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MODULE 4 PREGNANCY, CHILDBIRTH, AND POSTPARTUM AT RISK

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Title: MODULE 4 PREGNANCY, CHILDBIRTH, AND POSTPARTUM AT RISK


1
MODULE 4 PREGNANCY, CHILDBIRTH, AND POSTPARTUM
AT RISK
2
  • PREGNANCY AT RISK
  • PREGESTATIONAL
  • GESTATIONAL
  • CHILDBIRTH AT RISK
  • PRELABOR COMPLICATIONS
  • LABORRELATED COMPLICATIONS
  • POSTPARTUM AT RISK

3
MODULE 4 PART 1A PREGESTATIONAL RISKS SUBSTANCE
ABUSE
4
SUBSTANCE ABUSE DURING PREGNANCY
  • ALCOHOL
  • CNS DEPRESSANT
  • INCIDENCE OF ABUSE HIGHEST IN MOTHERS 20-40 YEARS
    OF AGE
  • PREGNANT WOMEN SHOULD AVOID ALCOHOL COMPLETELY
    DURING PREGNANCYWHY?
  • ADVERSE MATERNAL EFFECTS
  • ADVERSE FETUS/NEONATAL EFFECTS

5
Fetal Alcohol Syndrome
Retrieved from http//www.aafp.org/afp/2005/0715/
p279.html
6
SUBSTANCE ABUSE DURING PREGNANCY
  • COCAINE AND CRACK
  • PREVENTS REUPTAKE OF DOPAMINE, NOREPINEPHRINELEAD
    S TO VASOCONSTRICITION, TACHYCARDIA, HYPERTENSION
  • ADVERSE MATERNAL EFFECTS
  • ADVERSE FETAL/NEONATAL EFFECTS

7
SUBSTANCE ABUSE DURING PREGNANCY
  • MARIJUANA
  • NO STRONG RESEARCH INDICATING TERATOGENIC EFFECTS
  • SOCIAL FACTORS
  • HEROIN/METHADONE
  • ADVERSE MATERNAL EFFECTS
  • ADVERSE FETAL/NEONATAL EFFECTS

8
SUBSTANCE ABUSE DURING PREGNANCY
  • BARBITURATES
  • STIMULANTS
  • CAFFEINE
  • NICOTINE
  • PSYCHOTROPICS
  • METH

9
(No Transcript)
10
MODULE 4 PART 1B PREGESTATIONAL RISKS DIABETES
11
DIABETES MELLITUS IN PREGNANCY
  • PATHOPHYSIOLOGY
  • INSULIN PRODUCTION DECREASE BY PANCREAS
  • WITHOUT ADEQUATE INSULIN, GLUCOSE DOES NOT ENTER
    CELLS, WHICH BECOME ENERGY DEPLETED
  • BLOOD GLUCOSE LEVELS INCREASE
  • CELLS BREAK DOWN PROTEIN AND FAT STORES FOR ENERGY

12
DIABETES MELLITUS IN PREGNANCY
  • EARLY PREGNANCY
  • ESTROGEN, PROGESTERONE, OTHER HORMONES RISE TO
    STIMULATE INCREASED INSULIN PRODUCTION AND
    INCREASED TISSUE RESPONSE TO INSULIN
  • STORAGE OF GLYCOGEN IN LIVER PRODUCES ANABOLIC
    STATE DURING IST HALF OF PREGNANCY

13
DIABETES MELLITUS IN PREGNANCY
  • 2ND HALF OF PREGNANCY PRESENTS WITH INCREASED
    RESISTANCE TO INSULIN AND DECREASED GLUSOSE
    TOLERANCE DUE TO
  • SECRETION OF Hpl (INSULIN ANTAGONIST)
    PROLACTIN, INCREASED CORTISOL AND GLYCOGEN LEVELS
  • RESULTS IN CATABOLIC STATE
  • DIABETOGENIC EFFECT

14
DIABETES IN PREGNANCY
  • CLASSIFICATIONS
  • ETIOLOGIC
  • TYPE I
  • TYPE II
  • TYPE III
  • TYPE IV
  • BASED ON CAUSE
  • WHITES
  • CLASS A-T
  • DESCRIBES EXTENT OF DISEASE

15
(No Transcript)
16
(No Transcript)
17
GESTATIONAL DIABETES
  • GESTATIONAL DIABETES
  • WHY DOES THIS OCCUR?
  • -- WHEN DOES THIS OCCUR?
  • WHAT IS THE INCIDENCE OF THIS OCCURING DURING
    PRGNANCY?
  • HOW IS IT DIAGNOSED?

18
COMPARISON OF DIABETES MELLITUS AND GESTATIONAL
DIABETES
19
DIABETES MELLITUS IN PREGNANCY
  • INTRAPARTAL MANAGEMENT
  • WHEN TO DELIVER
  • LABOR MANAGEMENT, INSULIN REQUIREMENTS
  • POSTPARTAL MANAGEMENT
  • INSULIN REQUIREMENTS
  • BREAST FEEDING

20
DIABETES IN PREGNANCY
  • CHALLENGES, INFLUENCES
  • MATERNAL RISKS
  • FETAL, NEWBORN RISKS

21
DIABETES MELLITUS IN PREGNANCY
  • CLINICAL TREATMENT
  • GTT CRITERIA
  • LAB ASSESSMENT
  • ANTEPARTAL MANAGEMENT
  • DIET
  • GLUCOSE MONITORING
  • INSULIN REQUIREMENTS
  • FETAL EVALUATION

22
MODULE 4 PART 1C PREGESTATIONAL RISKS INFECTIONS
23
HIV IN PREGNANCY
  • RISKS TO MOTHER
  • RISKS TO FETUS/NEONATE
  • ANTEPARTUM, INTRAPARTUM, POSTPARTUM TREATMENT
    CARE

24
TORCH
  • TOXOPLAMOSIS
  • OTHER
  • GBS
  • RUBELLA
  • CYTOMEGALIVIRUS
  • HERPES

25
(No Transcript)
26
TORCH
  • MATERNAL RISKS
  • FETAL RISKS
  • ANTEPARTUM, INTRAPARTUM, POSTPARTUM TREATMENT AND
    CARE

27
GROUP B STREPTOCOCCUS
  • INCIDENCE
  • TESTING
  • TREATMENT
  • NURSING INTERVENTIONS

28
GESTATIONAL PREGNANCY RISKS
  • BLEEDING DISORDERS
  • HYPERTENSIVE DISORDER
  • Rh ALLOIMMUNIZATION
  • ABO INCOMPATIBILITY
  • DOMESTIC VIOLENCE
  • SURGERY, TRAUMA

29
MODULE 4 PART 2A GESTATIONAL ONSET
COMPLICATIONS BLEEDING DISORDERS
30
BLEEDING DISORDERS
  • ECTOPIC PREGNANCY
  • TREATMENT, RISKS
  • GESTATIONAL TROPHOBLASTIC DISEASE
  • HYDATIFORM MOLE
  • CHORIOADENOMA DESTRUENS
  • CHORIOCARCINOMA
  • TREATMENT, RISKS

31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
GESTATIONAL RISKS
  • INCOMPETENT CERVIX
  • CERCLAGE
  • HYPEREMESIS GRAVIDARUM
  • FLUID ELECTROLYTE ISSUES
  • DEHYDRATION
  • RISKS TO FETUS
  • NURSING CARE

35
Cerclage
Retrieved from www.drlindagalloway.wordpress.com
36
GESTATIONAL RISKS
  • PREMATURE RUPTURE OF MEMBRANES
  • PROM
  • PPROM
  • NST, BPP
  • RISKS
  • NURSING CARE

37
Positive Fern Test
Retrieved from commons.wikimedia.org
38
MODULE 4 PART 2B GESTATIONAL COMPLICATIONS AND
RISKS PREGNANCY REDUCED HYPERTENSION

39
PREGNANCY INDUCED HYPERTENSION--PIH
  • PREECLAMPSIA/ECLAMPSIA
  • CHRONIC HYPERTENSION
  • CHRONIC HYPERTENSION WITH SUPERIMPOSED
    PREECLAMPSIA OR ECLAMPSIA
  • TRANSIENT HYPERTENSION

40
PREECLAMPSIA
  • DISEASE OF THEORIES
  • MOST COMMON HYPERTENSIVE DISORDER IN PREGNANCY
  • PATHOPHYSIOLOGY
  • CAUSE UNKNOWN
  • 5-7 OF ALL PREGNANCIES
  • GENERALIZED VASOSPASM, DECREASE IN CIRCULATING
    BLOOD VOLUME

41
Preeclampsia
42
PREECLAMPSIA
  • PRENATAL FACTORS INCREASING RISK OF PIH
  • PRIMIGRAVIDA
  • ESSENTIAL HYPERTENSION
  • AGE EXTREMES (UNDER 17 OR OVER 35 YEARS OLD)
  • UNDERWEIGHT OR OVERWEIGHT
  • FAMILY HISTORY OF HYPERTENSION
  • DIAGNOSIS OF PIH IN PREVIOUS PREGNANCY
  • DIABETES MELLITUS

43
PREECLAMPSIA
  • CHARACTERIZED BY
  • DEVELOPMENT OF HYPERTENSION
  • 30MM HG INCREASE IN SYSTOLIC AND 15 MM HG
    DIASTOLIC OVER BASELINE ON AT LEAST 2 OCCASIONS 6
    OR MORE HOURS APART
  • PROTEINURIA ,HYPERREFLEXIA
  • EDEMA
  • MATERNAL RISKS
  • FETAL/NEONATAL RISKS

44
PREECLAMPSIA
  • CLINICAL MANAGEMENT/CARE
  • ANTEPARTAL MANAGEMENT
  • MILD PREECLAMPSIA
  • SEVERE PREECLAMPSIA
  • INTRAPARTAL MANAGEMENT
  • POSTPARTAL MANAGEMENT
  • HELLP SYNDROME
  • ECLAMPSIA

45
H E L L P Syndrome
  • H hemolysis- distortion and rupture of RBCs
  • E elevated
  • L liver enzymes- fibrin deposits obstruct
    blood flow
  • L low
  • P platelet count

46
(No Transcript)
47
(No Transcript)
48
(No Transcript)
49
MODULE 4 PART 2C GESTATIONAL RISKS
COMPLICATIONS Rh ISOIMMUNIZATION
50
Rh SENSITIZATION
  • ANTIGEN-ANTIBODY RESPONSE
  • IF AN Rh-NEGATIVE WOMAN IS EXPOSED TO Rh POSITIVE
    BLOOD, EITHER THROUGH TRANSFUSION OR A PRIOR
    PREGNANCY, SHE PRODUCES IMMUNOGLOBULIN (Ig)G
    ANTIBODY (ANTIRhD)
  • INDIRECT COOMBS TEST
  • DIRECT COOMBS TEST

51
Figure 135d Anti-Rh-positive antibodies
(triangles) are formed.
52
Figure 135b Pregnancy with Rh-positive fetus.
Some Rh-positive blood enters the mothers
bloodstream.
53
Figure 135e In subsequent pregnancies with an
Rh-positive fetus, Rh-positive red blood cells
are attacked by the anti-Rh-positive maternal
antibodies, causing hemolysis of the red blood
cells in the fetus.
54
Rh SENSITIZATION
  • RhoGAM
  • PROVIDES PASSIVE ANTIBODY PROTECTION AGAINST Rh
    ANTIGENS
  • ERYTHROBLASTOSIS FETALIS
  • HYDROPS FETALIS
  • KERNICTERUS

55
MODULE 4 PART 2C BLEEDING COMPLICATIONS
56
PRE-LABOR COMPLICATIONS
  • PREMATURE RUPTURE OF MEMBRANES
  • PRETERM LABOR
  • BLEEDING
  • MULTIPLE GESTATION
  • AMNIOTIC FLUID ALTERATIONS

57
ABRUPTIO PLACENTAE
  • ABRUPTIO PLACENTAE
  • PREMATURE SEPARATION OF PLACENTA FROM UTERINE
    WALL
  • THREE TYPES
  • MARGINAL
  • CENTRAL
  • COMPLETE
  • CLINICAL MANAGEMENT

58
Figure 1911a Abruption placentae. Marginal
abruption with external hemorrhage.
59
Figure 1911c Complete separation.
60
Figure 1911b Central abruption with concealed
hemorrhage.
61
PLACENTA PREVIA
  • PLACENTA PREVIA IMPLANTATION OF PLACENTA IN
    LOWER UTERINE SEGMENT
  • THREE CLASSIFICATIONS
  • LOW PLACENTAL IMPLANTATION
  • PARTIAL PLACENTA PREVIA
  • TOTAL PLACENTA PREVIA
  • CLINICAL MANAGEMENT

62
Figure 1912a Placenta previa. Low placental
implantation.
63
Figure 1912c Total placenta previa.
64
Figure 1912b Partial placenta previa.
65
(No Transcript)
66
MODULE 4 PART 2D SURGERY TRAUMA
INFECTION DOMESTIC VIOLENCE
67
  • SURGERY
  • TRAUMA FROM AN ACCIDENT
  • INFECTION AFFECTING THE FETUS
  • MATERNAL RISKS
  • FETAL RISKS

68
DOMESTIC VIOLENCE IN PREGNANCY
  • INCIDENCE
  • RESEARCH
  • STATISITICS
  • SIGNS AND SYMPTOMS

69
DOMESTIC VIOLENCE IN PREGNANCY
  • HOW DO WE ASSESS?
  • WHEN DO WE ASSESS?
  • WHAT DO WE DO IF THE WOMAN DISCLOSES ABUSE?
  • MATERNAL RISKS
  • FETAL RISKS

70
(No Transcript)
71
(No Transcript)
72
MODULE 4 PART 3A PRE-LABOR COMPLICATIONS AMNIOTIC
FLUID ALTERATIONS
73
OLIGOHYDRAMNIOS
  • SEVERELY REDUCED AMOUNT OF AMNIOTIC FLUID
  • OCCURS IN
  • POSTMATURITY
  • IUGR
  • FETAL RENAL MALFORMATION
  • SOMETIMES IDIOPATHIC

74
OLIGOHYDRAMNIOS
  • FETAL RISKS
  • CLINICAL MANAGEMENT
  • CRITICAL THINKING
  • WHAT TYPE OF DECELERATION MIGHT YOU EXPECT TO SEE
    ON THE FETAL MONITOR OF A WOMAN WITH
    OLIGOHYDRAMNIOS? WHY?

75
HYDRAMNIOS
  • HYDRAMNIOS gt 2000ML AMNIOTIC FLUID
  • CAUSE UNKNOWN 20 ASSOCIATED WITH CONGENITAL
    ANOMALIES
  • TWO TYPES
  • CHRONIC
  • ACUTE
  • RISKS
  • CLINICAL MANAGEMENT

76
True knot
77
MODULE 4 PART 3B PRE-LABOR COMPLICATIONS PRETERM
LABOR LABOR RELATED COMPLICATIONS
78
PRETERM LABOR
  • NONRECURRENT
  • SCREENING
  • FACTORS CORRELATED WITH PRETERM LABOR

79
PRETERM LABOR
  • PRETERM RISK FACTORS
  • LABOR THAT OCCURS BETWEEN 20-38 WEEKS
  • PREVELANCE
  • RESEARCH
  • RECURRENT

80
PRETERM LABOR
  • TREATMENT/CARE
  • HOME UTERINE ACTIVITY MONITORING
  • TOCOLYSIS
  • MGSO4
  • NEPHEDIPINE
  • PROSTAGLANDIN SYNTHESIS INHIBITORS
  • BETAMETHASONE (FETUS)

81
LABOR RELATED COMPLICATIONS
  • DYSTOCIA
  • POSTTERM PREGNANCY
  • FETAL MALPOSITION, MALPRESENTATION
  • MACROSOMIA
  • FETAL DISTRESS

82
LABOR RELATED COMPLICATIONS
  • HYPERTONIC LABOR
  • HYPOTONIC LABOR
  • LABOR MANAGEMENT
  • MATERNAL RISKS
  • FETAL/NEONATAL RISKS
  • PRECIPITOUS LABOR
  • LABOR LESS THAN 3 HOURS

83
LABOR RELATED COMPLICATIONS
  • PROLAPSED UMBILICAL CORD
  • AMNIOTIC FLUID EMBOLISM
  • CEPHALOPELVIC DISPROPORTION
  • COMPLICATION OF THIRD OR FOURTH STAGE OF LABOR

84
Uterine Tachysystole
85
LABOR RELATED COMPLICATIONS
  • MACROSOMIA
  • NEWBORN WEIGHT gt 4000 GMS
  • OFTEN SEEN IN
  • DIABETIC MOTHERS
  • GRAND MULTIPARITY
  • POSTTERM GESTATION
  • LARGE PARENTS
  • MATERNAL RISKS
  • FETAL / NEONATAL RISKS

86
MODULE 4 PART 3C LABOR RELATED COMPLICATIONS
87
POSTTERM PREGNANCY, MALPOSITION
  • POSTTERM PREGNANCY
  • PREGNANCY 42 WEEKS PAST 1ST DAY OF LAST MENSTRUAL
    PERIOD
  • MATERNAL RISKS
  • FETAL/NEONATAL RISKS
  • MALPOSITION
  • OCCIPUT POSTERIOR
  • PERSISTENT OCCIPUT POSTERIOR
  • LABOR MANAGEMENT
  • MATERNAL RISKS

88
PROLAPSED UMBILICAL CORD
  • PROLAPSED CORD WHEN CORD PRECEDES FETAL
    PRESENTING PART
  • DECREASED BLOOD FLOW IN CORD LEADS TO FETAL
    DISTRESS
  • MAY RESULT WITH RUPTURE OF MEMBRANES
  • CLINICAL MANAGEMENT

89
(No Transcript)
90
Nurse and Prolapsed cord
91
AMNIOTIC FLUID EMBOLISM
  • CLINICAL PRESENTATION
  • CHEST PAIN
  • DYSPNEA
  • CYANOSIS
  • HYPOTENSION
  • TACHYCARDIA
  • MASSIVE HEMORRHAGE
  • CLINICAL MANAGEMENT

92
AMNIOTIC FLUID EMBOLISM
  • AMNIOTIC FLUID EMBOLISM AMNIOTIC FLUID MAY LEAK
    INTO CHORIONIC PLATE AND MATERNAL CIRCULATORY
    SYSTEM THROUGH
  • TEAR IN AMNION OR CHORION
  • PLACENTAL SEPARATION
  • CERVICAL TEAR

93
CEPHALOPELVIC DISPROPORTION (CPD)
  • FETUS LARGER THAN PELVIC DIAMETERS
  • PELVIC MEASUREMENTS
  • PROLONGED LABOR
  • CLINICAL MANAGEMENT

94
MALPRESENTATION
  • MALPRESENTATION
  • BROW
  • FACE
  • BREECH
  • SHOULDER
  • TRANSVERSE LIE
  • COMPOUND PRESENTATION

95
MULTIPLE GESTATION
  • INCREASED INCIDENCE OF MULTIPLE BIRTHS
  • INCREASED INCIDENCE OF PRETERM LABOR
  • FETAL AND MATERNAL IMPLICATIONS AND CARE

96
(No Transcript)
97
(No Transcript)
98
FETAL DISTRESS
  • FETAL DISTRESS
  • CONTIBUTING FACTORS
  • CORD COMPRESSION
  • UTERO-PLACENTAL INSUFFCIENCY
  • PREEXISTING MATERNAL OR FETAL DISEASE
  • FETAL DISTRESS WARNING SIGNS
  • MECONIUM STAINED AMNIOTIC FLUID

99
FETAL DISTRESS
  • OMINOUS FHR PATTERNS
  • PERSISTENT LATE DECELERATIONS
  • PERSISTENT SEVERE VARIABLE DECELERATIONS
  • PROLONGED DECELERATIONS
  • DECREASED VARIABILITY

100
(No Transcript)
101
FETAL DEATH
  • INTRAUTERINE FETAL DEATH
  • POSSIBLE CAUSES
  • PREECLAMPSIA
  • ABRUPTIO PLACENTAE
  • PLACENTA PREVIA
  • DIABETES
  • CONGENITAL ANOMALIES
  • INFECTION

102
FETAL DEATH
  • ISOIMMUNE DISEASE
  • NUCAL CORD
  • UNKNOWN CAUSES
  • PROLONGED RETENTION OF FETUS MAY LEAD TO
  • DESSEMINATED INTRAVASCULAR COAGULATION (DIC)

103
(No Transcript)
104
COMPLICATIONS OF THE THIRD FOURTH STAGE OF LABOR
  • LACERATIONS
  • 1ST DEGREE
  • 2ND DEGREE
  • 3RD DEGREE
  • 4TH DEGREE
  • SULCUS TEAR
  • URETHRAL TEAR

105
COMPLICATIONS OF THE THIRD AND FOURTH STAGE OF
LABOR
  • PLACENTA ACCRETA
  • ATTACHMENT OF PLACENTA DIRECTLY TO THE UTERINE
    WALL WITHOUT INTEVENING DECIDUA BASALIS
  • UTERINE RUPTURE
  • RETAINED PLACENTA
  • UTERINE ATONY
  • HEMMORHAGE
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