MCN LEC | PRELIMS | 2ND SEM

LESSON 1: INTRODUCTION sometimes done intentionally to avoid legal

action
1990s - Trend in MMR
● Every minute, a woman dies in childbirth or from
complications of pregnancy PHILIPPINE MATERNAL MORTALITY RATE 1990-2015
● > 500,000 women die each year; almost all Maternal Mortality Ratio (MMR)
(95%) occur in developing countries ● Number of women who die from pregnancy
● For every woman who dies as many as 30 related causes while pregnant or within 42 days
others suffer chronic illness or disability of pregnancy termination per 100,000 live births.
● Maternal mortality is the health indicator with the ● Philippines maternal mortality rate for 2015 was
most disparity between developed and 114.00, a 2.56% decline from 2014
developing countries ● Philippines maternal mortality rate for 2014was 117.00,
○ The cumulative lifetime risk of dying as a 3.31% decline from 2013
a result of pregnancy is 1:2800 in ● Philippines maternal mortality rate for 2013 was
developed versus 1:16 in developing 121.00, a 3.97% decline from 2012
countries ● Philippines maternal mortality rate for 2012 was
● Maternal mortality trends are unacceptable, but 126.00, a 0.79% decline from 2011
not insurmountable because the major causes
are known and avoidable Lessons learned:
○ Nearly 2/3 of maternal deaths are due to: Most maternal deaths and disabilities would be
■ Hemorrhage averted if...
■ Obstructed labor - All pregnancies are wanted and planned
■ Pregnancy induced - All pregnancies are adequately managed
hypertension throughout its course
■ Sepsis/infection - All births are attended by skilled health
■ Complications of unsafe professionals (ideally facility-based)
abortion - All complications are managed in adequately-
● Interventions can be made available even in staffed and equipped facilities offering emergency
resource-poor settings obstetric care

“Women continue to risk life in order to give life.” Strategies to Reduce Maternal Mortality:
1. Universal access to contraceptive services to reduce
unintended pregnancies
2. Skilled attendance at all births

LESSON 2: GENETIC ASSESSMENT AND

COUNSELING
Genetic Disorders
1987 – Safe Motherhood Initiative ● Disorders that can be passed from one
1990 – World Summit for Children generation to the next
1994 – International Conference on Populations and ● Result from some disorder in gene or
Development chromosome structure
1995 – 4th World Conference on Women
2000 – Millennium Summit/Declaration Genes
2015 – Sustainable Development Goals (SDGs) ● Are basic units of heredity that determine both the
physical and cognitive characteristic of people
Why aim for maternal survival? ● Composed of segments of DNA
1. Moral imperative ● Woven into strands in the nucleus of all body
● The death of a woman during pregnancy or cells to form chromosomes
childbirth is a violation of her rights to life and
health Phenotype
● Governments must promote dignity and equity ● Refers to the person’s outward appearance or the
for women within the health-care system expression of the genes
2. Social implications
● Maternal death or disability can plunge Genotype
families into poverty and deeper despair; ● Refers to the person’s actual gene composition
surviving children esp. those < 5 years old
are at risk of dying since no one will attend Genome
to their needs ● Complete set of genes present
● The loss may reverberate throughout an ● Normal genome – 46XX or 46XY
entire community
MENDELIAN INHERITANCE: DOMINANT AND RECESSIVE
Maternal Death PATTERNS
- The death of a woman while pregnant or within Mendelian inheritance
42 days of termination of pregnancy, ● Discovered and described by Gregor
irrespective of duration and site of the Mendel in 1800’s
pregnancy, from any cause related to or ● A person who has two like genes for a trait – two
aggravated by the pregnancy or its healthy genes for example (one from the mother
management but not accidental or incidental and one from the father) is said to be
causes. HOMOZYGOUS for a trait
● If the genes differ (a healthy gene from the mother
Methodological Issues in Measuring Maternal and an unhealthy gene from the father, or vice
Mortality versa), the person is said to be
1. It is a rare event and therefore its number may HETEROZYGOUS for that trait.
not be large enough to detect statistically
significant changes over time Dominant genes
2. Underreporting – especially if most occur ● Dominant in action when paired with other genes
outside of health facilities (in the absence of ● Visibly expressed
health personnel to report them)
3. Misreporting because of the complicated Recessive genes
definition requiring also its cause and timing OR ● Gene that is not dominant
● Masked and does not show

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MCN LEC | PRELIMS | 2ND SEM
Homozygous dominant
● Individual with two homozygous genes for a dominant
trait
Homozygous recessive
● Individual with two genes for a recessive trait
GENETIC COUNSELLING
Aims of Genetic Counseling:
● To provide accurate information
● To provide reassurance
● To assist individual/couple to make informed choices
● To educate individual/couple about the effects of
genetic disorders
● To offer support
Who may benefit from genetic counselling?
● A couple who has a child with a congenital disorder
or an inborn error of metabolism
● A couple whose close relatives have a child with a
genetic disorder
● Any individual who is known balanced translocation
carrier
● Any individual who has an inborn error of
metabolism or chromosomal disorder
● A consanguineous (closely related) couple
● Any woman older than 35 years of age and any man
older than 45 years of age
● Couples of ethnic backgrounds in which specific
illnesses are known to occur
Assessment for Genetic Disorders
● Careful assessment of the pattern of inheritance
● History
● Physical assessment
● Diagnostic testing
Legal And Ethical Aspects Of Genetic Screening
And Counselling
● Participation by couples or individuals in
genetic screening must be elective
● People desiring genetic screening must sign
an informed consent
● Results must be interpreted
● Results must not be withheld, and given
only to the people directly involved
● After genetic counselling, persons must not
be coerced to have abortion or sterilization
COMMON CHROMOSOMAL DISORDERS RESULTING IN
PHYSICAL OR COGNITIVE DEVELOPMENTAL
DISORDERS
A. TRISOMY 13 SYNDROME (47XY13+ or
47xx13+)
● PATAU Syndrome
● Extra chromosome 13
● Severely cognitively challenged
● Midline disorders: cleft lip and palate, heart disorders,
abnormal genitalia
● Do not survive beyond early childhood
B. TRISOMY 18 SYNDROME (47XY18+ or 47xx18+)
● EDWARDS Syndrome
● Three copies of chromosome 18
● Severely cognitively challenged
● Small for gestational age, low-set ears, small jaw,
congenital heart defects, misshapen fingers and toes,
rounded soles of the feet
● Do not survive beyond infancy

C. CRI-DU-CHAT SYNDROME (46XX5P- or 46XY5P-)

● Missing portion of chromosome 5
● Abnormal cry (sound of a cat)
● Small head, wide-set eyes, downward slant to the
palpebral fissure of the eye, recessed mandible
● Severely cognitively challenged
DIAGNOSTIC TESTING D. TURNER SYNDROME (45XO)
Karyotyping ● GONADAL DYSGENESIS
● Visual presentation of the chromosome pattern of ● One functional chromosome
an individual ● Short in stature
● Specimen: venous blood/cells from buccal ● Small & nonfunctional
membrane ovaries
● Metaphase (stage of mitosis) ● Webbed & short neck/ wide
● Stained, place under microscope and neck folds
photographed ● Congenital anomalies-
coarctation of the aorta,
Maternal serum screening kidney disorders
● Alpha fetoprotein-glycoprotein produced by the ● Severely cognitively
fetal liver challenged
● Peaked in maternal serum between 13th and
32nd week E. KLINEFELTER SYNDROME (47XXY)
● Usually done at the 15th week of pregnancy ● Males with an extra X chromosome
● Elevated level: spinal cord disease ● At puberty, secondary sex characteristics do not
● Decreased: trisomy 21 develop
● Testes remain small & produce ineffective sperm
Chorionic Villi Sampling ● Gynecomastia (Increased breast size)
● Involves retrieval and analysis of ● High risk of male breast cancer
chorionic villi
● Commonly done at 8-10 weeks,earliest at week 5 F. FRAGILE X SYNDROME (46XY23Q)
● Reveals genetic abnormalities like ● Common cause of cognitive challenge in males
Retinoblastoma, myotonic dystrophy, sickle cell ● X-linked disorder – one long arm of an X
anemia, thalassemia chromosome is defective
● Hyperactivity, aggression, autism
Amniocentesis ● Deficits in speech & arithmetic
● Withdrawal of amniotic fluid through the abdominal ● Large head, long face with a high forehead,
wall at 14th-16th week prominent lower jaw, large protruding ears, obese
● Needle is inserted, aspirate 20ml ● After puberty, enlarged testicles may become
evident
Percutaneous Umbilical Blood Sampling ● Fertile & can reproduce
● Removal of blood from fetal umbilical cord at ● Carrier females – may show physical & cognitive
about 17 weeks using amniocentesis technique characteristics

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MCN LEC | PRELIMS | 2ND SEM
G. DOWN SYNDROME (TRISOMY 21) (47XY21+ or
47XX21+)
● Most common chromosomal disorder
● High risk – women more 35 yrs. old
● Nose is broad & flat
● Eyelids have extra fold of tissue at the inner
canthus (epicanthal fold)
● Palpebral fissure (opening between the eyelids)
tends to slant laterally upward
● Iris of the eye have white specks (Brushfield
spots)
● Protruding tongue (due to small oral cavity)
● Back of the head is flat
● Neck is short
● Low set ears
● Poor muscle tone – rag doll appearance
● Short & thick fingers
● Palm of the hand shows peculiar crease (Simian
line) – a single horizontal crease
● IQ less than 20
● Congenital heart disease
● Prone to Upper Respiratory Tract Infection
(URTI), Acute Lymphocytic, Leukemia (ALL)
● Life span is 50-60 years
d. Environmental
● Exposure to Teratogens due to employment
Environmental contaminants at home
● Poor Housing
CARING FOR A WOMAN WHO DEVELOPS A
COMPLICATION OF PREGNANCY:
Assessment
● Provide enough time for a thorough health history.
● Problems such as headache, blurred vision, vaginal
spotting should be discovered and investigated
thoroughly
Common Nursing Diagnosis
● Anxiety related to guarded pregnancy outcome
● Risk for infection related to incomplete
miscarriage
● Deficient knowledge related to signs and
symptoms of possible complications.
● Risk for ineffective tissue perfusion related to
pregnancy-induced hypertension.
● Ineffective role performance related to increasing
level of daily restrictions
● secondary to chronic illness and pregnancy

Implementation
● Interventions for women experiencing a complication
of pregnancy include measures to maintain a number
of different areas.
● Continued healthy fetal growth
● A woman’s and family‘s psychological health
● Continuation of the pregnancy as long as possible

Evaluation
● Client’s BP is maintained within acceptable
parameters
● Couple states they feel able to cope with anxiety
associated with the pregnancy complication
● Clients accurately verbalize crucial signs and
symptoms to report to the health care provider
immediately.

SUDDEN PREGNANCY COMPLICATION

In few women, unexpected deviations or complications
from the normal course of pregnancy happens.
● Bleeding during pregnancy
● Ectopic pregnancy
● Gestational trophoblastic disease
LESSON 3: NURSING CARE OF THE ● Premature cervical dilatation
HIGHRISK PREGNANT CLIENT ● Placenta previa
● Abruptio placenta
High risk pregnancy ● Disseminated intravascular coagulation
- One in which a concurrent disorder, pregnancy related ● Preterm labor
complications or external factor jeopardize the health ● Preterm rupture of membranes
of the woman, the fetus or both ● Pregnancy induced hypertension
● HELLP Syndrome
RISK FACTORS ● Multiple pregnancy
a. Physiological ● Abnormal amniotic fluid volume
b. Sociodemographic ● Isoimmunization
c. Psychological
d. Environmental A. BLEEDING DURING PREGNANCY
- Always a deviation from the normal
a. Physiological
● Concurrent illness SUMMARY OF PRIMARY CAUSES OF BLEEDING
● Malnutrition
● Physically challenged
● Frequent pregnancies

b. Sociodemographic
● Poverty
● Unemployment
● Lack of education
● Age
● Poor access to transportation for care
● Lack of support people

c. Psychological
● Cognitively challenge
● Single / Separated mothers
● Victims of Abuse, domestic violence, rape,
incest
● Mental Retardation

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MCN LEC | PRELIMS | 2ND SEM
A. Abortion
- Medical term for any interruption of a
pregnancy before a fetus is viable

B. Spontaneous miscarriage
- Early miscarriage if it occurs before 16th week
- Late between 16-24 weeks

Causes:
● Teratogenic factor
● Chromosomal aberrations/abnormal fetal
development
● Implantation abnormalities
● Failure to produce enough progesterone
● Infection
Presenting symptom:
● Vaginal bleeding/spotting
● Should consult attending obstetrician so that
instructions may be given

C. Threatened miscarriage
● Vaginal bleeding, scant, bright red usually,
slight cramping
● No cervical dilatation
Management:
● Fetal heart assessment
● Utz
● hCG determination
● Avoid strenuous activity
● Coitus usually restricted for 2 weeks
● Spotting usually stops within 24-48 hours

D. Imminent (inevitable) miscarriage

● Uterine contractions and cervical dilatation occurs
● Loss of product of conception cannot be halted
● If no FHT and UTZ reveals empty uterus dilatation
and evacuation may be performed

E. Complete miscarriage
● Entire products of conception are expelled
spontaneously without assistance

F. Incomplete miscarriage
● Part of the conceptus is expelled, but the
membrane or placenta is retained
Management:
● Dilatation and curettage or suction curettage

G. Recurrent pregnancy loss

● Women who had 3 spontaneous miscarriages
● Defective spermatozoa or ova
● Endocrine factors
● Deviations of the uterus
● Uterine infections
● Autoimmune disorders

Complications of miscarriage
● Hemorrhage
● Infection
● Risk for isoimmunization

Process of shock because of blood loss

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MCN LEC | PRELIMS | 2ND SEM
Signs and symptoms of hypovolemic shock
C. GESTATIONAL TROPHOBLASTIC DISEASE
(HYDATIDIFORM MOLE)
● Abnormal proliferation and then degeneration of the
trophoblastic villi
● Cells become filled with fluid and appears as fluid
filled grape sized vesicles
● 1 in every 1500 pregnancies

Two types:
● Complete mole – all trophoblastic villi swell and
become cystic
● Partial mole – some of the villi form normally

Assessment:
B. ECTOPIC PREGNANCY
● Implantation occurs outside the uterine cavity
● Ovary or cervix
● Most common is fallopian tube
● Due to fallopian tube scarring that slows the
travel of the zygote
● Woman still experiences the signs of pregnancy
● Uterus tends to expand faster
● Strong (+) result of hCG- 1 to 2 M IU compared
to a normal of 400,000IU)
● Symptoms of pregnancy induced hypertension may
appear before the 20th week
● Ultrasound – no fetal growth and fetal heart sound
● Marked nausea and vomiting
● Dark brown blood, profuse flesh flow(16 weeks) with
clear fluid filled vesicles

Therapeutic management:
● Suction curettage

Post-Surgery:
● Pelvic examination, chest radiograph,hCG level
● hCG monitoring
● Half of woman positive at 3 weeks
● ¼ positive result at 40 days
● Assess every 2 weeks until normal
● Every 4 weeks for the next 6 to 12 months
● Missed period
● Should use reliable contraceptive method
● Signs and symptoms of pregnancy is
● Plan pregnancy at 12 months if hcg is normal
● experienced by the woman
Prophylaxis
● (+) Pregnancy test
● Methotrexate
● Dactinomycin
Ruptured ectopic pregnancy
● Sharp stabbing pain in lower abdominal
D. PREMATURE CERVICAL DILATATION
quadrant
● Old name – Incompetent cervix
● Vaginal spotting
● Cervix that dilate prematurely, cannot hold a fetus
● Amount of bleeding not evident
until term
● May lead to shock
● Painless
● Falling hcg level
● Pink-stained vaginal discharge (1st symptom)
● Utz – provides clear cut picture
● Followed by Rupture of membrane, discharge of
amniotic fluid
● Uterine contractions – birth of the fetus

Associated with:
● Increased maternal age
● Congenital structural defect
● Trauma to cervix

Management:
● Cervical cerclage – purse-string sutures are
placed in the cervix by vaginal route
o McDonald Procedure - Nylon sutures are placed
vertically and horizontally across the cervix and
If the woman does not seek help at once: pulled tight to reduce the cervical canal
● Cullen’s sign o Shirodkar - Sterile tape is threaded in a purse
● Dull, vaginal abdominal pain string manner under the submucosal layer of the
● Movement of cervix cause excruciating pain cervix
● Pain in shoulders
E. PLACENTA PREVIA
Management: ● Placenta is implanted abnormally in the
● Unruptured – methotrexate followed by uterus
leucovorin, mifepristone (abortifacient) ● Most common cause of painless bleeding in the
● Ruptured – emergency situation third trimester of pregnancy
○ Laparoscopy – ligate the bleeding
vessels and remove/repair fallopian tube
○ CBC
○ Administration of fluids

Abdominal pregnancy
● Woman may report sudden lower quadrant pain
● Fetal outline is easily palpable
● Danger is infiltration of large blood vessel, bowel
perforation, poor nutrient supply to the fetus
● Infant must be born through laparotomy
● Rate of survival = 60%

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MCN LEC | PRELIMS | 2ND SEM
● Direct trauma
OCCURS IN 4 DEGREES ● Vasoconstriction
1. Low lying – implantation in the lower rather ● Autoimmune antibodies
than in the upper portion of the uterus ● Chorioamnionitis
2. Marginal – the placenta edge approaches that
of the cervical os Assessment:
3. Partial – implantation that totally obstructs the ● Sharp stabbing pain high in the uterine
cervical os fundus
4. Total placenta previa – totally obstructs the ● If labor begins, each contraction will be
cervical os accompanied by pain over and above the pain
of contraction
● Heavy bleeding – evident if separation
occurs at the edges
● Couvelaire uterus (uteroplacental
● apoplexy) – hard board like uterus with no apparent or
Minimally apparent bleeding
● Disseminated Intravascular Coagulation (DIC)
may occur

Therapeutic management:
● Emergency situation
● Large gauge IV catheter
● Oxygen by mask
Assessment: ● FHT and maternal VS monitoring
● Bleeding is abrupt, painless, bright red and ● Lateral position
sudden ● No abdominal, pelvic or vaginal examination
● Unless separation is minimal, pregnancy must be
Immediate care measures: TERMINATED
● Place the woman immediately on bedrest in a side
lying position DEGREES OF PREMATURE PLACENTAL SEPARATION
Associated with:
● Increased parity (pregnancy)
● Advanced maternal age
● Past CS
● Past uterine curettage
● Multiple gestations
● Male fetus

Assess:
● Duration of pregnancy
● Time the bleeding began
● Estimate amount of blood loss
● Accompanying pain
● Color of the blood
● What has she done?
● Prior episodes of bleeding
● Prior cervical surgery G. DISSEMINATED INTRAVASCULAR
COAGULATION (DIC)
Therapeutic management: - Acquired disorder of blood clotting, fibrinogen level falls
● Never attempt a pelvic or rectal examination with to below effective limits
painless bleeding late in pregnancy
● Obtain baseline VS Conditions associated with its development:
● IVF therapy ● Premature separation of placenta
● I and O monitoring ● PIH
● External monitoring equipment ● Amniotic fluid embolism
● Complete blood count ● Placental retention
● Blood typing and crossmatching ● Septic abortion
● Retention of dead fetus
How is the fetus delivered?
● Depends on the percentage of previa and the DIC
condition of the pregnancy ● Extreme bleeding causes many platelets and fibrin
from the general circulation rush to the site, not
F. PREMATURE SEPARATION OF THE PLACENTA enough are left for the rest of the body
(ABRUPTIO PLACENTA)
● Placenta appears to be implanted correctly Test clotting time:
● Begins to separate and bleeding results ● Test tube – clot must form
● Cause is unknown ● Platelet assessment – less than or equal to
100,000/uL
● Prothrombin – low
● Thrombin – elevated
● Fibrinogen – less than 150 mg/dL

Management:
● Halt the underlying insult
● IV administration of Heparin
● Blood or platelet transfusion

Predisposing factors: H. PRETERM LABOR

● High parity ● Labor that occurs before the end of the 37 weeks of
● Advanced maternal age gestation
● Short umbilical cord ● Persistent uterine contractions, cervical effacement
● Chronic hypertensive disease over 80% and dilation over 1cm
● Pregnancy induced hypertension ● Unknown cause

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MCN LEC | PRELIMS | 2ND SEM
Conditions associated: Monozygotic twins
● Dehydration - Single ovum and spermatozoon, zygote divides into
● UTI two identical individuals
● Periodontal disease - 1 placenta, 1 chorion, 2 amnions, 2 umbilical cords
● Chorioamnionitis
● Inadequate prenatal care Dizygotic (Fraternal/Non-identical)
- Double ova, 2 placentas, 2 chorions, 2 amnions, 2
Assessment: umbilical cord
● Persistent, dull, low backache
● Vaginal spotting
● Pelvic pressure or abdominal tightening
● Menstrual like cramping

Ways to predict which pregnancy will end early:

● Analyze change in vaginal mucus
● Presence of fetal fibronectin (protein produced by
trophoblast cells)
- preterm contractions are ready to occur
● Absence of fetal fibronectin
- labor will not occur at least 14 days

Therapeutic management:
● Woman usually admitted
● Bed rest
● IV fluids – hydration may stop contractions
● Tocolytic agent – halt labor (terbutaline)
● Advise to limit strenuous activities
● Fetal assessment – count to 10 test

Administration of terbutaline:
● Mixed with lactated Ringer’s (not given purely)
● Piggy back
● Microdrip
● Check blood pressure and pulse rate
● If contractions are halt, oral terbutaline may be
given

Drug administration:
● Steroid (betamethasone) – to hasten lung
maturity
● Effects after 24 hours and lasts 7 days

Labor that cannot be halted:

● Membranes have ruptured
● Cervix more than 50% effaced and 3-4 cm dilated Assessment:
● If fetus is very immature – CS ● Uterus increase in size at a rate faster than usual
● Alpha-fetoprotein levels elevated
Method of delivery: ● Quickening – flurries of action at different portions of
● If very immature – CS delivery to reduce abdomen
pressure on the fetal head ● Reveals by ultrasound
● Cord is clamped immediately – extra amount
of blood could overburden the circulatory Therapeutic Management:
system ● Closer prenatal supervisions

I. PRETERM RUPTURE OF THE MEMBRANES K. PREGNANCY INDUCED HYPERTENSION

● Rupture of fetal membranes with loss of ● Vasospasm occurs during pregnancy in both small
amniotic fluid during pregnancy before 37 and large arteries
weeks ● Used to be called toxemia
● Occurs most frequently in women of color – poor
Threats to fetus: nutrition
● Uterine and fetal infections ● Who have had 5 or more pregnancies
● Increased pressure on the umbilical cord (cord ● Hydramnios
prolapse) ● Underlying disease – heart disease, diabetes, renal
● Potter-like syndrome – distorted facial features involvement
and pulmonary hypoplasia from pressure
Occurs most frequently in women:
Assessment: ● Of color
● Sudden gush of clear fluid from vagina ● Multiple pregnancy
● Test with nitrazine paper – turns blue (alkaline) ● Primiparas younger than 20 years or older than 40
years
Therapeutic management: ● Low socioeconomic backgrounds
If labor does not begin, and fetus is at point of viability (24
weeks wherein there is production of lung surfactant): Classifications
● Woman is placed on bed rest and receives ● Gestational hypertension
corticosteroid ● Mild eclampsia
● Administration of broad-spectrum antibiotics ● Severe eclampsia
● Membranes resealed by fibrin-based commercial ● Eclampsia
sealant
Assessment:
J. MULTIPLE PREGNANCY ● Hypertension
- A woman’s body must adjust to the effects of more than ● Proteinuria
one fetus ● Edema

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MCN LEC | PRELIMS | 2ND SEM
Symptoms of Pregnancy Induced Hypertension
Hypertension
Symptoms
Type
Gestational BP 140/90 or SBP elevated 30 mm Hg or
HPN DBP elevated 15 mm above pre pregnancy
level; no proteinuria or edema, BP returns
to normal alter birth
Mild Pre- BP 140/90 or SBP elevated 80 mm or DPB
eclampsia elevated 15 mm above pre pregnancy level;
proteinuria of 1-2 + on a random sample,
weight gain over 2 lbs /week in 2nd
trimester and 1lb/wk on the 3rd trimester,
mild edema in upper extremities or face
Severe Pre- BP of 160/110, proteinuria 3-44 on a
eclampsia random sample and 5g on a 24hr sample,
oliguria, cerebral or visual disturbances,
pulmonary or cardiac involvement,
extensive peripheral edema, hepatic
dysfunction, thrombocytopenia (decrease in
the no, of platelets), epigastric pain
Eclampsia Seizure or coma accompanied by signs and
symptoms of pre eclampsia
N. POST TERM PREGNANCY
● Pregnancy that exceeds 42 weeks
● If there is evidence of placental insufficiency
Common in receiving salicylates
● Mgt: oxytocin to initiate labor or CS is
performed
O. ISOIMMUNIZATION
● Occur when an Rh negative mother carries a
fetus with an Rh positive blood( D antigen)
● Maternal antibodies may cross the placenta
causing: Hemolytic disease of the newborn
or Erythroblastosis fetalis (RBC destruction,
decreased O2 supply)
Assessment:
● Anti D antibody titer-done at 1st pregnancy visit
● If normal (0) or minimal (below 1:8) – test
repeated in the 28th week
● If normal – no therapy
● If elevated (1:16) – fetal condition monitored
every 2 weeks

Management Therapeutic management:

Mild Pre- ● Promote bed rest ● Passive Rh (D) antibodies against the Rh factor
is administered to women who are Rh negative at
eclampsia ● Antiplatelet therapy
28 weeks
● Promote good nutrition
● Provide emotional support ● Given in the 1st 72 hours after birth
● Cord blood is tested – if Rh positive (Coombs’
Severe Pre- ● Support bed rest
negative) – large amount of antibodies are not
eclampsia ● Monitor maternal well being
present in the mother, mother will receive RhIG
● Monitor fetal well being
injection
● Support nutritious diet
● If Rh negative – injection not necessary
● Administer medications to prevent
Eclampsia ● Tonic-clonic seizures
Intrauterine transfusion
● Maintain patent airway
● Injection of RBC directly into the vessel of the fetal
● Administer oxygen
cord or depositing them in the fetal abdomen
● Turn to side
● Administer Magnesium sulfate or
Fetal death
diazepam (Valium)
● If labor does not begin, it will be induced by a
● Assess FHT
combination of prostaglandin gel such as
● Check for vaginal bleeding
misoprostol (Cytotec) and oxytocin
L. HELLP SYNDROME
● Variation of PIH LESSON 4: NURSING CARE OF A FAMILY
● H-emolysis EXPERIENCING PREGNANCY
● E-levated L-iver enzymes COMPLICATIONS FROM A PRE-EXISTING
● L-ow OR NEWLY ACQUIRED ILLNESS
● P-latelet count
● Increased BP, edema, proteinuria + A. CARDIOVASCULAR DISORDERS AND
● Nausea, epigastric pain, general malaise, RUQ PREGNANCY
tenderness Concerns:
Management: ● Can a woman get pregnant?
● Improve platelet count by transfusion of fresh ● If the couple decides to get pregnant, how will it affect
frozen plasma or platelets the health condition of the woman and the growing
fetus?
M. ABNORMAL AMNIOTIC FLUID ● How does it affect the decision making of the
Hydramnios couple?
● Normal amniotic fluid volume 500-1000mL
● Fluid index above 24 cm or more than 2000 mL Cardiac Disease
● Suggests difficulty with the fetus’ ability to swallow ● Variety of health conditions both congenital and
● Unusual enlargement of uterus acquired that complicate pregnancy
● Difficult to
auscultate FHT Cardiac Output
● Shortness of ● Rises significantly
breath ● Plateau is 28-32 weeks
● Increase weight
gain Factors Increasing Cardiac Output:
● Hemorrhoid ● Blood volume
● Varicosities ● Hormonal influences
Management: ● Autonomic nervous system
● Bed rest
● Assess VS and edema Blood volume
● NSAID (Non-steroidal Anti-inflammatory Drugs) ● Increases by plasma volume expansion and RBC
● Amniocentesis almost daily multiplication
● Heart rate increases and dilated systemic
Oligohydramnios vasculature is maintained
● Pregnancy with less than the average amount
of amniotic fluid Hormonal influences:
● Caused by bladder or renal disorder ● Increase estrogen
● Fetus is cramped for space ● Systemic vasodilation
● Uterus fails to meet expected growth rate ● Lowered peripheral resistance
● Mgt: amnio transfusion ● Increased cardiac output

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MCN LEC | PRELIMS | 2ND SEM
Autonomic nervous system
● Cardiovascular system is hyperfilled from Criteria for establishing a diagnosis of cardiac
increased blood volume and hyperdynamic disease in pregnancy:
● Persistent murmur
Pt will likely report signs and symptoms that mimic ● Permanent cardiomegaly – enlargement of the heart
cardiac disease ● Severe dysrhythmias
● Dyspnea ● Severe dyspnea prior to stage of pressure on the
● Orthopnea diaphragm
● Edema
● Syncope Signs of Cardiac Decompensation:
● Palpitations ● Moist cough
● Pedal edema
Risk Factors: ● Dyspnea
● Rheumatic fever 90% ● Tachycardia
● Congenital defects ● Tachypnea
● Arteriosclerosis ● Chest pain on exertion
● Myocardial infections ● Cyanosis
● Pulmonary diseases ● Persistent heart murmur
● Renal diseases
● Heart surgery Maternal Effects:
● Patients with valvular problems causing atrial
Examples of Cardiac Diseases: fibrillation-susceptible to embolic episodes
● Left sided heart failure ● Cyanotic heart disease – increase the maternal
● Right sided heart failure mortality by 50%
● Cardiomyopathy
● Hypertensive vascular disease Fetal and Neonatal Effects:
● Thromboembolic disease
● Rheumatic heart disease

Classification of Heart Disease

I No limitation of physical activities, regular activities
do no produce symptoms
II Slightly compromised, slight limitation,
asymptomatic at rest but regular activities produce
palpitations, fatigue, dyspnea, and angina pains
III Marked limitations, ordinary/regular activities cause
symptoms
IV Marked limitation, symptomatic at rest

Left Sided Heart Failure

1. Mitral valve cannot effectively push blod forward General Management:
2. Back pressure on the pulmonary circulation ● Team approach
3. If the pressure within the pulmonary vein reaches 25 ● Adjust cardiac medications
mmHg, fluids pass from capillary membranes to ● Bed rest/restricted activity
interstitial space surrounding the alveoli ● Prophylactic antibiotic – to prevent infections
4. Pulmonary edema ● Careful titration of fluid volume
5. Dyspnea, blood-speckled sputum, change in vital ● Advance planning for route of delivery
signs, orthopnea, paroxysmal nocturnal dyspnea
Drug Therapy:
Right Sided Heart Failure ● Heparin – anticoagulant
1. Output of right ventricle < blood volume received by ● Warfarin – pulmonary embolism/prosthetic valves
right atrium from the vena cava ● Furosemide – diuretic
2. Back pressure = congestion of the systemic venous ● Digitalis – crosses placental barrier
circulation and less cardiac output to the lungs ● Tocolytics
3. Jugular venous distention, increased portal circulation ● Beta blockers – treat hypertension
● Extreme dyspnea
● Pain Nursing Implementations:
● Ascites ● Encourage early, frequent and regular prenatal visits
● Peripheral edema ● Encourage compliance with therapeutic regimen
● Decrease workload of the heart
Peripartal Cardiomyopathy ○ Adequate rest and sleep
● Weakness and enlargement of the heart muscle that ○ Treat early anemia
usually occurs from around the final month of ○ Prevent exhaustion, fatigue , stress
pregnancy through about five months after pregnancy. ● Avoid activities that decrease oxygenation
● No previous history of heart disease ○ Smoking
● Shortness of breath ○ Overcrowded place
● Chest pain ● Avoid constipation
● Edema ○ Daily fruits
○ Vegetables
Rheumatic Heart Disease ○ Regular bowel movement
● Complication of rheumatic fever in which the ○ Regular exercise
heart valves are damaged ● Proper nutrition
● Affects the valves of the heart secondary to ○ Well balanced diet
previous exposure to beta hemolytic ○ Adequate protein
streptococcus such as streptococcal ○ Low sodium, fats and carbohydrates
pharyngitis ○ No junk foods and stimulants

Assessment: Intrapartum Period Goals:

● History of pre pregnancy cardiac status ● Minimize changes in pulse and blood pressure:
● Level of exercise performance Lateral position
● Physical assessment ● Adequate pain relief
● Diagnostic tests ● Avoidance of hemorrhage
● Fetal assessment ● Avoidance of infection

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MCN LEC | PRELIMS | 2ND SEM
● Oxygen per mask those living alone or in poverty, and infants,
● Forceps or vacuum extraction especially those with infections or diarrhea)
● Elective CS ● Impaired absorption because of intestinal
dysfunction
Primary Goal: ● Bacteria competing for available folic acid
● Reduce risks for complications ● Overcooking of food, destroying valuable water
soluble nutrients, including a high percentage of
Achieved By: folic acid
● Education ● Limited storage capacity in infants
● Routine assessment ● Prolonged drug therapy, especially from
● Proper referral anticonvulsants and estrogens
● Facilitation of patient participation in decision ● Not addressing increased folic acid needs of
● Being an advocate and coordinator for the certain age groups
multidisciplinary team approach
May contribute to:
B. HEMATOLOGIC DISORDERS AND ● Early miscarriage
PREGNANCY ● Early separation of placenta

Anemia Prevention/Management:
- Decrease in oxygen carrying capacity of the ● 400 ug of folic acid daily before getting
blood due to decrease hemoglobin in the blood pregnant
● Folacin rich – food green leafy vegetables,
Risk Factors: oranges, dried beans
● Decrease nutritional intake ● During pregnancy – 600 ug/day
● Heredity
● Increased demands as in pregnancy and Sickle Cell Anemia
adolescence ● Caused by abnormal amino acid in the beta
● Poor absorption chain of hemoglobin
● Recessively inherited
Iron Deficiency Anemia ● Majority of RBCs are irregular or sickle shaped
● Most common and cannot carry much hemoglobin
● Diet low in iron ● If amino acid valine is replaced-sickle
● Heavy menstrual period hemoglobin (Hbs)
● Unwise weight reduction program ● If amino acid lysine is replaced- non sickling
● Woman experiences fatigue and poor exercise
tolerance

Rbc’s are:
● Microcytic – exceptionally small RBC
● Hypochromic – decreased hemoglobin in the RBC

Assessment Findings:
● Pale skin and mucous linings
● Pearl white sclera
● Brittle flattened nails
● Low Hgb (less than 10g/dl)
● Low hematocrit (less than 33%)
● Serum iron (< 65ug/100 ml blood)
May lead to:
● Low birth weight
● Preterm birth
● Increased incidence of abortion and premature labor
Prevention/Management:
● Prenatal vitamins containing iron supplement of 60
mg elemental iron
● Diet high in iron such as green leafy vegetables, meat,
legumes and fruits
● If with deficiency: 120-200 mg /day
● Severe anemia – IV iron dextran (substitute for blood
plasma for transfusion)
Nursing Implementations:
● Promote a balance of activity and rest with
avoidance of fatigue
● Provide dietary instructions
● Encourage regular intake of ordered hematinics
(ferrous sulfate)
Folic Acid Deficiency
● Folic acid – B vitamin necessary for the normal
formation of red blood cells
● Leads to megaloblastic anemia (abnormally large,
immature, and dysfunctional red blood cell)
● Becomes apparent in the 2nd trimester of
pregnancy
● More common in multiple pregnancy
Causes
● Alcohol abuse (alcohol prevents absorption of
several nutrients especially the B vitamins)
● Poor diets (common in alcoholics, the elderly,
May result to:
● Blockage to placental circulation
● Low birth weight
● Fetal death
Therapeutic Management:
● Exchange transfusion
● Administering oxygen
● Controlling pain
● Increasing fluid volume
● The chances of passing it to the offspring depends
on genetic composition of the parents
C. RENAL AND URINARY DISORDERS
Incidence:
● Infection – 1-5% of pregnancies
● Chronic kidney disease – 6 to 12 cases per
10,000 pregnancies
Kidneys
● Excrete water, electrolytes and nitrogenous
waste product
● Acid – base balance
● Secretes erythropoietin – kidney hormone that
increases the number of RBC in cases of anemia
● Renin-angiotensin-aldosterone system
● Renin – hormone released in the kidney in response
to either decrease BP or plasma sodium concentration
● Accounts 20-25% of the cardiac output
Urinary Tract Infection
● Ureters dilate from the effect of progesterone – urine
stasis/stagnation
● Minimal glucosuria – growth of microorganisms
● Ascending infection - Escherichia coli

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MCN LEC | PRELIMS | 2ND SEM
● Descending infection - Streptococcus B ● Body aches
● Sore throat
Assessment: ● May receive immunization
● Frequency and pain on urination ● Antipyretic
● Pain in the lumbar region ● TamiFlu (new antiviral drug)
● Nausea and vomiting
● Malaise Asthma
● Temperature elevation ● Asthma is a disorder marked by reversible
airway obstruction, airway hyperreactivity and
Maternal Effects: airway inflammation
● May lead to preterm labor ● Triggered by allergens – release of histamine
● Bacteremia causing septic shock bronchial smooth muscle constriction
● Most serious medical condition to complicate
Therapeutic Management: pregnancy
● Urine C&S ● Difficulty releasing air
● Administration of antibiotics ● High pitched whistling sound
● Amoxicillin and ampicillin are safe to administer (wheezes) Chest tightness
● Sputum production
Trimethoprim
● Antibiotic used mainly in the prevention and Maternal Effects:
treatment of urinary tract infections ● Adequately controlled – risk of complication is no
● Folic acid antagonist (neutralizes the effect of greater than non asthmatic
another drug) ● Poorly controlled – increased risk of hypertension
● Must not be given on the first trimester and hyperemesis gravidarum (excessive vomiting)

Prevention of UTI: Effect on Fetus:

● Void frequently ● Preterm birth
● Wiping perineal area from front to back ● Growth restriction
● Wearing cotton underwear
● Voiding immediately after sexual intercourse Management:
● Beclomethasone
Nursing Implementations: ● Budesonide
● Advise 3-4 L of water/day ● Terbutaline & Albuterol – tapered, close to term
● Knee chest position – to promote urine drainage because they may reduce labor contractions
● Compliance to medications ● Cromolyn sodium
● Montelukast sodium
Chronic Renal Disease
● Results in accumulation of waste products in the Nursing Interventions:
blood, electrolyte abnormalities and anemia ● Review various asthma medications
● CBC may indicate anemia ● Teach importance of avoiding environmental
● May develop severe anemia allergens
● Increased glomerular filtration rate/creatinine ○ Pollens
level ○ Molds
○ Dusts
Medical Management: ○ Nuts
● ACE inhibitor – preserves kidney function ○ Fish
but fetotoxic
● Low dose aspirin Tuberculosis
● Urine output monitoring ● Lung tissue invaded by mycobacterium
● Ultrasound every 2 weeks from 24 weeks tuberculosis
of gestation ● Calcification and scarring of the lungs
● Non-stress test
Assessment:
Care of the Woman with Chronic Renal Disease: ● Mantoux test/purified protein derivative (PPD) – If
● If undergoing dialysis, peritoneal (removal of fluid positive, should undergo chest radiograph
from the abdominal cavity) is more preferred – ● Sputum culture confirms the diagnosis
monitor for preterm labor ● Chronic cough
● Nutrition consultation ● Weight loss
● Emotional support ● Coughs out blood (hemoptysis)
● Night sweat
Nursing Interventions: ● Low grade fever
● Monitor I and O ● Chronic fatigue
● Evaluate degree of edema
● Make referral to a dietitian Therapeutic Management:
● Teach home blood pressure monitoring Isoniazid (INH) and ethambutol hydrochloride
● Teach pt signs and symptoms of preterm labor (Myambutol) – drugs of choice
● Educate on the importance of drinking variety of fluids
● Empty bladder at least every 2 hours Treatment Regimen:
● Perineal hygiene from front to back With active disease in pregnancy:
● Isoniazid (INH) 300 mg combined with rifampin (RIF)
600 mg and ethambutol 1 gram daily for 2 months
● RIF and INH for additional 7 months
● Pyridoxine (vitamin B6) taken with INH – to
D. RESPIRATORY DISORDERS AND prevent peripheral neuritis
PREGNANCY ● Ethambutol – may cause optic atrophy & loss of green
Acute Nasopharyngitis/Common Cold color recognition. Monthly Snellen chart test – if with
● Woman experiences nasal congestion due to s/s, discontinue the drug.
estrogen
● If viral, no medication is needed Health Education:
● Maintain an adequate intake of calcium – to ensure
Influenza that tuberculosis pockets form or are not broken
● Caused by virus down.
● High fever ● Wait 1 to 2 years to be negative of infection before

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MCN LEC | PRELIMS | 2ND SEM
deciding to conceive
● Woman with history of tuberculosis should have three
negative sputum culture before she can hold/cares
for her infant
● If with active infection – INH prophylaxis
E. AUTOIMMUNE RHEUMATIC DISEASES
● Result from the body’s immune system inability to
distinguish “self” from “non self”
● Body manufactures T cells and antibodies
directed against its own cells
Systemic Lupus Erythematosus
● Suppression of the body’s normal immunity
● Targets skin, joints, kidneys, lungs, cardiac and
nervous system
● In pregnancy, causes inflammation of the
connective tissue of the decidua resulting to
problem in implantation and functioning
Signs and Symptoms:
● Depends on the target organ
● Most common are fever, malaise, fatigue, weight
loss, skin rashes and polyarthralgia (aches and
pain affecting five or more joints)
11 Criteria:
● Butterfly rash
● Rash on face, scalp, ear, arms, chest
● Photosensitivity
● Oral ulcers
● Arthritis (inflammation of a joint, usually accompanied
by pain, swelling, and stiffness)
● Pericarditis (inflammation of the lining around the
heart)
● Renal disorder
● Neurologic disorder
● Hematologic disorder
● Immunologic disorder
● ANA positive titer (Antinuclear Antibody) – presence of
the antinuclear antibody which is associated with
several autoimmune diseases
Maternal Effects:
● If SLE is active during conception, exacerbation
(worsening/increase in the severity) is common
● If pt has renal insufficiency (kidneys are no
longer able to handle their jobs) before
pregnancy, disease deterioration is common
Fetal and Neonatal Effects:
● Increase risk of spontaneous abortion
● Intrauterine growth restriction
● Still birth
General Management:
● Counselling
● Planning pregnancy
● At least 6 months on remission (reduction or
disappearance of the signs and symptoms)
Drug Therapy:
● Corticosteroids-prednisone – decrease swelling,
tenderness, and pain associated with inflammation
● Low dose aspirin – for pain and anticoagulant
● Antimalarial agents (hydroxychloroquine) – for
skin rashes
● Cytotoxic agent
Nursing Interventions
● Emphasize frequent prenatal visits
● Assess weight gain
● Measure BP each day
● Balance between activity and rest
● Teach prevention and recognition of preterm
labor
● Instruct on skin care
● Fetal surveillance
● Evaluate fetal growth by UTZ every 3-4 weeks after
24 weeks AOG
● Fetal movement counting
● Assess coping styles and ability to cope with
chronic illness
Antiphospholipid Syndrome (APS)
● Antibodies formed against plasma protein
leading to a procoagulant state
● Superficial thrombophlebitis
● Deep vein thrombosis
● Pulmonary embolism
Maternal Effects:
● May lead to life threatening event for the
mother (pulmonary emboli, stroke)
Fetal and Neonatal Effects:
● Increases pregnancy loss
● Recurrent spontaneous abortion and unexplained 2nd
and 3rd trimester fetal death
● Increased risk in cardiac or neurological anomalies
Clinical Criteria:
● Vascular thrombosis
○ Venous
○ Arterial
● Fetal loss
● One or more unexplained fetal death beyond
10 weeks AOG
● One or more preterm birth before 34 weeks AOG
● 3 or more unexplained consecutive spontaneous
abortion without hormonal or chromosomal
abnormalities
Laboratory criteria:
● Anticardiolipin antibody
● Lupus anticoagulant
General Management:
● Low dose aspirin (81 mg)
● Heparin
● Prednisone
Nursing Management:
● Provide adequate information
● Collaborate with medical management plan
● Reinforce preconceptual counselling
● Interpret clinical information in lay terms
● Be vigilant in physical and psychosocial
assessment
Nursing Interventions for APL:
● Discuss medical and pregnancy risks
● Prenatal visits
● Screen for preeclampsia and preterm labor
● Teach self administration of prescribed
medications
● If heparin is used,take 1000mg of calcium,
Vitamin D and weight bearing exercises
● Serial ultrasound every 3 to 4 weeks starting 17
to 18 weeks AOG
● 32 weeks – daily fetal movement and
BPS (Bronchopulmonary Sequestration)
● Teach prevention and recognition of preterm
labor
F. DIABETES AND PREGNANCY
Diabetes
● Disease characterized by the inability to produce or
use sufficient endogenous insulin to metabolize
glucose properly
3 types
● Type 1 – absolute insulin deficiency
● Type 2 – receptor sites are resistant to insulin
● Type 3 – Gestational Diabetes mellitus
Gestational Diabetes Mellitus
● Carbohydrate intolerance that is first recognized
during pregnancy particularly in the 3rd trimester
Impaired Fasting Blood Glucose (IFG)
● FBS level that is 100 mg/dL or higher but lower than
126 mg/dL
Impaired Glucose Tolerance
● 2 hour post prandial blood sugar level higher than
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MCN LEC | PRELIMS | 2ND SEM
140 mg/dL but lower than 200 mg/dL
Signs and Symptoms of GDM in a Previous
Pregnancy
● Prior delivery of an infant weighing more than 9
pounds
● Previous stillbirth of an infant with congenital
defects
● Polyhydramnios
● Hx or recurrent monilial vaginitis
Signs of GDM in the Current Pregnancy
● Recurrent monilial vaginitis
● Macrosomia of the fetus on ultrasound
● Polyhydramnios
1 hour
● 139 mg/dL or less rules out GDM
● More than 139 to 199 mg/dL –follow up with OGTT
● If 200mg/ dL or greater, treat as GDM
Two or Three Hour Glucose Tolerance Test
● 150 g of complex carbohydrates should be eaten
for 3 days
● NPO 8 hours before the test
● Draw FBS sample
● Start timer, pt drinks 100 g of glucose solution
within 10 minutes
● Blood samples are drawn 1, 2, and 3 hours
Normal Serum Blood Glucose Values

Maternal Effects:
● Risk is directly related to glucose control initiated
before and throughout pregnancy

Risks:
● Spontaneous abortion
● Pre eclampsia
● Preterm labor
● Polyhydramnios
● Infection
● Diabetic ketoacidosis – body produces high levels of
blood acids called ketones Antepartum Glycemic Management:
● Cesarean or instrumental birth and induction ● Blood glucose monitoring
risks ● Urine testing
● Retinopathy – damage of the retina caused by ● Insulin management
complications of diabetes ● Exercise recommendations
● Hypoglycemia ● Antepartum fetal surveillance

Fetal and Neonatal Effects: Blood Glucose Monitoring

● Hypoglycemia ● Daily self-monitoring of blood glucose-3 to 10 times
● Hyperglycemia per day
● Capillary blood glucose samples are taken before
Hyperglycemia meals and snacks, 60-90 minutes after meals, at
● Congenital defects bedtime, occasionally between 2-4 AM
○ Risk is 3 to 5 times more often ● Hb A1c tests every 4-6 weeks
○ Directly affects the yolk sac
development Urine Testing
○ Neural tube defects ● Ketones
○ Congenital cardiac anomalies ● Sugar
○ GI and renal anomalies
○ Directly related to diabetic control in Insulin Management
the 3 months before conception and ● Usual type is biosynthetic human insulin (Humulin)
● Macrosomia
○ Elevated fetal glucose Classification:
○ Fetal hyperinsulinemia A. Rapid acting – lispro (Humalog) and aspart
○ Increase growth and fat deposition (Novolog)
○ Birth trauma B. Short acting – regular (Humulin R)
● Intrauterine growth retardation C. Intermediate acting – neutral protamine hagedorn(
○ Placental insufficiency or NPH, Humulin N)
vascular disease
● Delayed lung maturity ● Rapid acting insulin
○ Interfere with production of ○ Works within 10-15 minutes
phosphatidyl glycerol (fetal ○ Shorter duration (3-5 hours)
surfactant) ○ Must eat as soon as injection is administered
○ Good for high glycemic index foods:
Neonatal Hypoglycemia bread, rice and potatoes
- At birth, the supply of increased ● Short acting
glucose is suddenly cut off, but ○ Onset is 30 minutes or longer
insulin is still produced ○ Duration of 6-8 hours
● Learning disabilities ○ Snacks are essential in the morning,
○ Fetal brain cell damage and afternoon and bedtime
decreased brain growth
○ Low intelligence quotient (IQ) Comparison Chart for Human Insulins
● Childhood obesity and TYPe 2 dm later in life
○ 70% chance of developing type 2
DM and obesity

Establishing Diagnosis
Criteria for the diagnosis of GDM:
● Fasting plasma glucose (FPG) 126 mg/dl or
greater after 8 hour fasting
● Two hour postprandial glucose >200 mg/dl after
75 g glucose load Calculation Guidelines for Insulin During Pregnancy
● Polyuria, polydipsia and unexplained weight loss

Two-step Approach: Glucose Challenge Test

● Give 50 g of oral glucose, test blood sugar level after

13
MCN LEC | PRELIMS | 2ND SEM
● Standard infection precautions

Inflammatory Bowel Disease

● Crohn’s disease – inflammation of the
terminal ileus
● Ulcerative colitis – inflammation of the distal
colon
● Bowel develops shallow ulcers
● Woman develops chronic diarrhea, weight loss,occult
blood in stool, nausea and vomiting

Fetal Effects:
● Interfering with fetal growth
Diet Management: ● Total rest for GI tract
● In consideration to pre pregnancy weight, ● Sulfasalazine (Azulfidine)
general health status, dietary habits, activity
level and insulin therapy H. NEUROLOGIC DISORDERS AND PREGNANCY
Seizure Disorder
Exercise Recommendations: ● May be due to head trauma or meningitis
● Exercise can lead to improved sensitivity to
insulin after 4 weeks Common Drugs:
● Trimethadione (Tridione)
Antepartal Fetal Surveillance: ● Valproic acid
● Ultrasound ● Carbamazepine
● Maternal alpha-fetoprotein ● Phenytoin
● Fetal biophysical tests
● Amniocentesis I. MUSCULOSKELETAL DISORDERS AND PREGNANCY
Scoliosis
G. GASTROINTESTINAL DISORDERS AND PREGNANCY ● Lateral curvature of the spine
Gastroesophageal Reflux Disease/Hiatal Hernia ● Noticed in girls between 12-14 years old
● Gerd – Reflux of acid stomach secretions into the
esophagus Assessment:
● Hiatal Hernia – portion of the stomach ● Visible curve fails to straighten when the child
extends and protrudes up through the bends forward and hangs arms down toward
diaphragm into the chest cavity feet
● Hips, ribs and shoulders are
Symptoms: asymmetrical
● Heartburn ● Apparent leg length discrepancy
● Gastric regurgitation
● Dysphagia – impaired swallowing Scoliosis can interfere:
● Possible weight loss ● With respiration and heart action because of
● Hematemesis chest compression
● Pelvic distortion can interfere with childbirth
Management:
● Antacids Management:
● Histamine receptor antagonist (ranitidine) ● Braces
● Proton pump inhibitor (Esomeprazole-Nexium) ○ Usually worn 16-23 hours a day
● Loose clothing ○ Inspect skin for breakdown
● Sleep with head elevated ○ Keep skin clean
○ Advise to wear soft non irritating clothes
Pancreatitis under the brace
● Inflammation of the pancreas ○ Unless modified it cannot be worn during the
● Nasogastric suction last half of pregnancy
● Bowel rest ● Brace for scoliosis
● Analgesia – pancreatic pain is sharp ○ Boston Brace
● Intravenous hydration
Surgical Management:
Hepatitis
● Liver disease that may occur from invasion of the
A,B,C, D or E virus
● Hepatitis A
○ Spread by fecal-oral contact
○ Ingestion of fecally contaminated
water or shellfish
○ May be given prophylactic gamma globulin
● Hepatitis B & C
○ Spread by exposure to
contaminated blood or blood
products
○ Can be spread by contaminated
semen or vaginal secretions
Implementation Post-operatively:
Assessment: ● Maintain proper alignment
● Experiences nausea and vomiting ● Logroll when turning
● Liver is tender (painful) on palpation ● Neurovascular assessment of lower extremity
● Dark yellow urine function
● Hepatomegaly – enlargement of the liver ● Monitor for Mesenteric Artery Syndrome Disorder
● Jaundice (MASD) – mechanical changes in the position of
abdominal contents during surgery (emesis/vomiting,
Therapeutic Management: abdominal distention)
● Bed rest
● High calorie diet J. CANCER AND PREGNANCY
● CS delivery Incidence

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MCN LEC | PRELIMS | 2ND SEM
● 1 in 1000 pregnancies

First Trimester option

● Delay treatment
● End pregnancy

15