CHAPTER 1 0 Complications of Pregnancy

be started on< preventive isoniazid

< n 1coagu at1on therapy
a immediately. Skin ul at ion and a t. 1 . f ctors are s1multaneously
act i vated · DIC may occu r w1" th problems u n related
testing is repeated at 3 months. Isoniazid is usually contin
to
ued for the infant until the mother's TB has been inactive
for at least 3 months. Infant TB medication may be stopped
if the mother and other family members have received full
treatment and show no additional disease. If the skin test
result shows conversion to positive, a full course of drug
therapy should be given to the infant (AAP & ACOG, 2012;
Whitty & Dombrowski , 2017).

(S U M MA R Y C O NC E PT S
• Spontaneous abortion is a leading cause of pregnancy
loss. Treatment is aimed at preventing complications
such as hypovolemic shock and infection and provid
in g emotional support for the grieving mother and her
family.
• The incidence of ectopic pregnancy is increasing in the
United States as a result of pelvic inflammation associ
ated with sexually transmitted diseases. The goals of
ther apeutic management are to prevent severe
hemorrhage
and preserve the fallopian tube so that future fertility is
retained .
• Management of gestational trophoblastic disease (hydatid
iform mole) involves two phases: (1) evacuation of the
molar pregnancy and (2) evaluation of serum beta-human
chorionic gonadotropin levels monthly for 6 months, then
every 2 to 3 months for 6 months u ntil normal for three
values. Pregnancy must be avoided during the follow-up
because the normal rise of beta-hu man chorionic gonado
topin level in pregnancy would obscure evidence of cho
nocarcinoma.
' Disorders of the placenta (placenta previa and lcental
abruption) are responsible for hemorrhagic cond1t10ns
of the last half of pregnancy. Either condition may result
in
• tn tcrnal hemorrhage and fetal or materna deah.
Di ssem inated intravascular coagulation is a life-threat
ening complication of missed abortion, placental
abruption , and severe hypertension, in w 1ich procoag
 KNOWLEDGE CHECK
62. How can toxoplasmosis be prevented?
63. What are the risk factors for colonization of the
newborn with GBS during the intrapartum period? How
is coloniza tion prevented?
64. How is TB treated in the mother? How is it diagnosed
and treated in the newborn?
the placenta. Major maternal organs affected include the
liver, kidneys, heart, and brain.
• Treatment of preeclampsia includes reduced activity,
reduction of environmental stimuli, and administration
ofi medications to prevent generalized seizures.
• Magnesium sulfate, used to prevent preeclampsia
from progressing to generalized eclamptic seizures, may
Prc:gn an c
.
have adverse effects. The most serious of these is central
ner vous system depression, which includes
depression o the respiratory center. Adverse effects such
as respirator depression or absent deep tendon reflexes
are more like! to occur if the blood level of magnesium
rises over the therapeutic range.
• Nurses monitor the woman with preeclampsia to evalu
ate the effectiveness of medical therapy and identify signs
that her condition is worsening, such as increasing hyper
reflexia. Nurses also control external stimuli and initiate
measures to protect her during eclamptic seizures.
• Pregnant women who have chronic hypertension are at
increased risk for preeclampsia and should be monitored
for worsening hypertension, proteinuria, change in labo
ratory values, or development of signs and symptoms of
preeclampsia. Antihypertensive medication should be
continued or initiated if blood pressure is consistently ele
vated above 160 mm Hg systolic and 90 to 100 m m Hg
diastolic.
• Rh incompatibility can occur if an Rh -negative woman
conceives a child who is Rh-positive. As a result of expo
sure to the Rh -positive antigen, maternal antibodies may
develop that cause hemolysis of fetal Rh-positive RHCs i;1