Obstetrics Complications of Pregnancy PDF

1/16/2025 OB: COMPLICATIONS OF PREGNANCY Exam Date: Friday, January 24 Rosdahl Ch. 68 ATI: PN Maternal Newborn Nursing Ch. 5-9 E. Edge, RNC-MNN OBJECTIVES 1. Define and demonstrat...

1/16/2025 OB: COMPLICATIONS OF PREGNANCY Exam Date: Friday, January 24 Rosdahl Ch. 68 ATI: PN Maternal Newborn Nursing Ch. 5-9 E. Edge, RNC-MNN OBJECTIVES 1. Define and demonstrate understanding of Important Terminology and Acronyms. (CO 7) 2. Demonstrate understanding of the process, nursing interventions, and reasons for performing an Amniocentesis. 3. Identify priority assessment, defining characteristics, laboratory and diagnostic tests, and nursing interventions for women who present with signs and symptoms of Abruptio Placentae. 4. Distinguish between “nonreactive’ and “reactive” Stress and Nonstress tests. 5. Identify factors that put clients at risk for developing complications during pregnancy. 6. Demonstrate understanding of the Cardiff method of fetal movement documentation and factors that when present must be reported to the physician. 7. Compare and contrast the etiology, medical-surgical management, nursing care, and effect on the fetus of Rh incompatibility and ABO incompatibility. 8. Identify measures necessary in the care for a client with a chronic medical problem: diabetes, hypertension, heart disease, maternal PKU. 9. Distinguish between the different types of decelerations, causative factors, interventions and nursing considerations for each. OBJECTIVES 10. Identify signs and symptoms, distinguishing factors, and nursing interventions for clients with mild and severe preeclampsia, and eclampsia. 11. Demonstrate understanding of the development, medical-surgical management, and nursing care of a client with pregnancy-induced hypertension. 12. Demonstrate understanding of the purpose of the Lecithin/Sphingomyelin Ratio, the organ that it is evaluating, and what it is evaluating. 13. Differentiate among the different types of abortion and identify nursing interventions and considerations in the care of patients who have had each type of abortion. 14. Identify signs and symptoms, nursing considerations and medical management of a client with an ectopic pregnancy, including pre-operative and post-operative care, if applicable. 15. Demonstrate understanding of the development, medical-surgical management, risk factors and nursing interventions in the care of a client with Hydatidiform mole. 16. Identify priority assessment, defining characteristics, and nursing interventions for women who present with signs and symptoms of Placentae Previa. 17. Demonstrate understanding of the development, medical-surgical management, risk factors and nursing interventions in the care of a pregnant client who has a history of Diabetes. 18. Identify possible complications they may develop in a pregnant woman who has been exposed to Rubella (German Measles). 1  1/16/2025 OBJECTIVES 19. Identity the benefits of prenatal care and risk factors and complications that result in patients who do not get receive medical management of their pregnancy. 20. Identify causative factors, signs and symptoms, and complications associated with disseminated intravascular coagulations (DIC). 21. Identity nursing interventions for a patient who is having a seizure. 22. Demonstrate understanding of normal Magnesium sulfate (MgSO4) levels, signs and symptoms of Mag toxicity, nursing interventions, and medications used in the treatment of Mag toxicity. 23. Identity nursing considerations, interventions, and medical management in the care of patients who have a history of chronic heart disease. 24. Demonstrate understanding of medical management necessary for patients with a history of sexually transmitted diseases in the prevention of fetal infection. 25. Identify complications that may develop in a pregnancy that goes beyond 32 weeks gestation. 26. Identity signs and symptoms of a multiple pregnancy. 27. Demonstrate understanding of proper positioning of laboring patients and the factors that make these positions necessary. HIGH-RISK PREGNANCY RISK FACTORS Under age 15 Advanced Maternal Age = over 35 years of age Unmarried Low socioeconomic; little education Prenatal care begun later than recommended (27 weeks or later) Previous obstetrical problems Multiple pregnancy Medical history (chronic diseases, STD, Neuro/psych problems) Smoking, drug, alcohol abuse Nutritional deficit Obesity WHAT IS THE FETUS TELLING ME? How To Read Fetal Heart Rate And Contraction Tracings 2  1/16/2025 WHEN ASSESSING FHR TRACINGS, FOLLOW THESE STEPS EVERY TIME 1. Determine baseline FHR 2. Determine Variability 3. Determine if accelerations are present 4. Determine if there are any variables present 5. Determine if there are decelerations present and what kind they are 6. Determine contraction frequency 7. Determine contraction duration 1 minute 10 seconds FHR # Range Fetal oxygenation restored. Uterine & Ctx Fetal rest period. intensity BASELINE FETAL HEART RATE (FHR) Baseline FHR = the average FHR during a 10 minute period. Must have at least one continuous 2 minute segment present. Documented as a single number, not a range. Normal FHR Tachycardia Bradycardia 110-160 bpm >160 bpm before pregnancy or before the 20th week gestation that lasts longer than 6 weeks after delivery If poorly controlled, may show signs of: arteriosclerosis retinal hemorrhage renal disease placenta abruption placental infarctions 36  1/16/2025 HEART DISEASE The normal increase in blood volume peaks at about 28 – 32 weeks gestation This increased cardiac output and heart rate may cause problems in the client with heart disease HF may occur when the heart is no longer able to compensate for the increased demands Effects on the fetus/Neonate: Intrauterine Growth Restriction (IUGR) Hypoxia HEART DISEASE Followed by OB/GYN and cardiologist Prenatal care appointments may be increased to 2 or 3 per week between 28 – 32 weeks’ gestation when blood volume is at its highest and when the possibility of developing HF is greatest Diet should be high in iron and protein and low in sodium Adequate calorie intake for normal weight gain Physical activity may be restricted depending on status 8 – 10 hours sleep and frequent rest periods are recommended Side-lying (lateral) position improves utero-placental circulation and prevents compression on the vena cava (LEFT side is best ☺) DIABETES MELLITUS Women who have chronic diabetes before pregnancy must have it well controlled before getting pregnant because diabetes is much harder to control during pregnancy! Gestational Diabetes – only occurs during pregnancy when there is abnormal metabolism of glucose Pancreas has little or no reserve May result in chronic diabetes later in life The effects during pregnancy are the same for both chronic diabetes or gestational diabetes. 37  1/16/2025 DIABETES MELLITUS Increased Risks on the Fetus/Neonate: Macrosomia (>4000 grams) – large baby! Excessive fetal growth! Can cause birth trauma like a shoulder dystocia Electrolyte imbalances Caused by maternal hyperglycemia Increased fetal insulin = inhibits production of surfactant in lungs = increasing the risk of respiratory distress syndrome after birth Placental abruption Preterm labor DIABETES MELLITUS Increased Risks on the Fetus/Neonate Cont.: Fetal hypoxia d/t maternal hypoglycemia Hyperglycemia stimulates the fetal pancreas to increase its production of insulin After birth, there is no longer the extra glucose from the mother, but the fetal pancreas continues to secrete increased amounts of insulin resulting in fetal hypoglycemia within 2 – 4 hours Infant will often be on an IV glucose infusion Infant will require frequent blood glucose testing Nurses….get ya glucose monitors DIABETES MELLITUS charged and ready!!!! Babies of diabetic mothers are often treated as premature even if term by dates 38  1/16/2025 DIABETES MELLITUS Increased Risks for Mother: Infections – (urinary & vaginal) Polyhydramnios – can cause overdistention of uterus, placental abruption, preterm labor, and postpartum hemorrhage Ketoacidosis – from diabetogenic effect of pregnancy (increased insulin resistance), untreated hyperglycemia, or inappropriate insulin dosing Hypoglycemia - caused by overdosing insulin, skipped or late meals, or increased exercise Hyperglycemia- which can cause macrosomia Macrosomia can cause birth trauma for mother – tearing, episiotomy, etc. Pregnancy Induced Hypertension DIABETES MELLITUS Medical Management: Goal is to maintain normal glucose levels between 70 and 120 and to have a healthy mom and baby Often followed by OB/GYN and endocrinologist Self-blood glucose monitoring Usually before meals and fasting Insulin administration, often by sliding scale If client had been on oral hypoglycemics, they will be switched to insulin while pregnant DIABETES MELLITUS Diet: Increased calories divided between 3 meals and 3 snacks Complex carbohydrate and protein bedtime snack late as possible to prevent hypoglycemia during the night No more than 10 hours between the bedtime snack and breakfast Dietician Consult is best Activity should be maintained to control blood glucose levels TEACH YOUR CLIENT box 68-1in Rosdahl pg. 1114 39  1/16/2025 MATERNAL PHENYLKETONURIA (PKU) A genetically inherited, inborn error of metabolism There is a deficiency of the enzyme necessary to metabolize the amino acid phenylalanine (a common amino acid in proteins) The accumulation of this amino acid and its metabolites leads to irreversible brain damage mental retardation Seizures A poorly regulated maternal phenylalanine level causes an increased incidence of mental retardation, microcephaly, and heart defects All newborns in the US are screened for PKU Those diagnosed are placed on a phenylalanine free diet and continued throughout life INFECTIONS IN PREGNANCY ATI PN MATERNAL NEWBORN NURSING CH. 7 TORCH GROUP A group of infections that is harmful to the pregnant T Toxoplasmosis woman and teratogenic to the fetus O Other infections These infections can cross the placental barrier and have teratogenic effects on the R Rubella fetus TORCH does not include all the major infections that C Cytomegalovirus present risks to the mother and fetus H Herpes Virus Type 2 40  1/16/2025 TOXOPLASMOSIS A parasitic disease Caused by a protozoan ingested by eating raw, undercooked, or cured meat, unwashed vegetables, or by handling cat feces. Increases incidence of stillbirths, preterm births, abortions, neonatal death Earlier the gestation when the mother contracts the disease the more severe the effects Should wear gloves while gardening; pregnant women should not handle liter boxes; contact with soil increases risk significantly OTHER INFECTIONS S/S and effects on both the mother and the fetus varies depending on the infection Syphilis – can cause spread to fetus, cause abnormalities or even death Gonorrhea Chlamydia Condylomata (Venereal Warts) Hepatitis B Candida Albicans Vaginal Fungal Infection Trichomoniasis Vaginal Infection Cystitis (UTI) RUBELLA (GERMAN MEASLES) Spread by airborne droplets Risk factors include contact with children who have rashes or infants born to mothers who had rubella during pregnancy The earlier in pregnancy the infection occurs, the more severe the effects Congenital rubella syndrome occurs in the baby more commonly when infections occur before 8 weeks gestation Infants are born with deformities Characterized by cataracts, deafness, patent ductus arteriosus Often have IUGR, mental retardation, and hyperbilirubinemia These infants are infectious for months Prevention is the best cure 41  1/16/2025 RUBELLA (GERMAN MEASLES) Vaccination of the mother during pregnancy is contraindicated because rubella infection may develop Pregnant women should avoid crowds of young children Women with low titers should be immunized prior to pregnancy; should not get pregnant for 3 months following immunization Some doctors give vaccine prior to discharge to women with low titers or negative titers CYTOMEGALOVIRUS Member of the herpes virus group Transmitted by droplet infection from person to person Found in saliva, semen, vaginal secretions, cervical secretions, breast milk, placental tissue, urine, feces, and blood Antiviral meds for treatment Fetus may have extensive damage leading to death or may survive with hydrocephalus, microcephaly, mental retardation, cerebral palsy, or with no notable damage HERPES VIRUS TYPE 2 Causes painful, vesicular genital lesions that may appear within a few hours to up to 20 days after exposure Primary episode is the most severe Women who have their first infection close to the time of delivery have a greater chance of neonatal infection After the membranes rupture, the virus travels up from active lesions to the fetus or the fetus comes in contact with the lesions during a vaginal birth When it occurs in the first trimester about ½ will end up in spontaneous abortions or stillbirths Most infected infants have no S/S at birth After birth, the newborn can have: Poor feeding, jaundice, and seizures develop after a 2-12 day incubation period When active lesions are present at the time of delivery, a C-section is best to prevent fetal contact with the lesions 42  1/16/2025 GROUP B STREPTOCOCCUS (GBS) A bacterial infection that can be passed to a fetus during labor and delivery Vaginal and rectal cultures are performed at 35 – 37 weeks gestation Positive GBS can have maternal and fetal effects Premature rupture of membranes Preterm labor and delivery Chorioamnionitis Infections of the urinary tract Maternal sepsis Administer intrapartum antibiotic prophylaxis (IAP) PCN G or Ampicillin (clindamycin if PCN allergic) HUMAN IMMUNODEFICIENCY VIRUS (HIV)/ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Pregnancy is considered an immunosuppressive state and may theoretically speed up the rate of the process of going from HIV to AIDS May be transmitted to the fetus through the placenta, at the time of birth when exposed to maternal blood and vaginal secretions, or through breast milk The following should be avoided if at all possible to prevent exposure: Amniocentesis Episiotomy Internal fetal scalp electrodes Vacuum extraction Forceps Administration of injections and blood testing should not take place until the first bath is given to the newborn HUMAN IMMUNODEFICIENCY VIRUS (HIV)/ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Infants receiving routine shots at birth MUST have a bath prior to administering shots. Infants often have a positive antibody titer for as long as 15 months because of the transfer of maternal antibodies Those infants who are not infected with HIV will seroconvert to a negative antibody titer Mother will be administered Retrovir at 14 weeks, throughout pregnancy, before the onset of labor, during labor, or before cesarean birth Infant will receive Retrovir at delivery and for 6 weeks following birth 43  1/16/2025 RH INCOMPATIBILITY Can occur only when the mother is Rh negative and the fetus is Rh positive Father must be Rh positive for this to occur Fetal blood may enter the maternal circulation through infection of the placenta, abruption placenta, during birth or at the time of placental separation Mother is then sensitized by the fetal Rh positive blood If untreated with Rhogam, the next Rh positive fetus will have RBCs destroyed by the maternal Rh antibodies This results in anemia and eventually become a severe hemolytic disease of the newborn - erythroblastosis fetalis RH INCOMPATIBILITY Mother should be screened at the first prenatal visit for Rh factor If found to be Rh negative, she will receive Rhogam at approximately 28 weeks gestation and again after the baby is born if the baby is found to be Rh positive Rhogam must be given within 72 hours after birth This includes after any type of abortion, ectopic pregnancy, etc. Consent must be obtained – Rhogam is a blood product and some religions refuse any type of blood products If mom refuses, physician should be informed immediately and the mother should be thoroughly informed of the risks and consequences of refusing ERYTHROBLASTOSIS FETALIS 44  1/16/2025 ABO INCOMPATIBILITY Occurs when maternal blood enters fetal circulation Most common type is when the mother is type O and the Baby is type A, B, or AB Because this is naturally-occurring, ABO incompatibility can occur in the first trimester The affected newborn will have a positive Direct Coombs and will become jaundice within the first 3 days of life NUGGETS OF KNOWLEDGE 45  1/16/2025 MULTIPLE PREGNANCY 1st sign: Fundal height is greater than expected for the weeks of gestation Ultrasound identifies 2 or more fetuses and FHRs that differ by 10bpm PRETERM LABOR Labor that begins after 20 weeks but before 37 weeks gestation Confirmed by the presence of: Uterine contractions ROM Cervical dilation Effacement Stopped with tocolytics such as (brethine) terbutaline and magnesium sulfate if it is an otherwise healthy pregnancy Recommended that mother receive an injection of corticosteroids (ex: Betamethasone) to enhance fetal lung maturity PROLONGED PREGNANCY Pregnancy greater than 42 weeks gestation Overall placental function is decreased Due to placental deterioration, nourishment to the fetus is decreased Baby begins to lose weight Labor may be induced or a C/S performed depending on fetus condition 46  1/16/2025 NURSE… WHY CANT I LAY ON MY BACK DURING PREGNANCY? QUESTION Is the following statement true or false? Performing an abortion in unsanitary conditions can be fatal. QUESTION Is the following statement true or false? A client with severe preeclampsia should lie on her back as much as possible. 47  1/16/2025 QUESTION Is the following statement true or false? Abruptio placenta may require immediate cesarean delivery. 48