1.

PREGNANCY COMPLICATIONS
2. GESTATIONAL DIABETES MELLITUS [GDM]
3. GESTATIONAL DIABETES Gestational diabetes is a type of diabetes that occurs only during pregnancy.
Like other forms of diabetes, gestational diabetes affects the way the body uses blood sugar (glucose).
As a result, the blood sugar level is too high. If untreated or uncontrolled, gestational diabetes can result
in a variety of health problems to fetus and mother. The good news is that controlling the blood sugar
can helps ensure a healthy pregnancy and a healthy start for the baby.
4. SIGNS AND SYMPTOMS Most women don't experience any signs or symptoms of gestational diabetes.
When they do occur, signs and symptoms may include: Excessive thirst Increased urination
5. CAUSES During digestion, body breaks carbohydrates into simple sugar molecules that it can
eventually use for energy. One of these sugar molecules is glucose, the main energy source for the body.
Glucose is absorbed directly into the bloodstream after eating, but it can't enter the cells without the
help of insulin.
6. Pancreas a gland located just behind the stomach produces insulin continuously. The insulin
"escorts" sugar into the cells, providing the body with energy while maintaining a normal
level of sugar in the blood. Liver also plays a key role in maintaining a normal blood sugar level. If
presence of more glucose than the cells need for energy, the body can remove that excess from the
bloodstream and store it in the liver as glycogen.
7. When runs low glucose for example, if not eaten for a while body can tap into that stored glucose
and release it into the bloodstream. The amount of glucose in the blood fluctuates in response to a
number of factors, including the food eat, exercise, stress and infections. Yet the complex relationship
among insulin, glucose and the liver ensures that the blood sugar stays within set limits.
8. During pregnancy, the placenta the organ that supplies the baby with nutrients through the
umbilical cord produces hormones that prevent insulin from doing its job. These hormones, which
include estrogen, cortisol and human placental lactogen, are vital to preserving the pregnancy. Yet they
also make the cells more resistant to insulin.
9. As placenta grows larger in the second and third trimesters, it secretes even more of these hormones,
further increasing insulin resistance. Normally, the pancreas responds by producing enough extra insulin
to overcome this resistance. But may need up to three times as much insulin as normal, and sometimes
the pancreas simply can't keep up.
10. When this happens, too little glucose gets into the cells and too much stays in the blood. This is
gestational diabetes. It usually occurs about the 20th to 24th week of pregnancy and can be measured
by the 24th to 28th week of pregnancy. After the baby is born and placental hormones disappear from
the bloodstream, blood sugar levels should quickly return to normal.
11. NORMAL METABOLISM Normally, the sugar (glucose) in the food is absorbed into the bloodstream
during digestion. Insulin from the pancreas escorts glucose into the cells, where it provides energy for
the body. Excess glucose is stored in the liver.
12. RISK FACTORS Any woman can develop gestational diabetes, but some women are at greater risk
than are others. Risk factors increases: Age . Women older than age 25 are more likely to develop
gestational diabetes. Family or personal history . Chances of developing gestational diabetes increases if
a close family member, such as a parent or sibling, has type 2 diabetes. And also more likely to have
gestational diabetes if presence in a previous pregnancy.
13. Weight . Being overweight before pregnancy makes it more likely that develops gestational diabetes.
However, gaining weight during the pregnancy doesn't cause gestational diabetes. Race . For reasons
that aren't clear, women of some races are more likely to develop gestational diabetes than are others.
Blacks, Hispanic or American Indian are increased risk. Previous complicated pregnancy . Unexplained
stillbirth or a baby who weighed more than 9 pounds, may screened more closely for gestational
diabetes the next time becomes pregnant.
14. WHEN TO SEEK MEDICAL ADVICE Health care provider will address gestational diabetes as part of
regular prenatal care. If develops gestational diabetes regular checkups. Depends on the severity of
the diabetes and other complications recommends follow up. Office visits with the health care
provider are especially important during the final three months of the pregnancy, when he or she will
carefully monitor the blood sugar levels.
15. In addition, the health care provider may refer to other health professionals who specialize in the
management of diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator. They
can help in learning to manage blood sugar during the pregnancy. In some cases, the health care
provider may refer to consult a doctor who specializes in high-risk pregnancies.
16. To make sure that the glucose level has returned to normal after the baby is born, blood sugar
checking after delivery and again in six weeks. And later tested at least once a year. And continue
healthy lifestyle habits to lessen the chances of developing type 2 diabetes.
17. SCREENING & DIAGNOSIS In some places, screening for gestational diabetes is a routine part of
prenatal care for all women. To screen for gestational diabetes, most doctors recommend a glucose
challenge test. This test is usually done between 24 and 28 weeks of pregnancy, because the condition
usually can't be detected until then.
18. If patient is younger than 25 and have no other risk factors for gestational diabetes, there is some
debate about whether to undergo the test. Some doctors argue that younger women don't need this
test. Others say that screening all pregnant women no matter their age is the best way to catch all
cases of the disease.
19. What to expect from the test At the time of arrival for a glucose challenge test, will be asked to drink
a glucose solution that tastes like extra-sweet soda pop. Then should wait for a one-hour, before a blood
sample is drawn from a vein in the arm to determine the blood sugar level. The glucose drink may makes
feel nauseous or dizzy. But the syrupy solution and the wait are necessary to tell how efficiently the
body processes sugar.
20. A blood sugar level below 140 mg/dL is usually considered normal on a glucose challenge test.
Having a blood sugar level above 140 mg/dL doesn't necessarily mean presence of gestational diabetes.
To confirm the diagnosis needs a second test. For the follow-up test asked to fast overnight. Then
given another sweet solution to drink this one containing a higher concentration of glucose and
blood sugar levels are checked every hour for a period of three hours. Having at least two instances of
abnormally high blood sugar levels confirms the diagnosis of gestational diabetes.
21. Why these tests? Some women wonder why it's necessary to undergo these screening tests in
addition to routine urine samples. A urine sample isn't a reliable indicator of gestational diabetes
because the amount of sugar in the urine can vary throughout the day and as a result of what you eat.
Screening tests are a much better way to identify women with gestational diabetes.
22. COMPLICATIONS Some women worry that having gestational diabetes will cause birth defects.
Fortunately, this usually isn't the case. In general, birth defects originate during the first three months of
pregnancy, while gestational diabetes generally doesn't develop until the second or third trimester. This
means the blood sugar levels are normal during the first critical months. Most women with gestational
diabetes go on to deliver healthy babies. Untreated or uncontrolled blood sugar levels can cause
problems for both the mother and newborn.
23. Complications that affects the baby Consistently keeping the blood sugar levels within a normal
range can reduce these possible complications: Macrosomia. Shoulder dystocia. Hypoglycemia.
Respiratory distress syndrome. Jaundice. Stillbirth or death.
24. Complications that may affect Preeclampsia. Operative delivery. Gestational diabetes in another
pregnancy. Type 2 diabetes.
25. PREGNANCY-INDUCED HYPERTENSION [PIH] PREECLAMPSIA
26. PREGNANCY-INDUCED HYPERTENSION *PIH+ Hypertension (BP 140/90 mm Hg) during pregnancy
can be classified as chronic or gestational. Chronic hypertension is BP that is high before pregnancy or
before 20 wk gestation. Chronic hypertension complicates about 1 to 5% of all pregnancies. Gestational
hypertension develops after 20 wk gestation (typically after 37 wk) and remits by 6 wk postpartum; it
occurs in about 5 to 10% of pregnancies, more commonly in multifetal pregnancy.
27. PREECLAMPSIA Preeclampsia is a common problem during pregnancy, affecting up to one in seven
pregnant women around the world. This condition is defined by high blood pressure and excess protein
in the urine after 20 weeks of pregnancy. It may also be called toxemia or pregnancy-induced
hypertension. It can lead to serious, even deadly complications for the pregnant woman and the unborn
baby.
28. Globally, preeclampsia and other high blood pressure disorders during pregnancy are a leading cause
of maternal and infant illness and death. The only cure for preeclampsia is delivery of the baby. After the
baby is born, blood pressure usually returns to normal within a few days. So delivery is the obvious
solution when preeclampsia is found near the end of pregnancy, which is typically the case. However, if
diagnosed earlier, treatment is trickier. Doctor will be faced with the delicate task of prolonging the
pregnancy to allow the baby more time to mature, without putting the mother or unborn child at risk of
serious complications.
29. SIGNS AND SYMPTOMS The signs of preeclampsia are elevated blood pressure (hypertension) and
the presence of excess protein in urine (proteinuria) after 20 weeks of pregnancy. Other signs and
symptoms aren't always noticeable, but may experience: Severe headaches Changes in vision, including
temporary loss of vision, blurred vision or light sensitivity Upper abdominal pain, usually under the ribs
on the right side Unexplained anxiety
30. Nausea or vomiting Dizziness Decreased urine output Swelling (edema), particularly in the face and
hands. Gestational hypertension. Chronic hypertension. Preeclampsia superimposed on chronic
hypertension. Other high blood pressure disorders during pregnancy
31. Other high blood pressure disorders during pregnancy Gestational hypertension. Chronic
hypertension. Preeclampsia superimposed on chronic hypertension.
32. CAUSES Preeclampsia used to be called toxemia because it was thought to be caused by a toxin in a
pregnant woman's bloodstream. Today, doctors and researchers know preeclampsia isn't caused by a
toxin. They've replaced this debunked theory with lots of other theories about what may cause
preeclampsia, but there's no clear answer yet, despite extensive research.
33. Possible causes include: Insufficient blood flow to the uterus Injury to the blood vessels Damage to
the lining of the blood vessels A disruption in the hormones that maintain the blood vessels A mistake
by the immune system Poor diet Lack of magnesium or calcium
34. RISK FACTORS The biggest risk factor for preeclampsia is simply being pregnant. Additional risk
factors include: History of preeclampsia. First pregnancy. Age younger than 20 or older than 35.
Obesity. Multiple pregnancy. History of certain conditions.
35. In a 2006 study, pregnant women who had high levels of two specific proteins in their blood were
found to be more likely to develop preeclampsia than were other women. These proteins interfere with
the growth and function of blood vessels. Research to confirm the findings is needed but the
discovery suggests that a blood test may one day serve as an effective screening tool for preeclampsia.
36. WHEN TO SEEK MEDICAL ADVICE When pregnant, likely experiences some discomfort. Headaches,
nausea, and aches and pains can be common. It's difficult to know when new symptoms are just part of
being pregnant and when they may indicate a serious problem especially if it's first pregnancy. The
best policy is to trust the instincts and see health care provider if don't feel right.
37. Call health care provider right away if having severe headaches, blurred vision or severe pain in
abdomen. But don't take a wait-and-see approach to other ailments. Serious complications of
preeclampsia can occur even before symptoms of preeclampsia, and don't get any points for toughing it
out until the situation is serious.
38. SCREENING & DIAGNOSIS Preeclampsia usually shows up unexpectedly during a routine prenatal
blood pressure check and urine test. So, it's important to seek regular prenatal care throughout the
pregnancy. Diagnosed with preeclampsia if having an elevated blood pressure and protein in the urine
after 20 weeks of pregnancy. Normal blood pressure readings for pregnant women are below 130/85
mmHg. A blood pressure reading of 140/90 mmHg or higher is considered above the normal range.
39. If presence of preeclampsia, doctor may want to do some blood tests to see how well the liver and
kidneys are functioning and to see if the blood has the normal number of cells that help blood clot
(platelets). Doctor may also recommend close monitoring of the baby's growth usually using
ultrasound. This test combines high-frequency sound waves and computer processing to generate
pictures of the inside of the uterus.
40. Nonstress test (NST) or biophysical profile to make sure the baby is getting enough oxygen and
nourishment, especially approach due date. A nonstress test is just that a noninvasive test that causes
no stress to the baby. In fact, it shouldn't be stressful either. It's a simple procedure that checks how
often the baby moves and how much his or her heart rate increases with movement. A biophysical
profile combines an ultrasound with a nonstress test to provide more information about baby's
breathing, tone, movement and the volume of amniotic fluid in the uterus.
41. COMPLICATIONS Most women with preeclampsia go on to deliver healthy babies. But preeclampsia
is a serious condition that can lead to two serious conditions and some problems for the baby. The more
severe preeclampsia and the earlier it occurs in pregnancy, the greater the risks for mother and baby.
HELLP syndrome is one of two serious complications of preeclampsia. HELLP stands for: H emolysis
the destruction of red blood cells; E levated L iver Enzymes; L ow P latelet Count Eclampsia
42. The warning signs and symptoms of ECLAMPSIA include: Pain in the upper right side of the abdomen
Severe headache Vision problems, including seeing flashing lights Change in mental status, such as
decreased alertness.
43. Problems for baby Preeclampsia affects the arteries carrying blood to the placenta. If placenta
doesn't get enough blood, the baby may receive less oxygen and nutrients. This can cause slow growth
or a low birth weight. Preeclampsia is also a leading cause of preterm birth.
44. In addition, preeclampsia increases the risk of placental abruption in which the placenta separates
from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can
cause the mother to go into shock. This condition is rare, but it's life-threatening for mother and baby. It
requires immediate medical attention. Rarely, preeclampsia may affect the fetus earlier and more
severely than it affects the mother. So it's important for the doctor to monitor the unborn baby carefully
even if preeclampsia seems mild.
45. INTRAUTERINE GROWTH RETARDATION [IUGR]
46. Intrauterine growth retardation (IUGR) means the unborn baby is not growing properly. The baby's
weight is lower than it should be for its stage of the pregnancy. The baby's growth and weight are
important. Small babies are more likely to have problems near the time of birth and after delivery.
47. How does it occur? women who do not have a balanced diet or whose health is poor women who
drink alcohol during the pregnancy teenagers women who smoke who weigh very little before they
become pregnant with a history of small babies in other pregnancies who take certain medicines or use
illegal drugs who have a multiple birth, such as twins or triplets. Women whose babies are more likely to
have this problem include:
48. Some of the conditions that can cause IUGR include: a placenta that is unable to provide proper
nourishment to the baby birth defects or inherited problems, such as heart, kidney, or chromosome
problems in the baby high blood pressure infections physical defects in the uterus too little or too much
fluid in the baby's sac exposure to radiation or chemicals chronic illness in the mother, such as heart,
kidney, or lung disease, or lupus.
49. SIGNS AND SYMPTOMS The only symptom might be that not gaining as much weight as expected.
Health care provider may find that the uterus is smaller than expected for stage of pregnancy.
50. DIAGNOSIS Health care provider will examine and measure the size of the uterus. The exam of the
uterus may show that it is not growing as fast as it should. Provider will also estimate the size of the
baby. Ultrasound scan is to measure the baby. Sometimes the uterus is smaller because not as far along
in the pregnancy as thought.
51. Provider will try to determine the baby's correct age. Provider may do blood tests or other tests to
see if presence of genetic problem, infection, or other medical problem that may be slowing the baby's
growth.
52. TREATMENT When IUGR is suspected: Ultrasound scans done at regular intervals to check the
growth of the baby. May be told to stop working or work less, rest more often or stay in bed, stop
smoking, or talk to a dietitian about how to improve the diet. Nonstress tests or biophysical profiles may
be done once or twice a week during the last 2 months of the pregnancy to check on the baby's
condition.
53. How long will the effects last? The risk of problems for the baby will exist as long as the baby's
growth problems continue, or until some form of treatment or delivery takes place.
54. Some of the possible problems for the baby are: not getting enough oxygen pneumonia after birth
because meconium got into the baby's lungs (meconium is a substance from the baby's bowels) trouble
holding a normal body temperature high levels of bilirubin in the baby's blood (bilirubin is a substance
made from the breakdown of blood cells) problems at the time of delivery death, in extreme cases.
55. SELF - CARE Early and regular prenatal visits with health care provider allow this condition to be
discovered early. Then carefully checked throughout the rest of the pregnancy. Pay attention to the
baby's movements. If the baby does not move very often, call the healthcare provider because the baby
may be sick. The best way self-care is to remain calm and follow the provider's directions. The baby
may be perfectly normal. Keep all the appointments with provider. Be sure to discuss the provider if any
concerns.
56. YOGA PRACTICES YOGA IS BALANCE (SAMATVAM) I A Y T CORRECTS IMBALANCES AIMS : STRESS
REDUCTION RELIEF OF PAIN MEDICATION REDUCTION
57. Thank You








Pregnancy Induced Hypertension (PIH)
Nursing Management
Pregnancy Induced Hypertension is a form of high blood pressure in pregnancy.
It occurs in about 5 percent to 8 percent of all pregnancies.
It is a condition in which vasospasm occurs during pregnancy in both small and large arteries. With high
blood pressure, there is an increase in the resistance of blood vessels. This may hinder blood flow in many
different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta.
It occurs in about 5 percent to 8 percent of all pregnancies.
Originally, it was called toxaemia because researchers pictured a toxin of some kind being produced by
woman in response to the foreign protein of the growing fetus, the toxin leading to the typical symptoms.
No such toxin has ever been identified.
Causes of Pregnancy Induced Hypertension (PIH)
Possible causes may include:
Insufficient blood flow to the uterus
Damage to the blood vessels
A problem with the immune system
Poor diet
Genes
Risk factors of Pregnancy Induced Hypertension (PIH)
Preeclampsia develops only during pregnancy. Risk factors include:
History of preeclampsia - A personal or family history of preeclampsia increases the risk of developing
the condition.
First pregnancy The risk of developing preeclampsia is highest during the first pregnancy or the first
pregnancy with a new partner.
Age The risk of preeclampsia is higher for pregnant women who are older than age 35.
Obesity The risk of preeclampsia is higher if the pregnant woman is obese.
Multiple pregnancies Preeclampsia is more common in women who are carrying twins, triplets or other
multiples.
Gestational diabetes Women who develop gestational diabetes have a higher risk of developing
preeclampsia as the pregnancy progresses.
History of certain conditions Having certain conditions before becoming pregnant such as chronic high
blood pressure, diabetes, kidney disease or lupus.
Signs and Symptoms of Pregnancy Induced Hypertension (PIH)
Hypertension -Elevated blood pressure

Source: pennmedicine.org
Proteinuria - presence of excess protein in the urine after 20 weeks of pregnancy.
Other signs and symptoms of Preeclampsia, which can develop gradually or strike suddenly, often in the last
few weeks of pregnancy, may include:
Severe headaches
Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
Upper abdominal pain, usually under the ribs on the right side
Nausea or vomiting
Dizziness
Decreased urine output
Agitation
Sudden weight gain, typically more than 2 pounds a week
Edema swelling particularly in the face and hands, often accompanies preeclampsia as well. Swelling
isnt considered a reliable sign of preeclampsia, however, because it also occurs in many normal
pregnancies.
Classifications of Pregnancy Induced Hypertension (PIH)
1. Gestational Hypertension
A woman is said to have Gestational Hypertension when she develops an elevated blood pressure (140/90
mmHg) but has no proteinuria or edema. Perinatal mortality is not increased with simple gestational
hypertension, so no drug therapy is necessary. Systolic blood pressure greater than 30 mmHg and diastolic
blood pressure greater than 15 mmHg above pregnancy values. No edema, no proteinuria and blood pressure
returns to normal after birth.
2. Mild Pre-eclampsia
A woman is said to be mildly pre-eclamptic when her blood pressure rises to 140/90 mmHg, taken on two
occasions atleast 6 hours apart. Systolic blood pressure greater than 30 mmHg and diastolic blood pressure
greater than 15 mmHg above pregnancy values. In addition to the hypertension, a woman has proteinuria (1+
or 2+ on a reagent test strip on a random sample). A weight gain of more than 2 lbs/week in the second
trimester or 1 lb/week in the third trimester usually indicates abnormal tissue fluid retention.
3. Severe Pre-eclampsia
A woman has passed from mild to severe preeclampsia when her blood pressure has risen to 160 mmHg
systolic and 110 mmHg diastolic or above on atleast two occasions 6 hours apart at bed rest. Marked
proteinuria. 3+ or 4+ on a random urine sample or more than 5 g in a 24 hour sample and extensive edema are
also present. With the severe preeclampsia, the extreme edema will be noticeable as puffiness in a womans
face and hands. It is most readily palpated over bony surfaces. The woman may manifest oliguria (altered renal
function), elevated serum creatinine (more than 1.2 mg/dL); cerebral or visual disturbances (blurred vision);
thrombocytophenia and epigastric pain.
4. Eclampsia
This is the most severe classification of PIH. A woman has passed into this stage when cerebral edema is so
acute that seizure or coma occurs. With eclampsia, the maternal mortality is high from cause such as cerebral
hemorrhage, circulatory collapse or renal failure. The fetal prognosis in eclampsia is poor because of hypoxia
and consequent fetal acidosis. The manifestations are the same accompanied by seizures.
HELLP Syndrome
HELLP syndrome is a complication of severe preeclampsia or eclampsia. HELLP syndrome is a group of
physical changes including the breakdown of red blood cells, changes in the liver and low platelets (cells found
in the blood that are needed to help the blood to clot in order to control bleeding).
Nursing Responsibilities of Pregnancy Induced Hypertension (PIH)
A woman with mild PIH
Promote bedrest
Promote good condition
Provide emotional support
Nursing Intervention for a woman with sever PIH
Support bed rest
Monitor maternal and well being
Monitor Fetal Well being
Support a Nutritious Diet
Administer medications to prevent eclampsia
Prevention of Pregnancy Induced Hypertension (PIH)
Theres no known way to prevent preeclampsia. Eating less salt or changing your activities during pregnancy
doesnt reduce the risk. The best way to take care of yourself and your baby is to seek early and regular
prenatal care. If preeclampsia is detected early, you and your doctor can work together to prevent
complications and make the best choices for you and your baby.
In a preliminary 2006 study, women who took multivitamins and maintained a healthy weight before
conception reduced the risk of developing preeclampsia during pregnancy by more than 70 percent compared
with women of a healthy weight who didnt take multivitamins or with women who took multivitamins but
were overweight before conception.
Several earlier studies suggested that specific nutritional supplements could prevent preeclampsia, but these
studies havent stood the test of time. Although a healthy weight before pregnancy has clear benefits for both
mother and baby, more research is needed to determine the preventive effects of multivitamins and other
nutritional supplements.