Maternal Newborn Antepartum: Complications

What danger signs reflect the complications of pregnancy? Although pregnancy is considered a healthy, normal condition, complications do develop. They should not be confused with the expected discomforts of pregnancy, such as varicose veins, heartburn and constipation. Danger signs are ominous developments that you must teach your client to report to the healthcare provider without delay. They include vaginal bleeding in any amount or of any color, rupture of membranes, severe, persistent headache, visual disturbances, edema of the hands or face, abdominal pain, epigastric pain, elevated temperature above 101 degrees fahrenheit, that is, 38.3 degrees celsius, with chills, painful urination, persistent vomiting lasting more than one day and a significant change in or absence of fetal movement for six to eight hours. My wife's pregnant and she's bleeding. Is Show more

it frank bleeding frank? No, no, tom tom miller. Not everyone is familiar with medical terminology, especially in a stressful situation. Let's try that again. My wife's pregnant and she's bleeding. Is the blood bright, red or more of a brown, dried color? Any of these danger signs could mean a serious problem for your client or her fetus. Vaginal bleeding could mean a placental problem. Severe headaches, epigastric pain- possibly a sign of an impending seizure, edema of the face or hands and visual disturbances are signs of pregnancy-induced hypertension that is worsening. Painful urination could mean a urinary tract infection that might cause preterm labor, and an elevated temperature could mean an infection within the uterus or amnionitis. A potentially serious complication is hyperemesis gravidarum or severe vomiting during pregnancy. The cause is unknown, but it can create problems early and throughout pregnancy. Typical symptoms are persistent, uncontrollable vomiting, rapid pulse, decreased urinary output, low grade fever and weight loss. Complications include dehydration, electrolyte imbalance, severe weight loss and metabolic Show more

alkalosis. Diagnostic tests that reflect severity and guide the management are hematocrit and hemoglobin serum, electrolytes and urine, acetone and protein. Your goal is to control vomiting while maintaining a nutritious diet. Suggests that the client avoids spicy and fried foods and eat at least six small meals a day. Suggest eating dry crackers before arising to prevent nausea and vomiting, and sitting upright for 30 minutes or more after eating. In extreme cases, the pregnant woman might need tube beatings via a nasogastric tube or parental nutrition. Another serious complication is pregnancy-induced hypertension, or pih, also called pre-eclampsia. It is characterized by elevated blood pressure, edema of the hands and face and protein urea. Pih is more common among prima paris Show more

women who are younger than 20 or older than 35 years of age, women who have chronic hypertension, diabetes mellitus or renal failure and women in low socioeconomic groups. Pih results from systemic vasospasm, arteriolar vasoconstriction and vascular Show more

damage. Your interventions should include encouraging the pregnant woman to lie on her left side to reduce blood pressure and increase uterine and renal blood flow. Non-stress tests are routinely done to assess fetal well-being. If the woman is hospitalized, you'll monitor vital signs: edema, deep tendon reflexes, daily weights, urine output and fetal well-being. Implementing a seizure precaution- meaning put the side rails up and padded and low stimulus environment, plus having emergency medications and equipment readily available, are essential for assuring client safety. Be aware that signs and symptoms of preeclampsia range from mild to severe and will affect the fetus to varying degrees. With mild preeclampsia, blood pressure Show more

140 over 90 or above or it increases 30 millimeters of mercury systolic and 15 millimeters of mercury diastolic. Edema is one plus pitting after 12 hours of bed rest. Protein area is one plus or two plus or even higher, and the face and hands and feet have significant swelling that does not go away after 12 hours of bed rest. The symptoms of severe preeclampsia, they are a blood pressure of 160 over 110 or higher and extensive generalized edema, protein urea 3 plus or 4 plus or higher, and headache, visual disturbances and abdominal pain. If your client has the classic signs of headache, blurred vision, epigastric pain, decreased urine output and nausea and vomiting, then you know the disease is worsening. With further increases in blood pressure, Show more

pih becomes a seizure state or eclampsia. At this extreme state, the pregnant woman is at risk for fatal pulmonary edema, organ failure, cardiac failure or cerebral hemorrhage. If you receive a call from a pregnant client who has these symptoms, it is important to keep her calm. But to expedite help you might say something like: all right, i don't want you to have to deal with driving while you're not feeling well, i'm going to call 9-1-1. I want you to unlock your front door and go lay down on your left side and rest and wait for the paramedics to come. Show more

First line drug therapy for pih is magnesium sulfate. You must monitor a client on magnesium sulfate for the classic signs of toxicity: a decreased respiratory rate less than 8 to 10, an absence of reflexes and decreased urinary output that is less than 30 milliliters per hour. Should magnesium sulfate toxicity develop, be prepared to administer calcium gluconate to reverse the complications of respiratory depression. A variation of severe preeclampsia called the help syndrome is an acronym for the features of its presentation, which are hemolysis of red blood cells, elevated liver enzymes and low platelet count. Complications include disseminated intravascular coagulopathy or dic, acute renal failure and pulmonary edema. Maternal Show more

complications associated with pih are stroke, hemorrhage, cardiovascular problems and dic. Now, fetal complications of pih are intrauterine growth retardation and fetal distress caused by hypoxia. Keep in mind that the only cure for pih is the delivery of the fetus, so, should the situation become critical, anticipate preparing the client for an emergency cesarean section delivery. Another complication of pregnancy is gestational diabetes or the onset of carbohydrate intolerance, a variable severity diagnosed during pregnancy. When the pancreas cannot produce enough insulin to move sufficient glucose into the cells for energy production, gestational diabetes results. Gestational diabetes is usually diagnosed during the second trimester of pregnancy with a glucose challenge test. Although you can see the first signs of glycosyria on a routine urinalysis much earlier. The signs and symptoms of gestational diabetes disappear during the first few weeks after delivery. Factors associated with gestational diabetes are previous delivery of a large infant, family history of diabetes, glycogen on two successive occasions, obesity, previous spontaneous abortion or stillbirth, Show more

multiparity, polyhydramnios, previous delivery of an infant with congenital anomalies and hypertension. Signs and symptoms of gestational diabetes and the pregnant woman are hyperglycemia on a challenge test with results greater than 140 milligrams per deciliter, ketoacidosis, polydipsia, polyphasia and polyuria, glycosuria and an abnormal pattern of weight gain. Managing gestational diabetes focuses on maintaining a fasting blood glucose below 105 milligrams per deciliter. To do this, aim your nursing interventions towards diet, exercise and glucose monitoring, and be sure to evaluate the fetal status. Caloric intake should be limited to two thousand to twenty four hundred calories Show more

a day. Teach the client to recognize signs and symptoms of hypoglycemia in ketoacidosis. Show her how to monitor her blood glucose and urine for ketones at home. Because of the altered glucose levels in the vaginal environment, pregnant women who have gestational diabetes are more susceptible to vaginal yeast infections, candidiasis. Be sure to teach appropriate Show more

self-care and how to recognize the signs and symptoms of yeast infection so treatment may be obtained. Fetal surveillance is another area of concern with gestational diabetes, especially during the third trimester. Tests that evaluate fetal status are echocardiography, ultrasound and non-stress testing. Fetal growth patterns, amniotic fluid index, fetal movements, fetal anomalies and placental anomalies Show more

all require monitoring during a pregnancy complicated by gestational diabetes. Teach your pregnant client to monitor fetal movements on a regular basis at home, although there is not a uniform rule for the amount of episodes of fetal activity considered to be normal. However, the nurse would inform the woman that fewer than three fetal movements in an hour warrants further examination, such as nst. Recommend that she count fetal movements daily in a relaxing environment and a comfortable position, at about the same time each day, and to report a trend toward decreasing motion. Actually, this is a good practice for all pregnant women as it increases the awareness about the activity status of the baby, Show more

assuring general fetal well-being If diet alone does not achieve the fasting blood glucose goal, insulin therapy might be prescribed. Oral hypoglycemics are never used in pregnancy because of the potential adverse effects on the fetus. Make sure you give the client detailed instructions on the method of insulin administration, whether it is via injection or insulin pump, and monitoring blood glucose. Be absolutely sure that your client can recognize the signs and symptoms of hypoglycemia and hyperglycemia. Maternal complications of gestational diabetes are hyperglycemia, dystocia, Show more

hydramnios, pregnancy-induced hypertension, urinary tract infections, postpartum infections, increased risk of stillbirth, spontaneous abortion, preterm labor and maternal hypoglycemia. Fetal complications of gestational diabetes are birth injuries related to macrosomia, neonatal hypoglycemia, perinatal asphyxia, congenital abnormalities, intrauterine growth retardation and neonatal hypocalcemia, polycythemia and hyperbilirubinemia. Now, another facet of antipartial nursing is providing care for a client who has intrauterine fetal loss. The term for this is abortion, which is referring to the spontaneous or intentional termination of a pregnancy before fetal viability, that is, before the fetus can survive outside the uterus. Most spontaneous abortions occur during the first trimester, sometimes before the woman knows she is pregnant. These are due most often to chromosomal defects or blinded ovum. Other causes of Show more

spontaneous abortion are abnormal implantation and maternal disorders such as infection, diabetes, hormonal deficiencies or cervical incompetence. Signs and symptoms of abortion are vaginal bleeding, abdominal or uterine cramping, low back ache, ruptured membranes and dilation of the cervix. When you care for a client with a threatened abortion, determine the presence of any of these physical findings. Keep in mind that hemorrhage and infection are the most common complications of abortion. Also be vigilant for signs of disseminated intravascular coagulation, such as hypotension, decreased level of consciousness, reduced urinary output, diminished peripheral pulses, a decreased platelet count and bleeding for a client who aborts after eight to twelve weeks anticipate that the health care provider Show more

will perform a dilation and curettage, also called dnc, to remove any remaining products of conception. Remember that your client may experience feelings of loss, so be prepared to provide emotional support for her and her family. Another complication is placenta previa, an abnormal implantation of the placenta in the lower uterine segment, either near or partially or completely covering the cervical oss. It is usually detected after the onset of painless vaginal bleeding during the second or third trimester. Placenta previa can be marginal, that is, with the edge of the placenta near the Show more

cervical loss, partial, where the obstruction of the os is incomplete, or total, with a placenta completely covering the os. The incidence of placenta previa is one in about every 200 pregnancies and it is more likely in women who have uterine scarring, multiple gestation, a history of placenta previa, closely spaced pregnancies, uterine tumors, increased maternal age or endometritis. Signs and symptoms of placenta previa are painless vaginal bleeding, usually bright, red, and recurrent episodes of vaginal bleeding that become increasingly profuse. To confirm placental placement and position, an abdominal ultrasound is done. If your client is hospitalized she will undergo daily non-stress tests to evaluate fetal well-being. Beta methazone might be given to promote fetal lung maturity. Show more

If delivery is inevitable, she may also receive blood transfusions and iv replacement fluids depending on the severity of the anemia from blood loss. Vaginal exams are contraindicated because of the potential for hemorrhage. Monitoring fetal well-being by checking the fetal heart rate and fetal movement is very important. Check bleeding for a mountain color- is it frank? And observe for the onset of labor. If the client will be managed with the conservative measures at home, recommend that she avoid enemas, douching and sexual intercourse. Complications of placenta previa are hemorrhage, fetal distress or demise related to hypoxia and utero intrauterine growth retardation, cesarean delivery, preterm birth, premature ruptured membranes and blood transfusion reactions. A major concern is abruptio placenta, a life-threatening condition in which the placenta separates from the uterus before the fetus is delivered. Although the incidence is only about one percent, perinatal mortality is about 15 percent. Show more

The most common risk factor is high blood pressure during pregnancy. Others include history of placental abruption, cigarette smoking, alcohol consumption, cocaine use, history of uterine problems, multi-fetal pregnancies, premature rupture of membranes, folic acid deficiency, a short umbilical cord and trauma from a motor vehicle accident or direct blow to the abdomen. Abruptio placenta usually occurs during Show more

the third trimester and, as possible, at any time after the 20th week of pregnancy. Signs and symptoms of abruption include severe abdominal or epigastric pain, hypotonic contractions and a board-like abdomen. Unlike painless placenta previa, abruptio placenta is extremely painful. Show more

Bleeding is common, but the amount of vaginal bleeding does not necessarily correlate with the severity of the abruption, since bleeding might be concealed that is contained between the uterus and the placenta. Abruptions are graded on a scale from zero to three, with a grade zero considered marginal and a grade 3 severe with more than 50 detachment and blood loss of more than 500 milliliters. Your interventions will be guided by the severity of the abruption. These include assessing the amount and the character of bleeding, the degree of abdominal rigidity, the degree of abdominal pain, fetal activity and heart tones, and measuring fundal height if concealed bleeding is suspected. Monitor for signs of shock by checking vital signs, urine output and overall physical assessment. Because of the uncertainty of the situation, you'll offer the client and her family a great deal of emotional support. Be aware that the need for an emergency cesarean section could arise at any time. Your client and her family may fear the loss of mother and baby, so Show more

be sure to realize how frightening the situation is and act accordingly. You'll monitor hemoglobin, hematocrit and coagulation profiles if emergency delivery is required. Your client will have blood typing and cross matching in case transfusion becomes necessary. Complications of abruptio placenta include severely compromised fetal well-being and sudden detachment of more than 50 percent of the placenta from the uterine wall, causing severe hemorrhage and fetal death. A complication of both placenta previa and abruptio placenta is disseminated intravascular coagulopathy, or dic. You must be absolutely precise in your assessment of a woman who has suffered severe hemorrhage. Signs and symptoms of dic include bleeding of the gums and from injection sites, along with a rapid pulse. The skin may have purple areas or pupura with petechiae. Show more

Your client may be restless or upset and say something like i think i'm going to die or something is very wrong and i'm scared. When the client expresses feelings of doom, you must take this seriously and provide emotional support. If your client is in labor, the fetal monitor may show late decelerations, fetal tachycardia and little or no variability. These are signs of shock in the mother and in the fetus. But early recognition is the key to improving otherwise poor fetal and maternal outcomes: nursing interventions and assessment for the client who has dicr, accurate intake and output, fluid replacement, hemodynamic monitoring via s1 gans catheter and careful estimation of blood loss Nursing assessment with dic also includes indication of any alteration in mental status or confusion on the part of the client. Pulmonary dysfunction related to dyspnea, tachypnea and cyanosis, and liver dysfunction evidenced by jaundice and hepatomegaly. Rubella, also called german measles, is one of the torch infections acquired during pregnancy. This highly infectious viral disease has Show more

devastating effects on the fetus during the first and second trimesters of pregnancy. The possibilities include defective organ formation, blindness, hearing loss, heart disease, mental retardation and demise. The type of fetal defect is directly related to the timing of maternal exposure. Pregnant women should not receive the rubella vaccine because of the theoretical possibility of developing a rubella infection from the live virus while pregnant. Show more

However, women who are of childbearing age should definitely be immunized against rubella. If a woman's rubella tighter is high enough, she is considered immune and does not need a vaccine. However, a non-pregnant woman with a low titer should receive the vaccine after immunization. She should avoid pregnancy for three months to prevent rubella related problems in the fetus Substance abuse continues to be a major problem for many perspectives. It is defined in pregnancy as any use of alcohol or illicit drugs that causes physical, social or interpersonal problems. Show more

Any use of alcohol or illicit drugs during pregnancies is considered abuse because of the serious effect these substances have on the fetus and neonate. Such substances include nicotine, alcohol, cocaine, marijuana, narcotics, hallucinogens, stimulants, sedatives, tranquilizers and pain relievers. Substance abuse during the first trimester places the fetus at greatest Show more

risk, variable with strength, amount, frequency and route of administration. You should screen every pregnant woman for substance abuse, at least verbally, during the history taking, so that intervention can begin early in the pregnancy for those women who disclose patterns of substance abuse. One major problem with women who abuse drugs during pregnancy is that they tend to avoid prenatal care. If you suspect the use of drugs, ask: are you taking any medications prescribed for you? How about other prescriptive medication not ordered by your health care provider? Do you use any street drugs like cocaine or heroin? Are you in a drug or alcohol treatment program or in methadone? Substance abuse can be verified with maternal toxicology screening. Look for these physical and behavioral findings associated with maternal addiction: constricted pupils, dental caries, mood swings, rhinitis, frequent falls or accidents, anorexia, weight loss, poor hygiene, no prenatal care, irregular, fast heart rate and the reoccurrence of sexually transmitted diseases or outward signs of physical violence. Maternal complications of substance abuse during pregnancy are high blood pressure, anemia, nutritional deficiencies, pancreatitis, Show more

alcohol-induced hepatitis and liver cirrhosis. Complications for the fetus and newborn are many, depending on the specific substance involved. For example, if your client takes cocaine, heroin or amphetamines, the fetus will have intrauterine growth retardation. A common side effect of cocaine use is abruptio placenta. If alcohol is the substance abused, then signs of fetal alcohol syndrome will be apparent. These are prenatal and postnatal growth restriction, central nervous system malfunctions and characteristic features such as microcephaly small eyes, a flattened nasal bridge and a thin upper lip. Learning delays and behavioral abnormalities such as attention deficit disorder or adhd and oppositional defiant disorder are more common among children exposed to alcohol prenatally. Again, depending on the substance abused, signs of drug withdrawal will appear in the newborn soon after birth. Initially, the newborn might be listless and have poor muscle tone and poor feeding habits, such as uncoordinated suck and swallow. Other characteristics include a high pitched cry, jitteriness and tremors, restless sleeping Show more

and an inability to be consoled when crying. Keep in mind that the substances most often abused during pregnancy are tobacco and alcohol. Your interventions must focus on teaching the client about the consequences of exposing her fetus to all lethal substances. Finally, let's shift our attention to adolescent pregnancy. The united states has the highest incidence of adolescent pregnancy among western countries, and most of these teenage pregnancies are unintentional. Adolescents are less likely to seek early prenatal care and are more likely to be non-compliant in the areas of nutrition and prenatal care. As a result, teens are at a higher risk for pregnancy-induced hypertension, preterm birth and intrauterine growth restriction. Psychosocial risk factors affecting Show more

teens in general are transient relationships, single-parent families, disrupted education and low income. Factors contributing to teenage pregnancy include cohabitation, early sexual activity, poverty, low self-esteem, risk-taking behaviors, reduced impulse control, diminished ability to delay sexual gratification, a history of alcohol or drug abuse and delinquent or illegal activities. So how do you help your pregnant adolescent client? Focus your attentions on the education for the prevention of pregnancy through sexual abstinence practices, prevention of complications and resources for social and economic support. A thorough assessment of the client early in pregnancy will give you baseline information such as weight and blood pressure. Determining immunization status is important so that the essential prevention measures are taken and she is educated about the proper time to receive immunizations such as the rubella vaccine or immunoglobulin for rh factor. Assessing your client's understanding of pregnancy and delivery will give you some direction in teaching. Topics to consider are labor and delivery, newborn care, Show more

ways to prevent infection and available resources for pregnancy, delivery and child care. Another of your goals for promoting positive pregnancy outcomes is to assess nutritional status and teach your clients some strategies for healthy eating. Assessing the adolescent mother support system is paramount. For a teenager, pregnancy introduces additional physical and emotional stress during an already stressful developmental period. Teenagers are commonly impulsive and self-centered and do not plan for the future. For this reason, often children are born to teen moms with poor physical and emotional support and are at higher risk for abuse and neglect. Excess financial strain for clothing, feeding and sheltering the mother and the baby, as well as child care costs or altered employment or no employment, compound the stresses associated with pregnancy and motherhood by providing education and resources for community support to the pregnant adolescent You can help her reduce the infant's risk of abuse and abandonment and failure to thrive Show more