Caring for the Woman Experiencing Complications During Pregnancy

1
Chapter 11

• Caring for the Woman Experiencing Complications
  During Pregnancy
• Edited by Catherine Marin, MSN/Ed(c), WHCNP, RN

2
Early Pregnancy Complications

• Perinatal loss
• Ectopic pregnancy
• Gestational trophoblastic disease
• Signs/symptoms vaginal bleeding, excessive
  nausea/vomiting, abdominal pain, size/date
  discrepancy
• Management remove uterine contents

3
Spontaneous Abortion

• Before 20 weeks of gestation
• Signs/symptoms bleeding, cramping, abdominal
  pain, decreased symptoms of pregnancy
• Management D C

4
Incompetent Cervix

• Painless dilation and cervical effacement
• Second trimester
• Management

5
Hyperemesis Gravidarum

• Criteria persistent vomiting, measure of acute
  starvation, and weight loss
• Management
• Rest
• Small frequent meals (dry, bland foods)
• High-protein snacks

6
Hemorrhagic Disorders

• Placenta previa
• Signs/symptoms painless vaginal bleeding
• Management stabilization and fetal monitoring
• Abruptio placentae
• Signs/symptoms third-trimester bleeding
  associated with severe abdominal pain
• Management monitoring, delivery

7
Preterm Labor

• Morbidity and mortality
• Subtle signs/symptoms
• Biochemical markers
• Management goals
• Inhibit/reduce contraction strength/frequency
• Optimize fetal status

8
Premature Rupture of Membranes

• Signs/symptoms gush/trickle of fluid from vagina
• Management factors
• Establish gestational age
• Ultrasound to assess fetus
• Assess for advanced labor, infection
• If advanced labor or infection, deliver fetus

9
Hypertensive Disorders

• Classifications
• Chronic
• Preeclampsia-eclampsia
• Chronic hypertension with superimposed
  preeclampsia
• Gestational/transient

10
Preeclampsia

• Multisystem, vasopressive
• Disease of placenta
• SPASMS
• Morbidity and mortality
• Management
• Delivery of fetus only cure

11
Nursing AssessmentsPreeclampsia

• Identify hypertension
• Proteinuria- 24 hr urine collection for Total
  Protein
• Edema- especially facial edema, hands and feet
• CNS alterations
• Eclampsia seizures

12
HELLP Syndrome

• Complication of preeclampsia
• Treatment
• Improve platelets with FFP
• Delivery of fetus as soon as feasible

13
Disseminated Intravascular Coagulopathy (DIC)

• External or internal bleeding
• Nursing care
• Meticulous maternal and fetal assessment
• Place indwelling catheter
• Oxygenrebreathing mask
• Blood and blood products
• Emotional support

14
Multiple Gestation

• High-risk pregnancy
• Morbidity and mortality
• Management
• Delivery at Level III facility

15
Infections

• UTI
• Group B streptococcus
• TORCH
• STIs
• HIV and AIDS
• Tuberculosis

16
Inflammatory Disease Pregnancy

• Systemic lupus erythematosus (SLE)
• Increased risk of pregnancy complications
• Management
• Immunosuppression of SLE flare
• Careful fetal surveillance
• If flare-up during pregnancy, rapid
  implementation of treatment

17
Hemoglobinopathies

• Sickle cell disease
• Promote good dietary habits
• Early detection of infection and treatment
• Prevent dehydration
• Prompt treatment of sickle cell crises
• Fetal surveillance

18
Hemoglobinopathies

• Thalassemia
• Close maternal and fetal surveillance
• Rh0(D) isoimmunization
• Admininster RhoGAM to prevent antibody formation
• ABO
• Coombs test

19
Respiratory Complications

• Pneumonia
• Aggressive management
• Asthma
• Maternal and fetal risks
• Careful monitoring
• Adjustments in therapy

20
Cystic Fibrosis

• Fetus at risk for uteroplacental insufficiency
  and IUGR
• Monitor nutritional status
• Early recognition and treatment of pulmonary
  infections
• Maternal and fetal surveillance

21
Cardiovascular Disease

• Symptoms similar to normal pregnancy
  physiological changes
• Labor, birth, immediate postpartum period
• Lateral recumbent position
• Administer IV fluids with caution
• Invasive hemodynamic monitoring
• Medications e.g. prophylatic antibiotics

22
Other Cardiovascular Disorders

• Mitral valve prolapse
• Pregnancy may alleviate murmur and symptoms
• Peripartum cardiomyopathy
• No history of cardiac disease
• Signs/symptoms dyspnea, fatigue,
  peripheral/pulmonary edema

23
Diabetes Mellitus

• Morbidity and mortality
• Screening and diagnosis
• Management
• Home blood glucose monitoring
• Adjust diet, medication, physical activity
• Ongoing maternal-fetal surveillance

24
Thyroid Conditions

• Hyperthyroidism
• Signs/symptoms
• Depressed TSH and elevated free T4
• Antithyroid medications
• Hypothyroidism
• Symptoms
• Elevated TSH and low to normal T3 and T4

25
Venous Thrombosis and Pulmonary Embolism

• Symptoms
• Diagnosis
• Doppler ultrasound
• Ventilation-perfusion (VQ) scan

26
Psychiatric Complications

• Depression
• Bipolar disorder
• Anxiety disorders
• Eating disorders
• Substance addiction

27
Antepartum Fetal Assessment

• Chorionic villus sampling
• PUBS
• Amniocentesis
• Amnioscopy or fetoscopy
• Ultrasonography
• Fetal kick counts

28
Assessment of Fetal Well-Being (cont.)

• Doppler ultrasound
• Fetal biophysical profile (ultrasound and NST
• Non-stress test
• Vibroacoustic stimulation
• Contraction stress test
• Electronic fetal heart rate monitoring

29
Special Conditions and Circumstances that may
Complicate Pregnancy
30
Antenatal Bedrest

• Regular community health nurse home visits
• Involve various community resources
• Support groups
• Provide emotional support

31
Other Special Conditions

• Adolescent
• Advanced age
• Trauma
• Cancer
• Obesity
• Disability