Clinical aspects of Maternal and
Complications During Pregnancy
Characteristic Causes of
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
Preparing the patient
Clarifying and interpreting results
Collaboration with other healthcare
Danger Signs in Pregnancy
Sudden gush of fluid from the vagina
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
Excessive Nausea and vomiting
Significant weight loss
Decreased urine output
Correct dehydration and inadequate nutrition
Nursing Care for Hyperemesis
Reduce factors that trigger nausea and
Keep accurate I&O
Frequent, small meals
Easley digested carbohydrates
Drinking liquids between meals
Bleeding Disorders of Early Pregnancy
Bleeding Disorders of Late Pregnancy
Bleeding Disorders of Early Pregnancy
Theinvoluntary loss of the products of
conception prior to 24 weeks’ gestation
Cervix is closed & no tissue is passed
Increased bleeding & cervix dilates
Bleeding dilation of cervix & passage of
Bleeding Disorders of Early
Passage of all products of conception, cervix
closes and bleeding stops
Fetusdies in uterus but is not expelled,
uterine growth stops and sepsis is possible
2 or more consecutive spontaneous
Intentional termination of pregnancy
before age of viability to preserve the
health of the mother
Intentional termination of pregnancy for
reasons unrelated to mothers health
Nursing Care of Early Pregnancy
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
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
Pregnancy can occur before the first menstrual
period returns after the abortion procedure
Spiritual support from someone of the
family’s choice and community
support groups may help the family
work through the grief of any
Review effective and ineffective
95% occur in fallopian tube
Scarring or tubal deformity may result from:
Lower abdominal pain, may have light
If tube ruptures:
May have sudden severe lower abdominal
Signs of hypovolemic shock
Priority is to control bleeding
Actions can be taken:
Or by surgery to remove pregnancy from the
Signs and Symptoms of
Changes in fetal heart Falling blood pressure
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
Urinary Tract Infections
Pregnancy alters May develop cystitis
Burning with urination
due to pressure on and urgency of
urinary structures urination
Normal or slightly
Prevents bladder Pyelonephritis
from emptying High fever
Flank pain or
Nausea and vomiting
Effects of a High-Risk
Pregnancy on the Family
Disruption of usual roles
Delay attachment to the infant
Loss of expected birth experience
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
a- Health history
Cardinal signs and symptoms.
b- Physical examination
c- laboratory and diagnostic studies.
Nursing Process for women with
2- Nursing diagnosis.
a- general diagnosis.
b- complication related diagnosis.
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.
-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
-assist the client and family to deal with
physical emotional stress of
-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.
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.
-It is an infection developing in the birth structures
-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
-pain, redness, tenderness and firmness.
-It is inflammation of the breast tissue that
is usually caused by infection or by stasis
of milk in the ducts.
-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.
-Hx of thrombophlebitis.
-Hx of cesarean delivery.
-Maternal age older than 35 years.
-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.
-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.
1- promote resolution of symptoms and
prevent the development of embolus.
-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
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
-cystitis manifestations include frequency
hematuria, temperature elevation, and
-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.