Clinical aspects of Maternal and
Child Nursing
Complications During Pregnancy
Lectur 6
Othman Ta’ani
RN-MSN
Characteristic Causes of
High-Risk Pregnancies
Can relate to the pregnancy itself
 Or the woman has a medical
condition or injury
 Or from environmental hazards that
affect the mother or her fetus
 Or from maternal behaviors or
lifestyles that have a negative effect
on the mother or fetus
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Assessment of Fetal Health
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The Goal of fetal assessment
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Positive outcomes
Nursing responsibilities
Preparing the patient
 Explaining procedures/tests
 Clarifying and interpreting results
 Collaboration with other healthcare
providers
 Psychosocial support
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Danger Signs in Pregnancy
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Sudden gush of fluid from the vagina
Vaginal bleeding
Abdominal pain
Persistent vomiting
Epigastric pain
Edema of face and hands
Severe, persistent headache
Blurred vision or dizziness
Chills with fever over 38.0° C (100.4° F)
Painful urination or reduced urine output
Pregnancy-Related Complications

Hyperemesis Gravidarum

Excessive Nausea and vomiting
 Electrolyte/acid
base imbalance
 Significant weight loss
 Decreased urine output
 High hematocrit

Treatment

Correct dehydration and inadequate nutrition
Nursing Care for Hyperemesis
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Patient Education
Reduce factors that trigger nausea and
vomiting
 Keep accurate I&O
 Frequent, small meals

 Easley
digested carbohydrates
 Drinking liquids between meals
 Reduce stress
Pregnancy-Related Complications
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Bleeding Disorders of Early Pregnancy
Abortion
Ectopic Pregnancy
Bleeding Disorders of Late Pregnancy
Placenta previa
Abruptio placentae
Bleeding Disorders of Early Pregnancy

Abortion

Spontaneous Abortion
 The
involuntary loss of the products of
conception prior to 24 weeks’ gestation
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Threatened Abortion
 Cervix
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is closed & no tissue is passed
Inevitable Abortion
 Increased
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bleeding & cervix dilates
Incomplete Abortion
 Bleeding
tissue
dilation of cervix & passage of
Abortion
Bleeding Disorders of Early
Pregnancy (continued)

Abortion
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Complete
 Passage
of all products of conception, cervix
closes and bleeding stops

Missed
 Fetus
dies in uterus but is not expelled,
uterine growth stops and sepsis is possible
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Recurrent
2
or more consecutive spontaneous
abortions
Induced Abortions
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Therapeutic Abortion
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Intentional termination of pregnancy
before age of viability to preserve the
health of the mother
Elective Abortion
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Intentional termination of pregnancy for
reasons unrelated to mothers health
Nursing Care of Early Pregnancy
Bleeding Disorders
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Document amount and character of
bleeding
Save anything that looks like clots or tissue
for evaluation by a pathologist
Monitor vital signs
If actively bleeding, woman should be kept
NPO in case surgical intervention is needed
Post-Abortion Teaching
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Report increased bleeding
Take temperature every 8 hours for 3 days
Take an oral iron supplement if prescribed
Resume sexual activity as recommended by the
health care provider
Return to health care provider at the
recommended time for a checkup and
contraception information
Pregnancy can occur before the first menstrual
period returns after the abortion procedure
Emotional Care
Spiritual support from someone of the
family’s choice and community
support groups may help the family
work through the grief of any
pregnancy loss
 Review effective and ineffective
communication techniques
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Effective Communication
Ectopic Pregnancy
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95% occur in fallopian tube
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Scarring or tubal deformity may result from:
Hormonal abnormalities
 Inflammation
 Infection
 Congenital defects

Ectopic Pregnancies
(Continued)

Manifestations
Lower abdominal pain, may have light
vaginal bleeding
 If tube ruptures:
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 May
have sudden severe lower abdominal
pain
 Vaginal bleeding
 Signs of hypovolemic shock
Ectopic Pregnancies
(Continued)
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Treatment
 Pregnancy test
 Transvaginal ultrasound
 Laparoscopic examination
 Priority is to control bleeding
 Actions can be taken:
 Using medications
 Or by surgery to remove pregnancy from the
tube
Signs and Symptoms of
Hypovolemic Shock
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Changes in fetal heart
rate
Rising pulse
(tachycardia)
Rising respiratory rate
(tachypnea)
Shallow, irregular
respirations; air
hunger
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Falling blood pressure
(hypotension)
Decreased or absent
urinary output (usually
less than 30 ml/hr)
Pale skin or pale
mucous membranes
Cold, clammy skin
Faintness
Thirst
Urinary Tract Infections
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Pregnancy alters
self-cleaning action
due to pressure on
urinary structures
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Prevents bladder
from emptying
completely
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May develop cystitis
 Burning with urination
 Increased frequency
and urgency of
urination
 Normal or slightly
elevated temperature
Pyelonephritis
 High fever
 Chills
 Flank pain or
tenderness
 Nausea and vomiting
Effects of a High-Risk
Pregnancy on the Family
Disruption of usual roles
 Financial difficulties
 Delay attachment to the infant
 Loss of expected birth experience
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Postpartum complication
Postpartum complications
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Preexisting maternal health problems contribute to
many postpartum complications.
Overall nursing objectives for high risk post
partum clients include:
a-Promote diagnosis and treatment of post partum
complications to minimize risk morbidity and
mortality.
b- Promote comfort .
c- Explore emotional aspects.
d- Minimize separation of the mother and infant.
e- assist the client and family to deal with anger,
anxiety and fear.
Nursing Process for women
with postpartum complications
1- Assessment
 a- Health history
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Cardinal signs and symptoms.
 b- Physical examination
 -vital signs.
 -inspection.
 -palpation.
 c- laboratory and diagnostic studies.
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Nursing Process for women with
postpartum complications
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2- Nursing diagnosis.
a- general diagnosis.
b- complication related diagnosis.
3- Planning.
4- Implementation
a- promote a full physical recovery.
b- assist client and family to deal with physical and
emotional stresses of postpartum complication.
c-encourage parent- newborn bonding.
d- provide client and family teaching.
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5- outcome evaluation.
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1-Postpartum hemorrhage
-Postpartum hemorrhage is blood loss of more than
500 ml following the birth of a newborn.
-Early post partum hemorrhage which is usually due
to uterine atony, laceration or retained placenta
fragments, occurs in the first 24 hours after
delivery.
-Late postpartum hemorrhage occurs after 24 hours
after delivery and is generally caused by retained
placental fragments or bleeding disorder.
-Delayed uterine atony or placental fragments
prevent the uterus from contracting effectively.
The uterus is unable to form an effective clot
structure and bleeding continues.
-Nursing management includes
-prevent excessive blood loss and
resulting complications.
-assist the client and family to deal with
physical emotional stress of
postpartum complications.
2- subinvolution
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-It is delayed return of the enlarged uterus
to normal size and function.
-It results from retained placental
fragments and membranes, endometritis,
or uterine fibroid tumor.
-Uterine atony or placental fragments
prevent the contracting effectively.
-Clinical manifestations – prolonged lochial
discharges.
-irregular or excessive bleeding.
-larger than normal uterus.
-Nursing management
1-prevent excessive blood loss,
infection, and other complications.
2-assist the client and family to deal
with physical and emotional stresses
of postpartum complications.
3-Puerperal infection
-It is an infection developing in the birth structures
after delivery.
-It is a major cause of maternal morbidity and
mortality.
-The most common site of post partum infection is
the pelvic cavity.
-It can be caused by poor sterile technique, cesarean
birth.
-clinical manifestations:
-Fever.
-pain, redness, tenderness and firmness.
4- Mastitis
-It is inflammation of the breast tissue that
is usually caused by infection or by stasis
of milk in the ducts.
5-Thrombophlebitis and
thrombosis
-Thrombophlebitis is an inflammation of
the vascular endothelium with clot
formation on the vessels wall.
-A thrombus forms when blood components
(platelets and fibrin) combine to form an
aggregate body (clot).
-Pulmonary embolism occurs when a clot
traveling through the venous system
lodges within the pulmonary circulation
system, causing occlusion or infarction.
-Predisposing factors
-Hx of thrombophlebitis.
-obesity.
-Hx of cesarean delivery.
-Maternal age older than 35 years.
-Varicosities.
-Anemia .
-Pathophysiology
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-The three major causes of thrombus
formation and inflammation are-venous
stasis, hypercoagulable blood, and injury to
innermost layer of blood vessel.
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The level of most coagulation factors are
increased during pregnancy.
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A-Clinical manifestations
-superficial thrombophlebitis within the
saphenous vein system manifests as pain,
tenderness, and warmth along the vein.
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-Pathophysiology
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-DVT symptoms include muscle pain.
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-Femoral thrombophlebitis generally occurring 10-14
days after delivery, produces chills, fever, stiffness, and
pain.
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-Pulmonary embolism is heralded by sudden intense
chest pain with severe dyspnea followed by tachypnea,
pleuratic pain cough, tachycardia, hemoptysis, and
temperature above 38 C.
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B-Lab. Findings.
-Venography.
-Doppler ultrasound.
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Nursing Management
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1- promote resolution of symptoms and
prevent the development of embolus.
-Anticoagulant therapy.
-It is important not to administer estrogen
for lactation suppression .because it may
encourage clot formation.
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2- Provide client and family teaching.
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3- Assist the client and family to deal with
physical and emotional stresses of
postpartum complications.
6- Urinary tract infection
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-It is indicated by more than 100 thousands
bacterial colonies /ml of urine in two
consecutive clean, voided, midstream
specimens.
-Two common types of UTIs are cystitis,
inflammation of the urinary bladder, and
pyelonephritis, inflammation of the renal
pelvis.
-Another cause of UTIs is retention and
residual urine due to over distention and
incomplete emptying of the bladder.
- E-coli, (the most common causative
organism).
-Clinical manifestation
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-cystitis manifestations include frequency
,urgency, dysuria,
hematuria, temperature elevation, and
suprapubic pain.
-Pyelonephritis manifestations include high
fever, chills, flank pain, nausea and vomiting.
-Nursing management –
-recognize signs of infection and prevent the
development of further complications.
7-Postartum mood disorder
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-The disorders are1 -Postpartum blues.-include fatigue, anxiety,
mood instability, with onset 1 to 10 days
postpartum and lasting 2 weeks or less.
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2 -Postpartum depression without psychotic
features.
includes confusion, fatigue, feeling of
hopelessness and shame, and alteration in mood.
3 -Postpartum depression with psychotic features
(postpartum psychosis)-includes symptoms of
postpartum depression plus delusion, auditory
hallucinations, and hyperactivity.