Hemodynamic Monitoring in High-Risk Obstetrics Patients, II: Pregnancy-Induced Hypertension and Preeclampsia

Critical care nurses are called upon to assist with the care of critically ill obstetrics patients. Some of the most complex care is required for patients with pregnancy-induced hypertension or preeclampsia. This article provides an overview of the pathological changes and expected hemodynamic changes associated with pregnancy-induced hypertension. A previous article¹ addressed the changes expected during a normal pregnancy and the changes associated with cardiovascular disease or hemorrhage. The clinical manifestations and medical and nursing management are summarized in a case study.

Interpreting the pathophysiological changes that occur with pregnancy-induced hypertension requires a review of the hemodynamic changes expected during pregnancy, particularly during the third trimester. In summary (Table 1), increases in systolic and diastolic blood pressure of up to 10% of baseline are expected.^2–,4 These increases in blood pressure reflect an increase in stroke volume and cardiac output, despite a decrease in systemic vascular...