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Chapter 20 Pregnancy complication from a pre- existing or newly acquired illness.

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Presentation on theme: "Chapter 20 Pregnancy complication from a pre- existing or newly acquired illness."— Presentation transcript:

1 Chapter 20 Pregnancy complication from a pre- existing or newly acquired illness

2 Identifying the High-Risk Pregnancy High-risk pregnancy A concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the mother, fetus or both Table 20.1 Factors that categorize a pregnancy as High Risk: Psychological Social Physical


4 Congenital and Acquired Heart Disease Congenital usually due to structural defects at birth Number is diminishing Acquired primarily rheumatic in origin Functional classification system to predict pregnancy outcomes (Table 20.1) – Class I: asymptomatic; no limitation of physical activity: experience normal birth – Class II: symptomatic (dyspnea, chest pain) with increased activity: experience normal birth – Class III: symptomatic (fatigue, palpitation) with normal activity: complete pregnancy with maintenance of bedrest – Class IV: symptomatic at rest or with any physical activity: poor candidates advised to avoid pregnancy

5 Congenital and Acquired Heart Disease (contd) Pathophysiology – Hemodynamic changes overstressing womans cardiovascular system Therapeutic management – Risk assessment, prenatal counseling, increased frequency of prenatal visits Nursing assessment – Vital signs, heart sounds, weight, fetal activity, lifestyle – Signs and symptoms of cardiac decompensation


7 Cardiac Disease Left-sided heart failure Orthopnea Paroxysmal nocturnal dyspnea

8 Cardiac Disease Right-side heart failure Distended liver and spleen Ascites Peripheral edema

9 Cardiac Disease Peripartal heart disease Originates late in pregnancy Previously undetected heart disease Shortness of breath, chest pain, edema Cardiomegaly

10 Congenital and Acquired Cardiac Disease (contd) Nursing Management – Stabilization of hemodynamic status – Risk reduction measures: education, counseling, support – Cardiac medications if prescribed – Energy conservation; nutrition – Fetal activity monitoring – Signs and symptoms of cardiac decompensation – Monitoring during labor

11 Cardiac Disease Assessment Level of exercise Cough or edema Baseline vital signs Liver size ECG

12 Cardiac Disease Fetal assessment Promote rest Promote healthy nutrition Educate regarding medication Educate regarding infection

13 Cardiac Disease Nursing interventions during labor and birth Anesthesia Monitor fetal heart tones and uterine contractions Vital signs Postpartum nursing interventions Assess for heart failure Assess baby

14 Cardiac Disease (contd) Artificial valve prosthesis: Heparin LMW Chronic hypertension vascular disease: see next slide Venous thromboembolic disease: DVT – Heparin: PTT – Antiphospholipid Antibodies – Chief Danger is PE

15 Chronic Hypertension Hypertension before pregnancy or before 20 th week of gestation or persistence >12 weeks postpartum Therapeutic management: preconception counseling, lifestyle changes, antihypertensive agents for severe hypertension; fetal movement monitoring; serial ultrasounds Nursing assessment Nursing management: lifestyle changes (DASH diet); frequent antepartal visits; monitoring for abruptio placentae, preeclampsia; daily rest periods; home BP monitoring; close monitoring during labor and birth and postpartum follow-up

16 Hematologic Disorders Pseudo Anemia

17 Iron Deficiency Anemia Usually due to inadequate dietary intake Therapeutic management: eliminate symptoms, correct deficiency, replenish iron stores Nursing assessment – Fatigue, weakness, malaise, anorexia, susceptibility to infection (frequent colds), pale mucous membranes, tachycardia, pallor – Abnormal lab results Low hemoglobin, low hematocrit, low serum iron, microcytic and hypochromic cells, and low serum ferritin

18 Iron Deficiency Anemia (contd) Nursing management – Compliance with drug therapy: prenatal vitamin and iron supplement – Dietary instruction and counseling – Education for drug therapy

19 Folic Acid Deficiency B vitamin Megaloblastic anemia Multiple pregnancies, hydantoin, OCP, gastric bypass 400-800mcg folic acid

20 Sickle Cell Anemia Defect in hemoglobin molecule (hemoglobin S) Therapeutic management: dependent on status; supportive therapy; blood transfusions for severe anemia, analgesics for pain, antibiotics for infection Nursing assessment: signs and symptoms; evidence of crisis Nursing management – Support, education, follow-up – Labor: rest; pain management ; oxygen and IV fluids; close FHR monitoring – Postpartum: antiembolism stockings; family planning options

21 Thalassemia Two forms: alpha (minor); beta (major) – Women with minor form: little effect on pregnancy except for mild persistent anemia – Women with major form: usually no pregnancy due to lifelong, severe hemolysis, anemia, and premature death Management dependent on severity of disease Supportive care and expectant management

22 Malaria Infection causes RBC to stick to surface of capillaries causing obstruction. International travel Antimalaria drugs: Chloroquine

23 Other Genetic or Auto-Immune Hematologic Disorders Coagulation disorders Von Willebrand disease: history menorrhagia/epistaxis Hemophilia B: Female Carriers SAB Idiopathic thrombocytopenia purpura: decreased platelets after viral invasion Autoimmune

24 Renal and Urinary Disorders Urinary tract infection: Bladder Pyelonephritis: Urinary stasis/stricture of ureter Usually R side (intestines on left pushes uterus to R) Assessment Therapeutic management Chronic renal disease Kidney transplant


26 Chronic Renal Disease Difficult to interpret kidney function Develop severe anemia: diseased kidneys do not produce erythropoietin Safe administration in pregnancy

27 Respiratory Disorders Acute nasopharyngitis Influenza Pneumonia Severe acute respiratory syndrome Asthma

28 Pathophysiology – Effect of normal physiologic changes of pregnancy on respiratory system – May improve due to high circulating levels corticosteroids Therapeutic management – Drug therapy (budesonide, albuterol, salmeterol) – Taper albuteral close to term Nursing assessment – Asthma triggers; lung auscultation Nursing management – Client education – Oxygen saturation monitoring during labor

29 Tuberculosis Therapeutic management – Medications: combination of isoniazid, rifampin, ethambutol Nursing assessment – PPD at first prenatal visit in high risk areas – Risk factors; signs and symptoms of TB – Screening Nursing management – Compliance with drug therapy – Education; health promotion activities and Calcium – Transmission prevention

30 Respiratory Disorders COPD Cystic Fibrosis Modifications for pregnancy Modifications for postpartal period

31 Rheumatic Disorders Juvenile rheumatoid arthritis Systemic lupus erythematosus

32 Gastrointestinal Disorders Appendicitis Gastroesophageal reflux disease or hiatal hernia Cholecystitis and cholelithiasis Pancreatitis Hepatitis Inflammatory bowel disease

33 Neurologic Disorders Seizures Myasthenia gravis Multiple sclerosis

34 Musculoskeletal Disorders Scoliosis Girls 12-14 years of age If uncorrected, causes deformity Unable to wear brace during last half of pregnancy Potential for cephalopelvic disproportion

35 Endocrine Disorders Thyroid dysfunction Hypothyroidism Hyperthyroidism

36 Diabetes Mellitus Typical classification – Type 1 – Type 2 – Impaired fasting glucose and impaired glucose tolerance – Gestational diabetes Classification during pregnancy – Pregestational diabetes – Gestational

37 Diabetes Mellitus (contd) Pathophysiology and pregnancy – Fetal demands – Role of placental hormones – Changes in insulin resistance – Effects on mother – Effects on fetus

38 Diabetes Mellitus (contd) Assessment – Health history; physical examination; risk factors – Screening at first prenatal visit; additional screening at 24 to 28 weeks for women considered at risk OSullivan Test – Maternal surveillance: urine for protein, ketones, nitrates, and leukocyte esterase; evaluation of renal function/trimester; eye exam in 1 st trimester; HbA1c q 4-6 weeks <7% – Fetal surveillance: ultrasound; alpha-fetoprotein levels; biophysical profile; nonstress testing; amniocentesis



41 Diabetes Mellitus (contd) Therapeutic management – Preconception counseling – Blood glucose level control (HbA1C <7%) – FBG < 100 and 2hour PPL < 120 – Glycemic control: Humulin – Insulin Pump – Nutritional management: 30Kcal per kg of ideal weight (1800 to 2400 calories) divided into 3 meals and 3 snacks – Hypoglycemic agents – Close maternal and fetal surveillance – Management during labor and birth – Eye Exams

42 Diabetes Mellitus (contd) Education – Exercise – Insulin – Insulin-pump therapy – Blood glucose monitoring

43 Other Cancer Mental illness

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