HIGH RISK PREGNANCY

Is one in w/c the mother or fetus has a

significant increased chance of harm,
damage, injury, or disability (morbidity), and
loss of life or death (mortality)

1
 HIGH-RISK PREGNANCY
 A. DEMOGRAHPIC
FACTORS
1. Age
2. Weight
3. Height
 B. SOCIOECONOMIC
STATUS
1.inadequate finances
2. overcrowding, poor
standard of housing, poor
hygiene
2
3. Nutritional deprivation
4. Severe social problem
5. Unplanned and
unprepared
pregnancy,specially
among adolescents

3
Adolescent Pregnancy:
Contributing Factors
 Peer pressure
  Self-esteem
 Lack of role models
 Gain attention
 Media
 Poverty
 Rite of passage

4
Implications of Adolescent Pregnancy

Socioeconomic:
•reliance on welfare Fetal Health:
•cycle repeats itself •LBW
Maternal health:
•prematurity
•CPD
•resp complications
•PIH
•cp
•anemia
•cognitive deficits
•nut deficits
•death
 mortality 5
Adolescent Pregnancy: Assessment

 Risks
 fundal height
 # of sexual partners
 knowledge of infant care/needs
 family unit/support system
 baseline VS/weight

6
C. OBSTETRIC HISTORY
1.Hx of infrtility or multiple gestation
2. Grand multiparity
3. prev. abortion or ectopic preg.
4. Prev losses
5. prev. operative OB,uterine or cervical
abnormalities
6.prev. abnormal labor
7
7. prev. high-risk infant
8. prev. hydatidiform mole.

D. CURRENT OB STATUS
1. Late or no prenatal; care

2. Maternal anemia
3. Rh sensitization
4.Antepartal bleeding
5.preg. Induce hypertension

8
6.Multiple gestation
7. pre-term- post term labor
8.Polyhydramnios
9. PROM
10. Fetus inappropriately large or
small,abnormality in test fetal well
being; abnormality in presentation

9
E. MATERNAL MED.Hx/status
1. Cardiac or pulmonary dx
2. Metabolic ds.
3. Endocrine disoder
4. Chronic renal ds.
5.Chronic hypertension
6.Veneral and other infectious ds.
7.Major congenital disorder or rep.tract
10
8. Hemoglobinopathies
9.Seizure disorder
10.Malignancy
11. Major emotional dis, mental
retardation

11
 Diagnostic test in high-risk
preg./prenatal det. Of fetal
well being

1. Ultrasound-is a diagnostic technique

which uses high-frequency soundwaves
to create an image of the internal
organs. A screening ultrasound is
sometimes done during the course of a
pregnancy to monitor normal fetal
growth and verify the due date.
12
PURPOSES
In the first trimester:
 to establish the dates of a pregnancy

 to determine the number of fetuses and

identify placental structures

 to diagnose an ectopic pregnancy or

miscarriage
 to examine the uterus and other pelvic

anatomy
 to detect fetal abnormalities
13
Mid-trimester: (sometimes called the 18
to 20 week scan)
 to confirm pregnancy dates

 to determine the number of fetuses and

examine the placental structures

 to assist in prenatal tests such as an

amniocentesis
 to examine the fetal anatomy for

presence of abnormalities
 to check the amount of amniotic fluid

 to examine blood flow patterns

14
 to observe fetal behavior and activity
 to examine the placenta
 to measure the length of the cervix
 to monitor fetal growth

15
Third trimester:
 to monitor fetal growth

 to check the amount of amniotic fluid

 as part of other testing such as the

biophysical profile
 to determine the position of a fetus

 to assess the placenta

16
 NON – STRESS TEST
Tocodynamometer records fetal movements and
Doppler ultrasound measures fetal heart rate to assess
fetal well-being after 28 weeks.
 Nonstress test is basically performed to evaluate on how
the baby is doing inside. How often you need the test
will depend on your doctor; it can be every week or
more often till the baby is born.

17
 • The test result is considered to be
normal or reactive if baby's heart beats
faster on two separate occasions during
the 20 minute span.

 • If baby is resting the result will most

likely be non-reactive. However if results
persist to be non-reactive even after one
hour, it doesn't necessarily mean
something is wrong with the baby.

18
 • Results may also be non-reactive due
to baby's age; babies below week 32
have not hit the required maturity for
reactivity.
• The test time may be extended or the
mother may have to go for more
comprehensive tests like biophysical
profile
• If your doctor is absolutely sure that
baby is not thriving inside, the labor
may be induced
19
 Preparation
a. position- semi-fowler’s or left lateral
position slightly turn to the left
b. BP is check first
c. Explain
>procedure takes 30 to 60 mins long
>mother needs to activate”mark
botton”w/ each fetal movement
> does not need
hospitalization/ambulatory basis

20
Who needs the nonstress
test..
• Women with preexisting medical conditions such as diabetes
• Women with pregnancy-induced medical conditions such as
hypertension
• Baby is less active than normal
• Baby is small for its age
• Amniotic fluid is either too much or too little

21
• Women who have previously lost their
babies in the second half of their
pregnancies

• Women with pregnancies continuing

after week 40 to basically check on the
well- being of baby

22
 INTERPRETATION
A. Normal:Reactive- increased FHT
(acceleration) greater than 16 bpm /secor
more in 10 to 20 min. period w/ fetal
movement
B. Abnormal: Non reactive- No FHR
ACCELERATION WITH FETAL MOVEMENT

23
INTERPRETATION
A. Normal : high –risk pregnancy
continue
b. Abnormal result: mother needs another
test, maybe biophysical profile

24
OXYTOCIN CHALLENGE TEST(OTC) OR
CONTRACTION STRESS TEST (CST)
CST is based on the observation that during
contractions, blood flow to the placenta
lessens temporarily. An evaluation is done
on how the fetus handles this stress. (utero-
placental well being)

25
 Interpretation:
a. normal: negative – No late decelerations
of FHR w/ each of 3 contractions during a
10 minute interval
b. Abnormal: positive – with late
decelerations of FHR with 3 contractions in
10 minutes.

26
E. BIOPHYSICAL PROFILE
A scoring combining ultrasound assessment of:
a. Fetal breathing
b. Fetal movement
c. Fetal tone
d. Reactivity of the heart rate
e. Amniotic fluid volume BPP could be
used to predict fetal well-being in high-risk
pregnancy

27
Purpose

 The purpose of the BPP is to assess

fetal well-being. It is a tool used near or
at term by clinicians to assess the
potential risk of fetal compromise or
demise due to fetal hypoxia or acidosis.
Intervention such as maternal
hospitalization, or delivery may follow a
BPP score of four or below
28
Biophysical variable Normal ( score =2) Abnormal (score= 0)
Fetal breathing movement Greater than or = to 1 Absence of 30 secs. Or
episode of 30 sec. or more longer of fb movement in
of fetal breathing 30 min
movement in 30 min
Gross fetal movement 3 or more discreet 2 or lesser discreet
movements of the body or movement of body or a limb
any limb in 30 minutes in full extension or absent
fetal movement
Fetal tone Either slow extension with
return to partial flexion or
movement of limb in full
extension or absent fetal
movement

Reactive fetal heart rate

29
 EVALUATION OF FETAL
WELL-BEING
BIOPHYSICAL PROFILE
Surveillance of fetal well-being is based on 5 categories:

• Non-stress test (NST)

• Amniotic fluid index
• Fetal breathing movements
• Fetal tone
• Reactive heart rate

Note: each category carries a score of 2 and the summative

number interpreted by the physician. A score of 8-10 is
reassuring.
AMNIOCENTESIS
AMNIOCENTESIS
 EVALUATION OF FETAL
WELL-BEING
AMNIOCENTESIS
Used to determine fetal maturity and detect certain birth defects such as
DOWN SYNDROME, SPINAL BIFIDA, HEMOLYTIC DISEASE OF THE
NEWBORN, SEX AND CHROMOSOMAL ABNORMALITIES.

Amniotic fluid is aspirated by a needle which is inserted through the

abdominal wall and uterine walls.

Done at 16 weeks to assess L/S ratio and detect genetic

disorder.Possible after week 14.
 EVALUATION OF FETAL
WELL-BEING
AMNIOCENTESIS
PREPARATION:
Prior to procedure, the patient’s bladder should be emptied.
Ultrasound used prior to procedure to guide needle to prevent fetal
and placental trauma.
TEST RESULTS: within 2-4 weeks
COMPLICATIONS:

Premature labor, infection, Rh isoimmunization

Monitor fetus and uterine contractions after procedure.
Teach client to report decreased fetal movement or increased
abdominal discomfort.
 EVALUATION OF FETAL
WELL-BEING
ALPHA – FETOPROTEIN SCREENING

•Maternal serum screens for open neural tube defects.

Alpha-fetoprotein is a glycoprotein produced by fetal yolk
sac, GIT and liver.
•Test is done between 16-18 weeks gestation.
•High levels indicate neural tube defects and anencephaly
and spinal bifida; also associated with congenital nephrosis,
esophageal atresia, fetal demise.
 EVALUATION OF FETAL
WELL-BEING
LECITHIN/SPINGOMYELIN RATIO
• Uses amniotic fluid to ascertain fetal lung maturity through
measurements of presence and amounts of lung surfactants
Lecithin and Spingomyelin.

• At 35-36 weeks, ratio is 2:1 indicative of mature levels.

• May be done in laboratory or by “SHAKE” tests.

 EVALUATION OF FETAL
WELL-BEING
EVALUATION OF PHOSPHATIDYL GLYCEROL (PG)

• In conjunction with the L/S ratio, contributes to increased

reliability of fetal lung maturity esp. in diabetics.

• Value equal or greater than 3% is needed.

• May be done in laboratory or by “SHAKE” tests.
 EVALUATION OF FETAL
WELL-BEING
CREATININE LEVEL
Estimates fetal renal maturity and function.
More than 2.0 mg indicates fetal age greater than 36 weeks.

DETERMINATION OF SEX-CHROMATIN
Detects sex-linked disorders.( Hemophilia, Duchenne’s Muscular
Dystrophy, Color Blindness)

BILIRUBIN LEVEL
High in pregnancy then drops after 36 weeks’ gestation.
Increase in bilirubin needs evaluation for Rh incompatibility.
 EVALUATION OF FETAL
WELL-BEING
URINARY/ SERUM ESTRIOL
• Assess placental functioning.
INTERPRETATION OF RESULTS:
• Sudden drop = fetal hypoxia
• Continuous drop = fetal compromise.

LIPID CELLS (NILE BLUE STAIN)

20% of cells stained orange indicates fetal weight at least 2500 gms.
 EVALUATION OF FETAL
WELL-BEING
PERCUTANEOUS UMBILICAL BLOOD SAMPLING

• Involves inserting a needle into the fetal umbilical cord and

aspirating blood for analysis.

• The procedure is guided by U/S and is used to screen karyotypes

(chromosomes), examine antibodies for teratogenic viruses and
provide assess for fetal blood transfusions..
PERCUTANEOUS
UMBILICAL CORD
SAMPLING
COMPLICATION OF PREGNANCY
 Pre-gestational conditions:
 Pregnancy induced hypertension (PIH) is a
condition of high blood pressure
(HYPERTENSION) during pregnancy. Your
blood pressure goes up, you retain water
(EDEMA), and protein(PROTEINURIA) is
found in your urine. It is also called toxemia
or preeclampsia. The exact cause of PIH is
unknown.
 7-10%bof all preg. Major causes of MCn
mortality
42
ETIOLOGIC FACTORS:
 A first-time mom
 Women whose sisters and mothers had PIH
 Women carrying multiple babies; teenage
mothers; and women older than age 40
 Women who had high blood pressure or
kidney disease prior to
pregnancy,polyhydramnios, chronic
hypertension and renal disease
43
 SIGN AND SYMPTOMS:
 headaches,
 blurred vision
 inability to tolerate bright light
 fatigue
 nausea/vomiting
 urinating small amounts
 pain in the upper right abdomen
 shortness of breath
 and tendency to bruise easily
44
2 types of PIH

1. Preeclampsia (mild and severe)

2. Eclampsia

45
SIGN MILD PREECLAMPSIA SEVERE PREECLAMPSIA
Hypertension 40 /90 or symmHg or more 160/110 or systolic increase
above the at or above the 160 or
Baseline; diastolic rise morethan 50 mmHg over
15mm Hg or more the baseline; diastolic rise
systolic inc. of 30 greater than 110 mmHg or
more on 2 readings taken 6
hours apart after bed rest

Proteinuria 1+ or 1g/day 3+ to4+ or 5g/day

Edema Generalized, confined to Generalized, severe facial
face (periorbital) and puffiness, severe swelling of
fingers face

Weekly wt. gain-greater Excessive wt gain- 5

than 1lb/week lbs/week or more
Epig. Pain due to edema of
liver capsule
Cerebral disturbances
• severe frontal headache
• inc, irritability
• blurring of vision
• hyper reflexia 46
SIGN MILD PREECLAMPSIA SEVERE PREECLAMPSIA

• severe dizziness
• halo vision, blind spots
• persistent vomiting
•Disorientation

Oliguria Absent output above 500 ml Present; output 400ml or

in 24 hours less in 24 hours

IUGR (intra-uterine growth absent Present

retardation )

Others Hypoproteinemia
Hemoconcentration
Hypernatremia

47
TABLE 15–3 Deep Tendon Reflex Rating Scale
 FIGURE 15–4 To elicit clonus, with the knee flexed and the leg
supported, sharply dorsiflex the foot, hold it momentarily, and then
release it. Normally the foot returns to its usual position of plantar
flexion. Clonus is present if the foot “jerks” or taps against the
examiner’s hand. If so, the number of taps or beats of clonus is recorded.
B. DIABETES MELLITUS
 A chronic, metabolic disorder characterized
by a deficiency in insulin production by
islets of Langerhans resulting in improper
metabolic interaction of carbohydrates, fats.
Protein and insulin

 GDM] is usually diagnosed around 24 to 28

weeks of pregnancy.
50
 SIGN AND SYMPTOMS
1.Hyperglycemia
2.glucosuria
3. Polyuria
4. Polydipsia
5. weight loss
6. Ketoacidosis

51
 RISK FACTOR
A. Family history
B. Rapid hormonal change in pregnancy
C. tumor/ infection of the pancreas
D. Obesity
E. Stress

52
Complication of dm in mother
 Preeclampsia
 Urinary tract infections
 Future diabetes
 Dystocia
 Maternal mortality
 Diabetic retinophaty
 Diabetic nephropathy

53
 Fetus/ infant
 Excess growth. Extra glucose will cross the
placenta, which triggers your baby's
pancreas to make extra insulin. This can
cause your baby to grow too large
(macrosomia). Very large babies are more
likely to become wedged in the birth canal,
sustain birth injuries or require a C-section
birth.

54
 Low blood sugar (hypoglycemia).
Sometimes babies of mothers with
gestational diabetes develop low blood sugar
(hypoglycemia) shortly after birth because
their own insulin production is high. Severe
episodes of this problem may provoke
seizures in the baby. Prompt feedings and
sometimes an intravenous glucose solution
can return the baby's blood sugar level to
normal
55
 Respiratory distress syndrome. If your
baby is delivered early, respiratory distress
syndrome — a condition that makes
breathing difficult — is possible. Babies born
to women with gestational diabetes have
more breathing problems than do those born
to women without the problem, even at the
same gestational age. Babies who have
respiratory distress syndrome might need
help breathing until their lungs become
stronger.
56
 Jaundice. This yellowish discoloration of the
skin and the whites of the eyes may occur if a
baby's liver isn't mature enough to break down
a substance called bilirubin, which normally
forms when the body recycles old or damaged
red blood cells. Although jaundice usually isn't
a cause for concern, careful monitoring is
important.
 Type 2 diabetes later in life. Babies of
mothers who have gestational diabetes have a
higher risk of developing obesity and type 2
diabetes later in life. 57
 Developmental problems. If you have
gestational diabetes, your child may have
an increased risk of problems with motor
skill development, such as walking,
jumping, or other activities that require
balance and coordination. An increased
risk of attention problems or hyperactivity
disorders also is a concern.

58
CARDIAC DISEASE
 This involves a variety of heart conditions
both congenital and acquired that complicate
pregnancy.

59
TYPES OF SPONTANEOUS ABORTIONS

60
Spontaneous Abortion Management

Threatened  Notify MD/MW

 Check fetus by U/S
 Bedrest, no sexual activity
for 2 weeks after bleeding stops
 No false reassurance
 Check by U/S for complete vs.
Inevitable incomplete
 Analgesics for D&C
 RhoGAM

61
Spontaneous Ab Mgmt, cont.
Incomplete  Hospitalization
 Before 14 wks – D&C + IV
Pitocin
 After 14 wks – Pitocin or
Prostaglandins
 Wait 3 to 5 wks for spont Ab
Missed
(93%)
 Monitor for DIC

62
Post Abortion Education
 Bldg, cramping X 1-2 wks
 vaginal rest X 1 wk
  temp BID
 f/u in 2 wks

63
SITES OF ECTOPIC PREGNANCY

64
S & S Ectopic Pregnancy
 Missed Period
 Abdominal Pain
 Vaginal Spotting
 Rupture Severe lower abd pain
 ↓ hCG levels
 No gestational sac on U/S

65
Surgical Management of
Ectopic Pregnancy

Med Mgmt of Ectopic PG MTX

66
 S & S Hydatiform Mole
 Vaginal bleeding
anemia
  uterus size,
cramps
 No FHT’s
  N/V
 Early PIH
Therap. Mgmt: vacuum aspiration & curettage
67
Spontaneous Abortion Matching –
Choose all that apply.
1. Initial symptom is vaginal
1.
bleeding
A. Threatened abortion
2. 2. Membranes rupture and B. Inevitable abortion
cervix dilates
3. 3. Some, not all, products of C. Incomplete abortion
conception are expelled.
D. Complete abortion
4. 4. Treatment includes D&C
5. 5. All products of conception E. Missed abortion
passed
6. 6. All unsensitized Rh neg
women should receive
RhoGAM
7. 7. May be treated with bedrest
8. 8. Retained dead fetus
9. 9. May be complicated by DIC
10. 10. Pregnancy may continue
68
 Medical Mgmt of Placenta Previa

Mom stable, Fetus > 36 wks S&S hypovol

in mom
fetus immature

•Bedrest •Amnio to  •delivery

•no sex act lung maturity
•report bldg •delivery

69
 S&S Abruptio Placentae

•Vag bldg
(unless concealed)

•abd pain
 U-act
•hemorrhage
•boardlike
abd
•late decels
•s&s shock

70
Med Mgmt of Placental Abruption

Mom stable,
 bleeding,
fetus immature
fetal distress

bedrest
tocolytics Emergency CS

71
 DIC
Placental Bleeding

Thromboplastin release

Clot formation (systemic response)

 clotting factors (fibrinogen,  plts,  PTT,  FDP)


inability to form clots

profuse bleeding 72
The Pathological Processes of Pre-eclampsia

73
S&S Pre-eclampsia
 Rapid wt gain
 edema of hands & face
 proteinuria
 hyperreflexic DTR’s
 H/A, visual disturbances
 epigastric pain

74
 Treatment of Pre-eclampsia

Mild: diastolic < Severe: diastolic > 110,

100, trace to 1+ 3+ proteinuria,  U/O,
proteinuria, no H/A H/A, visual disturbances
 Bedrest  Bedrest,  stimuli
 protein diet  Meds
 document fetal  Apresoline for severe
activity HTN
 MgSO4 (anticonvulsant &
 weekly NST antihypertensive)
 Delivery

75
S&S Eclampsia/HELLP Syndrome

 Eclampsia  HELLP Syndrome

 facial twitching  RUQ pain
 tonic-clonic sz  n/v
 pulmonary edema  edema
 circ/renal failure   H/H,  plts
  liver enzymes

76
Treatment of Eclampsia/HELLP Syndrome

 Bedrest
 Meds
 MgSO4
 Valium or Phenobarb (if Mg not effective, not
within 2 hr of delivery)
 Hydralazine (for severe ↑ B/P)
 steroids to  fetal lung maturity
 Delivery
77
Assessment: Hypertensive
Disorders of Pregnancy
 Prenatal:
 wt, B/P, U/A, H/A, visual disturbances
 Hospitalized Ct:
 daily wt
 hourly u/o, dipstick urine Q4H
 VS, FHR
  LOC, DTR’s, H/A
  clonus
78
Risk Control Strategies for
Hypertensive Disorders of Pregnancy
 Sz precautions
 monitor for s/s Mg toxicity(RR<12, absent
DTR’s, sweating, flushing, confusion,  B/P)
 Ca gluconate @ BS
  Mg levels
 IV MgSO4 (should be “Y” connected to
another primary bag)
 D/C MgSO4 for RR < 12 or absent DTR’s
  renal function (30 mL/hr)
79
Incompetent Cervix
S&S
•advanced cervical dilation
•low abd pressure
•bloody show
•urinary frequency

Treatment
•cerclage

80
Premature Labor/Rupture of Membranes

 S&S  Treatment
 contractions  Tocolytics
 cramps  IV hydration
 backache  bedrest
 diarrhea  steroids, if needed
 vag d/c  abx, if needed
 ROM

81
Nursing Care for PTL/PROM
 Assessment  Teaching
 Thorough hx  Infection Control
  bleeding  FMC
  ROM
 BPP (for PROM)

82
Postterm Pregnancy
 S&S  Treatment
 Wt loss
  uterine size
 fetal surveillance
 Meconium in AF  NST, CST, BPP Q wk
 mom monitors mvmt
 Risks  Induction
  fetal mortality  Pitocin (10-20U/L) @
 cord compression 1-2 mU/min every 20-
 mec asp 60 min
 LGA  shoulder dystocia
 CS
 episiotomy/laceration
 depression

83
Disorders of Amniotic Fluid
 Polyhydramnios  Oligohydramnios
 S&S  Risks
 uterine dist  cord compression
 dyspnea  musculoskeletal
 edema of lower extr deformities
 Treatment
 pulmonary hypoplasia
 therapeutic
 Treatment
amniocentesis  amnioinfusion

84
Risks of Multifetal Gestation
 PIH
 GDM
 PPH
 Anemia
 UTI
 PTL
 Placenta previa
 CS
85
(Fetal) S&S Rh Incompatibility
 Hyperbilirubinemia
 jaundice
 Kernicterus (severe neuro d.o. r/t  bili)
 anemia
 hepatosplenomegaly
 Hydrops fetalis

86
Sequence of Assessments for Rh Sensitization
Blood Test for Type & Rh Factor

Rh-positive
Rh-negative

No further testing
Indirect Coombs
- +
Repeat frequently Titer increasing
Give 
RhoGAM Titer not increasing
amniocentesis ( bilirubin)

Elevated
continue to monitor No change

 retest, U/S
retest prn 
intrauterine transfusion or
early delivery 87
Management of Rh Incompatibility
Prenatal
•per algorithm

 Prevention  Postpartum
 RhoGAM at 28 weeks   direct Coomb’s
(unsensitized women  RhoGAM to mom if
only) baby is Rh+ (within
72 hrs of birth)

88
Hyperemesis Gravidarum
 S&S  Treatment
  U/O  IVF, TPN
 wt loss  antiemetics
 ketonuria  advance diet as tol
 dry muc membranes
 poor skin turgor

89
 Glucose Tolerance Test

1 GTT (24 - 28 wks) 3 GTT

drink 50g glucose, •hi carb diet X 2
if 1 BS > 140 days, then NPO
after MN
•FBS, then drink
100g glucose,
 1, 2, 3 BS
Gestational Diabetes is diagnosed with FBS > 105
or with 2 of the following BS results:
1 > 190, 2 > 165, 3 > 145 90
Effects of Pre-Existing DM

 Maternal  Fetal
  risk of:   risk of:
 PIH  NTD’s

 Cystitis  Cardiac defects

 DKA  Macrosomia or

 Spont Ab  IUGR

 Polycythemia

 hyperbilirubinemia

91
Treatment of Pre-existing DM
 Team approach
 Monitor glycosylated Hgb A
 Diet: 50% carb, 20% prot, 30% fat
 Insulin TID
 Hourly glucoses during labor
 NST’s weekly (starting at 28-30 wks)
 Amnio ( lung maturity)

92
Effects of Gestational Diabetes
 Maternal Effects  Fetal Effects
 UTI  macrosomia
 hydramnios  hypoglycemia at
 PROM/preterm labor birth
 shoulder dystocia  RDS
 epis/lac
 CS
 HTN

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Treatment of Gestational
Diabetes

 30 to 35 cal/kg/day (3 meals, 2 snacks)

 Insulin
  FBS, post-prandial BS’ Q week
 NST, BPP Q week
 glycosylated Hgb A
 Amnio ( lung maturity)
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Diabetes: Patient Education
 Glucose monitoring
 insulin administration
 type, onset, peak, duration, times, sites, injection

technique
 diet
 s/s hypoglycemia
 tremors, pallor, cold/clammy skin

 give milk & crackers or glucagon inj

 s/s hyperglycemia
 fatigue, flushed skin, thirst, dry mouth,

 check glu, call MD for insulin order

95
PPCM: Manifestations
 dyspnea
 edema, wt gain
 chest pain
 palpitations
 jug vein distention
 enlarged heart
  spont ab, PTL
96
PPCM: Energy Management
 Epidural
 Activity restriction
 Minimize anxiety

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PPCM: Cardiac Care
 Meds
 Sidelying, HOB ↑
 Monitor VS, FHR, heart pressures
(Swan-Ganz)
 Strict I/O
 Assess lungs

98
PPCM: Patient Education
 Avoid excessive wt gain/edema
 Diet: 2200 cal,  protein, NAS
 rest/avoid exertion
 avoid exposure to environmental
extremes
  emotional stress

99
Sickle Cell Disease
 Maternal Effects  Fetal Effects
 pain  IUGR/SGA
 jaundice  skeletal changes
 Pyelonephritis
 PIH/preeclampsia
 leg ulcers
 CHF

100
 Systemic Lupus Erythematosis
 Maternal effects  Fetal effects
 fatigue  IUGR
 muscle/joint pain  preterm delivery
 wt loss
 rash
 proteinuria Treatment
 PIH/preeclampsia/HELLP •PO or IV Steroids
 PG loss

101
 AIDS
 Maternal Effects  Fetal Effects
 vag candidiasis
 Asymptomatic at birth
 PID
 Candidal diaper rash
 genital herpes
 thrush
 HPV
 diarrhea
 PCP
 recurrent bacterial
infections
 FTT
 dev delay
Treatment:
ZDV (zidovudine) during PG, L&D
ZDV to neonate for 6 wks
102
Which of the following socioeconomic factors
contributes to the high incidence of
adolescent pregnancy in the US?

A. lack of adequate birth control

B. poverty
C. lack of information on safe sex
D. availability of public assistance for
unmarried mothers

103
Which genetic screening test for
chromosomal abnormalities provides an
older expectant couple with information
within the first trimester?

A. Chorionic villus sampling (CVS)

B. Amniocentesis
C. Genetic karyotyping
D. Ultrasonography

104
 When caring for a woman with mild
preeclampsia, the nurse would be concerned
with which finding?

a. +4 proteinuria
b. +2 dependent edema in ankles
c. Blood pressure 156/100
d. +2 DTR’s, absent clonus

105
 The nurse is preparing to infuse
magnesium sulfate to treat preeclampsia.
In implementing this order the nurse
understands the need to:

a. Prepare a solution of 20 g MgSO4 in

100cc D5W
b. Monitor maternal VS, FHR and uterine
contractions every hour
c. Expect the maintenance dose to be
approximately 4g/hr
d. Discontinue the infusion and report a
respiratory rate of < 12 breaths/minute

106
The primary expected outcome for care
associated with the administration of
MgSO4 would be met if the woman:

a. Exhibits a decrease in both systolic and

diastolic blood pressure
b. Experiences no seizures
c. States that she feels more relaxed and
calm
d. Urinates more frequently, resulting in a
decrease in pathologic edema

107
 A primigravida at 10 weeks gestation reports
slight vaginal spotting without passage of tissue
and mild uterine cramping. When examined, no
cervical dilation is noted. The nurse caring for this
woman should:

a. Anticipate that the woman will be sent

home and placed on bedrest with
instructions to avoid stress or orgasm
b. Prepare the woman for a dilatation and
curettage
c. Notify a grief counselor to assist the
woman with the imminent loss of her
fetus
d. Tell the woman that the doctor most
likely will perform a cerclage to help
maintain the pregnancy 108
 CASE STUDY I
A G3P2 woman, at 38 wks gestation, arrives at
the obstetric unit with c/o painless vaginal
bleeding.
1. What is the nursing priority at this time?
2. What assessments are necessary?
3. What is the most likely etiology of the
bleeding?
4. What is the expected treatment for
Anne?
109
 CASE STUDY II

A G1P0 woman, at 35 wks gestation, is

visiting the midwife for a routine prenatal
visit. On assessment, the nurse finds that
she has gained 8 lbs in the past month.
1. What is the significance (if any) of this
weight gain?
2. What other assessments should the
nurse make at this time?
3. What is the required treatment for
this client?
110
 CASE STUDY III
A 22 y.o. G1P0 who has a history of IDDM X 6 yrs and whose LMP
was 12 wks ago arrives at the prenatal clinic.
1. How will this client’s diabetes be affected by her
pregnancy?
2. What changes will she most likely have to make to adjust
to her pregnancy?
3. What routine assessments will be made at each prenatal
visit?
4. What tests will be required as the pregnancy
progresses?
5. What fetal effects occur with pre-existing diabetes?
6. How will L&D be altered by pre-existing diabetes?
7. What possible newborn complications could occur with
pre-existing diabetes?
8. What nursing care will the infant require?
111
MATH PROBLEM
For induction, Pitocin is ordered – 10
Units in 500 mL to start at 2 mU/min
and increase by 1 mU/min every 20
minutes until effective contractions are
achieved.
At what rate will the nurse start the IV?
By how much will the rate be increased
every 20 minutes?
112
THE END

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