MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2
Maternal LEC complications
Pre-existing – disease acquired even
before pregnancy
Nursing process
a. Chronic illness – Maintain woman’s
1. Assessment – focus on the signs and
symptoms of the illness (sub/obj)
a. Subjective – Interviews (woman’
level of exhaustion)
b. Objective – Vital signs, oedema
b. New illness – Allowing a woman to
Nursing Diagnosis
Example
1. Ineffective tissue perfusion related to
poor heart function during
pregnancy
2. Pain related to uterine pressure
3. Social isolation related to prescribed
bed rest during pregnancy
secondary to concurrent illness.
4. Ineffective role performance related
to increasing level of daily restrictions
secondary to chronic illness and
pregnancy.
5. Knowledge deficit related to normal
changes of pregnancy versus illness
complications.
6. Fear regarding pregnancy outcome
related to chronic illness.
7. Health-seeking behaviours related to
the effects of illness or pregnancy.
8. Situational low self-esteem related to
illness during pregnancy.
Outcome Identification and Planning
Example
1. Outcome should be related to the
entire family’s health
health during pregnancy so she can
remain at home as long as possible,
thereby minimizing hospitalization and
family disruptions.
choose among alternatives to help her
to participate in her own care and also
to maintain self-esteem as well as helps
her move a step forward parenthood
and assuming care for her family.
Implementation
Example
1. Teaching women on her new or
additional measures to maintain
health during pregnancy.
Outcome Evaluation
Example
1. Patients states she rests for 2 hours
morning and afternoon, dependent
oedema remains 1+ or less at next
prenatal visit
2. Family member state they are all
participating in an exercise
programs since mother developed
gestational diabetes.
3. Patient reports no burning or
urination or flank pain at next
prenatal visit.
4. Patient states she understands the
importance of taking daily thyroid
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2
medicine for total length of
pregnancy.
Cardiovascular disease and pregnancy
 The danger of pregnancy in a
woman with cardiac disease occurs
primarily due to the increase in
circulatory volume
 The most dangerous time for a
woman is between in 28 or 32
weeks, after the blood volume
peaks.
1. A woman with left sided heart failure
 Occurs in condition such as mitral
stenosis, mitral insufficiency and
aortic coarculation. The left ventricle
cannot move to the volume of
blood forward that is received by the
left atrium from the pulmonary
circulation.
 The level of failure is often at the
level of mitrial valve.
 The normal physiologic tachycardia
of pregnancy shortens diastole (atrial
contraction) and decreases the time
available for blood flow across this
valve.
 The inability of mitrial valve to push
blood forward causes back-pressure
on the pulmonary circulation,
causing it to become distended,
systemic blood pressure decreases in
the face of lowered cardiac output
and pulmonary hypotension occurs.
 When pressure in the pulmonary vein
reaches point in 25 mmHg, fluid
begins to pass from the pulmonary
capillary membranes into the
interstitial spaces surrounding the
alveoli and into the alveoli leads to
pulmonary oedema.
Pulmonary Edema
 interferes with oxygen-carbon
dioxide exchange because fluid
coats the alveolar spaces.
a. If pulmonary capillaries rupture
under the pressure, small amounts of
blood leak into the alveoli.
Signs and Symptoms
Productive cough of blood-speckled
sputum
Risks
a. Spontaneous miscarriage – because
oxygen is limited
b. Preterm labor
c. Maternal death – as oxygen
saturation of the blood decreases
from dysfuction of the alveoli,
chemoreceptors stimulate the
respiratory center to increase RR.
Signs and Symptoms
 With rest – increased fatigue
 Weaknesses
 Dizziness – lack of oxygen in the
brain
 HR increases
 Peripheral constriction occurs in an
attempt to increase the systemic BP
 Pulmonary edema – orthopneic
 Paroxysmal nocturnal dyspnea –
suddenly waking at night with
shortness of breath occurs because
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
heart action is more effective when
she is at rest
Medication
 Antihypertensives – to control
increased BP
 Diuretics – to reduce blood volume
 Beta blockers – to improve
ventricular filling
 Diet: low sodium diet
 Medical management-serial UTZ and
non stress test after 30 – 32 weeks of
pregnancy and monitor FHR.
 Surgical Management - Balloon
valve angioplasty to loosen mitral
valve adhesions If an anticoagulant
is required, heparin is the drug of
choice – it does not cross the
placenta.
2. Woman with Right Sided Heart Failure
Causes
 Congenital heart defects –
pulmonary valve stenosis and atrial
and ventricular septal defects
Occurs when the output of the right
ventricle is less than the blood
volume received by the right atrium
from the vena cava.
 Back pressure from this results in
congestion of the systemic venous
circulation and decreased cardiac
output to the lungs
 Blood pressure decreases in the
aorta because less blood is reaching
it.
 Pressure is high in the vena cava,
both jugular distention and
increased portal circulation occur
Signs and Symptoms
 Liver and spleen distended – leading
to dyspnea and pain in pregnant
woman because the enlarged liver,
as it pressed upward by the
enlarged uterus, puts extreme
pressure on the diaphragm
 Ascites – distention of abdominal
vessels can lead to exudates of fluid
from the vessels into the peritoneal
cavity.
 Peripheral edema – fluid also moves
from the systemic circulation into
lower extremity intersttial spaces.
 Eisenmenger Syndrome – the
congenital anomaly most apt to
cause the right sided heart failure in
women of reproductive age
Management
 Oxygen administration
 Frequent arterial blood assessment
to ensure fetal growth
 During labor – pulmonary artery
catheter to monitor pulmonary
pressure.
 Close monitoring to minimize the risk
of hypotension after epidural
anesthesia.
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
Hematologic Disorders and Pregnancy
 Involves either blood formation or
coagulation disorder
1. Anemia and Pregnancy
 because the blood volume expands
during pregnancy slightly ahead of
the red cell
count, most women have a
pseudoanemia of early pregnancy.
This condition is normal
and should not be confused with
true types of anemia
 True anemia – woman’s hemoglobin
(hgb) concentration is less than 11
g/dL (hematocrit:hct < 33%) during
thr first and third trimester of
pregnancy IV. * when hgb
concentration is < 10.5 g/dL
(hematocrit < 32%) during the
second trimester
2. A Woman with Iron-Deficiency
Anemia
 most common anemia of pregnancy
Causes
 diet low in iron- low socio economic
status
 heavy menstrual flow
 unwise weight –reducing programs
 getting pregnant less than 2 years
before the current pregnancy
 pica
 Iron is made available in the body by
absorption from the duodenum into
the bloodstream after it has been
ingested
 In the bloodstream it is bound for
transport to the liver, spleen and
bone marrow.
 At this site, it is incorporated into
hemoglobin or stored as ferritin.
SIGNS AND SYMPTOMS:
 Extreme fatigue and poor exercise
tolerance
o Reason: woman cannot transport
oxygen effectively
 Associated with low birth weight and
preterm birth
o Reason: the body recognizes that
it needs increased nutrients, some
women with this condition
develop pica
Management for Anemia and Iron-
Deficiency Anemia
1. Intake of prescribed prenatal
vitamins containing 27 mg of iron as
prophylactic therapy during
pregnancy
2. Advise woman to eat diet high in
iron and vitamins: green leafy
vegetables, meat and legumes
3. Ferrous Sulfate or Ferrous Gluconate-
120-200 mg elemental iron per day
4. Advise woman to take orange juice
or a vitamin c – Reason: iron is
absorbed in an acid medium
 Result: New red blood cells should
begin to increase almost
immediately or reticulocyte count
should rise from 0.5% and 1.5% to 3%
and 4% by two weeks
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
 Possible Effects:
o Constipation – high fiber diet,
increase fluid intake 6-8 glasses per
day
o Gastric irritation – take oral tablet
with full stomach
o Turning stools black in color-advice
woman that this is normal
o If iron deficiency is severe and
woman has difficulty in taking oral
tablet, Intravenous iron can be
prescribed.
3. A Woman with Folic Acid-Deficiency
Anemia
 Folic- acid or folate or folacin
IMPORTANCE
 one of the B vitamins which is
necessary for the normal formation
of red blood cells in the woman
 Helps in preventing neural tube and
abdominal wall defects in the fetus
Common among
 Multiple pregnancies- increased
fetal demands
 Women with secondary hemolytic
illness, due to rapid destruction and
production of new red blood cells
 Women taking hydantoin, an
anticonvulsant agent that interferes
with folate absorption
 Women who have poor gastric
absorption
Megaloblastic anemia
 enlarged red blood cells – type of
anemia that develops Because of
the size of the cells, the mean
corpuscular volume will be elevated
in contrast to the lowered level seen
with iron-deficiency anemia
Management
 All women expecting to become
pregnant should begin to take 400
ug folic acid daily plus eating folate
foods such as: green leafy
vegetables, oranges, dried beans)
4. A Woman with Sickle-Cell Anemia
 Sickle-Cell Anemia is a recessively
inherited hemolytic anemia caused
by an abnormal amino acid in the
beta chain of haemoglobin
 If the abnormal amino acid replaces
the amino acid valine, sickling
hemoglobin results
 If it is substituted for the amino acid
lysine, nonsickling hemoglobin results.
 An individual who is heterozygous
(with only one gene in which the
abnormal substitution has occurred,
has the sickle cell trait
 If the person is homozygous (with two
genes in which substitution has
occurred, sickle cell disease results
 With the disease, the majority of RBC
are irregular or sickle shaped, so they
cannot carry as much hemoglobin
as normally shaped RBC can.
 When oxygen tension becomes
reduced, as occurs at high altitudes,
or blood becomes more viscid than
usual, like in dehydration, the cells
clump together because of their
irregular shape, resulting in vessel
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
blockage with reduced blood flow
to the organs
 The cells will hemolyze, (destroyed),
reducing the number available and
causing severe anemia
 Races usually affected: Blacks has
the the sickle-cell trait or carries a
recessive gene for S hemoglobin but
asymptomatic
 Effects on pregnancy: blockage to
the placental circulation can directly
compromise the fetus causing low
birth weight and possibly fetal death
Assessment:
1. Screening at the first pre-natal visit:
hemoglobin analysis. Women with
the condition – hemoglobin: 6-8
mg/100 ml
2. Urinalysis- due to vascular stasis,
women are prone to bacteriuria
3. Monitor a woman’s nutritional intake-
if sufficient folic acid is consumed.
4. Ensure woman is drinking at least 8
glasses of fluid daily to
preventndehydration.
5. Assess lower extremities for
varicosities which can lead to red
cell destructions
6. Monitor fetal health by an ultrasound
examination at 16-24 weeks to assess
for intrauterine fetal growth.
THERAPEUTIC MANAGEMENT:
1. Periodic exchange or blood
transfusions throughout pregnancy
to replace sickled cells with non
sickled cells- serves as a secondary
purpose of removing a quantity of
the increased bilirubin resulting from
the breakdown of RBCas well as
restoring the hemoglobin level.
2. If crisis occurs, controlling pain,
administering oxygen and increasing
the fluid volume of the circulatory
system to lower viscosity
3. If with infection- hospitalization
4. If fetus is mature, the time and
method of delivery are considered
a. keep the woman well hydrated
during labor and delivery
b. epidural anesthesia is the method of
choice
 During post partal period: early
ambulation, and wearing pressure
stockings or IPC boots can help
reduce the risk of thromboembolism
from stasis in lower extremities
Parents are generally interested in
determining the condition of the infant.
 The condition is recessively inherited,
if one of the parents has the disease
and the other is free, the chance the
child will inherit the disease is zero.
 If the woman has the disease and
her partner has the trait, the chance
the child will inherit the disease is 50%
 If both parents has the disease, all
their children will have also have the
disease.
5. The Woman with Thalassemia
 Thalassemia are a group of
autosomal recessively inherited
blood disorders that lead to poor
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2
hemoglobin formation and severe
anemia.
 Most common in Mediterranean,
African and Asian populations.
 Symptoms first appear in childhood
 Treatment: combating anemia
through folic acid supplementation
and sometimes, blood transfusion to
infuse hemoglobin-rich RBC
 Women with the condition usually do
not take iron supplementation during
pregnancy because they could
receive an iron overload because
iron is infused with blood transfusions.
Coagulation Disorders and Pregnancy
 Most coagulation disorders are sex
linked or occur only in males and so
have little effect on pregnancies
1. Von Willebrand disease- a
coagulation disorder inherited as an
autosomal dominant trait and
occurs in women.
a. Women have normal platelet counts
but bleeding time is prolonged
b. Levels of factor VIII-related antigen
(VIII-R) and factor VIII coagulations
activity (VIII-C) are both reduced.
c. Since childhood, woman with the
disorder might have menorrhagia or
frequent episodes of epistaxis
d. Cannot diagnose immediately if not
severe, until the woman got
pregnant and experiences a
spontaneous miscarriage or
postpartum hemorrhage.
Management
 Replacement of the missing factors
by blood transfusion of
cryoprecipitate or fresh frozen
plasma before labor to prevent
excessive bleeding with birth.
2. Hemophilia B (Christmas Disease)
a. Factor IX deficiency, is a sex linked
disorder
b. Occur only in males
c. Females are carriers and may have
a reduced level of factor IX (only
33% of normal) that results to
hemorrhage with labor, or a
spontaneous miscarriage.
d. Carriers of the disorder should be
identified before pregnancy
Management
 Restoration of factor IX by infusion of
factor IX concentrate or frsh frozen
plasma.
 Maternal serum analysis can be used
to detect whether a fetus has a
coagulation disorder during
pregnancy.
3. Idiopathic Thrombocytopenic
Purpura (ITP)
 A decreased number of platelets is
not inherited
 Can occur at anytime in life and can
occur during pregnancy
 Cause is unknown
 Symptoms usually occur shortly after
a viral invasion such as an upper
respiratory tract infection
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
 It is assumed to be an autoimmune
reaction (an antiplatelet antibody
that destroys platelets is apparently
released)
 Laboratory analysis reveal a marked
thrombocytopenia-platelet count is
as low as 20,000/mm3 from a usual
count of 150,000/mm3
 If adequate number of platelet, the
woman is prone to frequent
nosebleeds and minute petechiae
or large ecchymosis appear on her
body.
Renal and urinary Disorders and
Pregnancy
1. A Woman with Urinary Tract Infection
 Caused by Escherichia coli from an
ascending infection.
 Can also be a descending infection
– can begin in the kidneys from the
filtration of organisms present from
other body infections.
 If caused by Streptococcus B –
indicates the woman has an
extensive infection
Assessment
 Based on signs and symptoms
 Pain on urination
 In case of Pyelonephritis – woman
develops pain in the lumbar region
usually on the right side that radiates
downward
o area is tendered upon palpation
o nausea and vomiting
o malaise
o frequency of urination
o temperature – 103 – 104 degrees F
Diagnosis
 urine culture – reveal over 100,000
organnisms per milliliter of urine
Therapeutic Management
 Clean catch urine
 Culture and Sensitivity (C & S) – to
determine what antibiotic needs to
be prescribed.
 Examples: Amoxicillin, Ampicillin and
Cephalosporins – safe antibiotics
during pregnancy
 Sulfonamides – can be used early in
pregnancynut not near term
because they interfere with protein
binding of bilirubin, which can lead
to hyperbilirubinemia in newborn
 Tetracyclines are contraindicated in
pregnancy – can cause retardation
of bone growth and staining of the
fetal teeth
Precautionary Measures
 Voiding frequently at least every two
hours
 Wiping from front to back after
bowel movement
 Wearing cotton, non synthetic fiber
underwear
 Voiding immediately after sexual
intercourse
 Drinking an increased amount of
fluid to flush out the infection from
the urinary tract – up to 3 – 4L/24H
 MATERNAL LEC
CARE OF MOTHER AND CHILD AT RISK /WEEK 2
Other Measures
 Knee chest position for 15 minutes
morning and evening – the weight of
the uterus is shifted forward,
releasing the pressure on the uterus
and allowing urine to drain more
freely.
 If with Pyelomephritis – hospitalized
for 24H – 48H then place on home
care and treated with IV antibiotics
 after this episode – maintained on a
drug such as Oral Nitrofurantoin
(Macrodanti) for the remainder of
the pregnancy
 Acidifying the urine by the use of
Ascorbic Acid (Vit. C) which is often
recommended in non pregnancy
women
 Not recommended during
pregnancy because the newborn
can develop scurvy in the
immediate neonatal period
 After birth – IVP scheduled to help
detect any urinary tract abnormality
that might be
Present.
2. A Woman with Chronic Renal
Disease
 before, women with this chronic
renal disease did not reach
childbearing age or were advised
not to have children because of
their automatic high-risk status during
pregnancy.
 Corticosteroid (prednisone) – infant
 Today, with conscientious prenatal
care, women with this condition,
who have had renal transplants can
expect to have healthy pregnancies
and healthy children
o Pregnancy increases the workload
of the kidneys because they must
excrete waste products not only for
the woman but also for the fetus for
40 weeks
o Can cause severe anemia on
women because their diseased
kidneys do not produce
erythropoietin, a glycoprotein
necessary for red cell formation
and so, they may develop a severe
anemia.
o The glomerular filtration rate are
normally increases during
pregnancy, the woman is able to
clear waste products from her
body for both herself and the fetus
with such efficiency that her serum
creatinine is slightly below normal
during pregnancy
o normal creatinine level – 0.7 mg
per 100 ml of blood during
pregnancy – 0.5 mg per 100 ml of
blood.
o if more than 2.0 mg/dL – advise the
woman not to get pregnant
because it can lead to kidney
failurethere is a possibility of
glucose and protein in the urine
durin pregnancy because of
increased glomerular permeability
Treatment
may be hyperglycemic at birth
because of the suppression of insulin
activity by corticosteroid
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
 Dialysis - to aid kidney function
Respiratory Disorders and Pregnancy
1. A Woman with Influenza
 Caused by a virus identified as type
A,B, or C
 Associated with preterm labor and
spontaneous miscarriage
Signs and Symptoms
 Increased temperature
 Sore throat
Treatment
 Antipyretic (Acetaminophen/Tylenol)
– to control fever
 Oseltamivir (Taminflu)
 Woman may be immunized against
influenza
2. A Woman with Pneumonia
 Bacteria or viral infection of lung
tissue by pathogens such as
Streptococcus pneumoniae,
Hemophilus influenzae and
Mycoplasma pneumonia
 after invasion, an acute
inflammatory response occurs in the
lung alveoli causing an exudate of
RBC, fibrin and polymorphonuclear
leukocytes to flood into the alveoli.
 this process has a helpful effect of
confining the bacteria or virus within
the segments of the lobes of the
lungs but it has a less helpful effect of
filling alveoli with fluid, blocking off
breathing space.
 If the collection of fluid becomes
extreme, it can limit the oxygen
available not only for the woman but
also for the fetus
 Associated with preterm labor due
to oxygen deficit
Treatment
 Antibiotic and oxygen administration
3. A woman with Asthma
 Marked by reversible airflow
obstruction, airway hyperactivity and
airway inflammation.
 Triggered by an irritant such as an
inhaled allergen (pollen, dust or
cigarette smoke)
o with inhalation of these allergen,
there is a release of bioactive
mediators such as histamine and
leukotrienes from an
immunoglobulin interaction.
o this results in constriction of the
bronchial smooth muscle
 Has the potential to reduce oxygen
supply in the fetus
o there is an immediate release of
histamine and leukotienes from an
IgE; immunoglobulin interaction –
leading to constriction of the
bronchial smooth muscle Is improved
during pregnancy because of high
levels of corticosteroid.
Signs and Symptoms
 Marked mucosal, inflammation and
swelling
 Production of thick bronchial
secretions
 Difficulty with air exchange
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
 High pitched whistling sound
(bronchial wheezing)
 if ineffective, inhaled glucocorticoid
such as Beclomethasone
(Beclovent/Vancrenase) or
fluticasone ( Flovent), an oral
corticosteroid such as prednisone or
a mast cell stabilizer such as Intal
may be added to the regimen
4. A Woman with Tuberculosis
 Caused by Mycobacterium
Tuberculosis – an acid fast bacilus
Assessment
 PDD test
 Follow up CXR with (+) reactions –
abdomen should be covered
Signs and Symptoms
 Chronic cough
 Weight loss
 Hemoptysis
 Night sweats
 Low grade fever
 Chronic fatigue
Treatment
 Izoniazid (INH) – result in peripheral
neuritis in women if doesn’t take
Pyridoxine (Vit B12)
 Ethambutol Hydrochloride (
Myambutol(
o no teratogenic affect
o main cause optic nerve
involvement : atrophy and loss of
green color recognition
o To detect, test woman with
Snellen test
o If symptoms continue, discontinue
the drug
o Take Calcium – to ensure
tuberculosis pockets forms are not
broken down.
o Wait for 1-2 years after the
infection becomes inactive
before attempting to conceive
because recent inactive
tuberculosis can become active
during pregnancy.
o Although tuberculosis can be
spread by the placenta to the
fetus, it usually spread to the
infant after birth.
o If with history of tuberculosis, 3
negative sputum culture before
she holds or cares for her infant.
o If negative, no need to isolate the
infant to the mother .
o If active TB is in the home, the
infant is discharge prophylactic
INH to preventing infection, with
follow up skin testing at 3 months
intervals.
o If infant is to be placed on INH, a
mother taking INH should not
breastfeed or it might be toxic to
the infant.
Rheumatic Disorders and Pregnancy
1. Woman with Systemic Lupus
Eryrhematosus (SLE)
 Is a multisystem chronic disease of
the connective tissue that can occur
in women of childbearing age.
 Widespread degeneration of
connective tissue ( heart, kidneys,
blood vessels, spleen, skin and
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
retroperitoneal tissue) occurs with
onset of the illness
Signs and Symptoms
 Marked skin change is a
characteristic erythematous butterfly
– shaped rash on the face
 Kidneys - fibrin deposits plugging
and blocking the glomeruli and
leading to necrosis and scarring
 Blood vessels – thickening of
collagen tissue cause vessel
obstruction
 Life threatening to the woman if
blood flow to vital organs is
obstructed and also to the fetus.
 Woman with SLE
havenantiphospholipid antibodies,
which increases the tendency for
thrombi to form.
Treatment
 Corticosteroid
 NSAID
 Heparin
 Salicylates
 To decrease symptoms
 The naturally increased circulation of
corticosteroid during pregnancy
may lessen symptoms in some
women
Complications
 Acute nephritis with glomerular
destruction
 Increased BP
 Develop hematuria and decreased
urine output
 PIH – no hematuria
 Diagnosis: frequent creatinine
assessment – to assess kidney
function.
Gastrointestinal Disorders and
Pregnancy
1. A Woman with Appendicitis
 inflammation of the appendix
Assessment
 Begins with few hours of nausea
 After 1-2H – generalized abdominal
discomfort
 Vomiting
 Typical sharp, peristaltic, lower right
quadrant pain
 If overstretched ligament pain –
morning sickness pain is diffuse or
sharp
 Non pregnant woman – the sharp
localized pain appears at the
McBurney’s point (a point halfway
between the umbilicus and the iliac
crest on the lower right abdomen.
 Pregnant woman – the appendix is
often displaced so far up in the
abdomen that it resembles the pain
of gallbladder disease
 CBC – leukocytosis; normal for non
pregnant woman to have elevated
WBC
 Increased temperature
 Ketones in the urine
Diagnosis
 Ultrasound
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2

Management Diagnosis

 Advise the woman not to take any  ultrtasound

food, liquid or laxative – increased
Management
peristalsis tends to cause an inflamed
appendix to rupture  Intake but not free fat diet during
 If 36 weeks – pregnant – C/S and pregnancy because of the
removed the appendix importance of linoleic acid for fetal
 If early pregnancy – laparoscopy grow
 If appendix ruptured before surgery –  If acute episode – IVF to provide fluid
risk for both mother and fetus and nutrients and analgesics for pain
 with ruptured appendix – infected  Surgical removal of gallstone –
materials are free in the peritoneum laparoscopic technique
and can spread by the fallopian
tubes to the fetus 3. A Woman with Hepatitis
 liver disease that may occur from
Complications
invasion of A, B, C, D and E virus
 Peritonitis
Hepa A
 Infertility
 Fecal – oral contact (children in day
2. A Woman with Cholecystitis and care settings)
Cholelithiasis  Fecally contaminated H20 or shellfish
 Cholecystitis – gallbladder after an incubation period of 2-3
inflammation and Cholelithiasis – weeks
gallbladder formation; gallstones are  Woman may be given prophylactic
formed from cholesterol gamma globulin to prevent the
Predisposing Factors disease and exposure
 Not known to be transmitted to fetus
 Age
 Obesity Hepa B and C
 Multiparity  Exposure to contaminated blood or
 High fat diet blood products
 Can be spread by contact with
Signs and Symptoms
contaminated semen or vaginal
 Constant aching and pressure in the secretions
right epigastrium  Considered as STD
 Jaundice  Incubation period – 6 weeks to 6 mos
- Hepa B
 Can lead to liver cirrhosis
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
 Hepa C – may demonstrate
symptoms for 12 mos
Treatment
 Immune globulin for prophylaxis
Assessment
 all forms of Hepatitis
 Nausea and vomiting
 Liver may feel tender to palpation
 Urine is light – colored from lack of
bilirubin
 Jaundice – late symptom
 Physical examination -
hepatomagaly (enlargement of the
liver)
 Bilirubin level increased
 Specific antibodies against the virus
can be detected in the blood serum
Management
 Bed rest
 Increased caloric diet
Standard precaution
 After birth – the infant should be
washed well to remove any
maternal blood and hepa B immune
globulin ( HBIg) and immunization
against Hepa B should be
administered.
 Advise woman not to breastfeed
because HBAg antigens can be
removed from bowel movement
Complications
 Lead to spontaneous miscarriage or
preterm labor
 Later in pregnancy – the mother
contracts Hepa B, the greater the risk
the infant will be affected or
develop Hepa B
Neurologic Disorders and Pregnancy
1. Myasthenia Gravis
 An autoimmune disorder
characterized by the presence of
IgG antibody against actylcholine
receptors in striated muscle.
 Causes failure of the striated muscles
to contract, particularly of the
oropharyngeal, facila and
extraocular groups
 Occurs usually at 20-30 year olds
Treatment and Management
a. Medications
 Anticholinesterase drugs such as:
pyridostigmine (Mestinon) or
neostigmine (Prostigmin)and
corticosteroid such as prednisone
 May be continued during
pregnancy as the fetus will
experienced no effects from them
 Antropine – lifesaving antidote for
neostigmine if an overdose should
occur
b. Plasmapheresis-removal of and
replacement of plasma/to remove
immune complexes from the
bloodstream.
 Smooth muscle is not affected by
the disease, labor should occur
without complications.
 Magnesium Sulfate – to halt preterm
labor or treat hypertension of
pregnancy should be avoided
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
because it can diminish the
acetycholine effect and increase
symptoms.
 An infant born to a woman with the
disease may show symptoms at birth
because of the transfer of
antibodies.
2. A Woman with Multiple Sclerosis
 Nerve fibers become demyelinated
and therefore lose functions
Signs and Symptoms
 Fatigue
 Numbness
 Blurred vision
 Loss of ccordination
Treatment and Management
a. Medication
 ACTH (adrenocorticotropic
hormone) or corticosteroid- to
strengthen nerve conduction and
both can be administered safely
during pregnancy
 Immunosuppresans such as
cyclosporine (Sandimmune),
azathioprine (Imuran), and
cyclophosphamide (Cytoxan) which
are usually prescribed should be
used with caution during pregnancy
b. Plasmapheresis
Muskuloskeletal Disorders and
Pregnancy
1. A Woman with Scoliosis
 Lateral curvature of the spine
 Most common among girls between
12 and 14 years of age
 If not corrected at this time, the
curvature progresses until it can
interfere with respiration
and heart action because of chest
compression.
 If a woman’s spine is extremely
curved, epidural anesthesia may be
difficult to administer for pain
management in labor
Management
 Preventive Measures
 Girls can wear body brace during
their adolescent years to maintain
an erect posture.
Surgical management
 Stainless steel rods implanted on
both sides of the vertebrae to
strengthen and straighten
the spine.
 Rods do not interfere with
pregnancy.
Side Effects
 woman may have have more than
usual back pain from increased
tension on back muscles.
 If woman’s pelvis is distorted, a
caesarean birth may be scheduled
to ensure a safe birth.
 If vaginal birth, the same
management is applied
 Cephalopelvic disproportion can be
recognized during the first stage of
labor
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
Endocrine Disorders and Pregnancy
1. A Woman with Hypothyroidism
 Underproduction of the thyroid
hormone is a rare condition in late
adolescents and especially rare in
pregnancy because women with
symptoms of untreated
hypothyroidism are often an
ovulatory and unable to conceive.
Signs and Symptoms
 Woman who conceive have
difficulty increasing thyroid function
to a necessary pregnancy level
which can lead to spontaneous
miscarriage
 Fatigue easily
 Tend to be obese
 Skin is dry (myxedema)
 Have little tolerance to cold
 Hyperemesis gravidarum
Management and Treatment
a. Medication
 levothyroxine (Synthroid)-to
supplement lack of thyroid hormone
 advice woman who is taking this
medication and planning to
conceive to consult her doctor tobe
certain her dose will be high enough
to maintain a pregnancy
o Rule -dose of the medication will
need to be increased as much as
20% to 30% for the duration of
pregnancy to stimulate the
increase that would normally
occur in pregnancy.
o Caution - take the medication at
a different time from any
medication containing iron,
calcium or any soy product by
about 4 Hours to be certain there
is no problem with the absorption
of the drug
 After pregnancy, medication should
be tapered back to the
prepregnancy level for both her
health and so she can breastfeed
safely
2. A Woman with Hyperthyroidism
 Overproduction of thyroid hormone
Signs and Symptoms
 Rapid heart rate
 Exopthalmia-protruding eyeballs
 Heat intolerance
 Heart palpitations
 Weight loss
 Graves disease- (overactive thyroid)
seen mostly in pregnancy than in
hypothyroidism
 If undiagnosed, woman may
develop heart failure due to her
heart already stresses, cannot
manage the increasing blood
volume that occurs during
pregnancy.
 More prone to have gestational
diabetes, fetal growth restriction and
pre-term labor
Diagnosis
 Using nuclear medicine imaging
study involving radioactive uptake of
I subtype
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2
 Should not be used during
pregnancy because the fetal thyroid
would also incorporate this drug,
resulting in destruction of the fetal
thyroid
Treatment
 Thioamides (methimazole) or
propythiouracil (PTUI)- reduce
thyroid activity cross the placenta
and can lead to congenital
hypothyroidism and enlarged thyroid
gland(goiter) in the fetus.
 women should be regulated on the
lowest possible dose and advice to
keep a record of doses taken so as
not to forget or unintentionally
duplicate a dose.
 Methimazole –drug of choice for
pregnant women
 If hyperthyroidism is not regulated
during pregnancy, an infant may be
born with symptoms of
hyperthyroidism because of the
excess stimulation he or she receives
in utero.
Signs and Symptoms among Newborn
 Jittery with tachypnea and
tachycardia
 Diagnosis - an assay of fetal cord
blood will reveal the level of
thyroxine (T4) and thyroid-stimulating
hormone and the need for therapy
in the infant.
 Women who are taking minimal
doses of antithyroid drugs may
breastfeed, if large dose, do not
breastfeed because they are
excreted in breast milk.
 If woman desires other children,
surgical treatment can be suggested
to reduce the functioning of the
maternal thyroid gland.
3. A Woman with Diabetes Mellitus
 Is an endocrine disorder in which the
pancreas cannot produce
adequate insulin to regulate body
glucose level
Classification
a. Type 1 Diabtetes Mellitus- a disorder
that involves an absolute or relatively
deficiency of insulin.
 results from immunologic damage to
islet cells in susceptible individuals
 If one child in the family has
diabetes, sibling will also develop the
illness
Disease Process
 Pancreas produce plenty of insulin (
the hormone responsible for
“unlocking” cells so that glucose can
enter them and provide energy), but
a condition known as insulin
resistance prevents them from using
it effectively. When insulin doesn’t
work properly, blood glucose or
blood sugar builds up in the
bloodstream and gestational
diabetes is the result.
From HYPERGLYCEMIA
 If kidneys detect this, it will excrete
excess glucose into the urine
 Gycosuria
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2

 Polyuria taken for glucose determination 60

 Polydipsia minutes after.
 The body still needs source of  If the result is more than 140mg/dL,
energy, it will break down protein patient is scheduled for a 100g 3-H
and fat fasting glucose tolerance test
 Weight loss and ketone bodies (the  If two of the four blood samples
acid end product of fat breakdown) collected are abnormal or the
 High serum cholesterol and fasting value is above 95mg/dL, a
ketoacidosis diagnosis of diabetes can be made.
 Potassium and Phosphate
Fetal Monitoring After Diagnosis of GD:
attempting to serve as buffers, pass
from body cells 1. Non Stress Test – or periodic
into the bloodstream ultrasound around 32 weeks to
Assessment check for the bay’s well being
 Also called as biophysical profile
a. among children  The test measures the baby’s fetal
heart rate, both at rest and during
 increased thirst
movement, by attaching a monitor
 increased urination to the mother’s abdomen.

Monitoring is done for 20 to 30
 dehydration that can also cause minutes, noting any fetal distress.
constipation
 If the baby is getting too big – insulin
Among pregnant women will be started

 Increased thirst Maternal Effects

 Increased appetite
 Hypoglycemia – during the first
 Unusual fatigue trimester
 Frequent Urination
 Hyperglycemia – during the third
Assessment thru Laboratory Studies trimester
 Frequent infection
1. Random plasma glucose level  ➢Moniliasis
greater than 200mg/dL  ➢Polyhaydramnios
 Normal range: 70 to 110 mg/dL  Dystocia
fasting: 90 to 180 mg/dL not fasting
2. Glucose Screening test – between Fetal Effects
24 to 48 weeks; may be repeated at
 Hypoglycemia
32 weeks if obese or over age 40
 Hyperglycemia
 After the oral 50g glucose load is
 Macrosomi
ingested, a venous blood sample is
 Preterm Birth
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CARE OF MOTHER AND CHILD AT RISK /WEEK 2

New Born Effects

b. Type 2 Diabetes
 The causes of type 2 diabetes are  Infants born to a Diabetic Mother
 Hypoglycemia (due to
obesity, diet, life styles, smoking,
alcohol consuming, stress etc. overproduction of insulin while still
inside the uterus and still present at
General Management birth), After delivery, the infant no
longer has excess blood glucose
 Depends on how serious the
from the mother, but may still have
condition is. high levels of circulating insulin
 Glucose monitoring – home glucose
 Hyperinsulination
meter or strips
o normal blood glucose level –70 to Signs and Symptoms
110 mg/dL fasting: 90 to 180
 shrill, high pitch cry
mg/dL not fasting
 Balanced Diet – based on height,  Tremors
 Hypocalcemia – less than 7 mg/dL
weight and activity level; must have
the correct balance of protein, fats  Hypocalcemia also may be
apparent in the first few hours after
and carbohydrates, proper vitamins,
minerals and calories. birth; symptoms may include
jitteriness or seizure activity.
 Moderate exercise – walking and
swimming; but is not advisable for Hypocalcemia (levels <7 mg/dL) is
believed to be associated with a
everyone
delay in parathyroid hormone
 Insulin therapy – if cannot be
controlled with diet and exercise synthesis after birth.
 Calcemia Tetany – Mgt: Calcium
Effects of Gestational Diabetes to the Gluconate
Fetus
Diagnosis
 With ↑ glucose in the blood stream of
the mother  Heel Stick Test – to check for glucose
level
 fetal macrosomia (glucose tend to
cross the placenta and enter the
bloodstream of the fetus)
 Fetus will produce more insulin (to
lower its own sugar level)
 Fetus will convert the extra sugar into
fat stores
 Additional fat stores→ extra weight
gain of the fetus