1. Complications During Pregnancy Lecture 5 Clinical aspects of Maternal and Child Nursing NUR 363 Complications During Pregnancy Lecture 5

2. Characteristic Causes of High-Risk Pregnancies Can relate to the pregnancy itself Can relate to the pregnancy itself Or the woman has a medical condition or injury Or the woman has a medical condition or injury Or from environmental hazards that affect the mother or her fetus Or from environmental hazards that affect the mother or her fetus Or from maternal behaviors or lifestyles that have a negative effect on the mother or fetus Or from maternal behaviors or lifestyles that have a negative effect on the mother or fetus

3. Assessment of Fetal Health The Goal of fetal assessment The Goal of fetal assessment Positive outcomes Positive outcomes Nursing responsibilities Nursing responsibilities Preparing the patient Preparing the patient Explaining procedures/tests Explaining procedures/tests Clarifying and interpreting results Clarifying and interpreting results Collaboration with other healthcare providers Collaboration with other healthcare providers Psychosocial support Psychosocial support

4. Danger Signs in Pregnancy Sudden gush of fluid from the vagina Sudden gush of fluid from the vagina Vaginal bleeding Vaginal bleeding Abdominal pain Abdominal pain Persistent vomiting Persistent vomiting Epigastric pain Epigastric pain Edema of face and hands Edema of face and hands Severe, persistent headache Severe, persistent headache Blurred vision or dizziness Blurred vision or dizziness Chills with fever over 38.0° C (100.4° F) Chills with fever over 38.0° C (100.4° F) Painful urination or reduced urine output Painful urination or reduced urine output

5. Pregnancy-Related Complications Hyperemesis Gravidarum Hyperemesis Gravidarum Excessive Nausea and vomiting Excessive Nausea and vomiting Electrolyte/acid base imbalance Electrolyte/acid base imbalance Significant weight loss Significant weight loss Decreased urine output Decreased urine output High hematocrit High hematocrit Treatment Treatment Correct dehydration and inadequate nutrition Correct dehydration and inadequate nutrition

6. Nursing Care for Hyperemesis Patient Education Patient Education Reduce factors that trigger nausea and vomiting Reduce factors that trigger nausea and vomiting Keep accurate I&O Keep accurate I&O Frequent, small meals Frequent, small meals Easley digested carbohydrates Easley digested carbohydrates Drinking liquids between meals Drinking liquids between meals Reduce stress Reduce stress

7. Pregnancy-Related Complications Bleeding Disorders of Early Pregnancy Bleeding Disorders of Early Pregnancy Abortion Abortion Ectopic Pregnancy Ectopic Pregnancy Bleeding Disorders of Late Pregnancy Bleeding Disorders of Late Pregnancy Placenta previa Placenta previa Abruptio placentae Abruptio placentae

8. Bleeding Disorders of Early Pregnancy Abortion Abortion Spontaneous Abortion Spontaneous Abortion The involuntary loss of the products of conception prior to 24 weeks’ gestation The involuntary loss of the products of conception prior to 24 weeks’ gestation Threatened Abortion Threatened Abortion Cervix is closed & no tissue is passed Cervix is closed & no tissue is passed Inevitable Abortion Inevitable Abortion Increased bleeding & cervix dilates Increased bleeding & cervix dilates Incomplete Abortion Incomplete Abortion Bleeding dilation of cervix & passage of tissue Bleeding dilation of cervix & passage of tissue

9. Abortion

10. Bleeding Disorders of Early Pregnancy (continued) Abortion Abortion Complete Complete Passage of all products of conception, cervix closes and bleeding stops Passage of all products of conception, cervix closes and bleeding stops Missed Missed Fetus dies in uterus but is not expelled, uterine growth stops and sepsis is possible Fetus dies in uterus but is not expelled, uterine growth stops and sepsis is possible Recurrent Recurrent 2 or more consecutive spontaneous abortions 2 or more consecutive spontaneous abortions

11. Induced Abortions Therapeutic Abortion Therapeutic Abortion Intentional termination of pregnancy before age of viability to preserve the health of the mother Intentional termination of pregnancy before age of viability to preserve the health of the mother Elective Abortion Elective Abortion Intentional termination of pregnancy for reasons unrelated to mothers health Intentional termination of pregnancy for reasons unrelated to mothers health

12. Document amount and character of bleeding Document amount and character of bleeding Save anything that looks like clots or tissue for evaluation by a pathologist Save anything that looks like clots or tissue for evaluation by a pathologist Monitor vital signs Monitor vital signs If actively bleeding, woman should be kept NPO in case surgical intervention is needed If actively bleeding, woman should be kept NPO in case surgical intervention is needed Nursing Care of Early Pregnancy Bleeding Disorders

13. Post-Abortion Teaching Report increased bleeding Report increased bleeding Take temperature every 8 hours for 3 days Take temperature every 8 hours for 3 days Take an oral iron supplement if prescribed Take an oral iron supplement if prescribed Resume sexual activity as recommended by the health care provider Resume sexual activity as recommended by the health care provider Return to health care provider at the recommended time for a checkup and contraception information Return to health care provider at the recommended time for a checkup and contraception information Pregnancy can occur before the first menstrual period returns after the abortion procedure Pregnancy can occur before the first menstrual period returns after the abortion procedure

14. Emotional Care Spiritual support from someone of the family’s choice and community support groups may help the family work through the grief of any pregnancy loss Spiritual support from someone of the family’s choice and community support groups may help the family work through the grief of any pregnancy loss Review effective communication techniques Review effective communication techniques

15. Ectopic Pregnancy 95% occur in fallopian tube 95% occur in fallopian tube Scarring or tubal deformity may result from: Scarring or tubal deformity may result from: Hormonal abnormalities Hormonal abnormalities Inflammation Inflammation Infection Infection Congenital defects Congenital defects

17. Ectopic Pregnancies (Continued) Manifestations Manifestations Lower abdominal pain, may have light vaginal bleeding Lower abdominal pain, may have light vaginal bleeding If tube ruptures: If tube ruptures: May have sudden severe lower abdominal pain May have sudden severe lower abdominal pain Vaginal bleeding Vaginal bleeding Signs of hypovolemic shock Signs of hypovolemic shock

18. Ectopic Pregnancies (Continued) Treatment Treatment Pregnancy test Pregnancy test Transvaginal ultrasound Transvaginal ultrasound Laparoscopic examination Laparoscopic examination Priority is to control bleeding Priority is to control bleeding Actions can be taken: Actions can be taken: Using medications Using medications Or by surgery to remove pregnancy from the tube Or by surgery to remove pregnancy from the tube

19. Signs and Symptoms of Hypovolemic Shock Changes in fetal heart rate Changes in fetal heart rate Rising pulse (tachycardia) Rising pulse (tachycardia) Rising respiratory rate (tachypnea) Rising respiratory rate (tachypnea) Shallow, irregular respirations; air hunger Shallow, irregular respirations; air hunger Falling blood pressure (hypotension) Decreased or absent urinary output (usually less than 30 ml/hr) Pale skin or pale mucous membranes Cold, clammy skin Faintness Thirst

20. Urinary Tract Infections Pregnancy alters self-cleaning action due to pressure on urinary structures Pregnancy alters self-cleaning action due to pressure on urinary structures Prevents bladder from emptying completely Prevents bladder from emptying completely May develop cystitis Burning with urination Increased frequency and urgency of urination Normal or slightly elevated temperature Pyelonephritis High fever Chills Flank pain or tenderness Nausea and vomiting

21. Lecture 6 Clinical aspects of Maternal and Child Nursing NUR 363 Postpartum complication Lecture 6

22. Postpartum complications Preexisting maternal health problems contribute to many postpartum complications. Overall nursing objectives for high risk post partum clients include: a-Promote diagnosis and treatment of post partum complications to minimize risk morbidity and mortality. b- Promote comfort. c- Explore emotional aspects. d- Minimize separation of the mother and infant. e- assist the client and family to deal with anger, anxiety and fear.

23. 1-Postpartum hemorrhage -Postpartum hemorrhage is blood loss of more than 500 ml following the birth of a newborn. -Early post partum hemorrhage which is usually due to uterine atony, laceration or retained placenta fragments, occurs in the first 24 hours after delivery. -Late postpartum hemorrhage occurs after 24 hours after delivery and is generally caused by retained placental fragments or bleeding disorder. -Delayed uterine atony or placental fragments prevent the uterus from contracting effectively. The uterus is unable to form an effective clot structure and bleeding continues.

24. -Nursing management includes -prevent excessive blood loss and resulting complications. -assist the client and family to deal with physical emotional stress of postpartum complications.

25. 2- subinvolution -It is delayed return of the enlarged uterus to normal size and function. -It results from retained placental fragments and membranes, endometritis, or uterine fibroid tumor. -Uterine atony or placental fragments prevent the contracting effectively. -Clinical manifestations – prolonged lochial discharges. -irregular or excessive bleeding. -larger than normal uterus.

26. -Nursing management 1-prevent excessive blood loss, infection, and other complications. 2-assist the client and family to deal with physical and emotional stresses of postpartum complications.

27. 3-Puerperal infection - It is an infection developing in the birth structures after delivery. -It is a major cause of maternal morbidity and mortality. -The most common site of post partum infection is the pelvic cavity. -It can be caused by poor sterile technique, cesarean birth. -clinical manifestations: -Fever. -pain, redness, tenderness and firmness.

28. 4- Mastitis -It is inflammation of the breast tissue that is usually caused by infection or by stasis of milk in the ducts.

29. 5-Thrombophlebitis and thrombosis -Thrombophlebitis is an inflammation of the vascular endothelium with clot formation on the vessels wall. -A thrombus forms when blood components (platelets and fibrin) combine to form an aggregate body (clot). -Pulmonary embolism occurs when a clot traveling through the venous system lodges within the pulmonary circulation system, causing occlusion or infarction.

30. 6- Urinary tract infection -It is indicated by more than 100 thousands bacterial colonies /ml of urine in two consecutive clean, voided, midstream specimens. -Two common types of UTIs are cystitis, inflammation of the urinary bladder, and pyelonephritis, inflammation of the renal pelvis. -Another cause of UTIs is retention and residual urine due to over distention and incomplete emptying of the bladder. - E-coli, (the most common causative organism).

31. -Clinical manifestation -cystitis manifestations include frequency,urgency, dysuria, hematuria, temperature elevation, and suprapubic pain. -Pyelonephritis manifestations include high fever, chills, flank pain, nausea and vomiting. -Nursing management – -recognize signs of infection and prevent the development of further complications.

32. 7-Postartum mood disorder -The disorders are- 1 -Postpartum blues.-include fatigue, anxiety, mood instability, with onset 1 to 10 days postpartum and lasting 2 weeks or less. 2 -Postpartum depression without psychotic features. includes confusion, fatigue, feeling of hopelessness and shame, and alteration in mood. 3 -Postpartum depression with psychotic features (postpartum psychosis)-includes symptoms of postpartum depression plus delusion, auditory hallucinations, and hyperactivity.