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 blo
od pressure) during pregnancy. Patients with kidney disease have a risk of developin
g pre-eclampsia.
Because pulmonary hypertension frequently worsens during pregnancy and postpartu
m, 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 l
ikely to affect pregnancy than those that do not.
Patients who have or have had kidney disease due to vasculitis, scleroderma, or lupu
s have an increased risk of severe hypertension and pre-eclampsia.
Pregnancy in women with APS should always be considered as high risk. Women wit
h 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 tr

eat rheumatic disease can cause problems. The 2020 American College of Rheumatol
ogy Guideline for the Management of Reproductive Health in Rheumatic and Muscu
loskeletal 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 fet
us, 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 rheu
matologist, as a precaution. Those with a high-risk profile should be managed by a m
edical 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