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High Risk Pregnancy

High Risk Pregnancy

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Published by: gracie_greys5755 on Nov 28, 2009
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NURSING CARE FOR WOMEN W/COMPLICATIONS DURING PREGNANCYHigh-risk pregnancy-One in which the health of the mother/fetusis in Jeopardy-increased risk of morbidity/mortalitybefore/after delivery-leading cause of death and disability amongwomen (515,000 women/yr)-women: 30-endure injuries; infection anddisabilities-early and consistent assessment for riskfactors during prenatal visitsWays for identification clients at risks1.Assessment of risk factorsa. Physiologicalb. PsychologicalC. SocialRisk Assessment Tool-Hobel, 1973-risk factors are assigned a scorecorresponding to the degree of risk-A score 19 or more indicates a high riskthat should receive more than routineprenatal careOB HxRisk Factor 
Previous still birth 10
Previous neonatal death 10
Previous premature infant 10
Post term.42 weeks 10
Fetal blood transfusion for hemolyticdisease 10
Repeated miscarriages 5
Previous infant >10lbs 5
Six/more completed pregnancy 5
Hx of eclampsia 5
Previous cesarean section 1
Hx of preeclampsia 1
Hx of preeclampsia 1
Hx of fetus w/ anomalies 1/0Medical HxRisk factor 
Abnormal PAP Test 10
Chronic HPT 10
Heart disease NYHA class II-IV(symptomatic) 10
Insulin dependent diabetes (>A2)10
Moderate to severe renal disease
Previous endocrine ablation 10
Sickle cell disease 5
Epilepsy 5
Heart disease NYHA class I (nosymptoms) 5
Hx of TB/PPD >10mm 5
Positive serology (for syphilis) 5
Pulmonary disease 5
Thyroid disease 5Family Hx
DM 1Physical risk factors
Incompetence cervix 10
Uterine malformalities 10
Maternal weight <100lbs or >200 lbs5
Maternal age 35 and over 15 andunder 5
Small pelvis 5Current pregnancy risk factors
Abnormal fetal position 10
Moderate to severe preeclamsia 10
Multiple pregnancy 10
Placenta abruption 10
polylydromnios/oligohydromnios 10
excessive use of drugs/alcohol 5
gestational diabetes (A1) 5
kidney infection 5
mild preeclampsia 5
Rh sensitization only 5
Severe anemia <9g/dl hemoglobin5
Severe flu syndrome/viral disease 5
Vaginal spotting 5
Bladder infection 1
Emotional problem 1
Mild anemia 9g/dl hemoglobin 1
Moderate alcohol use 1
Smoking > = 1 pack/dayFetal diagnostic tests-birth defects-diagnostic/screening testDiagnostic vs. screeningDiagnostic – whether a fetus has a particular condition w/ certainty but may providelimited information about the other types of birth defects
Screening- not accurate, help to identifypatient at risk who light benefit fromdiagnostic testFetal well-being-fetus movements are directly r/t infant’ssleep-wake cycle vary from mother -typical active fetal period lasts 40 min andpeaks between 9PM and 10 PM in responseto maternal hypoglycemiaUltrasound-non-invasive procedure;uses intermittentultrasonic waves transmitted by analternating current to a transducer applied toabdomen-ultrasonic waves: defect off tissues w/inabdomen, showing structures of varyingdensities-requires full bladder (1-2 qts of water)Transvaginal Ultrasound-detect shortened cervical length/funelling(predict preterm labor)-uses a probe inserted into vagina-done early is pregnancy (fetal age,suspected etopic pregnancy)Transabdominal Ultrasound-transducer -often scanned with full bladder (water every15 mins. 90mins before examination)Nursing Responsibility (UT2)-inform patient about the procedure-provide comfort and privacy*empty bladder (transvaginal UT2) -dorsalrecumbent*full bladder (transabdominal UTV) -supine*position*drapeAlpha-Fetoprotein Testing (AFP)-maternal alpha-fetoprotein test-determine level of fetal protein in women'sserum/sample of amniotic fluid-16-22 weeks of pregnancyHigh levels of AFP-a neural tube defectspinabifidy (open supine)anecephaly (incomplete division of skull and brain)-defects with esophagus-gastroschisix (baby's failure)Low levels of AFP-abnormal chromosomal or gestationaltrophoblastic disease-Trisomy 21 (Down syndrome)-Trisomy 18 (Edward's syndrome)Chorionic Villi Sampling (CVS)-obtain a small part of developing placentato analyze fetal cells-10-12 weeks-results = 24-48 hours-can't determine spina bifida/anecephaly-identify chromosome (abnormal)-newborn: limb reduction defects-Rh (D) immune globulin given to Rh-negative woman-↑ rate spontaneous abortion thanamniocentesisAmniocentesis-insertion of thin needle through abdominaland uterine walls (sample on amniotic fluid);invasive-15-17 weeks-early: 11-14 weeks of some disorder Usage (Amniocentesis)-identify chromosome abnormalities,biochemical disorders and level of AFP-spontaneous abortion-identify severity of maternal fetal bloodincompatibility and assess fetal lung maturity-Rh (D) immune globulin given to Rh-negative womanNursing Responsibilities (Amniocentesis)-obtain informed consent-provide comfort and privacyfull bladder, position, drape-aseptic technique (hand wash, gloves)Non-stress Test (NST)-response of FHR to fetal movement-monitor FHRUsage of (NST)-identify fetal compromise (poor placentafunction)-reassess placenta is functioning well andoxygenated, intact CNS*Non-reactive at risk = not good*1 fetal movement = +45FHR-30-32 weeks
*Reactive= 2 accelerations of FHR with fetalmovements of 15 beats/min, lasting 15 secor more for 20 min*2-15 beats-15sec-20minContraction Test (CT)-evaluating respiratory function of placenta-identify risk for intrauterine asphyxia byobserving response of FHR to stresscontractionNegative- shows 3 contractions good qualitylasting 40 or more secs in 10 min withoutevidence of late decelerations-fetus can handle the hypoxic stress of uterine contractionsPositive – shows repetitive persistent latedeceleration with more than 50% of contractions-hypoxic stress cause showing FHREquivocal – non persistent latedecelerations or with hyper stimulation (2min frequency of duration longer than 90)Percutaneous Umbilical Blood Sampling(PUBS)-anemic fetus (maternal fetal bloodincompatibility, placenta previa, abruptplacentae)-blood sample from placental vesselLecithin to Sphingomyelin (l/S) ratio-respiratory complications in adaptingextrauterine life34-38 weeks-lung mature → ↑ lecithin ↓ Sphingomyelin-2:1 (normal value)Phosphatidyl glycerol (+) - baby will notsuffer respiratory distress syndrome ondeliveryBiophysical Profile (BPP)1.FHR and reactivity (NST) [reactive -2]2.Fetal Breathing Movement[breathing/60sec – 2]3.Fetal Body Movement [3movements of arms, legs, body – 2]4.Fetal Tone [ return of flexion – 2]5.Volume of amniotic fluid [>1cm – 2]-identify reduced fetal oxygenation inconditions associated with poor placentalfunctioning-↑FHR → deprivation of oxygen-fetal hypoxia increases, FHR changes,cessation-amniotic fluid is reduced when placentalfunction is poor of fbrem, gross body movement, loss of FTA-mniocentesisL-/S ratioO-xytocin TestN- on-stress TestE-steriol levelPREGNANCY ATRISK:PREGESTAITIONAL PROBLEMSSexually Transmitted Disease (STD)-15-24y/o-↑ STD group: Sexually active youth-Pregnant: miscarriage, premature deliveryRisk factors:1.lower socio-economic status2.lower education level3.sexual activity with multiple partners4.unsafe sexual intercourseEtiologic Agent: Candida Albicaus (fungus)Candidiasis – thick yellow vaginal disharge
extreme pruritus (yeastyor no odor)Med management:1.application of an over-the-counteanti-fungal cream (Monistat) for 7days2.oral flucanozole (anti fungal)Trichomoniasis – irritation, itchingEtiologic agent: Trichomonas vagindlisSigns and symptoms – profuse greenish-yellow discharge with foul odor Effects – preterm labor, premature rapture of membranes, post cesarean infectionMed management:1.metronidazole ( anti fungal)Nursing management:1.Verbalize feelingsBacterial VaginosisEtiologic agent – Gardenella VaginalisSigns and symptoms – gray discharge, fishyodor/musty

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