NURSING CARE FOR WOMEN W/
COMPLICATIONS DURING PREGNANCY
High-risk pregnancy
-One in which the health of the mother/fetus
is in Jeopardy
-increased risk of morbidity/mortality
before/after delivery
-leading cause of death and disability among
women (515,000 women/yr)
-women: 30-endure injuries; infection and
disabilities
-early and consistent assessment for risk
factors during prenatal visits
Ways for identification clients at risks
1. Assessment of risk factors
a. Physiological
b. Psychological
C. Social
Risk Assessment Tool
-Hobel, 1973
-risk factors are assigned a score
corresponding to the degree of risk
-A score 19 or more indicates a high risk
that should receive more than routine
prenatal care
OB Hx
Risk Factor
• Previous still birth 10
• Previous neonatal death 10
• Previous premature infant 10
• Post term.42 weeks 10
• Fetal blood transfusion for hemolytic
disease 10
• Repeated miscarriages 5
• Previous infant >10lbs 5
• Six/more completed pregnancy 5
• Hx of eclampsia 5
• Previous cesarean section 1
• Hx of preeclampsia 1
• Hx of preeclampsia 1
• Hx of fetus w/ anomalies 1/0
Medical Hx
Risk factor
• Abnormal PAP Test 10
• Chronic HPT 10
• Heart disease NYHA class II-IV
(symptomatic) 10
• Insulin dependent diabetes (>A2)
10
• Moderate to severe renal disease
• Previous endocrine ablation 10
• Sickle cell disease 5
• Epilepsy 5
• Heart disease NYHA class I (no
symptoms) 5
• Hx of TB/PPD >10mm 5
• Positive serology (for syphilis) 5
• Pulmonary disease 5
• Thyroid disease 5
Family Hx
• DM 1
Physical risk factors
• Incompetence cervix 10
• Uterine malformalities 10
• Maternal weight <100lbs or >200 lbs
5
• Maternal age 35 and over 15 and
under 5
• Small pelvis 5
Current pregnancy risk factors
• Abnormal fetal position 10
• Moderate to severe preeclamsia 10
• Multiple pregnancy 10
• Placenta abruption 10
• polylydromnios/oligohydromnios 10
• excessive use of drugs/alcohol 5
• gestational diabetes (A1) 5
• kidney infection 5
• mild preeclampsia 5
• Rh sensitization only 5
• Severe anemia <9g/dl hemoglobin
5
• Severe flu syndrome/viral disease 5
• Vaginal spotting 5
• Bladder infection 1
• Emotional problem 1
• Mild anemia 9g/dl hemoglobin 1
• Moderate alcohol use 1
• Smoking > = 1 pack/day
Fetal diagnostic tests
-birth defects
-diagnostic/screening test
Diagnostic vs. screening
Diagnostic – whether a fetus has a particular
condition w/ certainty but may provide
limited information about the other types of
birth defects
Screening- not accurate, help to identify
patient at risk who light benefit from
diagnostic test
Fetal well-being
-fetus movements are directly r/t infant’s
sleep-wake cycle vary from mother
-typical active fetal period lasts 40 min and
peaks between 9PM and 10 PM in response
to maternal hypoglycemia
Ultrasound
-non-invasive procedure;uses intermittent
ultrasonic waves transmitted by an
alternating current to a transducer applied to
abdomen
-ultrasonic waves: defect off tissues w/in
abdomen, showing structures of varying
densities
-requires full bladder (1-2 qts of water)
Transvaginal Ultrasound
-detect shortened cervical length/funelling
(predict preterm labor)
-uses a probe inserted into vagina
-done early is pregnancy (fetal age,
suspected etopic pregnancy)
Transabdominal Ultrasound
-transducer
-often scanned with full bladder (water every
15 mins. 90mins before examination)
Nursing Responsibility (UT2)
-inform patient about the procedure
-provide comfort and privacy
*empty bladder (transvaginal UT2) -dorsal
recumbent
*full bladder (transabdominal UTV) -supine
*position
*drape
Alpha-Fetoprotein Testing (AFP)
-maternal alpha-fetoprotein test
-determine level of fetal protein in women's
serum/sample of amniotic fluid
-16-22 weeks of pregnancy
High levels of AFP
-a neural tube defect
spinabifidy (open supine)
anecephaly (incomplete division of
skull and brain)
-defects with esophagus
-gastroschisix (baby's failure)
Low levels of AFP
-abnormal chromosomal or gestational
trophoblastic disease
-Trisomy 21 (Down syndrome)
-Trisomy 18 (Edward's syndrome)
Chorionic Villi Sampling (CVS)
-obtain a small part of developing placenta
to analyze fetal cells
-10-12 weeks
-results = 24-48 hours
-can't determine spina bifida/anecephaly
-identify chromosome (abnormal)
-newborn: limb reduction defects
-Rh (D) immune globulin given to Rh-
negative woman
-↑ rate spontaneous abortion than
amniocentesis
Amniocentesis
-insertion of thin needle through abdominal
and uterine walls (sample on amniotic fluid);
invasive
-15-17 weeks
-early: 11-14 weeks of some disorder
Usage (Amniocentesis)
-identify chromosome abnormalities,
biochemical disorders and level of AFP
-spontaneous abortion
-identify severity of maternal fetal blood
incompatibility and assess fetal lung maturity
-Rh (D) immune globulin given to Rh-
negative woman
Nursing Responsibilities (Amniocentesis)
-obtain informed consent
-provide comfort and privacy
full bladder, position, drape
-aseptic technique (hand wash, gloves)
Non-stress Test (NST)
-response of FHR to fetal movement
-monitor FHR
Usage of (NST)
-identify fetal compromise (poor placenta
function)
-reassess placenta is functioning well and
oxygenated, intact CNS
*Non-reactive at risk = not good
*1 fetal movement = +45FHR
-30-32 weeks
*Reactive= 2 accelerations of FHR with fetal
movements of 15 beats/min, lasting 15 sec
or more for 20 min
*2-15 beats-15sec-20min
Contraction Test (CT)
-evaluating respiratory function of placenta
-identify risk for intrauterine asphyxia by
observing response of FHR to stress
contraction
Negative- shows 3 contractions good quality
lasting 40 or more secs in 10 min without
evidence of late decelerations
-fetus can handle the hypoxic stress of
uterine contractions
Positive – shows repetitive persistent late
deceleration with more than 50% of
contractions
-hypoxic stress cause showing FHR
Equivocal – non persistent late
decelerations or with hyper stimulation (2
min frequency of duration longer than 90)
Percutaneous Umbilical Blood Sampling
(PUBS)
-anemic fetus (maternal fetal blood
incompatibility, placenta previa, abrupt
placentae)
-blood sample from placental vessel
Lecithin to Sphingomyelin (l/S) ratio
-respiratory complications in adapting
extrauterine life
34-38 weeks
-lung mature → ↑ lecithin ↓ Sphingomyelin
-2:1 (normal value)
Phosphatidyl glycerol (+) - baby will not
suffer respiratory distress syndrome on
delivery
Biophysical Profile (BPP)
1. FHR and reactivity (NST) [reactive -
2]
2. Fetal Breathing Movement
[breathing/60sec – 2]
3. Fetal Body Movement [3
movements of arms, legs, body – 2]
4. Fetal Tone [ return of flexion – 2]
5. Volume of amniotic fluid [>1cm – 2]
-identify reduced fetal oxygenation in
conditions associated with poor placental
functioning
-↑FHR → deprivation of oxygen
-fetal hypoxia increases, FHR changes,
cessation
-amniotic fluid is reduced when placental
function is poor
of fbrem, gross body movement, loss of FT
A-mniocentesis
L-/S ratio
O-xytocin Test
N- on-stress Test
E-steriol level
PREGNANCY AT
RISK:PREGESTAITIONAL PROBLEMS
Sexually Transmitted Disease (STD)
-15-24y/o
-↑ STD group: Sexually active youth
-Pregnant: miscarriage, premature delivery
Risk factors:
1. lower socio-economic status
2. lower education level
3. sexual activity with multiple partners
4. unsafe sexual intercourse
Etiologic Agent: Candida Albicaus (fungus)
Candidiasis – thick yellow vaginal disharge
− extreme pruritus (yeasty
or no odor)
Med management:
1. application of an over-the-counter
anti-fungal cream (Monistat) for 7
days
2. oral flucanozole (anti fungal)
Trichomoniasis – irritation, itching
Etiologic agent: Trichomonas vagindlis
Signs and symptoms – profuse greenish-
yellow discharge with foul odor
Effects – preterm labor, premature rapture of
membranes, post cesarean infection
Med management:
1. metronidazole ( anti fungal)
Nursing management:
1. Verbalize feelings
Bacterial Vaginosis
Etiologic agent – Gardenella Vaginalis
Signs and symptoms – gray discharge, fishy
odor/musty
-pruritus
Effects:
1. pelvic inflammatory disease
2. posthysterectomy vaginal cuff
cellulitis
3. endometritis
4. amniotic fluid infection
5. preterm delivery/labor
6. PROM
7. spontaneous abortion
Med management:
1. topical – Metronidazole (Flagyl)
0.75% vaginal gel
Clyndamycin 2% cream
2. Oral – Metronidazole 500% mg (2x)
- Clyndamycin 300mg (2x)
Chlamydia
Etiologic agent – chlamydia vaginalis
-ectopic pregnancy, preterm PROM,
premature delivery
-heavy gray-white discharge
-cervicitis, urethritis, vaginalis, pelvic
inflammatory disease (clinical
manifestations)
-60-70% risk → infected birth canal
Effects – conjunctivitis, pneumonia
Med management
1. tetracydin and deoxycycline
2. amoxicillin – pregnant
3. aztromycin (1g) -pregnant
Syphilis
Etiologic agent – treponema pallidum
Signs and symptoms:
• primary stage – small, hard-based
sore
• secondary stage – skin rashes, loss
of patches of hair, malaise, fever
• latent stage – asymptomatic
• tertiary stage – gumma formation
(rubbery mass of tissue)
Effects:
1. spontaneous abortion
2. still born infant
3. premature labor
4. congenital syphilis (enlarged liver,
spleen, skin lesions, rashes,
pneumonia, hepa)
Med management:
1. benzathine penicillinG (pregnant)
2. procaine penicillin, IM, 750mg for 10
days
3. erythromycin 500mg, 4x//day for 14
days (allergy to penG)
4. azithromycin 500mg, daily for 10
days (allergy to penG)
Jarisch-Herxcheimer reaction
-caused due to sudden destruction of
spirochetes;last for 24 hours
Signs and symptoms – fever, tachycardia,
muscle aches
Gonorrhea
etiologic agent – neissoria gonorrhoeae
Signs and symptoms – yellow-green vaginal
discharge
effects to fetus/pregnancy:
1. severe eye infection → blindness
2. endocervitis
3. PROM
Med management
1. oral cefixime (Suprax) 400mg, once
2. ceftriaxone (rocephin) 125-250mg,
IM, once
Side effects: nausea, vomiting
HIV/AIDS
-4th leading cause of death among women
25-44 y/o
-leading cause of death and disease world
wide, main risk factor: unsafe sex
Stages of HIV infection:
1. initial invasion – flulike symptoms
2. serocoversion- converts from having
no HIV antibodies
-happens 6weeks-1year after exposure
3. asymptomatic period -weight loss,
fatigue (3-11yrs)
4. symptomatic period – oppurtunistic
infection occur oral and vaginal
candidiasis, Kaposi sarcoma...
Dx procedure:
a. ELISA(screening test)
enzyme-linked immunoabsorbent assay
antibody detection test
b. western blot analysis – confirmatory test
Dx:risk for infection r/t dysfunction immune
system
Nursing management:
 1. aseptic technique
2. administration of med as prescribed
3. provide health care education on:
-breastfeeding
-protected sexual activity
Nursing management for STD
1. assessment Hx taking (multiply
partners, unprotected sex)
2. Dx = knowledge deficit
3. intervention:
-discuss causes of STD:multiply partners
-teach about proper hygiene:perineal and
hand washing
-sensitivity, confidentiality
-counseling before and after testing allay
fears
-provide accurate information
-provide referral to needed medical and
psychological services
Cardiovascular Diseases
-total blood volume: at least 30%
-iron requirement: 800mg
-cardiac output by 25%-50%, increase heart
rate
NYHA
Class I – no discomfort (dyspnea,
palpitation, anginal pain) on ordinary act
Class II – discomfort on ordinary act
Class III- discomfort on less than ordinary
act
Class IV- dyspnea at rest. Patient is
decompensated
Effects to mother:
Left-sided H.F.
-edema
-Prod cough of blood-speckled sputum
-orthopnea
-increase RR
-fatigue
-dizziness
-weakness
-paroxysmal nocturnal dyspnea
Right-sided H.F.
-jugular vein distension
-hepatomegaly
-extreme dyspnea
-pain
-ascites (leak of fluid to peritoneal act)
-peripheral edema
Effect to fetus:
1. low birth weight
2. abortion
3. intrauterine growth retardation
4. still birth
5. premature labor
Med management:
1. Digoxin – to slow ventricular
response and to increase
myocardial contractility
2. diuretics -for acute and chronic
heart failure
3. beta-adrenergic blockers
(propandol) – arrhythmia associated
with ischemic heart disease
4. amonophylline – relives
bronchospasm
5. heparin- with artificial valves or
artrial fibrillation
Surgical management:
1. therapeutic abortion -Class II and IV
2. cardiac surgery – alternative to the
therapeutic abortion
-closed cardiac surgery is preferred
Nursing management:
1. monitor fetal well being (9PM-10AM)
2. promote rest
3. promote healthy nutrition – low
sodium diet
4. instruct about avoiding infection
-there you go. Aralin niyo yan! :))
©BSN-2H notes