Complications During Pregnancy by 888P3q


									Clinical aspects of Maternal and
          Child Nursing

Complications During Pregnancy

            Lectur 6

           Othman Ta’ani
    Characteristic Causes of
     High-Risk Pregnancies

 Can relate to the pregnancy itself
 Or the woman has a medical
  condition or injury
 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
    Assessment of Fetal Health

   The Goal of fetal assessment
       Positive outcomes
   Nursing responsibilities
     Preparing the patient
     Explaining procedures/tests
     Clarifying and interpreting results
     Collaboration with other healthcare
     Psychosocial support
    Danger Signs in Pregnancy
   Sudden gush of fluid from the vagina
   Vaginal bleeding
   Abdominal pain
   Persistent vomiting
   Epigastric pain
   Edema of face and hands
   Severe, persistent headache
   Blurred vision or dizziness
   Chills with fever over 38.0° C (100.4° F)
   Painful urination or reduced urine output
    Pregnancy-Related Complications

   Hyperemesis Gravidarum
       Excessive Nausea and vomiting
          Electrolyte/acidbase imbalance
          Significant weight loss
          Decreased urine output
          High hematocrit

   Treatment
       Correct dehydration and inadequate nutrition
    Nursing Care for Hyperemesis

   Patient Education
     Reduce factors that trigger nausea and
     Keep accurate I&O
     Frequent, small meals
         Easley digested carbohydrates
         Drinking liquids between meals
         Reduce stress
    Pregnancy-Related Complications

   Bleeding Disorders of Early Pregnancy
   Abortion
   Ectopic Pregnancy

   Bleeding Disorders of Late Pregnancy
   Placenta previa
   Abruptio placentae
Bleeding Disorders of Early Pregnancy

   Abortion
       Spontaneous Abortion
          Theinvoluntary loss of the products of
          conception prior to 24 weeks’ gestation
       Threatened Abortion
          Cervix   is closed & no tissue is passed
       Inevitable Abortion
          Increased   bleeding & cervix dilates
       Incomplete Abortion
          Bleeding   dilation of cervix & passage of
        Bleeding Disorders of Early
          Pregnancy (continued)

   Abortion
       Complete
          Passage of all products of conception, cervix
          closes and bleeding stops
       Missed
          Fetusdies in uterus but is not expelled,
          uterine growth stops and sepsis is possible
       Recurrent
         2 or more consecutive spontaneous
            Induced Abortions

   Therapeutic Abortion
       Intentional termination of pregnancy
        before age of viability to preserve the
        health of the mother
   Elective Abortion
       Intentional termination of pregnancy for
        reasons unrelated to mothers health
    Nursing Care of Early Pregnancy
          Bleeding Disorders

   Document amount and character of
   Save anything that looks like clots or tissue
    for evaluation by a pathologist
   Monitor vital signs
   If actively bleeding, woman should be kept
    NPO in case surgical intervention is needed
      Post-Abortion Teaching
   Report increased bleeding
   Take temperature every 8 hours for 3 days
   Take an oral iron supplement if prescribed
   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
   Pregnancy can occur before the first menstrual
    period returns after the abortion procedure
         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
 Review effective and ineffective
  communication techniques
Effective Communication
           Ectopic Pregnancy

   95% occur in fallopian tube

   Scarring or tubal deformity may result from:
     Hormonal abnormalities
     Inflammation
     Infection
     Congenital defects
         Ectopic Pregnancies
   Manifestations
     Lower abdominal pain, may have light
      vaginal bleeding
     If tube ruptures:
         May   have sudden severe lower abdominal
         Vaginal bleeding
         Signs of hypovolemic shock
         Ectopic Pregnancies
   Treatment
      Pregnancy test
      Transvaginal ultrasound
      Laparoscopic examination
      Priority is to control bleeding
      Actions can be taken:
         Using medications
         Or by surgery to remove pregnancy from the
      Signs and Symptoms of
        Hypovolemic Shock
   Changes in fetal heart       Falling blood pressure
    rate                          (hypotension)
   Rising pulse                 Decreased or absent
    (tachycardia)                 urinary output (usually
   Rising respiratory rate       less than 30 ml/hr)
    (tachypnea)                  Pale skin or pale
   Shallow, irregular            mucous membranes
    respirations; air            Cold, clammy skin
    hunger                       Faintness
                                 Thirst
      Urinary Tract Infections

   Pregnancy alters          May develop cystitis
                                 Burning with urination
    self-cleaning action
                                 Increased frequency
    due to pressure on            and urgency of
    urinary structures            urination
                                 Normal or slightly
                                  elevated temperature
   Prevents bladder          Pyelonephritis
    from emptying                High fever
                                 Chills
                                 Flank pain or
                                 Nausea and vomiting
     Effects of a High-Risk
    Pregnancy on the Family
 Disruption of usual roles
 Financial difficulties
 Delay attachment to the infant
 Loss of expected birth experience
Postpartum complication
    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
   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.
  Nursing Process for women
 with postpartum complications
 1- Assessment
 a- Health history
    Cardinal signs and symptoms.
 b- Physical examination
 -vital signs.
 -inspection.
 -palpation.
 c- laboratory and diagnostic studies.
    Nursing Process for women with
       postpartum complications
   2- Nursing diagnosis.
   a- general diagnosis.
   b- complication related diagnosis.
   3- Planning.
   4- Implementation
   a- promote a full physical recovery.
   b- assist client and family to deal with physical and
    emotional stresses of postpartum complication.
    c-encourage parent- newborn bonding.
    d- provide client and family teaching.

   5- outcome evaluation.
    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
-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.
-Nursing management includes

-prevent excessive blood loss and
  resulting complications.

-assist the client and family to deal with
  physical emotional stress of
  postpartum complications.
             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
   -irregular or excessive bleeding.
   -larger than normal uterus.
      -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.
         3-Puerperal infection

-It is an infection developing in the birth structures
   after delivery.
-It is a major cause of maternal morbidity and
-The most common site of post partum infection is
   the pelvic cavity.
-It can be caused by poor sterile technique, cesarean

-clinical manifestations:
    -pain, redness, tenderness and firmness.
               4- Mastitis

-It is inflammation of the breast tissue that
   is usually caused by infection or by stasis
   of milk in the ducts.
     5-Thrombophlebitis and
-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.
     -Predisposing factors

-Hx of thrombophlebitis.
-Hx of cesarean delivery.
-Maternal age older than 35 years.
-Anemia .

   -The three major causes of thrombus
    formation and inflammation are-venous
    stasis, hypercoagulable blood, and injury to
    innermost layer of blood vessel.

   The level of most coagulation factors are
    increased during pregnancy.

   A-Clinical manifestations
   -superficial thrombophlebitis within the
    saphenous vein system manifests as pain,
    tenderness, and warmth along the vein.

   -DVT symptoms include muscle pain.

   -Femoral thrombophlebitis generally occurring 10-14
    days after delivery, produces chills, fever, stiffness, and

   -Pulmonary embolism is heralded by sudden intense
    chest pain with severe dyspnea followed by tachypnea,
    pleuratic pain cough, tachycardia, hemoptysis, and
    temperature above 38 C.

   B-Lab. Findings.
    -Venography.
    -Doppler ultrasound.
         Nursing Management

   1- promote resolution of symptoms and
    prevent the development of embolus.
   -Anticoagulant therapy.
   -It is important not to administer estrogen
    for lactation suppression .because it may
    encourage clot formation.

   2- Provide client and family teaching.

   3- Assist the client and family to deal with
    physical and emotional stresses of
    postpartum complications.
       6- Urinary tract infection

   -It is indicated by more than 100 thousands
    bacterial colonies /ml of urine in two
    consecutive clean, voided, midstream
   -Two common types of UTIs are cystitis,
    inflammation of the urinary bladder, and
    pyelonephritis, inflammation of the renal

   -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
         -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.
     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
    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.

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