High-Risk Pregnancy & Abuse Indicators

• Course module 1, Unit 1A is titled "High-Risk Pregnant Client" and will be covered in week 1.

Unit Expectations (UEOs) for Students:

• Cognitive: Define high-risk pregnancy and its pre-existing factors.
• Cognitive: Determine methods for assessments and care for prenatal visits.
• Cognitive: Assess a pregnant woman with an illness for changes due to pregnancy.
• Affective: Listen, respect others' opinions, and accept classmates' comments.
• Psychomotor: Participate, follow class rules, and integrate high-risk pregnancy knowledge for quality care.

Required Readings:

• "Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family" (9th Ed.) by Adele Pilliteri and JoAnne Silbert-Flagg (2022).
• "Essentials of Maternity, Newborn, and Women's Health Nursing" (4th Ed.) by Susan Scott Ricci.
• RA 9262: Anti-Violence Against Women and their Children Act of 2004.

Republic Act 9262: Anti-Violence Against Women and their Children:

• This law applies to acts committed by an intimate partner (current or former spouse/partner, dating relationship) against a woman and/or her child.
• These acts result in physical, sexual, psychological, or economic abuse.
• Physical violence includes bodily harm or causing fear of harm.
• Sexual violence includes unwanted sexual acts or treating a woman/child as a sex object.
• Psychological violence includes controlling behavior, causing anguish/humiliation, or threatening harm.
• Economic abuse involves making a woman financially dependent.
• Protection orders are issued to prevent further violence and protect the victim.
  • Barangay Protection Orders (BPO): Issued by the Barangay, effective for 15 days.
  • Temporary Protection Orders (TPO): Issued by the court, effective for 30 days.
  • Permanent Protection Order (PPO): Issued by the court after a hearing, effective until revoked.

Intimate Partner Abuse:

• Intimate partner abuse is when someone in the family abuses another adults living in the same household.
• It occurs when someone in the family abuses another adult in the same house.
• 20-30% of women in emergency departments report have been abused by an intimate partner.
• Injuries include burns, lacerations, bruises, and head injuries.
• Abuse is more common during pregnancy due to stress.
• Homicide from partner abuse is the leading cause of death in pregnant women.
• Abused women may have unwanted pregnancies or believe a child will change their partner.
• Abused women display behaviors that reveal abuse i.e, late prenatal care, no maternity clothing, or difficulty following nutrition recommendations.
• Ultrasound can reveal trauma in the fetus caused by the abuse.

High-Risk Pregnancy:

• High-risk pregnancies have a chronic condition, impacting both mother and fetus, increasing chances for complications.
• High-risk pregnancy involves a concurrent disorder, complication linked to pregnancy, or external factors that endanger mother and/or fetus.
• Risk factors suggest the pregnancy could lead to the possibility of negative outcomes for the mother or unborn child.

Assessments/Care for Continuing Prenatal Visits

• Health Interview: Includes new or personal family developments, danger signs/symptoms of labor.
• Physical Exam: Includes BP, urine tests for glucose/protein/leukocytes, blood serum/syphilis/glucose/streptococci, Anti-Rh titer.
• Fetal Health: Includes heart rate, fundal height/movement, or ultrasound dating.

Factors Defining Pregnancy as "At-Risk"

• Obstetric History: Includes subfertility, previous cervical dilatation/preterm labor, or uterine anomalies.
• Medical History: Encompasses cardiac/pulmonary issues, metabolic/renal diseases, or surgeries.
• Psychosocial Factors: Includes finances, adolescent status, nutrition, acceptance/ideation of pregnancy, or housing.
• Demographic Factors include maternal age, education, substance use, alcohol and smoke use as well as stress.

High-Risk Pregnancy Factors in Social/Personal Circumstances:

• Poor antenatal care leads to potential low birth weight and intrauterine growth restriction.
• Poor nutrition can result in fetal malnutrition and prematurity.
• Living at high altitudes can lead to prematurity and intrauterine growth restriction.
• Being underweight or overweight can lead to IUGR and fetal macrosomia.
• Teen pregnancies have poor antenatal care, with fetal demise.
• Pregnancies above 35 increase congenital disorders and chromosomal abnormalities.
• Drug use and smoking increase risk of hypertension and cancer.

Screening Procedures for Identifying Problems During Pregnancy:

• Ultrasound (US): Measures response to sound waves, identifies abnormalities/ position, and dating.
  • Biparietal Diameter (BPD): Head measurements to predict fetal age.
  • Doppler US: Measures blood flow in uterine and fetal vessels.
  • Placental Grading by US measures calcium grading - Grade 3 suggests fetus is mature.
  • Amniotic Fluid Volume: Assesses fetal kidney output.
• Electrocardiography: Fetal ECG can detect early heart anomalies if needed.
• Magnetic Resonance Imaging (MRI): can detect ectopic pregnancy or trophoblastic disease.
• Maternal Serum Alpha-Fetoprotein: AFP measures spinal or abdominal wall defects.
• Triple Screening: Includes AFP, estriol, hCG detection for neural tube defects.
• Chorionic Villi Sampling: Includes chorionic villi sample for biopsy via coelocentesis to remove alternative cells.
• Amniocentesis: Aspiration of fluid, typically scheduled between the 14th and 16th weeks, to test of fetal maturity.
• Percutaneous Umbilical Blood: (PUBS) Cordocentesis/funicentesis involves aspiration of umbilical cord for labs such as karyotyping via ultrasound.
• Amnioscopy: Visual inspection of amniotic fluid via detection of meconium staining.
• Fetoscopy: Can help assess fetal well-being via performing elemental surgery.
• Biophysical Profile: combines heart/breathing recordings with amniotic fluid volume to assess placental function.

Bleeding Disorders

• Vaginal bleeding during pregnancy is always a deviation of the normal.
• A woman with any level of bleeding needs to be evaluated for blood loss.

Spontaneous Abortions

• Abortion is used to describe pregnancy interruption prior to the fetus reaching the stage of viable.
• Occurs prior to the 16th week.
  • Week 6 the degree of attachment to myometrium is present.
  • After week 12 it's penetrating and will be deep.

Causes of Spontaneous Abortion

• Fetal: Abnormal formation.
• Immune: Immunologic Factors.
• Implantation/Luteum Problems
• Infections
• Drugs or Alcohol
• Assessment: Bleeding description, episode history, and actions taken.
  • Threatened abortion: symptoms include red vaginal spotting.
  • Inevitable (Imminent) Abortion occur if uterine contractions and cervical are present.
  • Complete abortion: entails products expelled with slowed bleeding.
  • Incomplete Abortion: the conceptus part usually requires further evacuation with dilation.
  • Missed: Commonly discovered with no increase in size of fetal heart rate sounds.
  • Recurrent Pregnancy Loss (Habitual Abortion): Can be caused by chorioamnionitis or uterine infection.

Types of Possible Spontaneous Abortions:

• Threatened is closed and without passage.
• Inevitable is open with no passage.
• Incomplete is open with potential passage.
• Complete is closed with passage.
• Septic is open if uterus is infected.
• Complications of such a Miscarriage involves Hemorrhage, Infection, Septic abortion, Isoimmunization, or Powerlessness/Anxiety.

Ectopic Pregnancy

• Ectopic Pregnancy happens when implantation happens outside cavity.
• Approxinately 95% of pregnancies occur in a fallopian tube.
• Approximately 2% of pregnancies are ectopic are the second most frequent cause of bleeding during In pregnancy.
• Smoking increases such incidences with women.

Gestational Trophoblastic Disease (Hydatidiform Mole)

• Abnormal trophoblastic villi that occur in women with low intakes of beta protein increases the chance.
  • Complete mole involves swelling and becoming cystic, and embryo forms and dies early at only 1-2mm.
  • Complete mole is determined with chromosome analysis, and if an embryo forms, only 1 to 2 mm in with only by the father.
  • Partial Mole layer has swollen villi with a potential macerated embryo.

Terminologies:

• Grand Multiparity refers to having multiple birth pregnancies.
• Alpha-fetoprotein entails that protein be measured with blood to detect such defects.
• Amniocentesis happens with withdraw by means of a needle to remove any wall defects.
• Hemolysis is the destruction of any red blood cells.
• Hemolytic disease of the newborn means that there is a rH.

Explore factors indicating high-risk pregnancies, including obstetric history, medical conditions, and psychosocial elements. Learn about different forms of abuse—physical, psychological, and economic—and their impact on pregnancy. Understand the role and enforcement of protection orders.