Maternal Health Unit 2 PDF

# Unit 2: Care of At-Risk/High Risk and Sick Mother ## High Risk Pregnancy A pregnancy wherein maternal and fetal life is endangered by a disorder co-existing with or unique to the pregnancy. ### CATEGORIES: 1. **Biophysical** * **Genetic** * Example: trisomy 13 * **Medi...

# Unit 2: Care of At-Risk/High Risk and Sick Mother ## High Risk Pregnancy A pregnancy wherein maternal and fetal life is endangered by a disorder co-existing with or unique to the pregnancy. ### CATEGORIES: 1. **Biophysical** * **Genetic** * Example: trisomy 13 * **Medical** * Example: hypertension, CHF, asthma * **Obstetric** * Example: dystocia 2. **Behavioral** * Nutritional status * Substance abuse * Dental hygiene * Abuse and violence 3. **Psychological** * Failure to seek prenatal care * Extreme stress 4. **Socio-Demographic** * Maternal age * Parity * Marital status * Residence * Ethnicity * Income * Racial and ethnic origin * Occupational hazards: * Prolonged shifts * Extreme heat * Exposure to radiation ## Role of the Nurse * Identify risk factors and estimate the potential effect of the pregnancy outcome ## Causes of Maternal Mortality: 1. Normal delivery and other complications related to pregnancy occurring in the course of labor, delivery, and puerperium. 2. Hypertension complicating pregnancy, childbirth and puerperium. 3. Postpartum hemorrhage. 4. Pregnancy and abortive outcome. 5. Hemorrhage related to pregnancy. ## Maternal Infection:TORCH 1. **Toxoplasmosis** * An infection with parasite called toxoplasma gondii. * The parasite lives mainly in cats but can infect other animals and people. * Sources: * Food-borne (eating of undercooked meat) * Infected cats (cat feces) * Causes: Damage to CNS (brain), eyes or other organs * You can be infected by: * Eating raw or undercooked meat (meat showing any traces of pink or blood) * Eating cured, dried or smoked meats like salami * Eating raw oysters, clams or mussels * Drinking unpasteurized goats’ milk or eating any products made from it * Contact with sheep or lambs * Eating unwashed fruit and vegetables which may be contaminated by cat poo * Touching cat poo (for example, when changing the litter box) and then touching food. * Symptoms of toxoplasmosis: * No symptoms * Flu-like symptoms, such as: * High temperature (fever) * Aching body * Headache * Tiredness * Feeling sick * Sore throat * Swollen glands * Common symptoms: * Fever * Loss of appetite * Lathery * Drug of choice: Pyrimethamine * Supplemental folic acid necessary with intake of Pyrimethamine because it is folic acid antagonists. * Diagnosis: Blood test * Treatment: Medicines can help you to get better and may help prevent or reduce harm to your baby. You may be offered: * Antibiotics * A medicine that kills parasites (an anti-parasitic medicine) * A supplement called calcium folinate, which works in a similar way to folic acid * Most babies with toxoplasmosis seem healthy at birth. But many will have health problems months or years later. These may include: * Eye infections * Hearing problems * Seizures * Learning difficulties * Delayed growth 2. **Other infections** * **Syphilis** * Causative agent: Treponema pallidum * Infection occurs at 2nd/3rd trimester because of the protective nature of cytotrophoblasts * Drug of choice: Benzathine penicillin (if infected at 1st trimester) * Causes: Congenital anomalies, extreme rhinitis, and characteristic rash. * **Varicella Zoster** * Parvovirus B19 * Causative agent: Erythema infectiosum (fifth disease) * Acquired early pregnancy causes fetal death * Acquired late pregnancy causes anemia and congenital heart disease. * **Rubella** * A contagious viral infection best known by its distinctive red rash. It's also called German measles or three-day measles. * Causes: Damage to fetal heart, brain, eyes, and ears. * Given the nature of the immunization: A woman is not advised to get pregnant three (3) months after immunization and not to forget immunized during pregnancy. (measles-mumps-rubella (MMR) vaccine) * Causes: Rubella is caused by a virus that's passed from person to person through coughs or sneezes, spread by direct contact with infected mucus from the nose and throat. It can also be passed on from pregnant women to their unborn children through the bloodstream. * Complications: Growth delays, cataracts, deafness, problems with the development of the heart (congenital heart defects), problems with the development of other organs, problems with mental development and learning. 3. **Cytomegalovirus** * Is a common virus that spreads easily through an infected person's saliva or other body fluids. * Causes damage to the CNS, eyes, ears, and liver, manifested in fetuses by “Blueberry-muffin lesions (large petechiae)” * Symptoms of primary CMV, they're mild and include: Fatigue, swollen glands, fever, chills, sore throat, muscle aches, headache, antibiotic rash, changes in liver function, mononucleosis syndrome. * Cytomegalovirus Transmission: Saliva, semen, vaginal fluids, blood, urine, breast milk. * You can also get cytomegalovirus through: Sexual contact, blood transfusions, organ transplants. * Cytomegalovirus Diagnosis: Blood and urine tests, biopsy, eye tests, imaging tests. 4. **Herpes Simplex** * Causes oral herpes, genital herpes, and infections in other areas of your body. Fluid-filled blisters on your skin are common symptoms. * Fetal Effects: 1st trimester: Congenital anomalies, spontaneous abortion. 2nd and 3rd trimester: Preterm labor, intrauterine growth retardation, continuing infection at birth. * If mother has genital herpes: Caesarian is the choice of birth method. * Drug of choice: Acyclovir.