induced hypertension

Sep 3 2007

Warnings signs such as increased stress could indicate that pregnancy-induced hypertension is reaching life-threatening levels, found Temple University researcher Kathleen Black, DNSc, RNC, the author of a study in the September/October issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing.

“The condition is variable and can change quickly. We need to be aware of symptoms changing from mild to worse. A higher number of symptoms could also mean [pregnancy-induced hypertension] is getting worse,” Black said.

Also known as preeclampsia and gestational hypertension, pregnancy-induced hypertension occurs at about 20 weeks in 6 percent to 8 percent of pregnancies. The exact cause is not known. Severe forms of these conditions can play a role in perinatal developmental issues of the fetus or even death for both the mother and fetus. The perinatal period is defined as the time of birth (five months before and one month after).

Women should call their physician if they're experiencing headaches, dizziness, frequent vomiting and malaise, Black said.

Usually, the blood vessels expand during pregnancy to increase blood flow, but high blood pressure causes them to clamp down, Black explained.

Nurses currently monitor the condition on an outpatient basis by checking in regularly with their patients. They generally look for the symptoms of persistent headache, blurred vision and abdominal pain as signs that it could be getting worse. In the study, Black suggests also assessing for other symptoms such as perceived stress, vertigo, inability to concentrate and mental changes.

Women become hospitalized and could deliver early if the condition is either severe or getting worse.

“Right now, the ‘cure' in severe cases is delivery, which could mean a premature baby. If it stays mild, the pregnancy can still go smoothly,” Black said.

Philadelphia resident Michelle Murphy-Rosanski delivered five weeks early in October 2003 because her preeclampsia became too severe. She suffered from a persistent headache, more than usual weight gain and sound sensitivity with the condition.

“I'm so glad my daughter and I are doing well. It was very frightening, you kept wondering if the baby was OK,” said Murphy-Rosanski, who is a nursing instructor. “All these things are going on with your body, and you don't know what to about it.”

Gestational hypertension is diagnosed when there is high blood pressure without protein in the urine. Preeclampsia is more serious than gestational hypertension, where the kidney leaks protein. Preeclampsia can affect many organs and cause serious or even life-threatening problems.

Black became interested in studying the condition while working as a perinatal nurse for high-risk pregnancies and a labor and as a delivery nurse for more than 25 years.

“I followed women with mild preeclampsia and saw their condition go from mild to severe within a few days. We want nurses to catch the symptoms as soon as possible. I wanted to see if there was a trigger for this,” she said.

In her study, Black found that stress is higher in women with worsening or severe preeclampsia and gestation hypertension. She said nurses can help their patients reduce stress levels by identifying social supports within the family and in the community, or bringing in a home nurse if needed. Women with mild preeclampsia should slow down their activities.

“We can give emotional support just by simply listening to them,” Black said.

Murphy-Rosanski said a home help nurse and her midwife helped her through the stressful situation. She also made sure her family understood the condition.

“It's important everyone around you knows what's going on. It's not something that you did wrong to make it happen,” Murphy-Rosanski added.

Based on this research, Black is developing a comprehensive tool for all nurses to monitor the condition and to assist women in coping with it.

“As nurses, we take a holistic approach to this issue by addressing the psychological and physical needs of the patient,” Black said.