Professional Documents
Culture Documents
1 The High Risk Mother
1 The High Risk Mother
Introduction
Pregnancy poses a risk to the life of every woman. Some
pregnancies are riskier than the others. Woman who have co-
existing health problems as diabetes ,anemia, malaria etc. are
more likely to develop complications. Healthy women can
also suffer from complications.
It also poses a risk to babies. Complication and other health
problems of the woman can harm babies too.
Introduction
Death and disabilities from pregnancy can be
prevented or treated. These can be achieved by a
combination of interventions.
Family Planning can help avoid and prevent
unplanned too early, too late, too close, too sickly
and too many pregnancies particularly among very
high risk women.
Introduction
Quality prenatal, delivery and postpartum
services can prevent complications, detect
problems early and allow prompt treatment
and management, mobilizing communities and
local government will help improve the status
of women who needed care.
GOAL
Improve the survival, health and well
being of mothers and the unborn
through a package of services for the:
pre-pregnancy
prenatal
natal
postnatal stages
2a.2
Where are we now?
Every mom who dies leaves 3 orphans. In effect, 30 children are orphaned
every day
The Philippine Situation
Only 25.1% of births in poorest quintile were delivered
by a professional attendant compared to 92.4% of the
richest quintile (2003 NDHS)
Poor women are not consistently able to access
services. Only 1.7% have delivered by caesarean section.
TFR is highest among the poor
TFR is highest among the poor …
Wealth status
Fertility Rate
225
200 209
175
172 162
150
139.6
MMR
125
100
75
50 52.2
25
Maternal 8 20 41 44 160
Mortality
Percent 69.6
49.4
44.8 45.8
39.8 41.0
37.9
33.4
29.1 28.9
25.7 26.1
21.9 20.7 23.1
15.7 15.6
10.7
Phil NCR CAR R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 Caraga ARMM
Hospital
27%
Home
Others
70%
3%
Central Visayas is among the regions with higher
percentage in terms of birth delivery assistance by
health professionals.
87.9
85.8
59.8 59.6
53.2
47.4 47.6
41.0 42.5
36.0 37.2
29.3 31.0
21.9 21.7
Phil NCR CAR R1 R2 R3 R4A R4B R5 R6 R7 R8 R9 R10 R11 R12 Caraga ARMM
Nurse
1%
Doctor
33% Midwife
26%
Traditional Birth
Attendant
others
39%
1%
BLOOD LOSS
Renal failure
51
Chorionic Villus Sampling (CVS)
Amniotic Fluid Index
Kick Count ( Fetal Movement Counting)
55
Sandovsky Method
- mother is in a left lateral recumbent position;
fetus normally moves a minimum of twice every
10 minutes or an average of 10 -12x an hour
56
Kick Count Assessment Tool
Doppler Ultrasound Blood Flow
Assessment
Lecithin/ Sphingomyelin Ratio
(2:1)
– important components of surfactant, a
phosphoprotein that lowers surface
tension of the lungs that facilitates
extrauterine expiration
59
ALFA-fetoprotein
Test done between 15-18 weeks
Assess quantity of fetal serum protein
Increase : open neural tube defect
abdominal wall defects
renal anomalies
Decrease/low : chromosomal trisomies
Alpha Feto Protein
AMNIOCENTESIS
Aspiration of amniotic fluid
Done from 13-14 weeks of pregnancy
Empty bladder before procedure
Prepare for UTZ to locate placenta
PURPOSE :To determine genetic disorder, metabolic defect
and fetal lung maturity
RISKS
1.Maternal hemorrhage
2.Infection
3. Rh iso-immunization
4. Abruptio placentae
5. Amniotic fluid emboli
6. Premature rupture of membrane
Amniocentesis
Biophysical profile (BPS)
Identify the risk for asphyxia
Assesses 4 to 6 parameters (fetal breathing
movement, fetal movement, fetal tone, amniotic
fluid volume, placental grading, and fetal heart
reactivity/ reactive NST)
Each item has a potential for scoring a 2; 12
highest possible score
BPS 8 – 10: fetus is doing well
BPS 4 – 6: fetus is in jeopardy
64
SCORING THE BIOPHYSICAL PROFILE
OBSERVATION NORMAL (2 points) ABNORMAL (0 points)
Fetal Breathing Movement One breathing period lasting at least Breathing period less than 60 seconds
during 30 Minute Observation Period 60 seconds or no breathing observed
Fetal Body Movement 3 discrete and definite movements of Less than 3 discrete movements of
during 30 Minute Observation Period the arms, legs or body arms/legs or body
68
ELECTRONIC
MONITORING
Non-Stress Test (NST)
Non-Invasive
77
Percutaneous Umbilical Blood
Sampling
Percutaneous Blood Sampling
Danger Signs in Pregnancy
Sudden gush of fluid from vagina
Vaginal bleeding
Abdominal pain
Persistent vomiting
Epigastric pain
Swelling of face and hands
Severe, persistent headache
Danger Signs in Pregnancy –
Cont’d
Blurred vision or dizziness
Chills with fever > 100.4 degrees
Painful urination or reduced urine
output
Pregnancy-Related
Complications
Hyperemesis Gravidarum
Manifestations
Persisitent N/V
Significant weight loss
Dehydration: dry tongue and mucous membranes,
decreased turgor, scant concentrated urine, high
hematocrit
Electrolyte and acid-base imbalance
Unusual stress, emotional immaturity,
passivity, ambivalence
Pregnancy-Related
Complications
Treatment
Correct electrolyte imbalances and
acid-base imbalances with oral or IV
fluids
Antiemetic drugs
Possibly parenteral nutrition
Pregnancy-Related
Complications
Nursing Care
Focus is on teaching
Avoid foods that trigger N/V
Eat small, frequent meals
Teach about intake and output
Provide support to the mother
HYPERTENSION DISORDERS
Preexisting hypertension (HTN) – diagnosed
and treated before pregnancy; requires strict
medical and obstetrical management
Pregnancy-induced hypertension (PIH) – no
prior incidence, develops during pregnancy
and resolves during postpartum period
PRE-ECLAMPSIA
Vasospasm occurs during pregnancy
(synonymous with PIH)
may progress from mild to severe
TRIAD of symptomatology:
Hypertension (vascular effect)
Edema (interstitial effect)
Proteinuria (kidney effect)
MILD PRE-ECLAMPSIA
Elevated BP : 140/90 or
Increase of +30/ +15 mmHg on two consecutive
occasions at least 6 hours apart as compared to
first-trimester BPs
Edema: generalized edema that does not clear
overnight, or more significantly, facial; sudden
weight gain >2 lbs/wk (2nd trimester); >1 lb/wk
(3rd trimester)
Proteinuria 1+ - 2+ in two consecutive tests at
least 6 hours apart or 300 mg/L in a 24-h
specimen
May be managed at home
SEVERE PRE-ECLAMPSIA
BP 150-160/100-110, increased edema 3+ - 4+
proteinuria
Oliguria (Urine output <500 ml/ 24 hours)
Complaints of headache, visual changes,
epigastric pain, extreme irritability
Hyperreflexia
HELLP – hemolysis (significantly decreased
Hct), elevated liver enzymes (Hepatic
dysfunction- SGOT, SGPT), low platelet count
Managed in the hospital
ECLAMPSIA
Obstetrical emergency
Hypertension
Proteinuria
Convulsions
Coma
Proteinuria
Develops as reduced blood flow damages kidneys
Hypertension During Pregnancy
Other Manifestations of Preeclampsia
CNS – HA
Eyes – Visual disturbances
Urinary Tract – Decrease UOP
Respi9ratory – Pulmonary Edema
GI and Liver – Epigastric pain and N/V, elevated
liver enzymes
Blood – HELLP – hemolysis, elevated liver
enzymes, low platelets
Hypertension During Pregnancy
Eclampsia
Woman has one or more generalized seizures
Facial muscles twitch, then contraction of all muscles
Effects on Fetus
Decreased oxygen availability which may
IUGR
Fetal Death
Hypertension During Pregnancy
Treatment of PIH
Prevention
Management – as discussed previously
Drug Therapy
Magnesium Sulfate (anticonvulsant and antihypertensive)
Antihypertensive Drug Therapy if BP
> 160/100 mg Hg
Hypertension During Pregnancy
Nursing Care
Assist to obtain PNC
Help cope with therapy
Provide care/Monitor
Administer meds
Postpartum Care
Blood Incompatibility
Rh and ABO Incompatibility
Rh blood factor = Rh+
No Rh blood factor in erythrocytes = Rh-
Rh+ person can receive Rh- blood if all other factors
compatible because factor is not
present
Rh incompatibility only occurs if the mother is
Rh- and fetus is Rh+
Blood Incompatibility
subsequent pregnancies
Blood Incompatibility
Manifestations
If mother produces anti-Rh anitbodies no outward
manifestation
Labs reveal increased antibody titers
When maternal anti-Rh antibodies cross the placenta
fetal erythrocytes are destroyed (erythroblastocis fetalis)
Blood Incompatibility
Nursing Care
Prevent antibody production
Rhogam at 28 weeks and w/in 72 hours of delivery
if mother Rh- and baby Rh+
May also be given after amniocentesis as a precaution
Dyspnea
Folic acid-deficiency
Large, immature RBCs
Iron-deficiency anemia may also be present
Prevention – folic acid supplement
of preventative supplement
Pregnancy Complicated
by Medical Conditions
Sickle cell disease
Abnormal Hgb that causes erythrocytes to become sickle-
shaped during hypoxia or acidosis
Autosommal recessive trait
Approx 1/12 African Americans has the trait
Pregnancy may cause crisis
Risk to fetus – occulsion of vessels leading to preterm
birth, IUGR, fetal death
Thalasemia
Genetic trait that causes abnormality in one of two chains
of Hgb ,alpha or beta
Pregnancy Complicated
by Medical Conditions
Nursing Care for Anemias During Pregnancy
Nutrition education
Education about changes in stool pattern and
characteristics
Taught to avoid dehydration
TORCH test series
group of maternal systemic infections that can be
transmitted across the placenta or by ascending
infection to the fetus;
infection early in pregnancy may produce significant
and devastating fetal deformities,
later in pregnancy infection may result in
overwhelming active systemic disease and/or CNS
involvement, causing severe neurological
impairment or death of newborn
Pregnancy Complicated
by Medical Conditions
Infections
TORCH - Devestating infections for fetus
T – toxoplasmosis
O – other infections
R – rubella
C – cytomegalovirus
pregnancy)
Cytomegalovirus (CMV)
– transmitted in body fluids; detected by
antibody/serological testing
Virus found in urine, saliva, cervical mucus,
Breastmilk
Pregnancy Complicated
by Medical Conditions
Non-viral Infections
Toxoplasmosis – caused by Toxoplasma
gondii, a parasite that may be in cat feces in
raw meat and transmitted through the
placenta
Possible S/S in newborn
Low birth weight
Enlagred liver and spleen
Jaundice
Anemia
Inflammation of eye structures
Neurological damage
Pregnancy Complicated
by Medical Conditions
Treatment and Nursing Care
Cook all meats thoroughly
Wash hands after handling raw meat
Avoid litter boxes , soil and sand boxes
Wash fresh fruits and veggies well
Group B streptococcus – leading cause of perinatal infections.
Organism found in woman’s rectum, vagina, cervix, throat or skin.
Woman usually asymptomatic, but can be transmitted to baby at
delivery.
Diagnosis
+ culture of woman’s vagina or rectum at 35-37 weeks gestation
Treatment
Antibiotics to mother prior to delivery