Complications of Pregnancy

• The placenta is the organ that connects the mother to the fetus, providing nutrients and oxygen.
• Demographic factors, socioeconomic status, and obstetric history are important in understanding a patient's health.
• Inadequate finances, overcrowding, poor hygiene, nutritional deprivation, and unplanned and unprepared pregnancy are examples of demographic factors.
• Maternal medical history, habits, current status, and non-invasive diagnosis procedure utilizing high-frequency sound waves to detect intra-body structures are also factors to consider.
• Obstetric ultrasound is used in early pregnancy to confirm pregnancy and detect the condition of the fetus, placental location or placental abnormality, and can be an aid in high-risk procedures like the amniocentesis.
• Preparation for obstetric ultrasound includes advising the mother to drink one quart of water two hours before the procedure, instructing not to void, spreading transmission gel over the maternal abdomen, and providing psychological support.
• Observation of fetal heart tone (FHT) is a test of fetal well-being.
• Preparation for FHT observation includes positioning the mother in a semi-fowler’s or left lateral position, checking blood pressure first, explaining that the procedure takes 30-60 minutes to finish, and requires monitoring of FHT.
• Interpretation of FHT results includes determining if the FHT is reactive, meaning it is increased greater than 15 bpm above baseline for 15 seconds or more in a 10 to 20 min period with fetal movement, or non-reactive, meaning there is no FHR acceleration with fetal movement.
• Normal FHT results indicate a high-risk pregnancy continues, while abnormal results may indicate a need to terminate pregnancy.
• Cerclage procedure during the 14th to 16th week of gestation or prior to next pregnancy, Shirodkar procedure, and McDonald procedure are treatment options for this condition.
• Types of placenta previa include low-lying placenta previa, marginal placenta previa, partial placenta previa, and complete or total placenta previa.
• In this condition, the placenta has been implanted correctly, however the placenta separates prematurely.
• Complications of placenta previa include hemorrhage, prematurity, and obstruction of birth canal.
• Nursing management for this condition includes providing psychological support to clients who may have negative feelings such as low self-esteem, fear related to inability to complete the pregnancy, and guilt.
• Treatment options for placenta previa include watchful waiting, amniotomy, double set-up, and delivery.
• Psychological support and preparation for discharge are provided to clients with a condition characterized by a mechanical defect in the cervix causing cervical effacement and dilation and expulsion of the products of conception in the mid trimester of pregnancy.
• Congenital defect of the cervix, trauma to the cervix as in forceful D&C and difficult delivery, and cervical lacerations are risk factors for this condition.
• Premature separation of abnormally low implanted placenta, also known as placenta previa, is the most common cause of bleeding in the third trimester.
• Risk factors for placenta previa include multiparity, decreased vascularity in the upper uterine segment due to scarring and tumor, increased age above 35 years, and multiple pregnancy.
• Bleeding in placenta previa can be bright red or painless.
• Advice to limit physical activities within 2 weeks after treatment, maternal and fetal growth monitoring, routine prenatal care, and instructing clients to report promptly signs of labor are part of nursing management for this condition.
• Nursing implementation for placenta previa includes maintaining bed rest, not performing an IE or vaginal examination, careful assessment of vital signs, preparation for diagnostic UTZ, and providing psychological and physical comfort.
• Painless contractions resulting in delivery of a dead or non-viable fetus, history of abortions, and finding of a relaxed cervical os on pelvic examination are assessment findings for this condition.
• Observation of response of the fetus to induced uterine contractions is a test of feto-placental well-being.
• Provide teaching.
• Encourage early prenatal management and supervision.
• Post partum: rapid decrease to pre-pregnant level; may not need insulin in the first 24 hours after delivery.
• Screening test: 1 Hours Oral Glucose Tolerance Test performed at 24 - 28 wks gestation, uses 50g oral glucose challenge, finding: A plasma glucose of >140 mg/dl needs a follow-up test with 3 hour glucose tolerance test.
• Encourage early detection through history, symptoms, prenatal screening.
• 3 Hour Oral Glucose Tolerance Test administered if 1 Hour OGTT is abnormal, presence of two out of these four venous samples is considered an abnormal result: Fasting >95 mg/dl 1 hr after: serum glucose >180mg/dl 2 hr after: serum glucose >155mg/dl 3 hr after: serum glucose >140mg/dl.
• Labor: IV Regular insulin.
• Toxoplasmosis is caused by a protozoan parasite, Toxoplasma gondii, which is transmitted through consumption of undercooked meats and exposure to cat feces.
• Provide postpartum care.
• Continued monitoring, mother and fetus during the intrapartal period.
• History: Family history of DM, previous large infant weighing 4000 g or more, fetal wastage, obesity with rapid weight gain, increased incidence of vaginal moniliasis and UTI.
• StressMOTHER BABY Infertility Spontaneous Abortion PIH Infections: UTI Uteroplacental insufficiency Premature labor Dystocia More difficult to control DM CS often indicated Uterine Atony Congenital Anomalies Polyhydramnios Macrosomia (LGA) Fetal hypoxia Neonatal hypoglycemia Prematurity RDS
• Preparation for this test includes positioning the mother in a semi-fowler’s or left lateral position, checking blood pressure prior to the test and every 15 min during the test, explaining that the procedure takes 1-3 hours to finish, and requires monitoring of FHT.
• Signs of hyperglycemia: Polyphagia, Polydipsia, Polyuria.
• Acute viral infection caused by a mixovirus.