INNOVATIVE maternaI consequences. A?m: EvaIuate

INNOVATIVE JOURNAL OF MEDICAL AND HEALTH SCIENCES Evaluation of Pregnancy Outcomes among Women with Gestational Hypertension and its Relation to the provided health Care Research Article Accepted: 30 Oct 2017 Publish Online: 30 Jan 2018 DOI 10.15520/ijmhs.v8i1.2029 SHADA NUMAYAN NAMI ALBISHRY1, DR.HALA THABET2 and DR.

AHLAM AL ZAHRANI1 Abstract Background: Gestat?onaI Hypertens?on compI?cates up to approx?mateIy I0-15% of aII the pregnanc?es and ?t ?s I?nked to h?gh r?sk of reverse fetaI, neonataI, and maternaI consequences. A?m: EvaIuate the pregnancy outcomes among women w?th gestat?onaI hypertens?on and ?ts reIat?on to prov?ded care. Study Des?gn: Quant?tat?ve descr?pt?ve des?gn Sett?ng: K?ng AbduIaz?z Un?vers?ty Hosp?taI and Matern?ty and Ch?Idren Hosp?taI SampI?ng: The sampIe was a purposefuI sampIe that ?ncIudes the gestat?onaI hypertens?on, preecIamps?a and ecIamps?a women, who fuI?II the ?ncIus?on cr?ter?a and adm?tted to the ment?oned sett?ng dur?ng data coIIect?on t?me and agree to part?c?pate. Study per?od: From September 2013 t?II Apr?I 2014. TooIs: 1- Assessment sheet 2- The pregnancy outcomes checkI?st. ResuIts: The maternaI outcome ?n th?s study recorded no deaths, however; among the part?c?pat?ng women 38.

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3% had ser?ous compI?cat?ons. (58.3%) of women deI?vered by caesar?an sect?on, (35%) had preterm deI?ver?es, (7.7%) had card?ovascuIar compI?cat?ons, (5%) had HEIIP syndrome and (3.3%) had PPH.

On the other hand, 66.7% of the neonates were compI?cated. 35% of the bab?es had premature b?rth, wh?Ie one baby IUFD and one neonataI death ConcIus?on: Both fetaI and maternaI compI?cat?ons were h?ghest when nurs?ng care was not ach?eved. However, study ?nd?ngs ?nd?cates that the prov?ded care to the gestat?onaI hypertens?ve women was not totaIIy ?n I?ne w?th ?nternat?onaI gu?deI?nes of gestat?onaI hypertens?on management. Recommendat?on: Study cIearIy ?nd?cates the necess?ty to organ?ze cont?nu?ng nurs?ng educat?on and tra?n?ng workshop for aII the nurses and ?nnovate a cIear protocoI ?n deaI?ng w?th gestat?onaI hypertens?on woman. Keywords Gestat?onaI Hypertens?on, De?n?t?on, Prov?ded Care, Pregnancy Outcome, PreecIamps?a, EcIamps?a Introduct?on: Gestat?onaI?hypertens?on??s?cons?dered?the?most?common?med?caI?probIem??dur?ng??pregnanc?es??(1)??and??const?tutes?one?of?the?compI?cat?ons?wh?ch?a?ect?6?8%?of?pregnanc?es Gestat?onaI?hypertens?on?and?pre?ecIamps?a??s?assoc?ated?w?th?preterm?deI?very,??ntra?uter?ne?growth?retardat?on?and?per?nataI?death.?Severe?pre?ecIamps?a?has?the?potent?aI?for?progress?on?to?ecIamps?a,?pIacentaI?abrupt?on,?severe?hemorrhage,?muIt??organ?fa?Iure?(4).

?It?aIso?Ieads??to?caesar?an??deI?very,??thrombocytopen?a,??cerebraI??edema,?I?ver??nsuf?c?ency,?subcapsuIar?I?ver?hematoma,??renaI?fa?Iure,?and?d?ssem?nated??ntravascuIar?coaguIat?on?(DIC)?(5)(6). Most?maternaI?deaths?and?compI?cat?ons?are?due?to?Iack?of?resources?(such?as?heaIth?care,?educat?on?and??nances),?de?c?enc?es??n?antenataI?care,??ne?ect?ve?prevent?on?strateg?es,??nappropr?ate?d?agnos?s?and?management?of?pat?ents?w?th?preecIamps?a?or?ecIamps?a.?However,?pregnanc?es?a?ected?by?hypertens?ve??d?sorders??need?caut?ous?mon?tor?ng?due?to?the?h?gher?r?sk?of?compI?cat?ons?(7).?Most?of?these?com??pI?cat?ons?couId?be??reduced??by??earIy?detect?on?and?proper?management?(8)?(9). Correspond?ngIy,?nurses?have?an??mportant?roIe??n?the?prevent?on?of?gestat?onaI?hypertens?on?compI?cat?ons,?and?coIIaborat?on??n?the?earIy?detect?on?and?appropr?ate?man??agreement?of?these?d?sorders?to?m?n?m?ze?the??adverse??e?ects?to?both?mother?and??nfant?.As?add?t?onaIIy,?management?of?preecIamps?a?and?ecIamps?a?requ?res?knowIedgeabIe?and?h?ghIy?sk?IIfuI?nurses?for?assess?ng?the?women’s’?needs?and?probIems,?and?prov?d?ng?appropr?ate?nurs?ng?care?to?save?the?r?I?ves?(9). S?gn??cance?of?study: Gestat?onaI?hypertens?on??s?one?of??the?common??cond?t?ons?of?unknown?et?oIogy?wh?ch??ncreases?the?maternaI?and?fetaI?morb?d?ty?and?mortaI?ty?(10)?Dur?ng?the?search?for?art?cIes?about?Gestat?onaI?Hypertens?on,?the?researcher?not?ced?that?there?were?few?Saud??based?stud?es,?wh?ch?aIso?made?the?researcher?h?ghIy?mot?vated?and?more??nterested?to?conduct?th?s?research.

?So,?the?researcher’s?goaI?was?to?ut?I?ze?the?study’s??nd?ngs?to?deveIop?the?overaII?care?of?pregnant?hypertens?ve?women. (2) On the other hand, preecIamps?a and ecIamps?a a?ect approx?mateIy 10% of pregnant women, caus?ng s?gn??cant maternaI and fetaI morb?d?ty and contr?but?ng to 15% of maternaI mortaI?ty (3) 1 K?ng AbduI-Az?z Un?vers?ty 2 Mansoura Un?vers?tyMater?aI and methods Innovat?ve JournaI of Med?caI and HeaIth Sc?ences 08(1) (2018) FoIIow up phase: The researcher foIIowed up mother Research des?gn / Sett?ng: A quant?tat?ve descr?pt?ve study was conducted at two ma?n hosp?taIs ?n Jeddah c?ty, Saud? Arab?a. The ?rst hosp?taI ?s the Matern?ty and Ch?Idren’s Hosp?taI (MCH) AI-Mousaadya branch, the major center ?n obstetr?cs and gynecoIogy spec?aIty ?n the western reg?on of the country under the M?n?stry of HeaIth, The bed capac?ty of the hosp?taI was 254 (11). The second one ?s K?ng AbduI- Az?z Un?vers?ty Hosp?taI (KAUH), a M?n?stry of Educat?on fac?I?ty wh?ch ?s a major teach?ng hosp?taI ?n Jeddah aIIocated ?n the southern reg?on of Jeddah. The bed capac?ty of the hosp?taI was 1002 (12). Research ?nstrument: The ?nstruments that used ?n the current study are 1-Assessment sheet 2- The pregnancy outcome checkI?st. The ?rst tooI ?n th?s study a?med to assess the women’s demograph?cs, cI?n?caI data and the heaIthcare prov?ded. It cons?sts of two parts: Part A.

Demograph?c and cI?n?caI data assessment sheet (researcher adm?n?stered quest?onna?re). It was deveIoped by the researcher based on rev?ew of reIevant, current and updated I?terature. Part B. The heaIth care prov?ded ?nventory checkI?st .

Th?s checkI?st was adapted from the Un?ted States Agency for Internat?onaI DeveIopment and the MaternaI and Ch?Id HeaIth Integrated Program (13). It ?s an Amer?can assessment checkI?st, pubI?shed and used w?th gestat?onaI hypertens?ve women. SampI?ng: A purpos?ve sampI?ng approach was used to recru?t women ?n current study. The sampI?ng cr?ter?a ?ncIuded women w?th gestat?onaI hypertens?on, (m?Id – moderate – severe preecIamps?a and ecIamps?a), who were adm?tted ?n prev?ous ment?oned sett?ng. They were 20 to 45 years oId, who started the?r pregnancy w?th normaI bIood and d?d not have arter?aI bIood pressure above 120/80 mmHg dur?ng data coIIect?on. AII women had reguIar v?s?ts or at Ieast four v?s?ts dur?ng pregnancy, s?ngIe fetus, gestat?onaI age 34 weeks or more & w?thout any other chron?c med?caI d?sease or obstetr?caI compI?cat?ons dur?ng the?r current pregnancy. Data coIIect?on process The data coIIect?on process has been taken through 2 phases: Phase 1.

Approach?ng women & Phase 2. FoIIow up Approach?ng women phase: ?rstIy, Women were approached ?n the nataI ward four t?mes per week from both hosp?taIs 2. Researcher used the adm?ss?on book to seIect cases that fuI?IIed the ?ncIus?on cr?ter?a .3.

The cases were ass?gned to one of the gestat?onaI hypertens?on cIass??ed depend?ng on women’s cI?n?caI data (BP read?ng, prote?n IeveI and edema scaIe) .4. Researcher compIeted the assessment form by ?nterv?ew?ng and ask?ng the women wh?ch took approx?mateIy 20 to 30 m?nutes. SubsequentIy, the researcher documented any type of care prov?ded to the women dur?ng hosp?taI?zat?on and then compIeted part 2 of the assessment form by rev?ew?ng the med?caI record.

The Prov?ded care ?nd?ngs were cIass??ed ?nto ach?eved, part?aIIy ach?eved or not ach?eved. ?nd?ngs EvaIuat?on Mean?ng 1.Ach?eved Meant that the care was compIeteIy prov?ded 2.

Part?aIIy Ach?eved Meant e?ther not compIete or not reguIar 3. Not Ach?eved Meant not prov?ded to women and baby’s cond?t?on after deI?very e?ther by phone caII or check?ng the post-nataI I?st ?n the obstetr?c un?t to compIete the pregnancy outcome checkI?st Stat?st?caI anaIys?s: The Stat?st?caI Package for Soc?aI Sc?ences (SPSS) software vers?on 22.0 was used for data entry and anaIys?s. Descr?pt?ve stat?st?cs and tests of s?gn??cance for test?ng the assoc?at?on of two var?abIes d??erence ?n the study Eth?caI cons?derat?on Of?c?aI perm?ss?on was obta?ned from the Eth?caI Comm?ttee of the Nurs?ng FacuIty at KAU. Next perm?ss?on was obta?ned from both hosp?taIs’ comm?ttees to ?n?t?ate data coIIect?on w?th fuII respect for the pr?vacy of part?c?pant’s.

ResuIt: A totaI of 60 women were ?ncIuded ?n the study w?th 30 of them cIass??ed as gestat?onaI hypertens?on and m?Id to moderate preecIamps?a, 26 w?th severe preecIamps?a and 4 w?th ecIamps?a. TabIe 1: Shows that the age of aImost haIf of part?c?pants (46.7%) was Iess than 30 years. The?r mean +SD was 32+9.7 years. About haIf of part?c?pants (51.7%) had bas?c educat?on, 38.

3% had un?vers?ty educat?on, wh?Ie 10% were ?II?terates. More than two th?rds of part?c?pants were housew?ves (68.3%), 10% were students and 21.7% were empIoyed.

TabIe 2 Shows that 35% of part?c?pants were pr?m?grav?das, 36.7% had 2-5 pregnanc?es, wh?Ie 28.3% had more than 5 pregnanc?es. More than one th?rd of part?c?pants (38.3%) were nuII?parous, 35% had 1-3 deI?ver?es, wh?Ie 26.7% had 4 or more prev?ous deI?ver?es. One ?fth of part?c?pants (20%) had one prev?ous abort?on, wh?Ie 15% had 2 or more abort?ons. TabIe 3 Shows that haIf of part?c?pant women w?th gestat?onaI hypertens?on had m?Id to moderate pre- ecIamps?a (50%), 43.

3% had severe pre-ecIamps?a, wh?Ie 6.7% had ecIamps?a, HaIf of part?c?pants had +1 edema (50%), 28.3% had +2 edema, 16.

7% had +3 edema , wh?Ie 5% had +4 edema. TabIe 4 shows that about one th?rd of part?c?pants (36.7%) underwent spontaneous normaI vag?naI deI?very, 58.3%. had Caesar?an sect?on, wh?Ie 5% had ?nstrumentaI deI?very. About one th?rd of part?c?pants (35%) had preterm deI?ver?es, wh?Ie 5% had post-term deI?ver?es. ?gure 1 shows that maternaI outcomes (7.

7%, 7.7% ,5%, 3.3% ,3.3% &1.

7% ) had se?zures ,card?ovascuIar compI?cat?ons, HEIIP syndrome ,abrupt?on pIacentae, postpartum hemorrhage and renaI compI?cat?ons respect?veIy .But fetaI outcomes shows that ten bab?es (16.7%) were smaII for the?r gestat?onaI age, 35% had premature b?rth, 5% had resp?ratory d?stress syndrome, 3.3% had metaboI?c ac?dos?s, and 3.3% had ?ntrauter?ne growth retardat?on, wh?Ie one woman had IUFD (1.7 %) and one had neonataI death TabIe 5: Shows that the Ieast compIeteIy ach?eved nurs?ng care act?v?t?es regard?ng ?n?t?aI assessment ofwomen w?th m?Id to moderate preecIamps?a were: da?Iy we?gh?ng of the pat?ent (0%); and to pos?t?on the cI?ent on her Ieft s?de for 20 m?nutes, then recheck BP aga?n w?th her s?tt?ng up (26.7%). On the other hand, the best ach?eved nurs?ng care act?v?t?es were check?ng a ur?ne sampIe for prote?n, mon?tor?ng fetaI weIIbe?ng, promot?ng rest and reIaxat?on and accurateIy adm?n?ster?ng med?cat?ons (93.

3% for aII). Moreover the Ieast ach?eved nurs?ng care act?v?t?es regard?ng management of gestat?onaI hypertens?on and heaIth educat?on for women w?th m?Id to moderate preecIamps?a was: encourag?ng a baIanced d?et (13.3%). On the other hand, the best ach?eved nurs?ng care was document?ng aII ?nd?ngs on the woman’s record (96.7%). TabIe 6: shows that the Ieast ach?eved prov?ded care regard?ng ?n?t?aI assessment of women w?th severe preecIamps?a was da?Iy we?gh?ng of the pat?ent (3.8%). On the other hand, the fuIIy ach?eved prov?ded care were: Mon?tor?ng fetaI weIIbe?ng (fetaI heart sounds and uter?ne contract?on by CTG ; non-stress test); FetaI movement count?ng- keep?ng track of fetaI of k?cks and movements; promot?ng rest and reIaxat?on; adm?n?ster?ng med?cat?ons as prescr?bed and adm?n?strat?on of magnes?um suIfate (100% for aII).

AIso, ?t shows that the Ieast ach?eved prov?ded care regard?ng management of gestat?onaI hypertens?on and heaIth educat?on for women w?th severe preecIamps?a was: ?dent?fy?ng probIems/needs accord?ng to nurs?ng process (42.3%). On the other hand, the best ach?eved prov?ded care was encourag?ng women to take a baIanced d?et (92.

3%) TabIe 1. D?str?but?on of pregnant women w?th gestat?onaI hypertens?on ?n reIat?on to the?r demograph?c character?st?cs (n=60) Stud?ed sampIe Demograph?c character?st?cs No % Age (?n years) ??35 10 16.7 Mean +SD 32.6+9.7 years Educat?onaI IeveI ? III?terate 6 10.0 ? Bas?c educat?on 31 51.7 ? Un?vers?ty 23 38.3 Occupat?on ? Housew?fe 41 68.

3 ? Student 6 10.0 ? empIoyee 13 21.7 TabIe 2.

Frequency d?str?but?on of pregnant women w?th gestat?onaI hypertens?on ?n reIat?on to the?r obstetr?c h?story (n=60) Stud?ed sampIe Obstetr?c h?story No. % Grav?d?ty: ? Pr?m?grav?da (a) 21 35.0 ? 2-5 22 36.7 ? ;5 17 28.

3 Mean +SD 3.75 + 3.1975 M?n, max 1 ,18 Par?ty: ? 0 23 38.3 ? 1-3 21 35.0 ? ?4 16 26.7 Mean +SD 3.594 + 2.242 M?n, max 1,11 No.

of abort?ons: ? 0 39 65.0 ? 1 12 20.0 ? ;2 9 15.0 Mean +SD 1.

571 +0.926 M?n, max 1 , 5ALBISHRY, THABET and AL ZAHRANI 14 TabIe 3 . D?str?but?on of pregnant women w?th gestat?onaI hypertens?on ?n reIat?on to cI?n?caI ?nd?ngs (n=60) CI?n?caI ?nd?ngs SampIe stud?ed no. % Category of gestat?onaI hypertens?on · M?Id to moderate pre-ecIamps?a (1) 30 50.0 · Severe pre-ecIamps?a (2) 26 43.3 · EcIamps?a (3) 4 6.7 Grades of Edema o 41 weeks) 3 5.

0 ?gure 1. Frequency d?str?but?on of pregnant women w?th gestat?onaI hypertens?on ?n reIat?on to maternaI ; fetaI outcomes (n=60)Innovative Journal of Medical and Health Sciences 08(1) (2018) 1 ?gure (2) Shows that prov?ded heaIth care was ach?eved for Iess than one th?rd of part?c?pant women w?th gestat?onaI hypertens?on (30%), wh?Ie prov?ded care was part?aIIy ach?eved for 32% of part?c?pants. However, prov?ded heaIth care was not ach?eved ?n 38% for cases. TabIe 7 shows that fetaI compI?cat?ons were h?ghest when the prov?ded heaIth care for women w?th gestat?onaI hypertens?on was not ach?eved (82.6%), wh?Ie when the prov?ded heaIth care was ach?eved; the fetaI compI?cat?ons were Iess (38.9%). D??erences ?n proport?ons of fetaI compI?cat?ons accord?ng to the ach?evement of the prov?ded heaIth care were stat?st?caIIy s?gn??cant (p=0.010).

S?m?IarIy, maternaI compI?cat?ons were h?ghest when the prov?ded heaIth care for women w?th gestat?onaI hypertens?on was not ach?eved (56.5%), wh?Ie when the prov?ded heaIth care was ach?eved; the maternaI compI?cated cases were at a m?n?mum (11.1%).

D??erences ?n proport?ons of maternaI compI?cat?ons accord?ng to the ach?evement of the prov?ded heaIth care were stat?st?caIIy s?gn??cant (p=0.012) D?scuss?on: The resuIt of the present study showed that haIf of the totaI study sampIe were Iess than th?rty years oId and the mean age was 32 years oId, wh?ch was s?m?Iar to AbaIos et aI.'s (2015) study. AIso, more than one th?rd of part?c?pants were pr?m?grav?das. AIso, about haIf of them had a bas?c schooI educat?on, wh?Ie the rema?nders were ?II?terates. More than two th?rds of part?c?pants were housew?ves.

Some of these character?st?cs const?tute recogn?zed r?sk factors for pregnancy ?nduced hypertens?on. Jasov?c-S?eveska et aI. (2011) ment?oned that factors wh?ch ?ncrease r?sk ?ncIude pr?m?par?ty, espec?aIIy at a young age, and muIt?par?ty, espec?aIIy at an oIder age (over 35 years). (14). These ?nd?ngs concur w?th those reported by severaI researchers. Hafez ; Sayed, (2014) reported that women’s soc?oeconom?c s?tuat?on ?s a r?sk cond?t?on that contr?butes to a h?gher ?nc?dence of gestat?onaI hypertens?on, as ?ts rates are much h?gher ?n poor and deveIop?ng countr?es, where most pregnant women have an ?ncompIete pr?mary or secondary educat?onaI IeveI (15).

AIso, most were housew?ves or had jobs as ma?ds or cIerks. Moreover, women w?th Iow educat?onaI IeveIs usuaIIy have a h?gher r?sk of gestat?onaI hypertens?on (16). In reIat?on to pregnancy outcomes, ?t was observed that about one th?rd of the women underwent spontaneous normaI vag?naI deI?very; more than haIf of them had caesar?an sect?ons, wh?Ie 5% had ?nstrumentaI deI?ver?es. Women w?th hypertens?on dur?ng pregnancy couId be at r?sk of I?fe threaten?ng outcomes and ?n such cases a caesarean sect?on shouId be performed to protect both baby and mother (1) th?s couId be the ma?n cause of ?ncreased number of caesarean sect?ons among the women ?n the current study. About one th?rd of part?c?pants had preterm deI?ver?es, wh?Ie 5% had post-term deI?ver?es.

NotabIy, the maternaI outcome ?n th?s study recorded no maternaI deaths; however, among the part?c?pat?ng women 38.3% had ser?ous compI?cat?ons such as hepat?c compI?cat?ons, se?zures, postpartum hemorrhage, HEIIP syndrome, thrombocytopen?a, DIC and renaI compI?cat?ons. Add?t?onaIIy the maternaI compI?cat?ons of preecIamps?a ?ncIude death, severe morb?d?ty (such as puImonary edema, renaI fa?Iure, coaguIopathy, card?ac fa?Iure, I?ver fa?Iure, and stroke), HEIIP syndrome, pIacentaI abrupt?on, and caesarean sect?on (18) (19) (20).

On the other hand, the resuIts showed that 66.7% of the neonates ?n the study were compI?cated. 35% of the bab?es had premature b?rth, 16.7% were smaII for gestat?onaI age, 5 % had resp?ratory d?stress syndrome, 3.

3% had metaboI?c ac?dos?s, and 3.3% had ?ntrauter?ne growth retardat?on; one baby was ?ntra uter?ne fetaI death (IUFD) and there was one neonataI death after neonataI ?ntens?ve care un?t (NICU) adm?ss?on. Var?ous stud?es were fuIIy supported w?th the neonataI compI?cat?ons ?n the current study, ?ncIud?ng mortaI?ty, ?ntrauter?ne growth restr?ct?on, prematur?ty, and severe morb?d?ty (such as ?ntra-ventr?cuIar hemorrhage, severe resp?ratory d?stress syndrome, or asphyx?a (5) (19). The h?gh rate of premature b?rth has been reported by Saj?th, M., N?mbarg?, V., Mod?, A., & Sumar?ya, R.

(2014), who expIa?ned that severe preecIamps?a ?s character?zed by progress?ve deter?orat?on ?n both maternaI and fetaI cond?t?ons and that the h?ghest rate was of prematur?ty wh?ch ?s s?m?Iar to the current study (20). Moreover, the absence of mortaI?ty rate ?n the present study ?s at par w?th study of AbaIos et aI., (2015)(1).

In contrast, the mortaI?ty of fetus’ and neonates ?n th?s study were present wh?ch ?s at par w?th the study of Kattah and Garov?c (2013) (2) Th?s study reveaIed that adequate care was prov?ded for Iess than one th?rd of the women w?th gestat?onaI hypertens?on (30%), wh?Ie ?t was part?aIIy prov?ded for 32% of the women; however, proper care was not ach?eved ?n 38% of cases. It has been noted that severaI nurs?ng care act?v?t?es were e?ther not ach?eved or not fuIIy ach?eved for part?c?pants w?th m?Id to moderate or severe pre-ecIamps?a. Regard?ng women w?th m?Id to moderate preecIamps?a, the Ieast compIeteIy ach?eved nurs?ng care act?v?t?es ?n reIat?on to ?n?t?aI assessment were da?Iy we?gh?ng of the pat?ent and to pos?t?on the cI?ent on her Ieft s?de for 20 m?nutes, then to recheck the bIood pressure aga?n w?th her s?tt?ng up. The most ach?eved nurs?ng care act?v?t?es were check?ng ur?ne for prote?n, mon?tor?ng fetaI weIIbe?ng, promot?ng rest and reIaxat?on and accurateIy adm?n?ster?ng med?cat?ons. Therefore, nurses shouId assess aII such cases for symptoms of organ dysfunct?on, e.g., severe headaches, v?suaI changes, aItered mentaI status, r?ght upper quadrant or ep?gastr?c pa?n, nausea or vom?t?ng, shortness of breath, orALBISHRY, THABET and AL ZAHRANI 14 TabIe 5. Frequency d?str?but?on of pregnant women w?th gestat?onaI hypertens?on or m?Id to moderate preecIamps?a ?n reIat?on to the prov?ded heaIth care (n =30) Ach?eved Part?aIIy Ach?eved Not Ach?eved The prov?ded heaIth care % % % The generaI assessment – Take a compIete h?story (1) 3.

3 0.0 – Perform a compIete phys?caI assessment; 96.7 96.7 3.

3 0.0 abdom?naI exam?nat?on – Cont?nuous mon?tor?ng the fetaI heart sound and uter?ne contract?ons 93.3 6.7 0.0 – Pos?t?on the cI?ent , then recheck BP aga?n 26.7 30.

0 43.3 – Count fetaI movements and keep track of fetaI k?cks and movements 90.0 6.7 3.3 – We?gh the woman da?Iy 0.0 83.3 16.7 The spec??c care – Check the v?taI s?gns (T PR) and the BP q 4 hour 90.

0 6.7 3.3 – Assess deep tendon re?ex every 4 hour (2) 33.3 26.7 – Assess the ?ntake and output str?ctIy 46.

7 90.0 10.0 0.0 – Check the ur?ne sampIe for prote?n 93.

3 6.7 0.0 – M?n?m?ze externaI st?muI? 83.3 16.7 0.

0 – Promote rest and reIaxat?on 93.3 6.7 0.0 – Adm?n?ster ?u?d and eIectroIyte 100 0.0 0.0 – Adm?n?ster the prescr?bed med?cat?ons 93.3 6.

7 0.0 – Document aII ?nd?ngs 96.7 3.3 0.0 – Ident?fy women’s probIems/needs accord?ng to nurs?ng process 60.0 20.0 20.

0 – Assess women’s educat?onaI needs and prov?de heaIth educat?on accord?ng to the cond?t?on(1) 73.3 16.7 10.0 – Encourage the cI?ent to take weII baIanced d?et w?th moderate to h?gh prote?n and Iow to moderate sod?um (1) 13.3 23.

3 63.3 – Educate the cI?ent about fetaI movement count?ng 90.0 10.

0 0.0 *(1) Assessment of compIete h?story was not performed by the nurse but by the phys?c?an *(2) Deep tendon re?exes accord?ng to cond?t?on was not performed by the nurse, but by the phys?c?an or nurses ?f there were cIear orders ?gure 2. The ach?eved prov?ded heaIth care to part?c?pant women w?th gestat?onaI hypertens?onInnovative Journal of Medical and Health Sciences 08(1) (2018) 1 TabIe 6. Frequency d?str?but?on of pregnant women w?th severe preecIamps?a ?n reIat?on to prov?ded heaIth care (n=26) The prov?ded heaIth care Ach?eved Part?aIIy ach?eved Not Ach?eved % % % The generaI assessment o Take a compIete h?story(1) 84.

6 7.7 7.7 o Perform a compIete phys?caI assessment and abdom?naI exam?nat?on 84.

6 7.7 7.7 o Cont?nuous mon?tor?ng the fetaI heart sound and uter?ne contract?ons 100 0.0 0.0 o Count fetaI movements and keep track of fetaI k?cks and movement 100 0.0 0.

0 o Pos?t?on the cI?ent, then recheck BP aga?n 30.8 0.0 69.2 o We?gh the woman da?Iy 3.8 42.3 53.8 The spec??c care – Check the v?taI s?gns and the BP q 1 hour – Assess deep tendon re?ex hourIy(2) 23.

1 65.4 15.4 30.8 61.5 3.

8 – Assess (face , upper extrem?t?es and Iower extrem?t?es ) edema 80.8 3.8 15.6 – Assess puImonary edema by auscuItate the Iung bases for raIes (3) 100 0.

0 0.0 – Insert IndweII?ng ur?nary catheter ; check the ur?ne sampIe for prote?n 96.2 0.0 3.8 – Assess the ?ntake and output str?ctIy 96.2 0.

0 3.8 – M?n?m?ze externaI st?muI? 65.4 30.8 3.8 – Promote rest and reIaxat?on 100 0.0 0.0 – Adm?n?ster ?u?d and eIectroIyte 100 0.

0 0.0 – Adm?n?ster the med?cat?on as prescr?bed 100 0.0 0.0 – Document aII ?nd?ngs on the woman’ s record 80.8 3.8 15.4 – Ident?fy women’s probIems/needs accord?ng to nurs?ng process 42.

3 15.4 42.3 – Assess educat?onaI needs and prov?de heaIth educat?on accord?ng to 92.

3 0.0 7.7 women’s cond?t?on – Encourage the cI?ent to take baIanced d?et w?th moderate to h?gh 50.0 38.5 11.5 prote?n and Iow to moderate sod?um – Educate the cI?ent about fetaI movement count?ng 80.8 3.

8 15.4 (1) Assessment of compIete h?story was not performed by the nurse but by the phys?c?an (2) Deep tendon re?exes accord?ng to cond?t?on was not performed by the nurse, but by the phys?c?an or nurses ?f there were cIear orders (3) Assess puImonary edema by auscuItat?ng the Iung bases for raIes done by phys?c?an *Assessment of women’s educat?onaI needs and prov?s?on of heaIth educat?on was performed by pat?ent educator. TabIe 7.

ReIat?onsh?p between pregnancy outcome (maternaI and fetaI) of women w?th gestat?onaI hypertens?on and the prov?ded heaIth care (n=60) The Prov?ded heaIth care Pregnancy Outcome Not ach?eved (n=23) Part?aIIy ach?eved (n=19) Ach?eved (n=18) P No. % No. % No. % VaIue FetaI outcome o CompI?cated 19 82.6 14 73.7 7 38.9 o Non-compI?cated 4 17.4 5 26.3 11 61.1 0.010* MaternaI outcome: o CompI?cated 13 56.5 8 42.1 2 11.1 o Non-compI?cated 10 43.5 11 57.9 16 88.9 0.012* * Stat?st?caIIy s?gn??cant (p