NCM 109

• Abruptio Placenta:

  • Premature separation of the placenta that occurs late in pregnancy
  • Signs of internal bleeding: distended, rigid, tenderness
  • Signs of placental separation: sudden gush of blood, lengthening of the cord, globular shape of the uterus
  • Types of placental separation: fetal anoxia due to inadequate oxygenation of the mother, low maternal blood pressure, or abnormalities in the uterus, placenta, or umbilical cord
  • Risk factors: high parity, short umbilical cord, advanced maternal age, direct trauma, chorioamnionitis (maternal infection)
  • Symptoms: sharp stabbing pain, heavy bleeding
  • Medical management: intravenous therapy, oxygen inhalation, fibrinogen determination
  • Surgical management: cesarean delivery, hysterectomy
  • Nursing intervention: place in lateral position, monitor fetal heart sounds, monitor vital signs
• Preterm Labor:

  • Occurs before the end of the 37th week of gestation
  • Symptoms: persistent, dull, low backache, vaginal spotting, uterine contractions
  • Therapeutic management: bed rest, intravenous fluid therapy, tocolytic agents like Terbutaline
  • Medications: Betamethasone, Dexamethasone, Corticosteroids
  • Drug administration: administering corticosteroids to the fetus accelerates lung surfactant formation, magnesium sulfate may reduce the risk of cerebral palsy before 32 weeks
  • Cesarean birth may be planned to reduce pressure on the fetal head and reduce hemorrhage
  • Premature Rupture of Membrane (PPROM): rupture of fetal membrane with loss of amniotic fluid before 37 weeks
• Premature Rupture of Membrane (PPROM):

  • Incidence: 5-10% of all deliveries, risk factors include chorioamnionitis, vaginal infections, cervical abnormalities, smoking
  • Implications: maternal and neonatal infections, cord prolapse, Potter like syndrome
  • Complications: cord prolapse, cord compression, placental abruption, high cesarean section rate, fetal pulmonary hypoplasia
  • Diagnosis: history, examination, ultrasound, special tests like litmus, ferning, and nitrazine test
  • Management: emotional support, screening for lower genital tract infection
• Pregnancy-Induced Hypertension (PIH):

  • Vasospasm during pregnancy in small and large arteries
  • Most common medical problem during pregnancy (8% of pregnancies)
  • Form of high blood pressure in pregnancy
  • May hinder blood flow in various organ systems
  • Prenatal care includes monitoring blood pressure, lab tests for anemia, UTI, STDs, and other conditions
• Preeclampsia:

  • Condition characterized by high blood pressure in pregnancy
  • No seizures (treated with magnesium sulfate)
  • Eclampsia: with seizures
• Obstetrics is derived from the Greek word "obstare," meaning "to keep watch," and pertains to the care of women during childbirth
• Pediatrics comes from the Greek word "pais," meaning "child"
• Maternal and child health nursing involves four phases of health care:

  • Health promotion
  • Health maintenance
  • Health restoration
  • Health rehabilitation
• The primary goal of maternal and child health nursing care is the promotion and maintenance of optimal family health to ensure cycles of optimal child-bearing and childrearing
• A high-risk pregnancy is one in which a concurrent disorder, pregnancy-related complications, or external factors jeopardize the health of the woman, the fetus, or both
• Risk factors for high-risk pregnancy include:

  • Bad obstetric history
  • Heart disease
  • Hypertension or preeclampsia
  • Diabetes
  • Severe anemia
  • Twins or triplets
  • Placental abortion
  • Seizure disorder
  • Threatened preterm labor
  • Hemolytic anemia
  • Thrombocytopenia or megaloblastic anemia
  • Bleeding disorder
  • Thalassemia
  • History of thrombosis or thrombophilia
• Screening of high-risk cases is typically done in the first trimester of pregnancy
• Fetal Ultrasound in the second trimester is done to estimate fetal age, detect birth defects, and assess fetal position
• Diagnostic tests are used to establish the presence or absence of disease for treatment decisions
• Administer Folic acid, Iron, and Calcium during pregnancy for various benefits
• Non-invasive tests in pregnancy include Fetal Ultrasound, which is used to monitor fetal health and development
• Fetal Ultrasound in the first trimester is done to determine pregnancy progress, fetal health, and risk of chromosome defects
• Fetal Ultrasound in the third trimester is done to ensure fetal well-being and assess fetal size and position
• Cardiotocography is used to monitor fetal heart rate and uterine contractions during pregnancy
• Non-Stress Test (NST) is a common prenatal test to check a baby's health by monitoring the baby's heart rate
• Contraction Stress Test is performed near the end of pregnancy to assess how well the fetus will cope with contractions during childbirth
• Invasive tests like Chorionic Villus Sampling and Amniocentesis are used for prenatal diagnosis of chromosomal or genetic disorders in the fetus
• Amniocentesis is a test done during pregnancy to look for birth defects and genetic problems in the developing baby
• It involves removing a small amount of fluid from the sac around the baby in the womb
• Amniocentesis is most often offered to women at increased risk for bearing a child with birth defects, including those who are 35 or older, had abnormal screening test results, had babies with birth defects before, or have a family history of genetic disorders
• Genetic counseling may be chosen before amniocentesis to learn about other prenatal tests and make informed decisions regarding options for prenatal diagnosis
• Amniocentesis is a diagnostic test that is 99% accurate for diagnosing Down syndrome and is usually done between 14 and 20 weeks of pregnancy
• Amniocentesis can diagnose various gene and chromosome problems in the baby, including anencephaly, Down syndrome, rare metabolic disorders, trisomy 18, and others
• Embryoscopy is the examination of the embryo at 9-10 weeks' gestation through the intact membranes by introducing an endoscope into the exocoelomic space transcervically or transabdominally
• Fetoscopy is the examination of the fetus after 11 weeks' gestation, performed transabdominally in the amniotic fluid using fiber-optics technology
• Percutaneous umbilical cord blood sampling, also known as cordocentesis, is a diagnostic test that examines blood from the fetus to detect fetal abnormalities
• Cordocentesis is usually done after 17 weeks into pregnancy and can help diagnose chromosome abnormalities like Down syndrome and blood disorders like fetal hemolytic disease
• Common cardiovascular diseases in pregnant women include left-sided heart failure, right-sided heart failure, peripartum heart disease, cardiac disease, and others
• Thyroid disease is the second most common endocrine disorder in pregnant women, with poorly controlled disease having complications and risks during pregnancy
• Hyperthyroidism, such as Grave's disease, and hypothyroidism, like Hashimoto's thyroiditis, have distinct causes, symptoms, and treatments
• Diabetes Mellitus, an endocrine disorder, has three types: Type 1, Type 2, and Gestational Diabetes Mellitus (GDM)
• Diabetes during pregnancy, including type 1, type 2, or gestational diabetes, can negatively affect the health of women and their babies
• High blood sugar around the time of conception for women with type 1 or type 2 diabetes increases the risk of birth defects, stillbirth, and preterm birth
• Gestational Diabetes Mellitus (GDM) is diabetes not detected before pregnancy but discovered during pregnancy, with nearly all cases being Type 2 Diabetes
• Risk factors for GDM include obesity, age over 25 years, history of large babies, history of unexplained fetal or perinatal loss, history of congenital anomalies in previous pregnancies, and family history of diabetes