Week 3 Teacher Complications of Pregnancy (1).pptx PDF

Complications of Pregnancy Care and Management Fetal assessment Ultrasound Kick Count Alpha Feto Protein Amniocentesis Non-Stress Test Biophysical Profile Ultrasound Visualize a gestational sac in early pregnancy to confirm pregnancy Identify site of implantation Verify fetal...

Complications of Pregnancy Care and Management Fetal assessment Ultrasound Kick Count Alpha Feto Protein Amniocentesis Non-Stress Test Biophysical Profile Ultrasound Visualize a gestational sac in early pregnancy to confirm pregnancy Identify site of implantation Verify fetal viability or death Verify a multifetal pregnancy ie twins, triplets Diagnose fetal structural abnormalities Locate placenta Determine amount of amniotic fluid Observe fetal movements Determine EDB, between 7 and 14 weeks the crown-rump length can indicate fetal age, after 12 weeks the biparietal diameter of the fetus and the femur length provide an accurate estimation of fetal age Kick Count While lying on her side, 1 hour after a meal (this is usually an active time for the fetus) the pregnant woman will count fetal movements. Should feel a minimum of 6 in 2 hours A daily fetal movement record is kept for women at high risk Alpha Feto Protein An alpha-fetoprotein (AFP) blood test checks the level of AFP in a pregnant woman's blood. AFP is a substance made in the liver of an unborn baby (fetus). The amount of AFP in the blood of a pregnant woman can help see whether the baby may have such problems as spina bifida and anencephaly. An AFP test can also be done as part of a screening test to find other chromosomal problems, such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18). An AFP test can help find gastroschisis, a congenital problem in which some of the baby's intestines stick out through the belly wall. Amniocentesis A thin needle inserted through the abdominal and uterine walls guided by ultrasound to obtain a sample of amniotic fluid, which contains cast off fetal cells and various other fetal products Done 15-17 weeks gestation Identifies chromosome abnormalities and biochemical disorders in early pregnancy Identifies severity of maternal-fetal blood incompatibility and assess fetal lung maturity in late pregnancy Non-Stress Test What is a nonstress test? The nonstress test measures the fetal heart rate in response to fetal movement over time. The term "nonstress" means that during the test, nothing is done to place stress on the fetus. How is the nonstress test performed? This test may be done in the health care professional’s office or in a hospital. The test is done while you are reclining or lying down and usually takes at least 20 minutes. A belt with a sensor that measures the fetal heart rate is placed around your abdomen. The fetal heart rate is recorded by a machine. What do the results of a nonstress test mean? If two or more accelerations occur within a 20-minute period, the result is considered reactive or "reassuring." A reactive result means that for now, it does not appear that there are any problems. A nonreactive result is one in which not enough accelerations are detected in a 40-minute period. It can mean several things. It may mean that the fetus was asleep during the test. If this happens, the test may last 40 more minutes, or the fetus may be stimulated to move with sound projected over the mother’s abdomen. A nonreactive result can occur if the woman has taken certain medications. It also can mean that the fetus is not getting enough oxygen.  Biophysical Profile What is a biophysical profile? A biophysical profile (BPP) may be done when results of other tests are nonreassuring. It uses a scoring system to evaluate fetal well-being in these five areas: 1. Fetal heart rate 2. Fetal breathing movements 3. Fetal body movements 4. Fetal muscle tone 5. Amount of amniotic fluid Each of the five areas is given a score of 0 or 2 points, for a possible total of 10 points. How is the biophysical profile performed? A BPP involves monitoring the fetal heart rate (the same way it is done in a nonstress test) as well as an ultrasound exam. During an ultrasound exam, a device called a transducer is rolled gently over your abdomen while you are reclining or lying down. The transducer creates sound waves that bounce off of the internal structures of the body. The transducer receives these echoes, which are converted into images displayed on a computer screen for the technician to view. Danger Signs of Pregnancy to be Reported Any vaginal bleeding Swelling of the face and fingers Severe, continuous headache Vision changes Abdominal pain Chills and fever Persistent vomiting Sudden gush of fluid from the vagina © 2002 Delmar, a Thomson Learning comp 9 any Hyperemesis Gravidarum Excessive nausea & vomiting that can significantly interfere with food intake & fluid balance Treatment Correct dehydration & electrolyte imbalances Medications TPN Nursing Care Bleeding Abortion Ectopic pregnancy Hydatiform mole Placenta previa Abruptio placenta Abortion Spontaneous Threatened Inevitable Incomplete Complete Result of chromosomal abnormalities, faulty implantation, placental abnormalities, incompetent cervix, maternal disease/infections, endocrine imbalances and teratogenic substances  Threatened – unexplained bleeding and cramping. The cervix is closed and membranes intact Inevitable – Increased bleeding and cramping, cervix begins to dilate and membranes may rupture Incomplete – some products of conception are expelled. Most often the placenta is not expelled. Bleeding is heavy and cramping severe Complete – all products of conception are expelled Abortion Management 1. Symptoms – Cramping and backache with light spotting 2. Medical/Surgical management – Ultrasound to determine it fetus is living, limit activity, made need D&E –Dilation and Evacuation 3. Nursing management – Promote expression of grief by providing privacy, sympathy, assess for bleeding, education, vitals Ectopic pregnancy Ectopic pregnancy occurs when the fertilized ovum (zygote) is implanted outside the uterine cavity Of all ectopic pregnancies, 95% occur in the fallopian tube (tubal pregnancy). Ectopic pregnancy 1. Symptoms – missed menstrual period, lower abdominal pain, light vaginal bleeding (if ruptures – sudden severe lower abdo pain increased bleeding risk of hypovolemic shock) 2. Medical/Surgical management – Medical therapy – methotrexate if tube has not ruptured, inhibits cell division in the embryo and allows to be resorbed. Surgery to repair tube or removal of tube if severe damage occurs 3. Nursing management – assess bleeding, vitals, pain, post op, antibiotics, catheter, bed rest Hydatiform Mole or Molar Pregnancy Two types Complete- mole has only paternal material. There is no embryonic tissue, only fluid-filled cystic villi. A large amount of HCG is produced. Classic signs are bleeding (brownish, sometimes red), enlarging abdomen beyond expected gestation and no FHR Partial- a partial mole with only focal areas of vesicles. There is a fetus but with multiple chromosomal abnormalities and little chance of survival Symptoms - Classic signs are hyperemesis gravidarum because of higher HCG and PIH before 24 weeks  Effects on Fetus - Abnormality of the placenta, the fertilized ovum dies and the chorion develops into vesicles. There is a possibility of developing choriocarcinoma (fast growing cancer in uterus) Medical Management – after surgery to remove the mole the client must be monitored for 1-2 years. The care includes chest x-rays to detect metastases, physical examinations with a pelvic exam, lab measurement of HCG levels. The client is advised not to become pregnant during the follow up time Surgical Management – the desire of the client for future fertility influences the surgical procedure used to empty the uterus (D&C) may be performed. May need to open uterus for visualization to make sure no fragments remain or hysterectomy if no further children are wanted. Pharm – if HCG remains high methotrexate may be given. Activity – bed rest is maintained until after surgery Nursing management – monitor vaginal bleeding Placenta Previa Occurs when implantation is in the lower uterine segment with the placenta lying over or very near the cervical os, the opening to the uterus. Cause is unknown but predisposing factors such as multiparity, uterine scarring from D&C, cesarean birth, endometritus, advancing maternal age and smoking Classic symptoms is painless in last half of pregnancy. It can be occasional bright red spotting or intermittant gushes of blood Low-lying or marginal – placenta is near the internal cervical but does not cover it Partial – covers part of cervical os (opening in the cervix at each end of the endocervical canal) Complete or total – Placenta covers internal os (opening into the uterus from the cervix External os is near the vagina Placenta Previa cont. Medical Management – goal is to maintain pregnancy until the fetus is mature enough to survive outside uterus. Fetal maturity is determined by LS ratio Diagnosis is made with ultrasound. Once dx is made no vag exams are performed to decrease risk of disturbing placenta Surgical Management – if maternal situation becomes worse or signs of fetal distress a C-section is performed immediately Pharm- to accelerate fetal maturity a drug such as Celestone may be given to Mom Activity – bedrest with BRP. If bleeding begins, complete bed rest Abruptio Placenta The premature separation from the wall of the uterus of a normally implanted placenta Cause is unknown, contributing factors are maternal hypertension, multiple pregnancies, abdominal trauma, smoking, use of alcohol or cocaine , occurring late in pregnancy Three types 1. Central – center of placenta separates with blood trapped b/w the placenta and uterine wall, there is no apparent bleeding 2. Marginal - edge of placenta separates and bright red bleeding is apparent vaginally 3. Complete - entire placenta separates with profuse bleeding Abruptio Placenta cont’d Perinatal mortality (1:830) Outcomes depends on fetal maturity and severity of abruption. Preterm labour, hypoxia and anemia are the most serious complications Medical – IV fluids including ringers lactate are given to reverse hypovolemia. Lab tests performed to evaluate clotting, type and match for 4 units blood, RH sensitization, foley inserted Surgical – C-section Pharm- Rhogam to RH-negative mom’s. Cyroprecipitate “cryo” or plasma to treat hypofibrinogenemia – rich in clotting factors Activity – bedrest Nursing management – monitor client’s bleeding, pain, VS, FHR, and fetal activity. Position on left side preferred Placenta Video https://www.youtube.com/watch?v=lcGRa6a7OWM Gestational Hypertension PIH Classic symptoms hypertension edema proteinuria Risk Factors: Primipara or Multiples Age (>35 or