Framework for Maternal and Child blood pressure, unsafe abortion, and

Nursing on at-risk, high risk, and sick
clients.
Goals and Philosophies of Maternal and
Child Health Nursing
obstructed labor, as well as indirect
causes such as anemia, malaria, and
heart disease
Child Health

 Primary goal is the promotion and National Health Situation on Maternal

maintenance of optimal family health and Child Nursing
 Maternal and child health nursing
extends from preconception to  National Safe Motherhood Program
menopause of DOH
 Family-centered approach is the  Unang Yakap: Essential Newborn
preferred focus of nursing care Care (ENC)

Maternal and Child Health Goals and

Standards

 Global Health Goals

 To end poverty and hunger
 To achieve universal primary
education.
 To promote gender equality and
empower women
 To reduce child mortality.
 To improve maternal health.
 To combat HIV/AIDS, malaria, and
other diseases.
 To ensure environmental
sustainability.
 To develop a global partnership for
development

Maternal Health

 Refers to the health of women during

pregnancy, childbirth and the
postnatal period
Maternal Mortality in the Philippines
 Each stage should be a positive
experience  about 295 000 women
 WHO defines maternal mortality as
died during and following pregnancy
the annual number of female deaths
and childbirth in 2017
from any cause related to or
 Most common direct causes of
aggravated by pregnancy or its
maternal injury and death are
management (excluding accidental or
excessive blood loss, infection, high
incidental causes) during pregnancy
 and childbirth or within 42 days of
termination of pregnancy,
irrespective of the duration and site of
the pregnancy
 In 2020, the number of registered
maternal death reached a total of
1,975 with a corresponding maternal
mortality rate (MMR) of 1.3 deaths
per one thousand livebirths and
corresponds to about five (5.3)
maternal deaths daily. This is a 44.4
percent increase from previous year’s
MMR. This is the highest MMR since
1978.
Maternal Mortality in the Philippines
 Eclampsia was the leading cause of
maternal death in 2020 with 333
deaths and comprised 16.9 percent of
maternal deaths
 Followed by pre-eclampsia with 281
deaths and was 14.2 percent of the
total maternal deaths
 According to the statistics of POGS,
top causes of maternal mortality for
2020 were medical complications,
hemorrhage, hypertension, and
others. Hypertension and hemorrhage
have been the top causes of maternal
death in local and international
literature
Infant Mortality in the Philippines
 The death of an infant before his/her
death  16,885 infant deaths
registered in 2020 which were equal
to an infant mortality rate (IMR) of
13.0 deaths per one thousand
livebirths.
 IMR decreased by 15.4 percent from
13.0 in 2019 to 11.0 in 2020
 National Capital Region (NCR)
posted the highest IMR with 16.0
deaths per one thousand livebirths or
3,380 infant deaths.
 BARMM recorded the lowest IMR of
5.8 with 142 infant deaths
Infant Mortality in the Philippines
 From the total infant deaths of 16,885
more deaths occurred to infants less
than 28 days old with 62.8 percent or
10,612 deaths than to infants 28 days
to less than one year old with 6,273
deaths or 37.2 percent.
 Top three leading causes of infant
mortality were bacterial sepsis of
newborn (1,913; 11.3%); respiratory
distress of newborn (1,806; 10.7%),
and remainder of perinatal conditions
(1,485; 8.8%)
 Infant deaths from pneumonia
dropped from rank three in 2019 to
rank 8 in 2020  disorders related to
length of gestation and fetal growth
returned in the list as the tenth leading
cause of infant deaths
Genetics and Genetics Counseling
 Transmission of traits by single genes
 Inherited characteristics are passed
from parent to child by the genes in
each chromosome
 Traits are classified according to
whether they are dominant (strong) or
recessive (weak)
 Some genes, both normal and
abnormal, occur more fre-quently in
certain groups than in the population
as a whole
Genetics and Genetics Counseling
 Dominance
 Describes the way a person’s
genotype (genetic composition) is
 translated into the phenotype, or
observable characteristics.
 In the case of a dominant gene, one
copy is enough to cause the trait to be
expressed.  Two identical copies of
a recessive gene are required for the
trait to be expressed.
 Dominance and recessiveness are
relative qualities for many genes
Patterns of Single Gene Inheritance
 Three major patterns of single gene
inheritance are autosomal dominant,
autosomal recessive, and X-linked
 Autosomal Dominant traits
 Produced by a dominant gene on a
non-sex chromosome.
 Expression of abnormal autosomal
dominant genes may result in
multiple and seemingly unrelated
effects in the person.
 Some people may carry the dominant
gene but have no apparent expression
of it in their physical makeup
 Person who is affected by an
autosomal dominant disorder is
usually heterozygous for the gene
Patterns of Single Gene Inheritance
 Autosomal Recessive Traits
 Occurs if a person receives two copies
of a recessive gene carried on an
autosome.
 Everyone is estimated to carry
abnormal autosomal recessive genes
without manifesting the disorder
because everyone has a compensating
normal gene.
 Incidence of autosomal recessive
diseases is relatively low in the
general population.
 Many autosomal recessive disorders
are severe, and affected persons may
not live long enough to reproduce
Patterns of Single Gene Inheritance
 X-Linked recessive Gender
differences in the occurrence of X-
linked recessive traits and the
relationship of affected males to one
another are important factors
distinguishing these disorders from
autosomal dominant and recessive
disorders.  males are the only ones to
show full effects of an X-linked
recessive disorder
 Females can show the full disorder in
the following two uncommon
circumstances:
 If a female has a single X
chromosome (Turner syndrome)
 If a female child is born to an affected
father and a carrier mother
 X-linked recessive disorders can be
relatively mild (e.g., colorblindness),
or they may be severe (e.g.,
hemophilia)
Patterns of Single Gene Inheritance
 Single Gene Abnormalities
 A person affected with an autosomal
dominant disorder has a 50% chance
of transmitting the disorder to each
biologic child.
 Two healthy parents who carry the
same abnormal autosomal recessive
gene have a 25% chance of having a
child affected with the disorder
caused by this gene.
 Parental consanguinity increases the
risk for having a child with an
autosomal recessive disorder.
 One copy of an abnormal X—linked
recessive gene is enough to produce
the disorder in a male.
  Abnormal genes can arise as new
mutations. If these mutations are in
the gametes, they are transmitted to
future generations.
Chromosomal Abnormalities
 Can be numerical or structural
 Quite common (250%) in the embryo
or fetus spontaneously aborted
(miscarried)
 Often cause major defects because
they involve deletion or duplication
of many genes
 Numerical abnormalities
 Involve added or missing single
chromosomes or multiple sets of
chromosomes.
 Trisomy and monosomy are
numerical abnormalities of single
chromosomes.
 Polyploidy refers to abnormalities
involving full sets of chromosomes.
Chromosomal Abnormalities
 Structural Abnormalities
 May involve the structure of one or
more chromosomes.
 Part of a chromosome may be
missing or added, or DNA within the
chromosome may be rearranged.
 Another structural abnormality
occurs when all or part of a
chromosome is attached to another
(translocation)
 Fragile X syndrome is an X-linked
chromosomal abnormality.
Genetic Counseling
 Provides information and support to
help people understand the genetic
disorder they are concerned about
 Often available through facilities that
provide maternal-fetal medicine
services.
 Focuses on the family, not merely on
the affected individual.
 May be a slow process and is not
always straightforward
 Tests for rare disorders may be
performed at only one or a few
laboratories in the world,
 Individuals or families may request
genetic counseling before or during
pregnancy or after a child has been
born with a defect.
Nursing Care of Women With
Complications During Pregnancy
■ Assessment of fetal health
– Extraordinary technical advances have
enabled the management of high-risk
pregnancies so that both the mother and the
fetus have positive outcomes.
– Nursing responsibilities during assessment
of fetal health include:
■ Preparing the patient properly
■ Explaining the reason for the test
■ Clarifying and interpreting results in
collaboration with other healthcare providers
Fetal Diagnostic Tests
■ Ultrasound examination
– uses high-frequency sound waves to
visualize structures within the body
– Abdominal ultrasound – Transvaginal
ultrasound
■ Amniotic Fluid Volume – ultrasound scan
measures amniotic fluid pockets in all four
quadrants surrounding the mother’s
umbilicus and produces AFI (Amniotic Fluid
Index)
■ Estimation of Gestational Age – ultrasound
examination at 8 weeks gestation can
measure gestational sac, it is more accurate
than LNMP if used before 22 weeks gestation
■ MRI – provides a noninvasive radiological
view of fetal structures including the placenta
■ Kick count – maternal assessment of fetal
movement
Fetal Diagnostic Tests
■ Doppler Ultrasound blood flow assessment
- determines adequacy of blood flow through
the placenta and umbilical cord vessels in
women in whom it is likely to be impaired
■ AFP Testing - Identify high levels, which
are associated with open defects such as spina
bifida (open spine), anencephaly (incomplete
development of skull and brain), or
gastroschisis (open abdominal cavity).
Identify low levels, which are associated with
chromosome abnormalities or gestational
trophoblastic disease (hydatidiform mole).
■ Chorionic Villus Sampling - Identify
chromosome abnormalities or other defects
that can be determined by analysis of cells.
Fetal Diagnostic Tests
■ Cell-free DNA -Identify chromosomal
anomaly if there is evidence of high risk
■ Amniocentesis – Identify chromosome
abnormalities, biochemical disorders (such as
Tay-Sachs disease), and level of AFP in early
pregnancy; Identify severity of maternal–
fetal blood incompatibility and assess fetal
lung maturity in late pregnancy ■ NST -
Identify fetal compromise in conditions
associated with poor placental function, such
as hypertension, diabetes mellitus, or
postterm gestation
■ CST - Purposes are the same as for NST;
CST may be done if NST results are
nonreassuring (the fetal heart does not
accelerate)
Fetal Diagnostic Tests
■ BPP - Identify reduced fetal oxygenation in
conditions associated with poor placental
function but with greater precision than NST
alone.
■ Percutaneous umbilical blood sampling -
identify fetal conditions that can be
diagnosed only with a blood sample.
■ Tests for Fetal Lung Maturity - Evaluate
whether fetus is likely to have respiratory
complications in adapting to extrauterine life.
■ Lecithin/Sphingomyelin ratio - A 2:1 ratio
indicates fetal lung maturity (3:1 ratio
desirable for diabetic mother)
Danger Signs in Pregnancy
■ A sudden gush of fluid from vagina
■ Vaginal bleeding
■ Abdominal pain
■ Abnormal “kick count”
■ Persistent vomiting
■ Epigastric pain
■ Edema of face and hands
■ Severe, persistent headache
■ Blurred vision or dizziness
■ Chills with fever greater than 38.0°C
(100.4°F)
■ Painful urination or reduced urine output
Pregnancy-related complications
■ Hyperemesis Gravidarum
■ Bleeding Disorders
■ Bleeding Disorders of Late Pregnancy
■ Hypertension during Pregnancy
■ Blood incompatibility between the
pregnant woman and the fetus
Fetal growth may be restricted, resulting in a
low birth-weight infant. Dehydration impairs
perfusion of the placenta, reducing the
delivery of blood oxygen and nutrients to the
fetus.
Hyperemesis gravidarum Manifestations
Hyperemesis Gravidarum
■ excessive nausea and vomiting can
significantly interfere with her food intake
and fluid balance.
■ Manifestations:
– Persistent nausea and vomiting, often with
complete inability to retain food and fluids
– Significant weight loss (more than 5% of
prepregnant weight)
– Dehydration as evidenced by a dry tongue
and mucous membranes, decreased turgor
(elasticity) of the skin, scant and concentrated
urine, and a high serum hematocrit level
– Electrolyte and acid-base imbalances
– Ketonuria
– Psychological factors such as unusual
stress, emotional immaturity, passivity, or
ambivalence about the pregnancy.
– taught how to reduce factors that trigger
nausea and vomiting
– Accurate intake and output and daily
weight records are kept to assess fluid
balance
– Easily digested carbohydrates, such as
crackers or baked potatoes, are tolerated best.
Foods with strong odors should be eliminated
from the diet. Taking liquids between solid
meals helps to reduce gastric distention.
– Sitting upright after meals reduces gastric
reflux (backflow) into the esophagus.
– nurse should provide support by listening to
the woman’s feelings about pregnancy, child
rearing, and living with constant nausea.
Bleeding Disorder of the Pregnancy

Hyperemesis Gravidarum

■ Treatment
– to correct dehydration and electrolyte or
acidbase imbalances with oral or intravenous
fluids.
– Antiemetic drugs such as Diclegis at Several bleeding disorders can complicate
bedtime, transdermal clonidine, and oral early pregnancy, including spontaneous
ondansetron abortion (miscarriage), ectopic pregnancy,
– severe cases necessitate hospitalization and and hydatidiform mole. Maternal blood loss
total parenteral nutrition decreases the oxygen-carrying capacity of the
– Thiamine is often administered before blood, resulting in fetal hypoxia, and places
intravenous dextrose to prevent Wernicke’s the fetus at risk.
syndrome, which is characterized by double
vision and ataxia.

Hyperemesis Gravidarum

■ Nursing Care

– focuses on patient teaching because most

care occurs in the home
Bleeding Disorder of the Pregnancy A hydatiform mole (also known as a molar
pregnancy) is a gestational trophoblastic
disease (GTD), which originates from the
placenta and can metastasize. While
hydatiform moles are typically deemed
benign, they are premalignant and do have
the potential to become malignant and
invasive. HM, or molar pregnancy, results
from abnormal fertilization of the oocyte
(egg). It results in an abnormal fetus. The
placenta grows normally with little or no
growth of the fetal tissue. The placental tissue
forms a mass in the uterus.

The ovary (H), uterus, and fallopian tubes,

illustrating various abnormal implantation Abortion
sites. A to F are tubal pregnancies (the most
common); G is an abdominal pregnancy; and
X indicates the wall of the uterus where
normal implantation should occur. (From
Moore KL, Persaud TVN, Torchia MG: The
developing human: clinically oriented
embryology, ed 10, Philadelphia, 2016,
Saunders.)

Bleeding Disorder of the Pregnancy

When a threatened abortion occurs, efforts

are made to keep the fetus in utero until the
age of viability. In recurrent pregnancy loss,
causes are investigated; these can include
genetic, immunological, anatomical,
endocrine, or infectious factors.
Cerclage, or suturing an incompetent cervix Nursing Care
that opens when the growing fetus presses – Emotional care
against it, is successful in most cases. ■ Listens to the woman and acknowledges
A low human chorionic gonadotropin (hCG) the grief she and her partner feel
level or low fetal heart rate by 8 weeks
gestation may be an ominous sign.
Termination of pregnancy after 20 weeks of
gestation (age of viability) is called preterm
labor and is discussed in Chapter 8. Table 5.3
describes procedures used in pregnancy
termination.

In all cases of pregnancy loss, counseling of

the parents is essential. Even when the
mother elects to terminate pregnancy, there
are emotional responses that should be
recognized and addressed.

Oxytocin (Pitocin) controls blood loss before

and after curettage, much as the drugs do after
term birth. Rh0 (D) immune globulin
(RhoGAM [300 mcg] or the lower-dose
MICRhoGAM [50 mcg]) is given to Rh-
negative women after any abortion to prevent
the development of antibodies that might
harm the fetus during a subsequent
pregnancy. Ectopic Pregnancy

Abortion ■ occurs when the fertilized ovum (zygote) is

■ Nursing Care
– Physical care
■ documents the amount and character of
bleeding
■ saves anything that looks like clots or tissue
for evaluation by a pathologist
■ Check if patient’s bleeding and vital signs
■ Patient should be on NPO status
■ After vacuum aspiration or curettage, the
amount of vaginal bleeding is observed.
Blood pressure, pulse, and respirations are
checked
■ The woman’s temperature is checked on
admission to the recovery area
implanted outside the uterine cavity
■ 95% occur in the fallopian tube (tubal
pregnancy)
■ intrauterine device for contraception may
contribute to ectopic pregnancy
■ previous tubal pregnancy or a failed tubal
ligation is also more likely to have an ectopic
pregnancy
■ zygote or embryo may die and be resorbed
by the woman’s body, or the tube may rupture
with bleeding into the abdominal cavity,
creating a surgical emergency
An obstruction or other abnormality of the
tube prevents the zygote from being
transported into the uterus. Scarring from a
previous pelvic infection or deformity of the
fallopian tubes or inhibition of normal tubal
motion to propel the zygote into the uterus
may result from the following:
 Hormonal abnormalities
 Inflammation
 Infection
 Adhesions
 Congenital defects
 Endometriosis (uterine lining
occurring outside the uterus
Use of an intrauterine device for
contraception may contribute to ectopic
pregnancy because these devices promote
inflammation within the uterus.
Manifestations
– history of a missed menstrual period
– complains of lower abdominal pain
– light vaginal bleeding
– tube ruptures:
■ sudden severe lower abdominal pain
■ vaginal bleeding
■ signs of hypovolemic shock
Signs and Symptoms of Hypovolemic Shock
– Fetal heart rate changes (increased,
decreased, less fluctuation)
– tachycardia
– tachypnea
– Shallow, irregular respirations; air hunger –
hypotension
– Decreased (usually less than 30 mL/h) or
absent urine output
– Pale skin or mucous membranes
– Cold, clammy skin
– Faintness
– Thirst
Treatment
– Do pregnancy test
– Transvaginal ultrasound
– Culdocentesis – Blood transfusion
– Medical therapy with methotrexate
– Surgery to remove POC
Nursing Care
– Observing for signs and symptoms of
hypovolemic shock
– Should report any increasing pain
– If underwent surgery, preoperative and
postoperative care should be given
– Provide emotional support
Hydatidiform Mole (Molar Pregnancy)
■ occurs when the chorionic villi (fringelike
structures that form the placenta) increase
abnormally and develop vesicles (small sacs)
that resemble tiny grapes
■ Complete H mole - no fetus present
■ Partial H mole - only part of the placenta
has the characteristic vesicles
■ may result in hemorrhage, clotting
abnormalities, hypertension, and a possibility
of later development of cancer
(choriocarcinoma)
■ Manifestations
– Bleeding
– Rapid uterine growth
– Failure to detect fetal heart activity
– Signs of hyperemesis gravidarum
– Unusually early development of
hypertension
– Higher than expected levels of hCG
– “Snowstorm” pattern on ultrasound
■ Treatment
– Transvaginal ultrasound to confirm
diagnosis
– Vacuum aspiration and dilation and
evacuation of the uterus
– Levels of hCG is tested and rested until
undetectable; levels are tested again after 1
year.
Bleeding Disorders of Late Pregnancy
■ Placenta Previa
■ Abruptio Placenta
Placenta previa occurs when the placenta
develops in the lower part of the uterus rather
than the upper part. There are three degrees
of placenta previa, depending on the location
of the placenta in relation to the cervix
Marginal: Placenta reaches within 2 to 3 cm
of the cervical opening
Partial: Placenta partly covers the cervical
opening
Total: Placenta completely covers the
cervical opening
Placenta previa and abruptio placentae.
(A) Placenta previa. The placenta (purple) is
implanted low in the uterus. Detachment of
the placenta from the uterine wall occurs as
the cervix dilates, resulting in bleeding.
(B) Abruptio placentae. The placenta (purple)
is implanted normally in the uterus but
separates from the uterine wall. If the fetal
head is engaged, bleeding (red) may
accumulate in the uterus instead of being
expelled externally.
A low-lying placenta is implanted near the
cervix but does not cover any of the opening.
This variation is not a true placenta previa
and may or may not be accompanied by
bleeding.
Placenta previa
■ Manifestations
– Painless vaginal bleeding
– fetus is often in an abnormal
presentation
– fetus or neonate may have
anemia or hypovolemic shock
– Fetal hypoxia
Painless vaginal bleeding, usually
bright red, is the main characteristic
of placenta previa woman’s risk of
hemorrhage increases as term
approaches and the cervix begins to
efface (thin) and dilate (open) fetus is
often in an abnormal presentation
(e.g., breech or transverse lie) because
the placenta occupies the lower
uterus, which often prevents the fetus
from assuming the normal head-down
presentation.
Fetus or neonate may have anemia or
hypovolemic shock because some of
the blood lost may be fetal blood.
Fetal hypoxia may occur if a large
disruption of the placental surface
reduces the transfer of oxygen and
nutrients. A woman with placenta
previa is more likely than others to
experience an infection or
 hemorrhage after birth for the
following reasons:
 Infection is more likely to occur
because vaginal organisms can
easily reach the placental site,
which is a good growth medium
for microorganisms.
 Postpartum hemorrhage may
occur because the lower segment
of the uterus, where the placenta
was attached, has fewer muscle
fibers than the upper uterus.
 The resulting weak contraction of
the lower uterus does not
compress the open blood vessels
at the placental site as effectively
as would the upper segment of the
uterus.
■ Treatment
– Medical intervention depends
on the length of gestation and
the amount of bleeding
– Goal is to maintain the
pregnancy until fetal lungs are
mature
– Delivery is done if bleeding is
sufficient to jeopardize the
mother or fetus
– Patient should lie on her side
or put a pillow under one hip
to avoid supine hypotension
– Cesarean section is done if
bleeding is extensive, or the
gestation is near term
■ Nursing Care
– Continuous monitoring of
fetal heart rate
– Monitor character of
contractions
– Document and report vaginal
blood loss and signs and
symptoms of shock
– Vital signs every 15 minutes if
actively bleeding
– Oxygen is given to increase
the amount delivered to the
fetus
Abruptio Placenta
■ Premature separation of a placenta
that is normally implanted
■ Predisposing factors:
– Hypertension
– Cocaine
– Cigarette smoking and poor
nutrition
– Blows to the abdomen, such
as might occur in battering or
accidental trauma
– Previous history of abruptio
placentae
– Folate deficiency
Abruptio placentae may be partial or total it
may be marginal (separating at the edges) or
central (separating in the middle). Bleeding
may be visible or concealed behind the
partially attached placenta.
■ Manifestations
– Bleeding accompanied by
abdominal or low back pain
– most or all of the bleeding
may be concealed behind the
placenta
– uterus is tender and unusually
firm (boardlike)
– cramplike uterine
contractions often occur
– fetus may or may not have
problems
 ■ Disseminated intravascular
coagulation - complex disorder that
may complicate abruptio placentae
Obvious dark red vaginal bleeding occurs
when blood leaks past the edge of the
placenta. The woman’s uterus is tender and
unusually firm (boardlike) because blood
leaks into its muscle fibers. Frequent,
cramplike uterine contractions often occur
(uterine irritability).
Disseminated intravascular coagulation
(DIC) is a complex disorder that may
complicate abruptio placentae. The large
blood clot that forms behind the placenta
consumes clotting factors, which leaves the
rest of the mother’s body deficient in these
factors. Clot formation and anticoagulation
(destruction of clots) occur simultaneously
throughout the body in the woman with DIC.
She may bleed from her mouth, nose,
incisions, or venipuncture sites because the
clotting factors are depleted.
Postpartum hemorrhage may also occur
because the injured uterine muscle does not
contract effectively to control blood loss.
Infection is more likely to occur because the
damaged tissue is susceptible to microbial
invasion.
■ Treatment
– Immediate cesarean delivery
– Blood and clotting factor
replacement may be needed
■ Nursing care
– Prepare for cesarean section
– Close monitoring of vital
signs and fetal heart rate
– Look for signs and symptoms
of shock
– Report rapid increase in the
size of the uterus
Immediate cesarean delivery, is performed
because of the risk for maternal shock,
clotting disorders, and fetal death Blood and
clotting factor replacement may be needed
because of DIC. The mother’s clotting action
quickly returns to normal after birth because
the source of the abnormality is removed.
Hypertension During Pregnancy
■ When hypertension develops as a
complication during pregnancy, it is
known as gestational hypertension
■ Preeclampsia - increase in blood
pressure that occurs after 20 weeks
gestation with proteinuria
■ Eclampsia – Preeclampsia with
convulsions
GH is a transient form of hypertension during
pregnancy but can become chronic
hypertension later in life.
GH is closely related to the development of
complications such as abruptio placentae,
fetal growth restriction, preeclampsia,
prematurity, and stillbirth, so special care of
the pregnant woman with hypertension is
essential. GH is associated with an increased
risk of type 2 diabetes mellitus in the
offspring as an adult.
Vasospasm impedes blood flow to the
mother’s organs and placenta, resulting in
one or more of these signs: (1) hypertension,
(2) edema, and (3) proteinuria. Severe GH
can also affect the central nervous system,
eyes, urinary tract, liver, gastrointestinal
system, and blood clotting function.
Hypertension During Pregnancy
■ Symptoms of mild Preeclampsia
– Systolic blood pressure >140
mm Hg but <160 mm Hg
– Diastolic blood pressure >90
mm Hg but <110 mm Hg
■ Symptoms of severe Preeclampsia
– Sustained blood pressure of
systolic 160 mm Hg and
diastolic 110 mm Hg and
greater
– Proteinuria—urine dipstick
results of 1 + or greater on two
separate urine specimens
■ Edema is not always present
Blood pressure should be assessed on several
visits between 1 and 7 days apart.
Other symptoms include excess weight gain
more than 1.8 kg (4 lb) in 1 week in the
second or third trimester. Edema is not
always present in preeclampsia.
Preeclampsia progresses to eclampsia when
convulsions occur. Convulsions as a result of
eclampsia can occur antepartum, intrapartum,
or postpartum (one sometimes hears the term
toxemia, an old term for preeclampsia). The
cause of GH is unknown, but birth is its cure.
GH usually develops after 20 weeks
gestation. Vasospasm (spasm of the arteries)
is the main characteristic of GH. Although
the cause is unknown, any of several risk
factors increases a woman’s chance of
developing GH
Hypertension During Pregnancy
■ Preeclampsia progresses to eclampsia
when convulsions occur
■ Cause of GH is unknown, but birth is
its cure
■ Vasospasm is the main characteristic
of GH
■ Risk factors:
– First pregnancy
– Obesity
– Family history of
preeclampsia
– Age more than 35 years or less
than 19 years
– Multifetal pregnancy (e.g.,
twins)
– Chronic hypertension
– Chronic renal disease
– Diabetes mellitus
– Autoimmune disease
– history of a pregnancy interval
more than 10 years
Chronic Hypertension During Pregnancy
■ Pregnant patients with chronic
hypertension, new-onset proteinuria,
a sudden increase in blood pressure
that was previously controlled, or a
sign of kidney involvement is
indicative of preeclampsia.
■ Labetalol is the antihypertensive drug
of choice during pregnancy
■ Frequent fetal evaluations including
ultrasound examinations and non–
stress tests and possibly early delivery
at 36 to 37 weeks gestation
Pregnant patients with chronic hypertension,
new-onset proteinuria, a sudden increase in
blood pressure that was previously
controlled, or a sign of kidney involvement is
indicative of preeclampsia.
Labetalol is the antihypertensive drug of
choice during pregnancy, as angiotensin-
converting enzyme inhibitors are
contraindicated. However, labetalol should
not be used in patients with asthma or heart
failure frequent fetal evaluations including
ultrasound examinations and non–stress tests
and possibly early delivery at 36 to 37 weeks
gestation.
HELLP Syndrome
■ Variant of GH that involves
hemolysis (breakage of erythrocytes),
elevated liver enzymes, and low
platelets.
■ More common in preeclamptic
women conservatively managed but
may occur in women without
hypertension and proteinuria
■ RUQ or epigastric pain, nausea,
vomiting, and malaise may signal that
HELLP syndrome is developing
HELLP syndrome is a variant of GH that
involves hemolysis (breakage of
erythrocytes), elevated liver enzymes, and
low platelets. Hemolysis occurs as
erythrocytes break up when passing through
small blood vessels damaged by
hypertension.
Obstruction of hepatic blood flow causes the
liver enzyme levels to become elevated. Low
platelet levels occur when the platelets gather
at the site of blood vessel damage, reducing
the number available in the general
circulation.
Low platelet levels cause abnormal blood
clotting.
HELLP syndrome is more common in
preeclamptic women conservatively
managed but may occur in women without
hypertension and proteinuria (Sibai, 2016).
RUQ or epigastric pain, nausea, vomiting,
and malaise may signal that HELLP
syndrome is developing. Liver enzyme
laboratory reports should be monitored.
HELLP syndrome can also develop
postpartum, and all patients with
hypertension should be closely monitored
during the postpartum period.
The patient with severe HELLP syndrome is
monitored in the intensive care unit and given
magnesium sulfate to prevent convulsions
and antihypertensive medications.
The need for delivery of the fetus after steroid
therapy to improve fetal lung function is
evaluated, and the woman is monitored
closely for bleeding. Postpartum, the mother
is evaluated for fluid intake and output,
laboratory values, and pulse oximetry for at
least 48 hours. Most patients improve after
delivery.
Hypertension During Pregnancy
■ Eclampsia occurs when the woman
has one or more generalized tonic-
clonic seizures
– An eclamptic seizure may
result in cerebral hemorrhage,
abruptio placentae, fetal
compromise, or death of the
mother or fetus
– administration of magnesium
to control seizures, close fetal
monitoring as well as
monitoring of uterine
contractions, and measures to
prevent aspiration.
– Fetal hypoxia may result in
meconium (first stool)
passage into the amniotic fluid
or fetal distress.
– intrauterine growth restriction
(IUGR)
– Fetal death sometimes occurs.
Eclampsia occurs when the woman has one
or more generalized tonic-clonic seizures.
Facial muscles twitch; this sign is followed
by generalized contraction of all muscles
(tonic phase), then alternate contraction and
relaxation of the muscles (clonic phase).
Fetal hypoxia may result in meconium (first
stool) passage into the amniotic fluid or fetal
distress. The fetus may have intrauterine
growth restriction (IUGR) and at birth may
be long and thin with peeling skin if the
reduced placental blood flow has been
prolonged. Fetal death sometimes occurs.
Hypertension During Pregnancy
■ Prevention
– Balanced diet
– Early and regular prenatal
care
– Low dose aspirin between 12
and 14 weeks of gestation
■ Management
– Activity restriction
– Maternal assessment of fetal
activity
– Blood pressure monitoring
two to four times per day
– Daily weight measurement on
the same scale
– Checking urine for protein
with a dipstick
– Drug therapy (methyldopa,
labetalol, nifedipine,
hydralazine)
Excess magnesium first causes loss of the
deep tendon reflexes, which is followed by
depression of respirations; if levels continue
to rise, collapse and death can occur Calcium
gluconate reverses the effects of magnesium
and should be available for immediate use
when a woman receives magnesium sulfate.
Therapeutic serum level of magnesium is 4 to
8 mg/dL essential nursing responsibility
when caring for women receiving
magnesium sulfate is to monitor contractions
during labor and to take measures to maintain
a firm uterine fundus postpartum. The nurse
should alert the newborn nursery staff when
magnesium sulfate has been administered
during labor because if the newborn is treated
with aminoglycosides (such as kanamycin
[Kantrex] or neomycin), an interaction can
occur and can result in toxic responses in the
newborn.
Hypertension During Pregnancy
■ Nursing care
– Promoting prenatal care
– Helping to cope with therapy
– Caring for acutely ill woman
– Providing postpartum care
Rh and ABO Incompatibility
■ Rh-negative blood type is an
autosomal recessive trait
■ Rh-positive person may have
inherited two Rh-positive genes or
may have one Rh-positive and one
Rh-negative gene
■ Rh incompatibility between the
woman and fetus can occur only if the
woman is Rh negative and the fetus is
Rh positive.
■ Isoimmunization - If fetal Rh-positive
blood leaks into the Rh-negative
mother’s circulation, her body may
respond by making antibodies to
destroy the Rh-positive erythrocytes.
■ ABO Incompatibility – mother is type
O and infant’s blood type is type A or
type B
Rh-positive person may have inherited two
Rh-positive genes or may have one Rh-
positive and one Rh-negative gene. This
explains why two Rh-positive parents can
conceive a child who is Rh negative.
Because this leakage usually occurs at birth,
the first Rh-positive child is rarely seriously
affected. However, the woman’s blood levels
of antibodies increase rapidly each time she
is exposed to more Rh-positive blood (in
subsequent pregnancies with Rh-positive
fetuses). Antibodies against Rh-positive
blood cross the placenta and destroy the fetal
Rh-positive erythrocytes before the infant is
born. A similar response occurs with ABO
incompatibility when the mother is type O
and the infant’s blood type is type A or type
B, but the response is rarely life threatening
in the newborn, although the newborn may
develop jaundice after birth and should be
monitored.
Rh and ABO Incompatibility
■ Manifestations
– No obvious effects if her body
produces anti-Rh antibodies
– Maternal anti-Rh antibodies
cross the placenta and destroy
fetal erythrocytes,
erythroblastosis fetalis results
mother during pregnancy or at birth, causing
the mother to produce antibodies against
Rhpositive blood cells.
(B) The Rh-positive antibodies from the
maternal circulation cross the placenta, enter
the fetal circulation, and destroy fetal Rh-
positive blood cells.
Rh and ABO Incompatibility
■ Prevention, treatment, and nursing
care
– Give Rh0 (D) immune
globulin (RhoGAM) to the
Rh-negative woman at 28
weeks gestation and within 72
hours after birth of an Rh-
positive infant or abortion
– Some women are still
sensitized, usually because
they did not receive Rh0 (D)
immune globulin after
childbirth or abortion
– Carefully monitored during
pregnancy
– Several fetal assessment tests
may be used, including the
Coombs test, amniocentesis,
or percutaneous umbilical
blood sampling
– Intrauterine transfusion may
be performed for the severely
anemic fetus

Pregnancy complicated by medical

conditions

■ Diabetes mellitus
■ Heart disease
■ Anemia
■ Infections

Erythroblastosis fetalis.
(A) A few fetal Rh-positive red blood cells
enter the circulation of the Rh-negative
Diabetes Mellitus Diabetes Mellitus

■ Type 1 diabetes mellitus: Usually ■ Preexisting Diabetes Mellitus

caused by an autoimmune destruction – Alteration of management of
of the beta cells of the pancreas DM is needed
resulting in insulin deficiency. – Congenital anomalies occur
■ Type 2 diabetes mellitus: Usually from maternal hyperglycemia
caused by insulin resistance; usually – DM before pregnancy has a
has a strong genetic predisposition greater risk of having a
and is associated with obesity. newborn with congenital
■ Pregestational diabetes mellitus: anomaly than a woman who
Type 1 or 2 diabetes mellitus that develops GDM
existed before pregnancy occurred.
■ Gestational diabetes mellitus (GDM):
Glucose intolerance with onset during
pregnancy and glucose returns to
normal by 6 weeks postpartum

In true GDM, glucose usually returns to

normal by 6 weeks postpartum, although
women with GDM have increased risk of
developing type 2 diabetes mellitus later in
life

Diabetes Mellitus

■ Effect of pregnancy on glucose

metabolism
– Pregnancy affects a woman’s
metabolism to make ample
glucose available to the
growing fetus
– Hormones (estrogen and
progesterone), an enzyme
(insulinase) produced by the
placenta, and increased
prolactin levels have two
effects:
■ Increased resistance of
cells to insulin
■ Increased speed of
insulin breakdown
Diabetes Mellitus
■ Gestational Diabetes Mellitus
– Maternal obesity (greater than
90 kg or 198 lb)
– Large infant (greater than
4000 g or about 9 lb,
macrosomia)
– Maternal age older than 25
years
– Previous unexplained
stillbirth or infant having
congenital abnormalities
– History of GDM in a previous
pregnancy
 – Family history of diabetes
mellitus
– Fasting glucose more than
126 mg/dL or postmeal
glucose more than 200 mg/dL
GDM is common and resolves quickly after
birth; however, many women who develop
GDM develop overt type 2 diabetes mellitus
later in life. The following factors in a
woman’s history are high risk for GDM
Diabetes Mellitus
■ Treatment
– Identification of GDM
– Diet modifications
– Monitoring of blood glucose
levels
Woman does not have preexisting diabetes
mellitus, a prenatal screening test to identify
GDM is routinely performed between 24 and
28 weeks gestation, but it may be done earlier
if risk factors are present. Blood glucose level
is 130 to 140 mg/dL or higher, a more
complex, 3-hour glucose tolerance test is
done. Two abnormal 3- hour glucose
tolerance tests are diagnostic for GDM.
Avoid single large meals with high amounts
of simple carbohydrates. balanced food
intake is divided among meals and at least
three to four snacks throughout the day to
maintain stable blood glucose levels. bedtime
snack is important to minimize the risk of
hypoglycemia.
Ensure a successful pregnancy, the woman
must keep her blood glucose levels as close
to normal as possible and be taught the signs
and symptoms of both hypoglycemia and
hyperglycemia
Diabetes Mellitus
■ Treatment
– Monitoring of ketones
– Insulin administration
– Exercise
– Fetal assessments
– Care during labor
– Care of the neonate
■ Nursing care
- Teaching self care
-Providing emotional support
-Encouraging breastfeeding
Urine ketones may be checked to identify the
need for more carbohydrates. If the woman’s
carbohydrate intake is insufficient, she may
metabolize fat and protein to produce
glucose, resulting in ketonuria. However,
ketonuria that is accompanied by
hyperglycemia requires prompt evaluation
for diabetic ketoacidosis.
Oral hypoglycemic drugs can successfully
treat GDM (Kalra, 2015). Glyburide, which
does not cross the placenta, has been
considered superior to metformin, which
does cross the placenta but has not been
shown to be teratogenic to the fetus. because
both oral agents often require supplemental
injectable insulin to maintain adequate
glucose control, injectable insulin is the
preferred drug to lower blood glucose levels
during pregnancy. GDM may be controlled
by diet and exercise alone, or the woman may
require insulin injections
In GDM, however, exercise can help control
blood glucose levels, and diet and exercise
can minimize the need for insulin.
Assessments may identify fetal growth and
the ability of the placenta to provide oxygen
and nutrients. Diabetes can affect the blood
vessels that supply the placenta, impairing
the transport of oxygen and nutrients to the
fetus and the removal of fetal wastes.
Labor is work (exercise) that affects the
amount of insulin and glucose needed. Some
women receive an intravenous infusion of a
dextrose solution plus regular insulin as
needed. Regular insulin is the only type given
intravenously. Blood glucose levels are
assessed hourly, and the insulin dose is
adjusted accordingly.
Infant complications after birth may include
hypoglycemia, respiratory distress, and
injury caused by macrosomia. Some infants
experience growth restriction because the
placenta functions poorly involves helping
her to learn to care for herself and providing
emotional care to meet the demands imposed
by this complication.
Heart Disease
■ Affects a small percentage of
pregnant women.
■ During a normal pregnancy, an
increase in heart rate, blood volume,
and cardiac output places a
physiological strain on the heart that
may not be tolerated in a woman with
preexisting heart disease.
Heart Disease
■ Treatment
– Under care of both a
cardiologist and an
obstetrician
– Frequent antepartum visits
– Excessive weight gain must
be avoided
– Prevention of anemia
– Limit physical activity
– Drug therapy
– Vaginal birth is preferred
A vaginal birth is preferred over cesarean
delivery because it carries less risk for
infection or respiratory complications that
would further tax the impaired heart. Forceps
or a vacuum extractor may be used to
decrease the need for maternal pushing
Heart Disease
■ Nursing care
– should be taught about
necessary changes
– Report prompt signs of signs
of excess anticoagulation such
as bruising without reason,
petechiae (tiny red spots on
the skin), nosebleeds, or
bleeding from the gums when
brushing her teeth
– Teach signs that may indicate
CHF
Anemia
■ Reduced ability of the blood to carry
oxygen to the cells
■ Hemoglobin levels that are <10.5
g/dL in the second trimester and are
<11 g/dL in the first and third
trimesters indicate anemia during
pregnancy
 ■ Nutritional Anemias
– Iron-deficiency anemia
– Folic acid-deficiency anemia
■ Genetic Anemias
– Sickle cell disease
– Thalassemia
Anemia
■ Iron-deficiency anemia
– Pregnant women need
additional iron for their own
increased blood volume, for
transfer to the fetus, and for a
cushion against the blood loss
expected at birth
– oral doses of elemental iron
and continues this therapy for
about 3 months after the
anemia has been corrected.
■ Folic acid-deficiency anemia
– characterized by large,
immature RBCs
(megaloblastic anemia).
– Folic acid deficiency has been
associated with neural tube
defects in the newborn.
– daily supplement of 400 to
800 mcg
The RBCs are small (microcytic) and pale
(hypochromic) in iron-deficiency anemia.
Iron supplements are commonly used to meet
the needs of pregnancy and maintain iron
stores. Vitamin C may enhance the
absorption of iron. Iron should not be taken
with milk or antacids because calcium
impairs absorption.
Iron-deficiency anemia is often present at the
same time
Anemia
■ Sickle cell disease
– Autosomal recessive disorder
– Abnormal hemoglobin that
causes their erythrocytes to
become distorted into a sickle
(crescent) shape during
episodes of hypoxia or
acidosis
– Pregnancy may cause a sickle
cell crisis, with massive
erythrocyte destruction and
occlusion of blood vessels.
– Frequent evaluation and
treatment for anemia during
prenatal care
– Fetal evaluations concentrate
on fetal growth and placental
function
Anemia
■ Thalassemia
– genetic trait that causes an
abnormality in one of two
chains of hemoglobin, the
alpha (α) or beta (β) chain
– woman with β-thalassemia
minor usually has few
problems other than mild
anemia, and the fetus does not
appear to be affected
■ Nursing care
– teach which foods are high in
iron and folic acid to help her
prevent or treat anemia.
Foods high in iron Meats, chicken, fish, liver,
legumes, green leafy vegetables, whole or
enriched grain products, nuts, blackstrap
molasses, tofu, eggs, dried fruits
Foods high in folic acid Green leafy
vegetables, asparagus, green beans, fruits,
whole grains, liver, legumes, yeast
Foods high in vitamin c (may enhance Infections
absorption of iron) Citrus fruits and juices,
strawberries, cantaloupe, cabbage, green and ■ Rubella
red peppers, tomatoes, potatoes, green leafy – mild viral disease with a low
vegetables fever and rash
– can disrupt the formation of
Infections major body systems in early
pregnancy
■ TORCH (Toxoplasmosis, Rubella, – acquired later is more likely to
Cytomegalovirus, Herpes simplex damage organs
virus, ”Other” infections) – Effects on on the embryo or
■ Viral infections have no effective fetus
therapy ■ Microcephaly (small
■ immunizations can prevent some of head size)
these infections ■ Intellectual
impairment
Viral infections often have no effective ■ Congenital cataracts
therapy and may cause serious problems in ■ Deafness
the mother or the fetus or newborn. However, ■ Cardiac defects
immunizations can prevent some of these ■ IUGR
infections. ■ Treatment and nursing care
– Immunization against rubella
Infections infection

■ Cytomegalovirus infection Infections

– herpes infection that is
sexually transmitted
– infected infant may have some
of the following:
■ Intellectual
impairment
■ Seizures
■ Blindness
■ Deafness
■ Dental abnormalities
■ Petechiae (often called
a “blueberry muffin”
rash)
■ Treatment and nursing care
– Primary prevention via hand
hygiene is essential
– Ganciclovir or valganciclovir
are antiviral drugs
■ Herpesvirus
– Type 1 – cause fever blisters
or cold sores
– Type 2 - cause genital herpes
– infection during the first half
of pregnancy may cause
spontaneous abortion
– Neonatal herpes infection can
be either localized or
disseminated
– survivors may have
neurological complications
■ Treatment and nursing care
– Avoiding contact with the
lesions
– cesarean delivery may be
required to prevent fetal
contact
– Antiviral drugs such as
acyclovir may be given

The infant is infected in one of the following
ways:
The virus ascends into the uterus after the
membranes rupture.
The infant has direct contact with infectious
lesions during vaginal delivery.
Avoiding contact with the lesions can prevent
neonatal herpes infection
cesarean delivery may be required to prevent
fetal contact during birth or the development
of an ascending infection
Infections
■ Hepatitis B
– Blood, saliva, vaginal
secretions, semen, and breast
milk can transmit the virus
– can also cross the placenta
– may be asymptomatic or
acutely ill with chronic low-
grade fever, anorexia, nausea,
and vomiting.
■ Treatment and Nursing care
– Screening for Hepatitis B
during prenatal care and
should be repeated during
third trimester
– Infants born to positive for
hepatitis B should receive a
single dose of hepatitis B
immune globulin and hepatitis
B vaccine
Infections
■ Zika virus infection
– spread by the bite of an Aedes
mosquito and can be spread
by sexual contact
– no preventive vaccination or
treatment for the infection
– Infection during first trimester
can result in specific fetal
anomalies that severely affect
the brain development
■ Treatment and nursing care
– Prevention involves
eliminating breeding sources
for the mosquito, wearing
long-sleeved shirts and pants,
and use of plant-derived insect
repellants containing DEET,
picaridin, oil of lemon,
eucalyptus, or para-menthane-
3,8-diol (PMD)
ika virus is spread by the bite of an Aedes
mosquito and can be spread by sexual contact
(Simon and Carpanetti, 2016). At the present
time, there is no preventive vaccination or
treatment for the infection.
Sexually Transmitted Infections
■ Common mode of transmission is
sexual intercourse
■ Typically transmitted are syphilis,
gonorrhea, chlamydia,
trichomoniasis, and condylomata
acuminata (genital warts)
Sexually Transmitted Infections
■ Human Immunodeficiency Virus
– causative organism of
acquired immunodeficiency
syndrome (AIDS)
– cripples the immune system
and makes person susceptible
to infections
– no known immunization or
curative treatment
– control of opportunistic
infections has increased the
life expectancy of infected
persons
Sexually Transmitted Infections
■ Human Immunodeficiency Virus
– Can be acquired through
 Unprotected sexual contact with
an infected person
 Sharing a needle with an infected
person
 Mucous membrane exposure to
infected body fluids
 Perinatal exposure (infants)
– Infants may be infected
through
 Transplacentally
 Through contact with infected
maternal secretions at birth
 Through breast milk
Counseling should be provided to all women
concerning behaviors that place them at risk
for contracting HIV
HIV testing is recommended for all prenatal
patients.
HIV-positive women should be educated that
the transmission of HIV infection to the
newborn can be greatly reduced by
appropriate drug therapy
Breastfeeding is contraindicated for mothers
who are HIV positive.
Nonviral Infections
■ Toxoplasmosis
– Caused by Toxoplasma gondii
– Acquired by contact with cat
feces or raw meat and
transmitted through the
placenta
– Congenital toxoplasmosis
includes the following
possible signs in the newborn:
 Low birth weight
 Enlarged liver and spleen
 Jaundice
 Anemia
 Inflammation of eye structures
 Neurological damage
Nonviral Infections
■ Toxoplasmosis
– Treatment and nursing care
 Pyrimethamine and sulfadiazine
are used after the first trimester
and leucovorin after 18 weeks
gestation
 Treatment of infants involves
pyrimethamine, sulfadiazine, and
leucovorin for 1 year
 Cook all meat thoroughly.
 Wash hands and all kitchen
surfaces after handling raw meat.
 Avoid touching the mucous
membranes of the eyes or mouth
while handling raw meat.
 Avoid uncooked eggs and
unpasteurized milk.
 Wash fresh fruits and vegetables
well.
 Avoid materials contaminated
with cat feces, such as litter boxes,
sand boxes, and garden soil.
Nonviral Infections
■ Group B streptococcus
– leading cause of perinatal
infections that result in a high
neonatal mortality rate.
– can be found in the woman’s
rectum, vagina, cervix, throat,
or skin
– significant cause of maternal
postpartum infection
■ Treatment and nursing care
– culture of the woman’s rectum
and lower vagina for the
presence of GBS is routinely
taken at 35 to 37 weeks
gestation
 – All positive cultures require
antibiotic treatment during
labor
Nonviral Infections
■ Tuberculosis
– adult with tuberculosis
presents with fatigue,
weakness, loss of appetite and
weight, fever, and night
sweats
– newborn may acquire the
disease by contact with an
untreated mother after birth
■ Treatment and Nursing care
– infant may receive preventive
therapy with isoniazid for 3
months after birth
 Pyelonephritis is treated with
multiple antibiotics
– Nursing care
 Teach how to reduce the
introduction of rectal
microorganisms into the bladder
 Front-to-back direction should be
used when wiping after urination
 Adequate fluid intake
 Urinating before intercourse
reduces irritation
Environmental Hazards during
Pregnancy
■ Bioterrorism and the pregnant patient
■ Substance abuse
■ Trauma during pregnancy

Nonviral Infections Environmental Hazards during

Pregnancy
■ Urinary Tract Infections
– woman with cystitis has the ■ Teratogen – a substance that causes
following signs and an adverse effect on the developing
symptoms: fetus
 Burning with urination ■ Some birth defects are caused by a
 Increased frequency and urgency combination of genetic and
of urination environmental factors
 A normal or slightly elevated ■ First weeks of life - vital organs are
temperature developing, and exposure to
– Pyelonephritis signs and environmental teratogen may cause
symptoms: miscarriage
 High fever ■ Exposure to teratogen in late
 Chills pregnancy may cause growth
 Flank pain or tenderness restrictin
 Nausea and vomiting ■ 4 main teratogens are drugs,
chemicals, infectious agents, and
Nonviral Infections radiation

■ Urinary Tract Infections Bioterrorism and the pregnant patient

– Treatment
 Short-term oral antibiotics ■ Three basic categories of biological
 Asymptomatic bacteriuria is agents
treated with oral antibiotics for 10
days
 – Category A: Easily
transmitted from person to
person
– Category B: Spread via food
and water
– Category C: Spread via
manufactured weapons
designed to spread disease
■ Observe for unusual symptoms
present in large numbers of people
Category A: Easily transmitted from person
to person (such as smallpox, anthrax, or
tularemia)
Category B: Spread via food and water (such
as Q fever, brucellosis, and Staphylococcus
enterotoxin B)
Category C: Spread via manufactured
weapons designed to spread disease (such as
hantavirus and tick-borne encephalitis)
Obstetric nurse must be observant for unusual
symptoms present in large numbers of young,
healthy pregnant patients who come to the
clinic or emergency department
Nurses should participate in community
emergency preparedness programs that set up
response protocols for patients of all ages and
provide shelters, supportive services,
intensive care units, emergency supplies, and
communication services.
Substance abuse
■ Use of illicit or recreational drugs
during pregnancy has an adverse
effect on both the mother and the
fetus
Substance abuse
■ Treatment and Nursing Care
– Care focuses on identifying
the woman with substance
abuse early in pregnancy
– educate her about the effects
of substance abuse
– encourage her to reduce or
eliminate use
– Appropriate referrals should
be made.
– Dietary support, monitoring
of the woman’s weight gain,
and fetal assessment promote
better pregnancy outcomes.
Trauma during Pregnancy
■ High incidence of trauma during the
childbearing years
■ Falls are not uncommon because of
the woman’s altered sense of balance.
■ Wear a seat belt every time she is in a
car, both as a driver and as a
passenger. The lap portion of the belt
is placed low, just below her
protruding abdomen
■ Physical abuse against women
(battering) is a significant cause of
trauma, and violence often escalates
during pregnancy
■ Women abused during pregnancy are
more likely to have miscarriages,
 stillbirths, and low-birthweight
infants

Trauma during Pregnancy

■ Treatment and Nursing care

– be aware that any woman may
be in an abusive relationship.
– nonjudgmental
communication helps
establish a trusting nurse–
patient relationship
– determine whether there are
factors that increase the risk
for severe injuries or homicide
– determine whether the
children are being hurt
– Nursing care for the acutely
injured pregnant woman
supplements medical
management

Effects of high-risk pregnancy on the

family

■ Disruption of usual roles

■ Financial difficulties
■ Delayed attachment to the infant
■ Loss of expected birth experience