Complications of Pregnancy Module B

1. Complications of Pregnancy Module B NUR 106 Spring, 2005

2. Assessment of Fetal Well-being • Detect physical abnormalities • Monitor fetal condition • Fetal movement • Complex diagnostic testing • Risks and benefits

3. Amniocentesis • Aspiration of amniotic fluid • Determine genetic disorders • Sex of fetus • Fetal lung maturity • Risks • Nursing management

4. Amniocentesis

5. Chorionic Villus Sampling • Aspiration of small sample of chorionic villus tissue • 8 to 12 weeks gestation • Detects genetic abnormalities • Risks and benefits • Nursing management

6. Hormone Levels • Estriol • Human chorionic gonadotropin • Maternal serum—alpha fetoprotein

7. Alfa-Fetoprotein Screening • MSAFP • AFAFP • Time sensitive • Low MSAFP levels associated with Down syndrome • High MSAFP levels associated with neural tube defects

8. Triple Marker Screening • Alpha-fetoprotein • Human chorionic gonadotropin • Unconjugated estriol

9. High Risk Assessment • Daily fetal movement count • Nonstress test • Biophysical profile • Contraction stress test

10. Daily Fetal Movement Count • Begin at 27th week • Consider • Fetal sleep-wake cycles • Maternal food intake • Drug-nicotine use • Environmental stimuli • Maternal position • Procedure

11. Fetal Monitor

12. Fetal Monitoring • Normal fetal heart rate • Baseline

13. Baseline FHR • Rate • Variability • Assesses average rate for at least 2 minutes within a 10 minute window • Normal: 110 to 160 bpm • Bradycardia: < 110 bpm for 10 minutes • Tachycardia: > 160 bpm for 10 minutes

14. Variability • Normal irregularity of fetal cardiac rhythm • Short-term • Beat-to-beat changes • Need fetal scalp electrode • Long-term • Rhythmic changes (waves) from the baseline value • Usually 3 to 5 beats

15. Reduced Variability

16. Accelerations

17. Bradycardia

18. Tachycardia

19. Deceleration

20. Nonstress Test • Assess response of FHR to periods of fetal movement • After 27th to 30th week • Frequency depends on condition of maternal-fetal unit • Indications

21. Procedure • Perform test during a time of activity • Maternal preparation • Maternal vital signs • Attach monitor • Monitor fetal movement

22. Interpretation • Reactive result • Nonreactive result • Unsatisfactory result

23. Reactive NST

24. Nonreactive Test

25. Contraction Stress Test • Assess ability of fetus to withstand the stress of uterine contractions • Assesses placental oxygenation and function • Determines fetal well being • Performed if NST is abnormal

26. Interpretation • Negative CST • Positive CST • Equivocal • Unsatisfactory

27. Negative CST; Reactive NST

28. Positive CST

29. Biophysical Profile • Assess fetal status • NST • Fetal breathing movements • Fetal body movements • Fetal muscle tone • Amniotic fluid volume • Placental grading

30. Biophysical Profile Scoring

31. Lung Maturity Testing • Lecithin to sphingomyelin ratio • Phosphatidylglycerol

32. Fibronectin • Test for preterm delivery • Negative test result highly reliable • Reassures that risk of preterm delivery is low • Presence of fFN in symptomatic women during weeks 22 – 34 of gestation = increased risk of preterm delivery

33. Hyperemesis Gravidarum Intractable nausea and vomiting that persists beyond the first trimester and causes disturbances in nutrition, electrolytes, and fluid balance

34. Assessment • Nausea most pronounced on arising • Persistent vomiting • Weight loss • Signs of dehydration • Electrolyte imbalances • Ketonuria • Increased hematocrit levels

35. Nursing Interventions • Monitor vital signs • Monitor FHR, fetal activity and fetal growth • Monitor for dehydration and electrolyte imbalance • Daily weight, I&O, calorie count • Monitor urine for ketones • Administer IV fluids, antiemetics

36. Bleeding Disorders of Early Pregnancy • Spontaneous abortion • Ectopic pregnancy • Hydatidiform mole

37. Abortion • Threatened • Imminent • Complete • Incomplete • Missed • Habitual • Elective

38. Threatened Abortion

39. Imminent Abortion

40. Incomplete Abortion

41. A 22 year old gravida i, para 0, is 11 weeks pregnant. She was admitted to the hospital with moderate vaginal bleeding and some abdominal cramping. Vaginal examination reveals that the cervix is dilated 2 cm. She is diagnosed as having an imminent abortion. What nursing interventions are indicated when caring for this patient?

42. Nursing Interventions • Save perineal pads / tissue • Emotional support • Observe for shock • Bed rest / diversional activity • RhoGAM • Possible surgery • Medication / Blood

43. Ectopic pregnancy is often difficult to diagnose because its symptoms are similar to those of abdominal conditions. Identify at least five signs or symptoms of ectopic pregnancy and briefly explain why each occurs.

44. Ectopic Sites • l

45. Ectopic Pregnancy • Fertilized ovum implants outside the uterus • Symptoms at 6 to 12 weeks of gestation • Severe unilateral pelvic-abdominal pain • Pain may refer to shoulder • Tender abdominal mass • Nausea, faintness • Bleeding – frank or occult

46. Nursing Interventions • Monitor vital signs • Administer intravenous fluids • Provide oxygen when needed • Medicate for pain • Assess lab results • Prepare for possible surgery • Provide emotional support

47. Incompetent Cervix • Premature dilation of cervix • Occurs in 4th or 5th month of pregnancy • Associated with cervical trauma • Vaginal bleeding at 18 to 28 weeks • Fetal membranes visible through cervix • Treatment is surgical

48. Hydatidiform Mole • Gestational trophoblastic disease • Developmental anomaly of placenta • Changes chorionic villi into a mass of clear vesicles • Edematous grapelike cluster • May develop into choriocarcionoma

49. Hydatidiform Mole

50. Assessment • FHR not detectable • Vaginal bleeding • Symptoms of PIH • Fundal height > expected for date • Elevated hCG • Ultrasound shows characteristic snowstorm pattern