Pregnancy Induced Hypertension

Post-Partum Clinical Journal Patient (RM) was a 26 year old primigravid admitted on 10/27/13. She had type O+ blood, non-immune to Rubella, negative for group beta strep, previous appendectomy, and right rotator cuff surgery. She had spontaneous rupture of membranes and was admitted with a blood pressure ranging in the 180’s for systolic and 100’s-110’s for diastolic. She also had increased amounts of protein in her urine which is a warning sign for renal damage. She was placed on magnesium sulfate to help treat her hypertension and as prophylaxis for seizures. She stated she was unaware of her blood pressure until she was admitted. She also stated she is very active and is involved in high school sports and coaching and was very surprised to learn about how increased her blood pressure had become. Hypertension does not run in her family but there is a history of arthritis and cancer among her grandparents. During labor, progression had slowed significantly and eventually became arrested. It was suspected that cephalopelvic disproportion was the cause. A cesarean section was scheduled and she was administered an epidural and ancef as prophylaxis for infection (Cefazolin, 2011). She delivered on 10/28/13 without complications. Her blood pressure decreased to the 140’s/80’s-90’s range where it remained. She was given the rubella vaccine and magnesium sulfate was discontinued. Pregnancy-induced hypertension (PIH) occurs in 5-10% of pregnancies (Sibai & Ross, 2010). Symptoms include nausea, vomiting, dizziness, headaches, and sudden weight gain (Sibai & Ross, 2010) but its occurrence may never be noticed and the mother may feel perfectly well as was the case for RM. She did have pitting edema in her feet and ankles which is a common symptom. PIH seems to be caused by inflammatory dysregulation due to increased proinflammatory molecules released by adipose tissue (Sibai & Ross, 2010). PIH is also associated with continued hypertension and future

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