Maternal and Child Nursing: Pregnancy Abnormalities

Maternal and Child Nursing: Abnormalities of Pregnancy

• Abnormalities of pregnancy encompass a range of conditions that deviate from normal pregnancy.
• These abnormalities can affect the health and well-being of both the mother and the developing fetus or newborn.
• Early identification and management are crucial to optimize outcomes.

Hyperemesis Gravidarum

• Severe and persistent nausea and vomiting during pregnancy characterize this condition.
• Hyperemesis Gravidarum leads to dehydration, electrolyte imbalances, nutritional deficiencies, and weight loss.
• Typically starts in the early weeks of pregnancy and may persist throughout.
• The exact cause remains unknown.
• Hormonal factors, such as elevated hCG and estrogen, are thought to play a role.
• Risk factors include a history of hyperemesis gravidarum, multiple gestation, molar pregnancies, and certain medical conditions.
• Management includes dietary modifications (small, frequent meals), antiemetic medications (e.g., pyridoxine, doxylamine, promethazine, ondansetron), IV fluids, and electrolyte replacement.
• Hospitalization and nutritional support may be necessary in severe cases.

Gestational Hypertension and Preeclampsia

• Gestational hypertension is defined as elevated blood pressure (≥140/90 mmHg) that develops after 20 weeks of gestation in a previously normotensive woman.
• Preeclampsia is a more severe condition characterized by gestational hypertension accompanied by proteinuria (≥300 mg in a 24-hour urine collection) or other signs of end-organ damage.
• Signs of end-organ damage include thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, or neurological symptoms.
• The underlying cause of preeclampsia is thought to be abnormal placental development, leading to endothelial dysfunction and widespread systemic effects.
• Risk factors for preeclampsia include nulliparity, multiple gestations, a history of preeclampsia, pre-existing hypertension, diabetes, renal disease, obesity, and advanced maternal age.
• Management depends on the severity and the gestational age.
• Mild gestational hypertension may be managed with close monitoring of blood pressure and fetal well-being.
• Severe preeclampsia requires hospitalization for intensive monitoring, antihypertensive medications (e.g., labetalol, hydralazine, nifedipine), and magnesium sulfate to prevent seizures (eclampsia).
• Potential delivery of the fetus may be necessary.
• Eclampsia is the occurrence of seizures in a woman with preeclampsia, representing a life-threatening emergency.
• A definitive cure for preeclampsia is delivery of the placenta.

Gestational Diabetes Mellitus (GDM)

• GDM is defined as glucose intolerance first recognized during pregnancy.
• It typically develops in the second or third trimester and usually resolves after delivery.
• Hormonal changes during pregnancy can lead to insulin resistance, requiring the pancreas to produce more insulin to maintain normal glucose levels.
• Women with GDM are unable to produce enough insulin to overcome the insulin resistance, resulting in elevated blood glucose levels.
• Risk factors for GDM include obesity, a family history of diabetes, previous GDM, a history of macrosomic infants, and certain ethnicities.
• Diagnosis of GDM typically involves a glucose challenge test followed by a glucose tolerance test if the challenge test is abnormal.
• Management focuses on dietary modifications (consistent carbohydrate intake), regular exercise, and blood glucose monitoring.
• Some women with GDM may require insulin or oral hypoglycemic medications (e.g., metformin, glyburide) to control their blood glucose levels.
• Poorly controlled GDM can lead to complications such as macrosomia, shoulder dystocia, neonatal hypoglycemia, and an increased risk of developing type 2 diabetes later in life (mother and child).

Preterm Labor and Birth

• Preterm labor is defined as labor before 37 completed weeks of gestation.
• Preterm birth is the delivery of a baby before 37 completed weeks of gestation.
• Preterm birth is a leading cause of neonatal morbidity and mortality.
• Risk factors for preterm labor and birth include a history of preterm birth, multiple gestations, uterine abnormalities, cervical insufficiency, infections (e.g., UTIs, bacterial vaginosis), and certain medical conditions.
• Signs and symptoms include regular contractions, lower back pain, pelvic pressure, vaginal bleeding or spotting, and changes in vaginal discharge.
• Management may include tocolytic medications (e.g., magnesium sulfate, nifedipine, indomethacin) to suppress uterine contractions.
• Corticosteroids (e.g., betamethasone, dexamethasone) are used to promote fetal lung maturation, and antibiotics are administered if infection is suspected.
• If preterm labor cannot be stopped, delivery may be necessary.
• Preterm infants are at increased risk for a variety of complications, including respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and long-term neurodevelopmental disabilities.

Placenta Previa

• Placenta previa is a condition in which the placenta implants in the lower segment of the uterus, partially or completely covering the cervical os.
• It can cause painless vaginal bleeding, especially in the second or third trimester.
• Risk factors include previous placenta previa, multiple gestations, previous cesarean delivery, uterine surgery, advanced maternal age, and smoking.
• Diagnosis is typically made by ultrasound.
• Management depends on the severity of the bleeding, the gestational age, and the stability of the mother and fetus.
• If the bleeding is mild and the woman is not in labor, she may be managed conservatively with pelvic rest, avoiding strenuous activity, and close monitoring.
• If the bleeding is heavy or the woman is in labor, a cesarean delivery is usually necessary.
• Placenta previa can lead to significant maternal hemorrhage and preterm birth.

Placental Abruption

• Placental abruption is the premature separation of the placenta from the uterine wall before delivery.
• It can cause vaginal bleeding (which may be concealed), abdominal pain, uterine tenderness, and fetal distress.
• Risk factors include hypertension, preeclampsia, previous placental abruption, abdominal trauma, smoking, cocaine use, and multiple gestations.
• Diagnosis is typically based on clinical findings and may be confirmed by ultrasound.
• Management depends on the severity of the abruption, the gestational age, and the stability of the mother/fetus.
• Mild abruptions may be managed conservatively with close monitoring.
• Severe abruptions require immediate delivery, usually by cesarean section.
• Placental abruption can lead to maternal hemorrhage, disseminated intravascular coagulation (DIC), and fetal hypoxia.

Ectopic Pregnancy

• Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tube.
• It can cause abdominal pain, vaginal bleeding, and shoulder pain (due to diaphragmatic irritation from intra-abdominal bleeding).
• Risk factors include previous ectopic pregnancy, pelvic inflammatory disease (PID), tubal surgery, and use of assisted reproductive technologies.
• Diagnosis is typically based on clinical findings, serum hCG levels, and ultrasound.
• Management may involve medication (methotrexate) to dissolve the ectopic pregnancy or surgery (laparoscopy or laparotomy) to remove the ectopic pregnancy.
• Ectopic pregnancy can be life-threatening if it ruptures, leading to severe internal bleeding.

Miscarriage (Spontaneous Abortion)

• Miscarriage is the spontaneous loss of a pregnancy before 20 weeks of gestation.
• It is a common occurrence, with an estimated 10-20% of recognized pregnancies ending in miscarriage.
• Risk factors include advanced maternal age, previous miscarriage, chromosomal abnormalities, uterine abnormalities, and certain medical conditions.
• Signs and symptoms include vaginal bleeding, abdominal cramping, and passage of tissue.
• Types of miscarriage include threatened miscarriage, inevitable miscarriage, incomplete miscarriage, complete miscarriage, missed miscarriage, and septic miscarriage.
• Management may involve expectant management (allowing the miscarriage to occur naturally), medical management (using medications such as misoprostol to induce uterine contractions), or surgical management (dilation and curettage or dilation and evacuation).
• Rh-negative women who experience a miscarriage should receive Rh immunoglobulin (RhoGAM) to prevent Rh sensitization.

Stillbirth

• Stillbirth is defined as the death of a fetus at or after 20 weeks of gestation.
• The causes of stillbirth are often unknown, but may include placental problems, fetal abnormalities, infections, and maternal medical conditions.
• Risk factors for stillbirth include advanced maternal age, obesity, smoking, multiple gestations, and previous stillbirth.
• Diagnosis is typically made by ultrasound.
• Management involves labor induction and delivery of the fetus.
• Emotional support and counseling are essential for parents who have experienced a stillbirth.
• Autopsy and placental examination may be performed to help determine the cause of the stillbirth.