Complications of Pregnancy: Preterm Labor, HELLP, Multiple Pregnancy PDF

Complication s of Pregnancy Preterm Labor  Labor that occurs before the end of the 37th week Occurs in 9%-11% of all pregnancies Can cause 2/3 of fetal death The mother’s dilation is over 1 cm and is 80% effaced  Rest frequently Drink 8-10 glasses of water...

Complication s of Pregnancy Preterm Labor  Labor that occurs before the end of the 37th week Occurs in 9%-11% of all pregnancies Can cause 2/3 of fetal death The mother’s dilation is over 1 cm and is 80% effaced  Rest frequently Drink 8-10 glasses of water daily Keep mentally active Avoid activities that Prevention stimulate preterm labor Know sexual restrictions Report signs of ruptured membrane Keep appointments for prenatal care  If uterine contractions recur: Empty your bladder LLP Increase hydration Contact your health care provider  Previous preterm birth Short interval between pregnancies Short cervical length Smoking and elicit drug use Perinatal infection Predisposin g Factors: Placenta previa Polyhydramnios Uterine anomalies Fetal birth defects Below 18, above 35 y/o  Persistent dull, low backache Vaginal spotting Sympto Feeling of pelvic pressure or abdominal tightening ms: Menstrual-like cramping Increased vaginal discharge Uterine contractions Intestinal cramping How to check Ultrasound for the Vaginal mucus analysis possibility of for fibronectin (a preterm protein produced by labor? trophoblast cells)-its presence predict that preterm contractions will occur and its absence predicts that labor will not occur for the next 14 days  Let the patient be admitted Bed rest External Fetal Monitorng IVF therapy Rule out urine infection (UTI-Group B. Strep.-fatal to the newborn) Tocolytics Terbutaline (warning: not be used for more than 48-72 hrs- can lead to heart problems and death, must not be used in OPD’s) MgSO4-no longer used because it has been found out that patients having MgS04 and no MgS04 have no differences Now, MgS04 is being used for fetal neuroprotection prior to 32 weeks to help prevent cerebral palsy in premature infants  Stop labor if : Therapeu Fetal membranes have not ruptured No fetal distress tic There is no evidence that bleeding is Manage occurring Cervix is not dilated beyond 4-5 cm ment Effacement is not more than 50%  For reasons not clearly understood, if in the time beginning between when preterm contraction and preterm birth occurs, a patient is administered a corticosteroid (Betamethasone), the formation of lung surfactant appears to accelerate, thus reducing the possibility of respiratory distress syndrome or bronchopulmonary dysplasia Betamethasone 12mg once a day-2 doses Dexamethasone 6mg twice a day -4 doses The effect of betamethasone lasts for about 7 days, it takes 24 hrs for the drug to begin its effect The dose of Betamethasone can be repeated if the baby is not born within 7 days. Betamethasone interferes with glucose regulation for both the parent and the fetus  Hypertensive Disorders in Pregnancy Cause: Unknown Predisposing Factors 1. Antiphospholipid syndrome (APS) 2. Presence of antiphospholipid antibodies 3. Being a person of color 4. Experiencing multiple pregnancy 5. Being primiparous (40) 6. Having come from a low socioeconomic background, which may lead to a history of poor nutrition 7. Having a status of gravida five or more  Hypertensive Disorders in Pregnancy Cause: Unknown Predisposing Factors 1. Antiphospholipid syndrome (APS) 2. Presence of antiphospholipid antibodies 3. Being a person of color 4. Experiencing multiple pregnancy 5. Being primiparous (40) 6. Having come from a low socioeconomic background, which may lead to a history of poor nutrition 7. Having a status of gravida five or more 8. Experiencing polyhydramnios 9. Having an underlying disease such as heart disease, diabetes, renal involvement, and essential hypertension  Hypertensive Disorders in Pregnancy 1. Gestational Hypertension- a condition in which vasospasm occurs in both small and large arteries during pregnancy causing hypertension. -patient’s blood pressure is 140/90 in 20 weeks but with NO proteinuria and edema -if a patient develops gestational hypertension before full term but does not progress to preeclampsia, they should be induced t 37 weeks of gestation  If a seizure from preeclampsia occurs, a patient has eclampsia 2. Any status above gestational PREECLAMP hypertension and below the point of SIA seizures is PREECLAMPSIA WITHOUT PREECLMAPSIA WITHOUT SEVERE SEVERE FEATURES- FEATURES (+) on a urine dip or 300mg in a 24-hour urine protein collection or 0.3 or higher on a urine protein- creatinine ratio BP 140/90 mmHg (taken on 2 occasions, 4 hours apart) Systolic greater than 30mmHg and diastolic greater than 15 mmHg  Nursing Interventions 1. Monitor antiplatelet therapy Mild antiplatelet agent Low-dose aspirin (81 mg) 2. Provide emotional support  BP is 160 mmHg systolic, 110 mmHg diastolic or above Platelet count less ( taken in 2 occasions than 100, 000 4 hrs apart at bed rest) 3. Elevated liver PREECLAMPSI enzymes above Serum creatinine Pulmonary twice the A WITH normal upper above 1.1 mg per dl edema SEVERE limit FEATURES New-onset severe Visual headache not disturbances relieved by medication  Epigastric pain Nausea and vomiting Pulmonary edema (shortness of breath) Cerebral edema (blurred vision, hyperreflexia, ankle clonus)  Admission Alleviate symptoms if pregnancy is less than 34 weeks Support bed rest No visitors during hospitalization Raise side rails Nursing Darken room Intervent Avoiding stress Monitor well-being ions Take blood pressure regularly Obtain blood studies Cross-match blood Place indwelling catheter Monitor fetal well-being  Administer MgSO4 Hydralazine Calcium gluconate 4. ECLAMPSIA  Most severe classification Cerebral edema with tonic-clonic seizure Mortality is 20% (due to cerebral hemorrhage, circulatory collapse, renal failure). Prognosis of fetus is poor Abruptio placenta  Watch Watch out for “aura” out Administ Administer Diazepam (Valium) Nursing er Intervent ions Manage Manage tonic-clonic seizures Monitor blood pressure until postpartum to Monitor detect residual hypertension Summary of Symptoms Read on: Table 21.7 page 561 Box 21.10 page 562  HELLP SYNDROME  It is variation of the gestational hypertensive process named for common symptoms that occur: Hemolysis leads to anemia Elevated Liver Enzymes lead to epigastric pain Low Platelets lead to bleeding/clotting  It occurs in 4% to 12% of patients with elevated blood pressure during pregnancy SERIOUS syndrome because it results in 24% maternal mortality rate with infant mortality rate as high as 35%. Cause: Unknown Predisposing factors: -occurs in both primigravida and multigravida  Signs and Symptoms General HEP Nausea Epigastric pain malaise Right upper quadrant Thrombocytop Elevated liver tenderness Hemolysis enia enzymes from liver inflammation  Complications Supracapsular liver hematoma Hyponatremia Renal failure Hypoglycemia from poor liver function Cerebral hemorrhages Aspiration pneumonia Hypoxic encephalopathy Fetal growth restriction Preterm birth  Management Fresh frozen plasma of platelets transfusion IV glucose infusion Infant may be born via NSD or CS Epidural anesthesia should not be given Patients need reassurance that symptoms are pregnancy related and will NOT return Counsel the patient with possible risks of HELLP syndrome and preeclampsia in a subsequent pregnancy  Multiple Pregnancy  Considered a complication of pregnancy because the body must adjust to the effects of more than one fetus It occurs in 2%-3% of all births and in vitro fertilization increased its incidence. Identical or Monozygotic Twins  Begins with a single ovum or spermatozoa First cell division-the zygote divides into two identical individuals They have one placenta, one chorion, two amnios, and two umbilical cords The twins are always the same sex They account for 1/3 of twin births Dizygotic/ Fraternal/ Non- identical Twins  Results from fertilization of two separate ova by two separate spermatozoa Rarely but possibly from different sexual partners 2/3 of twin births They have two placentas, two chorions, two amnions and two umbilical cords May have the same or different sex  Multiple pregnancies of two to eight children may be single- ovum conceptions, multiple- ova conceptions, or a combination of two types Due to in vitro fertilization Inheritance plays a role in natural dizygotic twinnings  ASSESSME NT Increase in the size of the uterus AFP is elevated Quickening is not in one spot Multiple sets of fetal heart sounds UTZ reveal multiple pregnancies but 30% may have only one fetus that will remain Mother may grieve  Therapeutic Management They are most susceptible to complications of pregnancy such as hyperemesis, gestational hypertension, polyhydramnios, placenta previa, preterm labor, and anemia than patients carrying one fetus. More prone to postpartum bleeding, low birth weight babies If monozygotic twins share a common vascular communication, it can lead to the overgrowth of one fetus and the undergrowth of the other one resulting in discordant infants If a single amnion is present, knotting and twisting of the umbilical cords causing fetal distress or birth difficulty  Polyhydra mnios Amniotic fluid greater than 2000ml and an index of 24 cm Can cause fetal malpresentation Can lead to premature rupture of membranes, leading to additional risks of infection, prolapsed cord, and preterm birth.  Assessmen t Fetus’s inability to swallow or absorb amniotic fluid or it may be due to excessive urine production The inability to swallow could be due to an infant who is anencephalic with a tracheoesophageal fistula. Excessive urine outputs of fetuses are due to having diabetic mothers Hyperglycemia in the fetus increases urine production Unusual rapid enlargement of the uterus Small parts of the fetus are hard to palpate Difficult to auscultate FHR Extreme shortness of breath Lower extremities varicosities and hemorrhoids Increase weight gain  Therapeutic Management Cared at home but bed rest is not indicated Tell the patient to report signs of ruptured membranes Straining in defecation can cause rupture of membranes High-fiber diet and stool softeners Assess VS and lower extremity edema Amniocentesis to remove extra fluids-repeated frequently Tocolytics are given To prevent cord prolapse-membranes must be “needled” Infant must be assessed with the presence of gastrointestinal blockage