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Complications of Pregnancy

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Title: Complications of Pregnancy


1
Complications of Pregnancy
2
Assessment of Fetal Well-being
  • Detect physical abnormalities
  • Monitor fetal condition
  • Fetal movement
  • Complex diagnostic testing
  • Risks and benefits

3
Amniocentesis
  • Aspiration of amniotic fluid
  • Determine genetic disorders
  • Sex of fetus
  • Fetal lung maturity
  • Risks
  • Nursing management

4
Amniocentesis
5
Chorionic Villus Sampling
  • Aspiration of small sample of chorionic villus
    tissue
  • 8 to 12 weeks gestation
  • Detects genetic abnormalities
  • Risks and benefits
  • Nursing management

6
Hormone Levels
  • Estriol
  • Human chorionic gonadotropin
  • Maternal serumalpha fetoprotein

7
Alfa-Fetoprotein Screening
  • MSAFP
  • Time sensitive
  • Low MSAFP levels associated with Down syndrome
  • High MSAFP levels associated with neural tube
    defects

8
Triple Marker Screening
  • Alpha-fetoprotein
  • Human chorionic gonadotropin
  • Unconjugated estriol

9
High Risk Assessment
  • Daily fetal movement count
  • Nonstress test
  • Biophysical profile
  • Contraction stress test

10
Daily Fetal Movement Count
  • Begin at 27th week
  • Consider
  • Fetal sleep-wake cycles
  • Maternal food intake
  • Drug-nicotine use
  • Environmental stimuli
  • Maternal position
  • Procedure

11
Fetal Monitor
12
Fetal Monitoring
  • Normal fetal heart rate
  • Baseline

13
Baseline FHR
  • Rate
  • Variability
  • Assesses average rate for at least 2 minutes
    within a 10 minute window
  • Normal 110 to 160 bpm
  • Bradycardia lt 110 bpm for 10 minutes
  • Tachycardia gt 160 bpm for 10 minutes

14
Variability
  • Normal irregularity of fetal cardiac rhythm
  • Short-term
  • Beat-to-beat changes
  • Need fetal scalp electrode
  • Long-term
  • Rhythmic changes (waves) from the baseline value
  • Usually 3 to 5 beats

15
Nonstress Test
  • Assess response of FHR to periods of fetal
    movement
  • After 27th to 30th week
  • Frequency depends on condition of maternal-fetal
    unit
  • Indications

16
Procedure
  • Perform test during a time of activity
  • Maternal preparation
  • Maternal vital signs
  • Attach monitor
  • Monitor fetal movement

17
Interpretation
  • Reactive result
  • Nonreactive result
  • Unsatisfactory result

18
Contraction Stress Test
  • Assess ability of fetus to withstand the stress
    of uterine contractions
  • Assesses placental oxygenation and function
  • Determines fetal well being
  • Performed if NST is abnormal

19
Interpretation
  • Negative CST
  • Positive CST
  • Equivocal
  • Unsatisfactory

20
Biophysical Profile
  • Assess fetal status
  • NST
  • Fetal breathing movements
  • Fetal body movements
  • Fetal muscle tone
  • Amniotic fluid volume
  • Placental grading

21
Biophysical Profile Scoring
22
Hyperemesis Gravidarum
  • Intractable nausea and vomiting that persists
    beyond the first trimester and causes
    disturbances in nutrition, electrolytes, and
    fluid balance

23
Assessment
  • Nausea most pronounced on arising
  • Persistent vomiting
  • Weight loss
  • Signs of dehydration
  • Electrolyte imbalances
  • Ketonuria
  • Increased hematocrit levels

24
Nursing Interventions
  • Monitor vital signs
  • Monitor FHR, fetal activity and fetal growth
  • Monitor for dehydration and electrolyte imbalance
  • Daily weight, IO, calorie count
  • Monitor urine for ketones
  • Administer IV fluids, antiemetics

25
Bleeding Disorders of Early Pregnancy
  • Spontaneous abortion
  • Ectopic pregnancy
  • Hydatidiform mole

26
Abortion
  • Threatened
  • Imminent
  • Complete
  • Incomplete
  • Missed
  • Habitual
  • Elective

27
Threatened Abortion
28
Imminent Abortion
29
Incomplete Abortion
30
  • A 22 year old gravida i, para 0, is 11 weeks
    pregnant. She was admitted to the hospital with
    moderate vaginal bleeding and some abdominal
    cramping. Vaginal examination reveals that the
    cervix is dilated 2 cm. She is diagnosed as
    having an imminent abortion. What nursing
    interventions are indicated when caring for this
    patient?

31
Nursing Interventions
  • Save perineal pads / tissue
  • Emotional support
  • Observe for shock
  • Bed rest / diversional activity
  • RhoGAM
  • Possible surgery
  • Medication / Blood

32
  • Ectopic pregnancy is often difficult to
    diagnose because its symptoms are similar to
    those of abdominal conditions. Identify at least
    five signs or symptoms of ectopic pregnancy and
    briefly explain why each occurs.

33
Ectopic Sites
  • l

34
Ectopic Pregnancy
  • Fertilized ovum implants outside the uterus
  • Symptoms at 6 to 12 weeks of gestation
  • Severe unilateral pelvic-abdominal pain
  • Pain may refer to shoulder
  • Tender abdominal mass
  • Nausea, faintness
  • Bleeding frank or occult

35
Nursing Interventions
  • Monitor vital signs
  • Administer intravenous fluids
  • Provide oxygen when needed
  • Medicate for pain
  • Assess lab results
  • Prepare for possible surgery
  • Provide emotional support

36
Incompetent Cervix
  • Premature dilation of cervix
  • Occurs in 4th or 5th month of pregnancy
  • Associated with cervical trauma
  • Vaginal bleeding at 18 to 28 weeks
  • Fetal membranes visible through cervix
  • Treatment is surgical

37
Hydatidiform Mole
  • Gestational trophoblastic disease
  • Developmental anomaly of placenta
  • Changes chorionic villi into a mass of clear
    vesicles
  • Edematous grapelike cluster
  • May develop into choriocarcionoma

38
Hydatidiform Mole
39
Assessment
  • FHR not detectable
  • Vaginal bleeding
  • Symptoms of PIH
  • Fundal height gt expected for date
  • Elevated hCG
  • Ultrasound shows characteristic snowstorm pattern

40
Bleeding Disorders of Late Pregnancy
  • Placenta previa
  • Abruption placenta

41
Placenta Previa
  • Painless
  • Spotting or heavy bleeding
  • Bright-red bleeding
  • Soft, non-tender, relaxed uterus with normal tone
  • Shock in proportion to observed blood loss
  • Signs of fetal distress usually not present

42
Placenta Previa
43
Assessment
  • Episodic painless vaginal bleeding after 20th
    week of pregnancy without contractions
  • Each successive bleeding episode heavier than the
    last
  • Profuse hemorrhage
  • Ultrasound shows location of placenta

44
Nursing Interventions
  • No vaginal exams
  • Bedrest
  • Monitor vital signs and fetal well-being
  • Assess blood loss
  • IV access
  • Provide adequate nutrition
  • Provide emotional support

45
Abruptio Placenta
  • Severely painful
  • Heavy bleeding may be partially or completely
    hidden
  • Usually dark-brown bleeding
  • Rigid, board-like, tender uterus possibly with
    contractions
  • Shock seeming to be out of proportion to blood
    loss
  • Signs of fetal distress

46
Abruptio Placenta
47
Assessment
  • Painful, rigid, board-like abdomen with vaginal
    bleeding
  • Central abruption
  • Marginal abruption
  • Fetal outcome

48
Nursing Interventions
  • Monitor vital signs
  • Continuous EFM
  • Assess for bleeding, uterine activity, abdominal
    pain
  • Measure abdominal girth
  • Review lab values
  • IV access
  • Provide oxygen

49
Hypertensive Disorders
  • Pregnancy induced hypertension
  • Preeclampsia and eclampsia
  • Chronic hypertension
  • Superimposed preeclampsia
  • Transient hypertension

50
Pathophysiology
  • Vasospasm reduces blood flow to mothers organs
    and placenta
  • Vascular endothelial damage
  • Hypertension
  • Edema
  • Proteinuria

51
PIH - Assessment
  • Mild preeclampsia
  • Severe preeclampsia
  • Systemic responses
  • Lab values

52
Nursing Interventions
  • Bedrest -- left lateral position
  • Monitor B/P and weight
  • Monitor neurological status
  • Monitor DTRs
  • Provide adequate fluids
  • Monitor I O
  • Increase dietary protein
  • Administer medications as prescribed

53
Magnesium Sulfate ( Mg SO4 )
  • Mg causes vasodilation
  • Therapeutic levels 4 to 8 mg/dL

54
Mg SO4 Therapy
  • Monitor blood pressure closely
  • Monitor maternal serum Mg SO4 levels every 6 - 8
    hours
  • Monitor respirations closely
  • Assess patellar tendon reflex
  • Determine urinary output
  • Monitor FHR continuously
  • Continue Mg SO4 infusion for approximately 24
    hours after birth

55
Maternal Side Effects
  • Vasodilation
  • Flushing
  • Headaches
  • Hot Flashes
  • Blurred vision
  • Nasal Congestion
  • Decreased peripheral vascular resistance

56
Maternal Side Effects
  • Neuromuscular depression
  • Respiratory depression
  • Myocardial depression
  • Gastrointestinal system
  • nausea
  • vomiting

57
Neonatal Side Effects
  • Hypocalcemia
  • Hypermagnesemia
  • Respiratory depression

58
Chronic Hypertension
  • Occurs before pregnancy
  • Diagnosed before 20th week of gestation
  • Diagnosed during pregnancy and persists beyond
    the 42 day postpartum

59
Assessment
  • Headaches
  • Visual changes
  • Blood pressure 140/90 mm Hg or gt
  • Delayed fetal growth
  • Oligohydramnios

60
Antihypertensives
  • Given for diastolic blood pressure of 105 to 110
    or above
  • Methyldopa
  • Hydralazine
  • Labetalol
  • Nifedipine

61
Diabetes
  • Pregnancy places demands on carbohydrate
    metabolism
  • Insulin requirements increase in 2nd and 3rd
    trimester
  • Insulin-dependent diabetes
  • Diabetes in pregnancy

62
Assessment
  • Risk factors
  • Classic symptoms
  • Frequent UTIs and yeast infections
  • Screening at 24-28 weeks gestation

63
Nursing Interventions
  • Prenatal visits bimonthly for 6 months than
    weekly
  • Maintain blood glucose between 65-130 mg/dL
  • Monitor for hypoglycemia / hyperglycemia
  • Glucose control
  • Monitor for infection, PIH, ketoacidosis
  • Reinforce diet instructions

64
Gestational Diabetes
  • Occurs during 2nd and 3rd trimesters
  • No prior diagnosis
  • Screened during 26th week
  • Glucose 105 mg/dL
  • Diet
  • Medications
  • Normal after delivery

65
Cardiac Disease
  • Rheumatic fever
  • Congenital heart disease

66
Assessment
  • Dyspnea and fatigue
  • Cough
  • Peripheral edema
  • Anginal-type pain
  • Palpitations and tachycardia
  • Signs of pulmonary edema
  • Signs of respiratory infection

67
Nursing Interventions
  • Monitor VS, FHR, condition of fetus
  • Activity and rest
  • Encourage adequate nutrition
  • Maintain bed rest as ordered
  • Monitor for signs of respiratory infection
  • Encourage adequate nutrition
  • Administer cardiac medications

68
Anemia
  • Decrease in RBCs
  • Types
  • Iron deficiency
  • Folic acid
  • Hemoglobinopathies
  • Sickle cell disease
  • Thalassemia

69
Assessment
  • Fatigue
  • Headache
  • Pallor
  • Tachycardia
  • Diagnostic test H H
  • Treatment Iron and folic acid

70
Nursing Interventions
  • Monitor H H every 2 weeks
  • Iron and folic acid supplements
  • Take iron with vitamin C
  • Foods high in iron, folic acid and protein
  • Monitor for infection
  • May use parenteral iron / transfusions

71
Infection in Pregnancy
  • Immunological system suppressed
  • Genitourinary adaptations to pregnancy
  • Risk factors increase severity
  • Fever
  • Pneumonia
  • Direct infection of fetus
  • Systemic infection

72
TORCH Infections
  • T Toxoplasmosis
  • O Other infections
  • R Rubella
  • C Cytomegalovirus
  • H Herpes

73
Group B Streptococcus
  • Bacterial infection found in the lower GI and
    urogenital tracts
  • Screening cultures at 35-37 weeks
  • Leading infectious cause of neonatal sepsis and
    mortality
  • Carriers often asymptomatic
  • Intrapartum prophylaxis

74
Sexually Transmitted Diseases
  • Syphilis
  • Gonorrhea
  • Chlamydia
  • Trichomoniasis
  • HPV
  • HIV

75
Vaginal Infections
  • Candidiasis
  • Bacterial vaginosis

76
Urinary Tract Infections
  • Cause preterm labor
  • Untreated may cause pyelonephritis

77
Rh Incompatibility and Sensitization
  • Determine maternal blood type and Rh factor
  • Antibody screen (indirect Coombs test)
  • RhoGAM administration
  • Serial ultrasounds
  • Amniotic fluid analysis
  • Erythroblastosis fetalis

78
Nursing Interventions
  • Client education
  • RhoGAM protocol
  • Kleihauer-Betke test
  • Ultrasound
  • EFM, BPP
  • Intrauterine exchange transfusion

79
Multifetal Pregnancy
  • Monozygotic or dizygotic
  • Assisted reproductive techniques
  • Diagnosis
  • Interventions
  • Complications

80
Nursing Interventions
  • Monitor vital signs
  • Monitor FHR, fetal activity, fetal growth
  • Monitor cervical changes
  • Ultrasound
  • Monitor for anemia
  • Monitor and treat preterm labor
  • Prepare for possible cesarean section

81
Substance Abuse
  • Tobacco
  • Alcohol
  • Marijuana
  • Cocaine
  • Heroin

82
Preterm Labor
  • Occurs after the 20th week and before the 37th
    week of gestation
  • Contractions every 10 minutes lasting 30 seconds
    or longer
  • Documented cervical change
  • Effacement of 80
  • Dilation of 2 cm

83
Risk Factors
  • Previous history of preterm labor or birth
  • Demographic factors
  • Lifestyle factors
  • Health problems
  • Uterine factors

84
Assessment
  • Increased or bloody discharge
  • Leaking amniotic fluid
  • Backache
  • Pressure and cramping
  • Palpable uterine contractions
  • Diarrhea

85
Nursing Interventions
  • Maintain bedrest
  • Tocolytic agents
  • Betamethasone
  • Magnesium sulfate
  • Monitor fetal status
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