Chapter 20:

Nursing Care of a Family

experiencing a pregnancy
complication from a pre-existing
or Newly Acquired Illness

Prepared by: Carmela Joy L. Abril

Renal and Urinary Disorders and
Pregnancy
Respiratory Disorders and
Pregnancy
Rheumatic Disorders and
Pregnancy
Renal and Urinary Disorders and
Pregnancy
Renal Disorders

Urinary tract infection

Chronic renal disease
Acute Renal failure
Pregnancy in renal transplant recipient
Urinary Tract Infection

Asymptomatic bateriuria
Acute cystitis
Acute pyelonephritis
 Acute Cystitis

Incidence
Cystitis complicates 1%of pregnancies

Clinical Features
Urinary frequency, dysturia, haemeturia, and suprapubic
pain

Diagnosis
Significant bacteriuria on MSU
Chronic Renal Disease
Acute Renal Failure
Pregnancy in Renal Transplant
Recipient
RESPIRATORY DISORDERS IN
PREGNANCY
 INVESTIGATIONS IN PREGNANCY

• Ultrasound and MRI do not expose mother or baby to ionising

radiation.
• Chest X-ray is considered to be safe for both the mother and fetus as
the radiation dose is very low
• CT of the chest, also delivers a low amount of radiation to the fetus.
Maternal breast tissue receives a large dose of radiation.
A single CT of the chest is thought to increase the woman's lifetime
risk of breast cancer by as much as 13.6%.
 INVESTIGATIONS IN PREGNANCY

Iodinated contrast medium may theoretically affect fetal or

neonatal thyroid function.

Ventilation–perfusion (V/Q) scanning only exposes the woman to

approximately one-fifth of the radiation dose of a CT.

may be reduced by performing only the perfusion element, adding

in ventilation imaging only if a
perfusion defect is noted
 INVESTIGATIONS CONTINUED

Peak expiratory flow rate: The normal values are dependent on

age, sex and height
but are not influenced by pregnancy.
D-dimers are not useful in pregnancy and should not be performed
• D-dimers increase with gestation, postnatally, and with pre-
eclampsia.
INVESTIGATIONS CONTINUED
 BREATHLESSNESS IN PREGNANCY

50% experience dyspnea before 19/40

75% by 31/40
Related to effect of progesterone on resp. centre
Mechanical factors: weight gain, reduced venous return
Exclude anaemia as this is common
Exam remains normal as does RR and saturation
 PNEUMONIA

Aetiology is similar to the non pregnant population

• Strep Pneumoniae most commonly isolated
• Due to the reduction in cell-mediated immunity pregnant women are
at risk from atypical organisms eg influenza and varicella
All pregnant women offered influenza vaccine
At risk groups offered pneumococcal vaccine
Signs & symptoms the same as non pregnant population
 PNEUMONIA

Investigations as non pregnancy should be performed eg CXR,

bloods, ABG, Blood cultures
Pregnancy increases the risk of complications & need for ICU
admissions
A venous thromboembolism risk assessment should be performed
and thromboprophylaxis initiated if applicable
Increased risk of preterm labour and low birthweight offspring
 TREATMENT

• Admit for initial therapy

• Macrolide in combination with a beta lactam
• Avoid Doxycycline and Levofloxacin
• Should see improvement within 72hrs
• Switch to PO agents once afebrile >24hrs
• Continue PO 14d
• Remember FU CXR
 INFLUENZA

• Diagnosis is made on a clinical basis, although should be confirmed

on viral throat swab
• Often complicated by ARF, ARDS, secondary bacterial infection
• Epidemics generally occur in the winter
• Those at greatest risk of serious infection & death include pregnant
women
• Especially if co morbidities
• MBRRACE Data
 INFLUENZA

• Effects on the Fetus are related to severity of maternal illness

• Mx is largely supportive care and Tx of superimposed infection
• Limited evidence regarding neuromidase inhibitors Zanamivir &
Oseltamivir
• Prevention is the most important measure
 ASTHMA

• 3.7-8.4% of all pregnancies

• 1/3
• reporting an improvement
• experiencing a deterioration
• noticing no change
> improvement after 36/40
• Pregnancy outcomes less favourable if poor control prior and during
pregnancy
 ASTHMA

• In the MBRRACE report on maternal deaths in 2009–2012, 15% of the

women who died were known to have
asthma
• uncontrolled asthma is associated with preterm birth, low
birthweight, perinatal mortality and pre-eclampsia
 MX OF ASTHMA IN PREGNANCY

• Avoid known triggers

• Encourage smoking cessation
• Discuss NSAID sensitivity
• Lifestyle advice regarding GORD
• Immunisation for influenza
• Encourage compliance of medication
• Acute exacerbations are managed as for non pregnant women
• Growth surveillance if poor control
• Steroids intrapartum
• Encourage breastfeeding : reduces the risk of the baby developing
asthma
MEDICATION IS SAFE
 TAKE HOME MESSAGE

• Poorly controlled asthma is associated with increased risk to mother

and child
• Acute asthma should be treated aggressively with all usual
medications
• Drugs are safe and compliance should be strongly promoted with
close monitoring
Pregnancy & Rheumatic Disease
 Rheumatic Disease

Rheumatic diseases often affect women during childbearing

years. With careful medical and obstetric management, most women
living with rheumatic diseases can have successful pregnancies.
However, women should not consider getting pregnant until their
rheumatic disease is under control.
 What Are the Effects of Pregnancy on
Rheumatic Disease?

Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and

antiphospholipid syndrome (APS) typically are modified by pregnancy.
RA symptoms often improve in pregnant patients, frequently resulting
in a reduced need for medication, but they often flare up after
delivery.
Pregnancy in lupus is associated with mild to moderate flares.
However, most of these flares do not endanger the mother's or the
baby's life, nor do they substantially alter the long-term prognosis of
lupus.
Antiphospholipid syndrome (APS) increases the risk of clots in veins
and arteries as well as complications such as miscarriage, premature
birth, or hypertension (high blood pressure) during pregnancy.
Patients with kidney disease have a risk of developing pre-eclampsia.
Because pulmonary hypertension frequently worsens during
pregnancy and postpartum, it is not advised for women with this
condition to become pregnant.

Other diseases such as polymyositis, dermatomyositis, and vasculitis

do not seem to be affected by pregnancy. If a patient does not have
pulmonary hypertension or lung fibrosis, scleroderma does not appear
to be affected by pregnancy either.
Diseases with the potential to affect the kidneys (especially SLE and
APS) are more likely to affect pregnancy than those that do not.
Patients who have or have had kidney disease due to vasculitis,
scleroderma, or lupus have an increased risk of severe hypertension
and pre-eclampsia.
Pregnancy in women with APS should always be considered as high
risk. Women with anti-Ro antibodies should be closely monitored
during pregnancy.
 Use of Rheumatic Medications During
Pregnancy and Lactation

During pregnancy, active rheumatic disease inflammation and

medications used to treat rheumatic disease can cause problems. The
2020 American College of Rheumatology Guideline for the
Management of Reproductive Health in Rheumatic and
Musculoskeletal Diseases is an important resource that can guide
decision making.
 Management of Pregnancy in Women
with Rheumatic Diseases

Each woman’s rheumatic disease should be well under control for at

least three - six months before attempting pregnancy. As long as
medicines are not harmful to the fetus, you should remain on your
medicines to prevent a disease flare.
Women with a low-risk profile should include regular three-month
visits to the rheumatologist, as a precaution. Those with a high-risk
profile should be managed by a medical and obstetric team with
experience in high-risk pregnancies.
 SOURCES

https://www.slideshare.net/ahsanshafiq90/renal-disorders-in-pregnancy
https://rheumatology.org/pregnancy-rheumatic-disease

MBRRACE Report 2016

StratOG
Greentopguideline 37b "thromboembolic disease in pregnancy and the
puerperium, acute Mx"
De SweitMedical disorders in obstetric practice 5th edition
C. Nelson-PiercyHandbook of Obstetric Medicine 4th Edition