complications Flashcards
What are the local issues on maternal health? (5)
- access/rurality
- centralisation of services to urban areas
- poverty and low health literacy
- lack of access to antenatal and post-natal care– childcare, inflexible appointments
- culturally unsafe services
Maternal health risk factors (4)
- alcohol = fecal alcohol spectrum disorder
- drugs
- smoking = low birth weight
- family violence
Pregnancy complication
HYPEREMESIS GRAVIDARUM- define, risks, nursing management
define: excessive vomiting during pregnancy. likely due to increased human chorionic gonadotropin
risks:
- dehydration
- electrolyte imbalance
- unsustained nutrition
- Hypotension
- hypovolemia
- tachycardia
- decrease urine output
- if untreated: muscle wasting, severe protein and vitamin deficiency
management:
- antiemetic medications
- IV therapy
- total parenteral nutrition
- quiet and odour-free environment
- encourage oral hygiene (from dry mouth and irritation)
- monitor weight
- emotional support
Maternal complication
Bleeding EARLY/DURING pregnancy- causes (4), assessment Qs, diagnostic testing
Causes:
1. ectopic pregnancy- fertilised egg implants outside uterus
2. miscarriage
3. anembryonic gestation- gestational sac but no embryo or yolk sac
4. molar pregnancy- hydatidiform mole (tumour) abnormal tissue grows around the fertilised egg
Assessment questions:
1. weeks of gestation or last period
2. duration, amount, color, and quality of bleeding
3. cramps/pain
4. associated symptoms: fever, fatigue, dizziness, nausea, vomiting
5. last sexual intercourse
6. history of bleeding disorder
7. history of ectopic pregnancy, pelvic inflammatory disease or tubal surgery
diagnostic test:
1. urine pregnancy test
2. blood type with Rh factor
3. transvaginal ultrasound
4. blood B-hCG levels
Maternal complication
Rh isoimmunisation- nursing considerations, fetal risks
nursing considerations:
1. routine maternal blood type and Rh factor with a routine Rh antibody screen.
2. antibody screening repeated at 28 weeks, if still negative they are given IM injection of Rh immune globulin.
3. after birth, the baby’s blood type is tested. if Rh+, Rh immune globulin injection is repeated to prevent developing antibodies.
fetal/neonatal risks:
1. hydrops fetalis characterised by
- anemia
- jaundice
- generalised oedema
- enlarged liver and spleen
Maternal complication
Bleeding in LATE pregnancy (2nd or 3rd trimester)- types (2), risk factors (6), s/s (3)
Placenta previa: placenta implants over or within 2cm of the internal cervix os= painless bleeding
Placental abruption: separation of the placenta from the uterine wall before delivery. revealed (bleeding outside vagina) or concealed (blood is trapped behind placenta)
Risk factors:
- tobacco or cocaine use
- chronic htn
- preeclampsia
- clotting disorder
- abdominal trauma
- hx of abruption in prev pregnancy
s/s:
- pain with bleeding
- contractions
- unrelenting pain
Lochia
few days-1week PP
Red lochia: red or dark brown discharge with fleshy smell
2-3 weeks PP
pink lochia: pinkish-brown discharge
3-6weeks PP
white lochia: white-yellow discharge
Maternal complication
POSTPARTUM HAEMORRHAGE (PPH)- define, 2 types, 4 causes, risk factors before and after birth
define: excessive bleeding; blood loss of >/= 500 mL; major PPH if >/= 1000mL.
types:
Primary- within 24 hours of delivery
secondary- 24 hours to 12 weeks after delivery
causes:
- genital tract trauma
- coagulopathies
- retained placental tissue
- uterine atony
risk factors (before birth)
- placenta previa
- carrying twins/triplets
- previous PPH
- BMI >35
- anemia
- fibroid (growths in uterus)
- clotting problems
- preenclampsia (persistent HTN)
risk factors (during and after birth)
- delivery by caesarian
- induction of labour
- retained placenta
- perineal tear or episiotomy
- forceps or ventouse delivery
- long labour
- large baby )>4kg)
- fever during labour
- GA
- precipitous/rapid delivery
- infections
- coagulation abnormalities
- uterine atony (weak muscle tone)
Maternal complication
GESTATIONAL DIABETES- risk factors, adverse outcomes for mother and infant
risk factors:
- overweight or obese BMI over 40
- maternal older age >25
- family history of diabetes
- previous delivery of macrosomic newborn (4kg)
- history of unexplained stillbirth or miscarriage
- polycystic ovarian syndrome
-Maori or Pacific descent
adverse outcomes for mother:
- pregnancy associated HTN
- 3rd or 4th degree perineal tears
- PPH
- caesarean birth
- operative vaginal birth
- preterm labour
- polyhydramnios
- lifetime risk of CVD
adverse outcomes for infant
- shoulder dystocia with possible bone fracture or nerve palsy
- macrosomia
- hypoglycemia
- respiratory distress syndrome
- jaundice
- large or small for gestational age
- stillbirth
-childhood obesity
- metabolic syndromes later in life
- T2DM later in life
Maternal complication
Types of HYPERTENSION in pregnancy (3)
- Gestational Hypertension or Pregnancy-induced hypertension (PIH)
- new onset of hypertension AFTER 20 WEEKS gestation
- no signs of pre-eclampsia - Chronic Hypertension
- onset of hypertension BEFORE pregnancy - Pre-eclampsia- a multisystem disorder associated with hypertension and proteinuria, which rarely presents before 20 weeks gestation. The pathological changes are primarily ischemic, affecting the placenta, kidney, liver, brain and other organs.
Maternal complication
PRE-ECLAMPSIA- s/s (6 cardinal and 5 severe), lab tests (5), pharmacological management (3), risk factors (14), follow-up (4)
cardinal s/s:
1. oedema feet swelling is normal, but hands+face=HTN)
2. oliguria
3. proteinuria (systemic peripheral vasoconstriction= glomerular endothelial damage, fibrin disposition and resulting ischemia reduce renal flow and GFR)
4. weight gain (>2kgs in 1 week)
5. elevated LFTs
6. low platelets
severe s/s:
7. headache
8. visual disturbances
9. epigastric pain
10. nausea/vomiting
11. hyperreflexia
lab tests:
1. urinary protein
2. blood tests for kidney function (BUN, creatinine, uric acid levels)
3. clotting studies
4. liver enzymes
5. magnesium levels
pharmacological management:
1. low dose aspirin in 2nd trimester (reduce risk)
2. antihypertensives
3. magnesium sulfate given IV during labour (counteract hyperflexia)
risk factors:
1. history of pre-eclampsia
2. renal disease
3. chronic htn
4. history of haemolysis, elevated liver enzymes and low platelet count
5. diabetes
6. family hx of preeclampsia
7. genetic ancestry- african, indian, maori, pacific
8. nulliparity
9. multiple pregnancy
10. change in partner
11. BMI >35
12. maternal age >40
13. pregnancy interval >10 years
14. diastolic BP >=80
long-term follow up:
1. chronic htn
2. risk of preeclampsia on subsequent pregnancies
3. annual htn screening and lifestyle changes
4. child- CVD risk, poor verbal and neurocognitive abilites
Maternal complication
What is considered as hypertension in pregnancy?
> 140mmhg systolic
90mmhg diastolic
Maternal complication
Life-threatening emergencies- CORD PRESENTATION AND PROLAPSE- define, risks, management
define: cord is interposed between fetal presenting part and internal os of cervix, but the amniotic sac is intact
risks:
- if amniotic fluid break = umbilical cord prolapse thru vagina
- risk to baby- fetal hypoxia
management:
- if cord is presenting, move away from baby’s head.
- if cord has prolapsed, emergency c-section
Maternal complication
PRETERM LABOUR- define, risk factors, s/s
define: labour starting before 36 weeks gestation
risk factors:
- hx of premature birth
- multiple gestations (twins etc)
- use of reproductive technology
- STI, UTI, other vaginal infections
- short cervix
- smoking, drinking, illegal drugs
- underweight or obese
- poor dental hygiene
- diabetes
- domestic violence
s/s:
- gush of fluid
- bleeding
- contractions gradually stronger and more regular
- less specific: abdo crampls pelvic pressure, low back ache, diarrhoea, nausea
Maternal complication
VENOUS THROMBOEMBOLISM (VTE)- types+s/s, define, risk factors
- Deep Vein Thrombosis: blood clot usually in deep parts of body eg legs
s/s: leg pain, unilateral swelling, lower abdominal pain (referred pain)
- Pulmonary thromboembolism: blood clot travels to artery in lungs and cause blockage. leading cause of pregnancy death
s/s: dyspnoea, chest pain, low grade fever, blood in sputum, collapse
1&2 risk factors:
- birth-related hormones
- immobility
- stasis of blood flow
- hypercoagulation
Maternal assessment
CHRIONIC VILLUS SAMPLING- define
prenatal diagnostic test on the placenta to check for possible genetic abnormalities of the fetus. e.g. Edward’s Syndrome, Patau’s syndrome
Maternal complication
Life-threatening emergencies- BREECH PRESENTATION- define, types, management
define: position of fetus lying within the uterus with its bottom towards the cervix and its head towards fundus
types:
- legs extended at the knee
- both legs flexed at the hips and knees
- single or double footing breech
management:
- manual turning from skilled provider
- c-section
Maternal complication
Life-threatening emergencies- ECLAMPSIA- define, symptoms, management
define: a medical emergency. convulsion coming from pre-eclampsia
symptoms:
- adverse effect on placental function
- high BP
- protenuria
- oedema
management:
- oxygen therapy for hypoxia
- anticonvulsants for seizure
Maternal complication
Life-threatening emergencies- UTERUS RUPTURE- 2types+define, management
- complete: involves a tear in the uterine wall with or without expulsion of the fetus
- incomplete: involves tearing of the uterine wall but not the perimetrium
management:
- immediate c-section
Maternal complication
Life-threatening emergencies- TRAUMA- define muscle affected in babies
define: includes trauma to skin and superficial tissues, muscle trauma, nerve trauma, and fractures
affected muscle:
sternocleidomastoid- causes babies to develop “infant torticollis” where neck muscles contract, pulling the head to one side
Maternal complications
reasons for EMERGENCY CAESAREAN SECTION
- distressed baby during pregnancy/labour
- abnormal fetal position
- baby too big to pit pelvis
- labour not progressing at all
- cord prolapse
- mother’s anatomy stop baby from moving into birth canal
- placenta previa or placental separation
- previous surgery to cervix, uterus or bladder
Maternal complications
List 4 potential serious POST PARTUM complication
- postpartum hemorrhage
- postpartum puerperal (uterus/vagina) infection
- thromboembolic disorders
- psychiatric disorders
Maternal complications (post partum)
POSTPARTUM INFECTION- define, assessment
define: infections of the genital tract
assessment:
- assess for abdo pain or rigidity
- assess episiotomy wound site
- assess fundus for involution
- assess lochia
Maternal complications (post partum)
PSYCHIATRIC DISORDERS- 2 types, s/s
- POSTPARTUM DEPRESSION
define: depression lasting weeks to months after giving birth
s/s:
- anger
- anxiety
- dysphoria
- guilt
- feeling numb or empty
- irritability
- loss of interest
- low level energy
- sleep and appetite disturbances
- POSTPARTUM PSYCHOSIS
define: most severe postpartum psychiatric illness. dramatic onset within the first 2 weeks postpartum.
s/s: (similar to PPD plusss)
- hallucinations
- impaired perception of reality
confusion
- delusions
- disorientation
Breastfeeding
Nursing intervention- education on BREAST FEEDING (4)
- set goals, acknowledge maternal feelings, practical help with positioning and attachment, reassurance, praise and encourgement
- promote skin-to-skin time. this tactile stimulation stimulates oxytocin release and breastmilk production
- educate of importance of breastmilk- it serves as antibody protection to infant
- encourage support from partner and family
Breastfeeding
Recommended age
Recommended exclusive period
Recommended age: up to 2 years
Recommended exclusive period: first 6 months
Breastfeeding complications
Define Mastisis, Ankylossia, Premature or low birth weight babies
Mastisis: an inflammatory condition of the breast which may or may not be accompanied by infection
Ankyloglossia (tongue-tie): the frenulum of the tongue is too tight, too short, or attached to the tip of the tongue
Premature or low birth weight: poor sucking reflex
Maternal health
Vitamins
- Folic acid: before and during first trimester, to develop neural tube and spinal cord
- Vitamin D: deficiency is common. may lead to bone conditions like Rickets, delayed physical development and abnormal bone growth in infants
- Iodine supplementation: throughout pregnancy and while breastfeeding for brain development
Fetal Alcohol Syndrome Disorder
- behavioural disability
- brain damage
- growth restrictions
- learning disability
- low birth weight
- physical disability
- preterm birth
Sudden Infant Death Incidence- prevention
- remove clutter
- smoke free environment
- sleep on back
- no co-sleeping
- ensure no gap 6. between mattress
Vaccination
Diphtheria + tetanus + whooping cough
Influenza
