Cardiovascul

ar Disorders
and
Pregnancy

Chari V. Rivo, RM, RN

 Cardiovascular Disorder and
Pregnancy
• complicates only
approximately 1% of all
pregnancies
• responsible for 5% of
maternal deaths during
pregnancy (Cunningham,
Leveno, Bloom, et al., 2014)
• Infant Mortality Rate - Number of deaths per 1000 live births
occurring at birth or in the first 12 months of life
– 20.9 deaths/1,000 live births (2018 est.)
– male: 23.8 deaths/1,000 live births
– female: 17.9 deaths/1,000 live births
• Maternal Mortality Rate - Number of maternal deaths per
100,000 live births that occur as a direct result of the reproductive
process.
– 121 deaths/100,000 live births (2017 est.)
• Childhood Mortality Rate - Number of deaths per1000
population in children, 1 to 14 years of age.
• Childhood Morbidity Rate
 Maternal and Child Health
Nursing
• Primary Goal: Promotion and maintenance of optimal family
health to ensure cycles of optimal child-bearing and childrearing.
• Range of practice includes:
– Preconceptual health care
– Care of women during three trimesters of pregnancy and the
puerperium (the 6 weeks after childbirth, sometimes termed the fourth
trimester of pregnancy)
– Care of infants during the perinatal period (6 weeks be-fore conception
to 6 weeks after birth)
– Care of children from birth through adolescence
– Care in settings as varied as the birthing room, the pediatric intensive
care unit, and the home
 Purposes Of Prenatal Care
1. Establish a baseline of present health
2. Determine the gestational age of the fetus
3. Monitor fetal development and maternal well
being
4. Identify women at risk for complications
5. Minimize the risk of possible complications
by anticipating and preventing problems before
they occur
6. Provide time for education about pregnancy,
lactation, and newborn care
 Preconceptual Visit
• appointment with a physician or nurse-midwife before
becoming pregnant to obtain accurate reproductive life planning
information, receive reassurance about fertility (as much as can
be given based on a health history and a routine physical
examination), and detect any problems that may need
correction through a thorough health history, and physical and
pelvic examinations(Rojas, Wood, & Blakemore, 2007)
• Hemoglobin level and blood type (including Rh factor)
• Papanicolaou (Pap) test,
• minor vaginal infections such as those arising from Candida or
chlamydia can be corrected to help ensure fertility.
• Counseling on the importance of a good protein diet, adequate
intake of folic acid and other vitamins,
• Early prenatal care if she does become pregnant.
 Health Assessment Suring
Prenatal
• Initial Interview
– Establishing rapport
– Gaining information about a woman’s physical and
psychosocial health
– Obtaining a basis for anticipatory guidance for the
pregnancy
– To be accomplished in private, quiet setting
 Components of a Health History
• Demographic Data
• Chief Concern
• Family Profile
• History of Past Illnesses
• History of Family Illnesses
• Day History/Social Profile
• Medical History
• Gynecologic History
– Reproductive tract problems/ surgeries
– Women’s health problems such as breast disease
– Menarche
– Use of family planning methods
• Obstetric History
– History of previous pregnancies– baby’s gender,
BW, BL, other significant findings
– Hx of miscarriage
– Rh Immunoglobulin injection
T: Number of full-term
infants born (infants born at
37 weeks or after)
P: Number of preterm
infants born (infants born
before 37 weeks)
A: Number of spontaneous
miscarriages or therapeutic
abortions
L: Number of living
children
M: Multiple pregnancies
TPAL/TPALM
Example:
• A woman who has had two previous
pregnancies, has given birth to two term
children, and is again pregnant.
– gravida 3, para 2002 (GTPAL) or 320020
(GTPALM)
• A woman who had term twins, then one
preterm infant, and is now pregnant again
– gravida 3, para 21031 (GTPALM)
• Review of Systems
– Head to Toe Assessment
• Conclusion
• Physical Examination
– Baseline Height/Weight and Vital Sign
Measurement
– Normal weight gain during pregnancy: 25-35 lbs
– sudden increase of BP and weight:
• HPN
– Sudden increase in pulse and respiration:
• Bleeding
 Assessment of Systems
• General Appearance and Mental Status
– Closely inspect for signs such as careless hygiene, un-
washed hair, inappropriate or soiled clothing, and sad
facial expression that may suggest fatigue or depression
about their diagnosis
• Head and Scalp
– chloasma
• Eyes
– Edema of the eyelids combined with a swollen optic disk
(identified on ophthalmoscopic examination)
• Edema of PIH - pregnancy-induced hypertension also usually
report spots before their eyes or diplopia (double vision)
• Nose.
– The increased level of estrogen associated with pregnancy
may cause nasal congestion or the appearance of swollen
nasal membranes.
• Ears
– nasal stuffiness that accompanies pregnancy may lead to
blocked eustachian tubes and therefore a feeling of “fullness”
in the ears or dampening of sound during early pregnancy
• Sinuses
– Sinuses should feel nontender
• Mouth, Teeth, and Throat
– Gingival hypertrophy
– Check for cracked corners of the mouth
• Vitamin A Deficiency
• Neck
– Slight thyroid hypertrophy may occur with pregnancy because
the overall metabolic rate is increased
• Lymph Nodes
– No palpable lymph nodes should be present; however, because
pregnant women may develop an increased number of upper
respiratory infections because of reduced immunologic resistance,
one or two pea-sized cervical lymph nodes may be palpable
• Breast
• Breast changes may be one of the first things women
notice in pregnancy:
– Areolae darken.
– Secondary areolae develop.
– Montgomery tubercles (sebaceous glands in the
areolae)become prominent.
– Overall breast size increases.
– Breast consistency firms.
– Blue streaking of veins becomes prominent
– Colostrum may be expelled as early as the 16th week of
pregnancy.
– Any supernumerary nipple also may become darker and
enlarge in size.
Secondary areola
• Heart
– a woman may develop an innocent
(functional) heart murmur during
pregnancy because of her increased
vascular volume
• Lungs
– Shortness of breath (in late pregnancy)
may occur because diaphragm cannot fully
descend
• Back
– Lumbar curve (lordosis)
• Rectum
– Hemorrhoids
• Extremities and skin
– palmar erythema or itching early in pregnancy from a high
estrogen level and perhaps subclinical jaundice (jaundice that is
not yet apparent by a color change) from reabsorbed bilirubin be-
cause of slowed intestinal peristalsis.
– Varicosities
– Capillary refill (toes)
– Edema
• Blood Studies
– complete blood count- Hgb, Hct, WBC, Plt
– genetic screen
– serologic test for syphilis - VDRL or rapid plasma reagin test
– Blood typing (including Rh factor)
– Maternal serum for alpha-fetoprotein (AFP) - normal value
is 2.5 MOM
– indirect Coombs’ test - determination if Rh antibodies are
present in an Rh-negative woman
– Antibody titers for rubella and hepatitis B(HBsAg)
– HIV screening
– glucose loading/tolerance test – 50-gram oral 1 hour glucose
loading (OGTT)
• plasma glucose level should not exceed 140 mg/dL at 1 hour
• Urinalysis – proteinuria, glycosuria, pyuria
• Tubercolosis Test
• Ultrasonography
Risk Assessment