The hazards and nursing measures of pregnancy-induced hypertension

Pregnancy-induced hypertension is a common and relatively serious complication during pregnancy, which can seriously threaten the health of mothers and babies. Hypertension (≥140/90mmhg) and urine protein (-) that occur after 20 weeks of pregnancy are called gestational hypertension. Pregnancy-induced hypertension can further develop into preeclampsia and eclampsia. The basic pathological changes of this disease are systemic small blood vessel spasms and vascular endothelial damage. In severe cases, end organs are damaged and even convulsions occur. This article will describe the hazards and nursing measures of pregnancy-induced hypertension to help pregnant women better understand and deal with this disease.

1. The hazards of pregnancy-induced hypertension

1. Harm to pregnant women:

Hypertension is one of the main symptoms of pregnancy-induced hypertension. If not controlled in time, hypertension can cause headaches, blurred vision, nausea, vomiting and other discomfort symptoms in pregnant women. In addition, it can also cause damage to multiple organ functions in pregnant women, such as cardiovascular, brain, kidney, liver, blood, endocrine and metabolic systems. Hypertension can also lead to preeclampsia and eclampsia, seriously affecting the health of mothers and babies and increasing maternal mortality.

2. Harm to the fetus:

Pregnancy-induced hypertension also has a great impact on the fetus. Due to insufficient blood and oxygen supply to the placenta and decreased placental function, it leads to fetal development retardation, fetal growth restriction, premature birth, and severe cases can lead to stillbirth, etc. It increases the premature birth rate, asphyxia rate, and mortality rate of newborns.

2. Nursing measures for pregnancy-induced hypertension

1. General care: (1) Rest: Advise pregnant women to rest in bed more often, preferably in the left lateral position, to reduce the pressure of the right-rotated and enlarged uterus on the inferior vena cava, increase the amount of blood returning to the heart, and improve placental circulation. (2) Dietary guidance: Pregnant women should eat foods rich in protein, vitamins, iron, calcium, and trace elements such as zinc. Those with systemic edema should limit their salt intake. (3) Increase the number of outpatient prenatal examinations. Pregnant women with moderate or severe conditions must be hospitalized for treatment, and the wards should be kept quiet and clean.

2. Psychological care: During pregnancy, guiding pregnant women to maintain a happy mood will help inhibit the development of gestational hypertension. Informing pregnant women of the importance of treatment can relieve their mental concerns, enhance their confidence, and actively cooperate with treatment.

3. Observation of the condition: (1) Observe changes in blood pressure, especially diastolic blood pressure, to determine changes in the condition. (2) Regularly send urine routine tests and 24-hour urine protein quantitative tests. (3) Pay attention to subjective symptoms and observe whether the pregnant woman has headaches, dizziness, or chest tightness at any time. Once symptoms such as nausea and vomiting appear, it means that the condition has progressed and has entered the pre-menstrual pain stage, which should be treated promptly. (4) Pay attention to the occurrence of complications. Severely ill pregnant women should pay attention to the occurrence of complications such as placental abruption, DIC, cerebral hemorrhage, pulmonary edema, and acute renal failure. For example: D. Ask whether there are symptoms such as abdominal pain, palpitations, and vaginal bleeding. Check the fetal position and fetal heart rate and pay attention to the tension of the uterine wall and fetal movement to detect placental abruption early. Avoid abdominal trauma. After using sedatives, you should rest in bed and avoid resting in the supine position for a long time to prevent the right-rotated enlarged uterus from compressing the inferior vena cava and causing increased uterine venous pressure, leading to placental abruption. Check the coagulation function regularly and pay attention to the bleeding tendency such as nose bleeding, gum bleeding, easy blockage of the needle during blood drawing, and bleeding from the injection needle hole. Observe for symptoms of cerebral edema such as headache, nausea, vomiting, blurred vision, and impaired consciousness. When giving dehydrating agents, pay attention to the state of consciousness, pupils, limb movements, and diuretic effects to detect intracranial pressure and intracranial lesions. Record 24-hour urine volume, send urine for routine testing, and take blood samples for urea nitrogen, creatinine, uric acid, etc., and monitor renal function.

4. Strengthen intrauterine fetal monitoring: listen to fetal movement and fetal heart rate, use a fetal monitor, provide intermittent oxygen when necessary, and give intravenous infusion of carbon monoxide to enhance the fetus' tolerance to hypoxia in the uterus.

5. Pay attention to adverse drug reactions during treatment: (1) Magnesium sulfate Normal pregnant women have a serum magnesium ion concentration of 0.75~1mmol/L. If it exceeds 3mmol/L, magnesium ion poisoning may occur, that is, the knee reflex disappears, the whole body muscle tension decreases, and respiratory depression occurs in severe cases, and cardiac arrest occurs. Therefore, when using magnesium sulfate for treatment, it should be ensured that: the knee reflex exists and the breathing is not less than 16 times per minute; the urine volume is not less than 600ml per 24 hours and not less than 25ml per hour. The kidney is the only excretion pathway for magnesium ions, and magnesium ions are prone to accumulation and poisoning. Therefore, when using magnesium sulfate, 10ml of 10% calcium gluconate must be prepared as an antidote.

6. Delivery care: During delivery, care should be taken to maintain a quiet environment, closely observe the delivery process, try to shorten the second stage of labor, monitor the fetal heart rate and fetal movement, and in the third stage of labor, pay attention to check whether the placenta and fetal membranes are delivered in a timely and complete manner.

7. Postpartum care: 24-48 hours after delivery, attention should be paid to prevent postpartum pain, and a quiet rest environment should be arranged as much as possible. Blood pressure should be measured every 4 hours, and the understanding and cooperation of pregnant women and their families should be obtained, and visitors and accompanying personnel should be limited. Pay attention to observe uterine contractions and vaginal bleeding, strengthen perineal care, and prevent infection. 24-48 hours after delivery, attention should be paid to prevent postpartum pain, and a quiet rest environment should be arranged as much as possible. Blood pressure should be measured every 4 hours, and the understanding and cooperation of pregnant women and their families should be obtained, and visitors and accompanying personnel should be limited. Pay attention to observe uterine contractions and vaginal bleeding, strengthen perineal care, and prevent infection.

8. Make good emergency preparations: (1) Pregnant women with eclampsia should be placed in a single room, which should be darkened to avoid the stimulation of sound and light. (2) Prepare emergency items at the bedside: tongue opener, tongue puller, tongue depressor, electric sputum suction device and ambulance.

In summary, gestational hypertension is a serious pregnancy complication that may threaten the life and health of mother and baby. Therefore, pregnant women and their families should pay attention to the risk of gestational hypertension, take appropriate nursing measures, follow the doctor's guidance, and through various nursing measures and scientific treatment, the occurrence and harm of gestational hypertension can be reduced to ensure the health of pregnant women and fetuses.

(Liu Jianxia, ​​Lingshou County People's Hospital, Shijiazhuang City, Hebei Province)