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Pregnancy at Risk: Gestational Onset Chapter 15. Abortion 20 wk or less than 500 gms Threatened Imminent Complete Incomplete Missed Habitual.

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Presentation on theme: "Pregnancy at Risk: Gestational Onset Chapter 15. Abortion 20 wk or less than 500 gms Threatened Imminent Complete Incomplete Missed Habitual."— Presentation transcript:

1 Pregnancy at Risk: Gestational Onset Chapter 15

2 Abortion 20 wk or less than 500 gms Threatened Imminent Complete Incomplete Missed Habitual

3 Nursing Interventions S/S backache and bleeding Monitor for S/S of shock Assess blood loss IV HX ABO and Rh Comfort and support Anticipatory guidance 1st trimester deliver in ER

4 Ectopic Ovum implants outside of uterus S/S of pregnancy present(+ preg. test) Tube may rupture and cause bleeding S/S - sharp pain, syncope, rigid ab., referred shoulder pain, adnexal pain hCG levels fall Methotrexate, salpingostomy or salpingectomy

5 Nursing Management Assess for abdominal pain and missed menses Report of continued pain after Methotrexate may indicate tx failure Give emotional support Nursing consideration-EP = fetal loss

6 Gestational Trophoblastic DX Abnormal development of placenta and proliferation of trophoblastic tissue Complete- only placenta, no baby, sperm fertilizes empty egg Associated with choriocarcinoma Partial – two sperm fertilize an egg

7 Clinical Manifestation Bleeding-size greater than dates hCG levels high- “morning sickness” Often develop PIH Need close follow-up –chemo X 1 yr. Check hCG levels Do not get pregnant for 1 year At risk for choriocarcinoma

8 Incompetent Cervix Premature dilation of cervix Painless and bloodless second trimester losses Consider cerclage Contact HCP for ROM or contractions

9 Hyperemesis Risk for dehydration- assess urinary output Risk for electrolyte imbalance Acidosis Give K+ to prevent hypokalemia Allow dietary choices Check weight

10 Premature Rupture of Membranes ROM prior to 37 weeks Causes- infection, polyhydramnios At risk for infection Fetal risk for RDS, sepsis, malpresentation, high risk for morbidity and mortality

11 Management Use speculum for exam, NO VE Confirm with Nitrazine paper- Alk.=blue Gestational age determines management Prophylactic abx NST, BPP Steroids given prior to 32 weeks Monitor- V/S, color, odor, amt. of amniotic fluid

12 Preterm Labor Labor between weeks Risk factors Teach S/S of PTL fFN- protein present, predictive for 1 wk Transvaginal UTZ- shortening of cervix DX- more than 6-8 uc q hr, cervical change, =fFN, 2cm dilation

13 Tocolysis MgS04-CNS depressant and smooth muscle relaxer SE- pulmonary edema, flushing, resp. depression, lethargy, HA, lethargy \ Antidote= calcium gluconate

14 Nursing Care Report ucs, rom, cramps, backache, pressure Monitor- resp, pulse, BP, breath sounds, I&O’s, dtr’s Keep left lat. Minimize vaginal exams Assess labs, keep labs current

15 Pregnancy Induced Hypertension Most common and serious disorder Hypertension with proteinuria and edema 140/90 or increase of 30 systolic and 15 diastolic increase More frequent in the extremes of the reproductive years, mutiparas, DM, GTD, Rh incompatibility Does not manifest until 20wks Eclampsia presence of seizure

16 Pathophysiology Unknown- delivery is cure Loss of resistance to angiotensin II Thromboxane cause platelets to aggregate and pressure to increase Vasospastic changes = decrease in placental perfusion Edema = decrease in GFR, sodium retained, damage to vascular epitheleal lining Less intravascular volume increases viscosity of blood cause hemoconcentration

17 HELLP Hemolysis -elevated liver enzymes low platelets Hemolysis- caused by damage to RBCs as pass through damaged vessels Elevated liver- due to obstruction caused by fibrin deposits and liver pain due to distention of liver capsule. Vascular damage cause platelets to aggregate at site of damage, drop in platelets

18 Maternal and Fetal Risks Hyperreflexia- increased intracellular sodium Headache- vasospasms, cerebral edema, Seizures due to vasoconstriction Hypertension causes fetal hypoxia and malnutrition At risk for prematurity Hypermagnesia Nursing-h/a, epigastric pain,visual changes

19 Mild Preeclampsia Managed at home Encourage side lying position Teach- S/S of worsening preeclampsia Weight gain, headaches, epigastric pain, visual changes In hospital evaluate fetal status, amnio, doppler

20 Severe Preeclampsia Can develop suddenly Excessive weight gain, 5lbs/ week Protein in urine Assess for H/A, “Spots”, N/V, retinal edema, pulmonary edema, epigastric pain Bed rest Diet MgSo4 Monitor I&Os- reflexes, respiratory status

21 Eclampsia Give MgSo4 and Diazepam Auscultate lungs Keep safe At risk for abruption Monitor fetus Keep family notified Decrease stimuli

22 Intrapartal Management Provide good pain relief Consider epidural Keep wedged to left lateral Give 02 Be prepared for hemorrhage, hypovolemia PP- 48 hrs at risk for seizure

23 Nursing Care Maintain quiet environment Side rails up and padded Have suction available Provide supportive care Provide continuity of care Explain complication of pregnancy

24 Chronic Hypertension Occurs before 20 weeks At risk for preeclampsia Rest L lat Self monitor BP Limit salt Continue to take antihypertensive meds

25 Rh Sensitization Rh negative exposed to Rh positive blood Antigen –antibody response occurs Antibody response slow Danger is to subsequent pregnancy Crosses placenta and causes fetal anemia First PNC visit determine ABO and Rh Rh- need indirect Coombs to determine antibodies in mother If positive increase fetal surveillance

26 Rhogam Give at 28 weeks and before discharge Give mini dose if chance of exposure Do not give if mother sensitized Assess level of knowledge

27 ABO Incompatibility Rarely causes hemolysis Limited to O mothers with AB newborn Anti-A Anti B antibodies are naturally occurring in O mothers Antibodies cross placenta and can produce some hemolysis Assess for hyperbilirubinemia

28 Surgery Increases risk for AB, PTL, IUGR in first tri Second tri less risky Keep client wedged during surgery and recovery Decrease gastric emptying-Increased secretions Assess FHR Deep breath and cough Thrombophlebitis

29 Trauma Fall, assaults, care accident, domestic violence Increase risk for abruption Increase risk for PTL Goals- maintain volume, monitor fetus Monitor for ucs

30 Abuse Under reported Screen for old injuries Provide safe supportive, nonjudgmental environment Give referrals to community resources

31 TORCH Toxoplasmosis– raw meat, feces of cat Identify woman at risk Test serologically Rubella- risk in first trimester Do not give attenuated virus to pregnant woman

32 Cytomegalovirus CMV - transmitted to fetus by asymptomatic mother CMV in urine HSV-2, transmission occurs after ROM, or during delivery Active lesions deliver by C/S


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