It’s actually not been called “PIH” for years now 😉 and I’ve been reminded of this at the last few AWHONN conferences and conventions.
Preeclampsia is something that all of us deal with, regardless of what area of obstetrics you practice in. We seem to be seeing more and more patients with high blood pressure, and there doesn’t seem to be one way providers deal with it. It’s no wonder we get confused!! Last year after the 2014 AWHONN Convention I put together a handy little blog post about high blood pressure. Another year, another convention, and now another (updated) blog post 🙂 I hope someone out there finds this useful…
Some key points that I learned (or re-learned) at the 2015 AWHONN Convention that I think every nurse needs to remember:
- The diagnosis of severe preeclampsia is no longer dependent on the presence of proteinuria. Do not delay management of preeclampsia in the absence of proteinuria.
- There is preeclampsia with or without severe features (so no more “mild preeclampsia”).
- If a patient has “white-coat syndrome” (she’s nervous about being in her provider’s office), she’s more likely to end up with gestational hypertension or preeclampsia later in her pregnancy.
- These are the characteristics of severe preeclampsia:
- Hypertension: systolic >160 or diastolic >110 on two occasions at least 4 hours apart while the patient is on bed rest (unless antihypertensive therapy is initiated before this time).
- Thrombocytopenia (platelet count <100,000).
- Impaired liver function (elevated blood levels of liver transaminases to twice the normal concentration), severe persistent RUQ or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses, or both.
- New development of renal insufficiency (elevated serum creatinine greater than 1.1 mg/dL, or doubling of serum creatinine in the absence of other renal disease).
- Pulmonary edema.
- New-onset cerebral or visual disturbances.
Here are some online resources that will tell you everything you ever wanted to know about high blood pressure and pregnancy:
- Hypertension in Pregnancy – Report of the ACOG Task Force on Hypertension in Pregnancy – Updated 11/2013
- ACOG Committee Opinion Number 623 – Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period – Updated 2/2015
- Maternal Safety Bundle for Severe Hypertension in Pregnancy – This is a slide set for ob-gyns and health care providers developed as part of the Safe Motherhood Initiative, a collaborative project of ACOG, District II, and the New York State Department of Health’s Bureau of Women’s Health. Updated 1/2014
- California Preeclampsia Toolkit – Seriously, is there anything this collaborative doesn’t do?! They consistently produce amazing work. This is no different.
I pulled this directly off of ACOGs Frequently Asked Questions page, and I thought it was a great quick reference guide:
- What is high blood pressure?
- What is chronic hypertension?
- What is gestational hypertension?
- What kinds of problems can hypertension cause during pregnancy?
- How is chronic hypertension during pregnancy managed?
- What is preeclampsia?
- When does preeclampsia occur?
- What causes preeclampsia?
- What are the risks for my baby if preeclampsia occurs?
- What are the risks for me if preeclampsia occurs?
- What is HELLP syndrome?
Until my next delivery ❤
Categories: Nursing Students