NURSING CARE

MANAGEMENT 109
Care for the Mother and Child at risk
(Acute and Chronic)

Sharmaine
S. Pero, RN
Clinical
Instructor
Let’s
review
 MODULE 1
LESSON 2 WEEK 2

Hypereme
sis
Gravidaru
Nausea and vomiting is a common condition of pregnancy that
affects 70% to 85% of pregnant women and usually resolves by
the 16th week of gestation.
Hyperemesis gravidarum represents the extreme end of the
nausea/vomiting spectrum in terms of severity.

Hyperemesis gravidarum is the most common indication for

admission to the hospital during the first part of pregnancy and
is second only to preterm labor as the most common reason for
hospitalization during pregnancy (ACOG, 2004a; Hunter, Sullivan,
Young, & Weber, 2007).
 RISK FACTORS : generally unknown but;
Hyperemesis gravidarum may be related to the elevated
levels of estrogen or hCG. Or, it may be associated with
the transient elevation of thyroid hormone during
pregnancy.
✔ increased placental mass associated with multiple gestation
and molar pregnancy;
✔ a history of hyperemesis gravidarum in a previous pregnancy;
✔ a history of motion sickness or migraine headaches;
✔ pregnant with a female child is also considered to be at risk
(ACOG, 2004a).
 Maternal Effects

Serious complications of hyperemesis gravidarum for the

woman and fetus arise in the group of women who cannot
maintain their weight despite antiemetic therapy. In addition to
increased hospital admissions, some women experience
psychosocial morbidity of such significance that they feel
compelled to terminate the pregnancy. Depression,
somatization (the conversion of mental experiences into
physical symptoms), and hypochondriasis can also be a
problem for some women (ACOG, 2004a)

Fetal Effects
❑ fetal intrauterine growth restriction (IUGR)
 Diagnosis and
management
DIAGNOSIS
Criteria for the diagnosis of hyperemesis gravidarum include persistent
vomiting unrelated to other causes, a measure of acute starvation
(usually large ketonuria), and some discrete weight loss, most often 5%
of the pre-pregnancy weight.
MANAGEMENT
✔ Advised to regularly take multivitamins before the next conception
✔ Rest
✔ avoid foods and sensory stimuli that provoke symptoms
✔ eat small frequent meals of dry, bland foods and include
high-protein snacks in their diet.
✔ Avoid spicy foods.
✔ Eating crackers before arising in the morning may be of benefi t
and ginger capsules have been shown to be effective.
Placen
ta
Previa
NORMAL PLACEMENT OF
THE PLACENTA
Placenta previa is an implantation of the placenta in the
lower uterine segment, near or over the internal cervical
OS. This condition accounts for 20% of all antepartal
hemorrhages.
Three variations

Complete/ Total Placenta Previa - the placenta

covers the entire cervical os. Since it is associated
with the greatest amount of blood loss, a complete
placenta previa presents the most serious risk.
Three variations

Partial Placenta Previa -

describes a placenta that
partially occludes the cervical
os.
Three variations

Marginal Previa - is characterized by

the encroachment of the placenta to
the margin of the cervical
 RISK FACTORS : Placenta previa may be associated with
conditions that cause scarring of the uterus such as a prior
cesarean section, multiparity, or increased maternal age.
A previa may also occur with a large placental mass as
seen in multiple gestations and erythroblastosis. Other
risk factors include smoking, cocaine use, a prior history of
placenta previa, closely spaced pregnancies, African or
Asian ethnicity, and maternal age greater than 35 years
 Signs and
symptoms

✔ Painless vaginal bleeding – scant to heavy

 Diagno
sis
Ultrasound between 24-28 weeks AOG
 Nursing
considerations
No vaginal examination.
Bed rest.
Continuous monitoring of the FHT.
Blood typing should be done (for emergency blood
transfusion)
Administration of Betamethasone for premature delivery.
Abrupti
o
Placent
 The premature
separation of a
normally implanted
placenta from the
uterine wall. An
abruption results in
hemorrhage between
the uterine wall and the
placenta.
 Etiolo
gy
At the initial point of placental separation, non-clotted blood
courses from the site of injury. The enlarging collection of blood
may cause further separation of the placenta.
50% - occur before labor and after the 30th week
15% - occur during labor
30% - identified only on inspection of the placenta after
delivery
 A concealed hemorrhage
occurs in 20% of cases and
describes an abruption in which
the bleeding is confined within
the uterine cavity.
The most common abruption is
associated with a revealed or
external hemorrhage, where
the blood dissects downward
toward the cervix
 Classificati
ons
GRADE 1 - Slight vaginal bleeding and some uterine irritability are
usually present. Maternal blood pressure is unaffected and the
maternal fibrinogen level is normal. The fetal heart rate pattern is
normal.

GRADE 2 - External uterine bleeding is absent to moderate. The uterus

is irritable and tetanic or very frequent contractions may be present.
Maternal blood pressure is maintained, but the pulse rate may be
elevated and postural blood volume deficits may be present. The
fibrinogen level may be decreased. The fetal heart rate pattern often
shows signs of fetal compromise.
 Classificati
ons
GRADE 3- Bleeding is moderate to severe but may be
concealed. The uterus is tetanic and painful. Maternal
hypotension is frequently present and fetal death has
occurred. Fibrinogen levels are often reduced or are less than
150 mg/dL; other coagulation abnormalities
(thrombocytopenia, factor depletion) are present.
 Signs and
symptoms
✔ 3rd trimester bleeding associated with abdominal pain
✔ Uterine tenderness
✔ Abdominal/back pain
✔ Board-like abdomen with no vaginal bleeding
✔ Abnormal contractions and increased uterine tone
✔ Fetal decelerations, fetal demise,bradycardia
 Diagno
sis
Diagnosis is made by clinical findings and, when available,
ultrasound examination
Managem
ent
Special
considerations
Questions?
 Purposive
Assignment
By group:

Among the topics discussed choose

one topic and make a
Nursing Care Plan.