Complications of Pregnancy

1. Complications of Pregnancy

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 • 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. 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

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

17. Interpretation • Reactive result • Nonreactive result • Unsatisfactory result

18. 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

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

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

21. Biophysical Profile Scoring

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

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

24. 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

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

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

27. Threatened Abortion

28. Imminent Abortion

29. Incomplete Abortion

30. 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?

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

32. 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.

33. Ectopic Sites • l

34. 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

35. 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

36. 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

37. 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

38. Hydatidiform Mole

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

40. Bleeding Disorders of Late Pregnancy • Placenta previa • Abruption placenta

41. Placenta Previa • Painless • Spotting or heavy bleeding • Bright-red bleeding • Soft, non-tender, relaxed uterus with normal tone • Shock in proportion to observed blood loss • Signs of fetal distress usually not present

42. Placenta Previa

43. Assessment • Episodic painless vaginal bleeding after 20th week of pregnancy without contractions • Each successive bleeding episode heavier than the last • Profuse hemorrhage • Ultrasound shows location of placenta

44. Nursing Interventions • No vaginal exams • Bedrest • Monitor vital signs and fetal well-being • Assess blood loss • IV access • Provide adequate nutrition • Provide emotional support

45. Abruptio Placenta • Severely painful • Heavy bleeding may be partially or completely hidden • Usually dark-brown bleeding • Rigid, board-like, tender uterus possibly with contractions • Shock seeming to be out of proportion to blood loss • Signs of fetal distress

46. Abruptio Placenta

47. Assessment • Painful, rigid, board-like abdomen with vaginal bleeding • Central abruption • Marginal abruption • Fetal outcome

48. Nursing Interventions • Monitor vital signs • Continuous EFM • Assess for bleeding, uterine activity, abdominal pain • Measure abdominal girth • Review lab values • IV access • Provide oxygen

49. Hypertensive Disorders • Pregnancy induced hypertension • Preeclampsia and eclampsia • Chronic hypertension • Superimposed preeclampsia • Transient hypertension

50. Pathophysiology • Vasospasm reduces blood flow to mother’s organs and placenta • Vascular endothelial damage • Hypertension • Edema • Proteinuria