CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
NURSING CARE DURING HIGH-RISK
PREGNANCY
COMPLICATION OF PREGNANCY
Normally, women do not experience problems
until pregnancy. They experience problems
after birth due to changes in hormones, and
other body chemicals.
High risk pregnancy – one in which the life or
health of the mother or infant is jeopardized by
a disorder coincidental with or unique to
pregnancy. Risk factors:
- Genetic consideration
- Medical and obstetrical d.o.(doctor of
osteopathic medicine) (Abortion, health
problems)
- Nutrition
- Teratogens: Smoking, Alcohol, Drugs,
Caffeine(caffeine
increase
blood
pressure).
- Environmental considerations
- Age extremes
- Lack of prenatal care
- Multiple gestation
o
o
o
o
o
o
o
o
Vomiting and retching that far exceed
those seen with the usual morning
sickness.
-
o
o
o
o
o
Frequency, amount, and character of
emesis
Fluid intake and output
Skin turgor and mucous membranes
Psychosocial assessment
Fetal status
Daily weight
o
o
o
o
o
Intravenous fluids
Solid intake is restricted until vomiting
stops.
Bland solids such as toasts and crackers
are introduced slowly. (Toasts, crackers
and ice chips help with vomiting).
In severe cases, TPN may be required.
Small frequent meals.
Oral hygiene
Emotional support
Patient teaching
• Provide dietary consult.
• Educate
patient
regarding
condition.
• Teach patient how to assist with
her treatment.
• Provide referrals for follow up
treatment.
Twins are classified as:
o Monozygotic - Originate from
one fertilized ovum and results in
Maternal/identical.
▪ Same placenta for the
twins
▪ Occurs
when
1
ovum(normal)
finds
1
sperm.
o Dizygotic
fraternal
Two
separate ova fertilized at the
same time.
▪ Different placenta for the
twins
▪ Only happens when the
woman releases 2 ova and
meets 2 different sperms.
▪ Possible to have abortion
on one if it will cause
danger to the other.
o
Maternal and fetal risks are increased
during multiple pregnancy.
Because of over distention of the uterus,
twins usually are delivered before term
and may have extended hospital stays.
Most delivered by C-section.
HYDATIDIFORM MOLE (MOLAR PREGNANCY)
o
o
A gestational trophoblastic disease
May be complete or partial mole.
ETIOLOGY
o
MEDICAL MANAGEMENT
o
o
PATIENT
PATHOPHYSIOLOGY
ASSESSMENT
o
AND
MULTIFETAL PREGNANCY
Vomiting during pregnancy that
becomes excessive to cause electrolyte,
metabolic, and nutritional imbalances.
Usually morning sickness end after 3
months of pregnancy but hyperemesis
gravidarum lasts for up to 5 months.
Results in smaller babies.
Exact cause is unknown; Possibly
hormones (HCG) or psychogenic factors.
CLINICAL MANIFESTATATIONS
INTERVENTIONS
ETIOLOGY
HYPEREMESIS GRAVIDARUM
ETIOLOGY
o
Liquids between meals.
NURSING
TEACHING
o
o
o
Enlargement of the sack but without a
fetus. Unknown cause, although an
ocular defect possible.
Women at higher risk are those who
have undergone ovulation stimulation
an
A gestational trophoblastic disease
May be complete or partial mole.
PATHOPHYSIOLOGY
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
o
o
o
Placental villi abnormally increase and
develop vesicles.
The fluid filled vesicles grow rapidly,
causing the uterus to be larger than
expected.
Usually there is no fetus, placenta,
amniotic membranes or fluid.
o
o
o
ECTOPIC PREGNANCY
o
o
Implantation occurs somewhere other
than within the uterus.
Most common sites are within the
fallopian tube; Other possible sites are
the abdominal cavity, ovary, ligaments,
and cervix.
The progress of the fertilized ovum
through the fallopian tube is slowed or
obstructed.
for
SPONTANEOUS ABORTION/MISCARRIAGE
ETIOLOGY
ETIOLOGY
o
Methotrexate
administration
unruptured ectopic pregnancy.
Termination of pregnancy before the
age of viability.
May be caused by abnormal embryonic
development, chromosomal defects,
inheritable
disorders,
advancing
maternal age and partly, chronic
infections, chronic debilitating diseases,
poor nutrition and recreational drug
use.
CLINICAL MANIFESTATIONS
o
o
o
o
o
o
o
Threatened: bleeding and cramping.
Inevitable: Bleeding increases and
cervix dilates.
Complete: All products of conception
expelled (Usually all bleeding stops).
Incomplete: Some, but not all, products
of conception are expelled(Continuous
bleeding)
Missed: Fetus dies and growth ceases,
but fetus remains in utero. (Cannot be
felt by the mother, need ultrasound)
Septic: Malodorous bleeding, fever, and
cramping. (Due to the baby rotting)
Habitual: Spontaneously aborted in
three or more consecutive pregnancies.
MEDICAL MANAGEMENT
PATHOPGYSIOLOGY
o
Rupture of the fallopian tube and
bleeding into the abdominal cavity.
CLINICAL MANIFESTATIONS
o
o
o
Slight vaginal bleeding.
Signs of peritoneal irritation: Sharp,
localized, one-sided pain or pain
referred to the shoulder.
Abdomen may be rigid and tender.
MEDICAL MANAGEMENT
o
o
Rapid
surgical
treatment:
Salpingectomy or salpingostomy
Blood replacement
o
o
o
o
IV fluids may be administered
Replacement of blood loss
Dilation and curettage (D&C) (Need
dilators).
Dilation and evacuation (D&E) (No need
for dilators).
PATIENT TEACHING
o
o
o
o
Need for rest
Iron supplementation, blood
occurred
Psych support: HEAL program
Rhogam if RH neg
INCOMPETENT CERVIX
ETIOLOGY
loss
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
o
Passive and painless dilation of the
cervix during the first and second
trimester
TREATMENT WITH PROPHYLACTIC CERCLAGE
o
o
o
o
Use suture material to constrict the
internal os of the cervix.
Placed at 10 – 14 weeks gestation.
Refrain
from
sexual
intercourse,
prolonged standing, or heavy lifting.
If removed for delivery, must be
replaced with subsequent pregnancies.
MEDICAL MANAGEMENT
o
o
Vaginal exam attempted only if ready
for birth.
Cesarean birth is usually the treatment
of choice.
ABRUPTIO PLACENTAE
ETIOLOGY
o
o
o
o
o
o
This is premature separation of the
normally implanted placenta from the
uterine wall.
It generally occurs late in pregnancy,
frequently during labor.
Cause is unknown
Predisposing factors include trauma,
chronic hypertension, and pregnancyinduced hypertension, drug use.
Blunt external abdominal trauma may
also be a cause.
LIFE THREATENING
PATHOPHYSIOLOGY
When the placenta separates from the
uterine wall, bleeding occurs from the
uterine sinuses.
o The most common classification of
placental abruption is according to type
and severity.
• GRADE I, II, III
a. Grade I- Small amount of bleeding,
some uterine contractions and signs of
fetal distress.
b. Grade II- mild to moderate amount of
bleeding, some uterine contractions
and signs of fetal distress.
c. Grade III- several bleeding, intense
abdominal pain, and signs of fetal
distress.
o
BLEEDING DISORDERS
PLACENTA PREVIA
ETIOLOGY
o
o
o
Placenta implants in the lower uterine
segment.
Described by the degree to which the
placenta covers the internal cervical os.
a. Marginal
b. Partial
c. Total
d. Low implantation
Most important risk factor: previous
cesarean birth.
CLINICAL MANIFESTATION
Sudden, severe, pain is accompanied by
uterine rigidity.
MEDICAL COMPLICATIONS OF PREGNANCY
o
PREGNANCY INDUCED HTN (PIH)
ETIOLOGY
o
o
PATHOPHYSIOLOGY
o
o
In the last trimester of pregnancy,
uterine size increases and the cervix
begins to dilate and efface.
As the placenta separates from the
cervix, sinuses at the site begin to bleed.
CLINICAL MANIFESTATION
o
o
Painless, bright-red, vaginal bleeding
occurs.
Bleeding may be intermittent or occurs
in gushes.
o
o
A
disease
encountered
during
pregnancy or early in puerperium.
Classic S&S
• HTN
• Edema
• Proteinuria
Includes pre-eclampsia and eclampsia.
Increased risk for PIH if have multiple
pregnancy, DM, or family history of PIH.
PATHOPHYSIOLOGY
o
Complex hormonal
changes occur.
and
vascular
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
o
These lead to increased blood pressure,
decreased
placental
perfusion,
decreased renal perfusion, altered
glomerular filtration rate, and fluid and
electrolyte imbalance.
CLINICAL MANIFESTATION
o
o
o
Edema
Hypertension
Proteinuria
Encourage
high-quality
protein,
vitamin, and mineral intake.
COMPLCATIONS RELATED TO EXISTING
MEDICAL CONDITION
o
GESTATIONAL DIABETES
PATHOPHYSIOLOGY
o
ASSESSMENT
o
o
o
o
Blood pressure
Weight
Edema (scale 1-4)
Urine tested for albumin.
Gestational
diabetes
mellitus
is
characterized by an inability to produce
sufficient insulin to maintain normal
glucose levels during pregnancy.
CLINICAL MANIFESTATION
Alteration in blood glucose levels; 120
mg/dl significantly increases the risk of
complications.
o Polyuria, polydipsia, and polyphagia
a. Polyuria (excessive excretion of urine)
b. Polydipsia (excessive thirst)
c. Polyphagia (excessive eating)
o
ASSESSMENT
o
o
o
o
MEDICAL MANAGEMENT
o
o
o
o
o
o
May or may not need to be hospitalized.
Bedrest: Lateral recumbent position left
side (Better tissue perfusion when lying
on left side)
Well-balanced diet with adequate
protein.
IV therapy for emergency situations.
Magnesium sulfate to prevent seizures.
(sedative)
Sedatives and antihypertensives.
NURSING INTERVENTIONS
o
o
o
o
o
o
o
o
o
Assess for headache, edema, and
blurred vision.
Monitor I&O; indwelling catheter may
be necessary.
Monitor fetal heart rate; fetal monitor
may be needed.
Perform kick count.
Monitor daily weight.
Enforce bedrest.
Provide emotional support.
DTR’s, Vitals, respirations of >12.
Magnesium levels: want between 57mg/dl for therapeutic
PATIENT TEACHING
o
o
Educate
on
danger
signs
of
complications of pregnancy.
Stress the importance of regular
medical supervision.
Urine testing should be done at all
prenatal visits.
Presence of glucose indicates need for
further testing.
Stress, diet, activity, and medication
compliance
Assess
for
vascular
system
complications.
DIAGNOSTIC TESTS
o
o
o
Blood glucose levels; glucose tolerance
tests
Glycosylated hemoglobin
Tests to evaluate fetal well-being.
NURSING INTERVENTIONS
o
o
o
Assess the patient carefully at each visit.
Complete all blood glucose level
evaluations.
Report any abnormalities to the
physician.
NORMAL GLUCOSE LEVELS
a. FBS (Fasting Blood Glucose)
70-100 mg/dl (3.9 – 5.6 mmol) or lower
b. RBS (Random Blood Glucose)
125 mg/dl (6.9 mmol) or lower
c. OGTT (Oral Glucose Tolerance Test)
140 mg/dl (7.8 mmol) or lower
d. Post Meal Glucose (Post Prandial- 2
hours after eating)
110 mg/dl (6.1 mmol ) or lower
e. Average Glucose
100mg/dl ( 5.6 mmol ) or lower
PATIENT TEACHING
o
o
o
Diet, medication, and health practices
Necessity Of good control Of the disease
Medications
• Insulin — preferred drug; doesn't
cross placenta.
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
•
•
Oral hypoglycemics — potential
teratogenic effects
• May consider Glyburide.
COMPLICATIONS RELATED TO
CARDIOVASCULAR SYSTEM
o
o
o
Pregnancy increases demands on the
cardiovascular system.
The normal, healthy heart can adapt to
the increased demands.
Women who have preexisting cardiac
disease face increased risk when cardiac
function is challenged by pregnancy.
o
ETIOLOGY
o
Most common problem result from
rheumatic heart disease, congenital
heart defects, and mitral valve prolapse.
PATHOPHYSIOLOGY
o
o
Increased blood volume, heart rate, and
cardiac output overstress the cardiac
muscle, valves, and vessels.
Symptoms of the underlying pathologic
condition are exacerbated, resulting in
cardiac decompensation, congestive
heart failure, and other medical
problems.
o
o
o
EXSITING MEDICAL CONDITIONS
a. Rheumatic heart disease
usually under the age of 25, damage to
heart valves from rheumatic fever, auto
immune reaction to streptococcus
infection like tonsilitis
b. Congenital heart defects
scarring from heart surgery and may
cause changes
in heart rhythm.
c. Mitral Valve Prolapse
It causes blood to leak backwards
through the valve or called mitral valve
regurgitation.
SIGNS AND SYMPTOMS
•
•
•
Irregular heartbeat
Dizziness
fatigue
o
o
o
CONCERNS OF DRUG THERAPY
o
o
o
Oral anticoagulants
Beta blockers
• Medications that lower blood
pressure.
• Blocks the effect of hormone
epinephrine(adrenaline)
that
causes the heart to beat faster,
therefore increasing the blood
pressure.
Thiazide diuretics
• Used to treat hypertension.
• Excrete in urine > Urine excretion
lowers blood pressure.
o
Can also cure congestive heart
failure and swelling by removing
excess fluid.
• Be careful with the blood
pressure as it can become too
low.
ACE Inhibitors
• Treats hypertension
• Treats heart failure, diabetes and
certain chronic diseases.
• Used if a pregnant women is a
cardiac patient.
ANEMIAS DURING PREGNANCY
Iron deficiency anemia
• Blood cell with of healthy RBC
Folic acid deficiency anemia.
• Pregnant women does not have
enough vitamin b9
• Causes fatigue and weakness.
• Can be caused by poor nutrition.
Sickle cell anemia
• Inherited disorder.
• More common in women but
also possible in men.
• Cause
pain,
swelling
and
infection.
• Small pain tolerance
Thalassemia
• Inherited blood disorder
• Affect
the
production
of
hemoglobin (carries oxygen).
• Causes fatigue, bone deformities,
and jaundice.
• Can
be
cured
by
blood
transfusion
TORCH INFECTIONS
Diseases that can cross the placenta,
and infect the baby.
Toxoplasmosis
➢ Parasitic infection.
➢ Caused by toxoplasma gondii
➢ By eating uncooked meat and
through contact with cat feces.
Other
• HEPA A
➢ Short term disease
➢ Inflammation of the liver.
➢ Spreads to unvaccinated
person consumes food
and water contaminated
with fecal matter.
• HEPA B
➢ Transmitted when blood
serum or another bloody
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
fluid enter the body of an
uninfected individual.
• HIV/AIDS
• Group B Streptococcus
➢ bacteria commonly found
in intestines, liver, GI tract,
common bacteria of UTI,
Pneumonia
and
meningitis.
• STD’s
➢ Obtained in sexual contact
• UTI
• RUBELLA
• CYTOMEGALOVIRUS
➢ Chicken
pox,
herpes
simplex
• HERPESVIRUS
➢ Through
skin-to-skin
contact
or
sexual
intercourse.
COMPLICATIONS RELATED TO AGE
o
o
o
ADOLESCENTS
GROWTH AND DEVELOPMENT
•
•
•
Developmental
tasks
of
adolescents
must
be
accomplished before the child
can become a mature adult.
Pregnancy interrupts work on
identity
formation
and
developmental tasks.
There are several physiological
concerns
with
pregnant
adolescents.
▪ Increased risks of PIH,
cephalopelvic
disproportion,
abruptio
placentae,
low
birth
weight, IUGR anemia,
infection,
preterm
delivery, and perinatal
death.
o
o
HYPERTONIC LABOR DYSFUNCTION
o
o
o
ASSESSMENT
o
o
Encourage
early
and
continued
prenatal care.
Refer the adolescent for appropriate
social support.
NURSING INTERVENTIONS
o
Labor and Birth
• Support of a knowledgeable
coach is necessary.
• Promote Kegel Exercise to
increase the strength of the
pelvic floor.
• Teach
about
relaxation,
ambulation,
side-lying,
and
comfort measures.
Post-partum care
• Explicit directions for self-care
and infant care are required.
• Assess new mother's parenting
abilities.
• Postpartum contraception is a
high priority.
• Provide emotional support if
contemplating adoption.
Adolescent Father
• Needs
support
to
discuss
emotional responses.
• May have feelings of guilt,
powerlessness,
or
bravado
(something
unnecessary
or
dangerous).
Older Pregnant Woman
• Women who have their first child
after they are 35 years old have an
increased risk of maternal and
fetal complications.
• As women maintain better
overall
health
and
fitness,
increased age appears to be less
of an impediment to a normal
pregnancy.
• Psychosocial
adjustment
to
parenthood at this time of life
depends greatly on the individual
and her situation.
COMPLICATIONS DURING LABOR
Dysfunctional Labor= Abnormal Labor
Dystocia= Difficult Labor
Occurs during latent phase; frequent,
poorly-coord., cramp-like contractions;
painful & nonproductive.
Treatment — mild sedation; uterine
relaxant (tocolytic)
Provide comfort measures; promote
rest & relaxation.
HYPOTONIC LABOR DYSFUNCTION
o
o
o
Weak, ineffective contractions; begin
normally then diminish
Treatment — amniotomy, oxytocics, IVF
Provide emotional support; keep
notified of progress; position △
PRECIPITATE BIRTH
o
Completed in <3 hours; may be no
healthcare provider present.
PREMATURE RUPTURE OF MEMBRANES
o
o
Spontaneous Range of Motions @ term
at least 1 hour before contractions begin.
Amniotic sac ruptured.
PRETERM PREMATURE
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
o
o
o
PROLONGED PREGNANCY
o
o
o
o
o
o
o
•
•
range of motion before term with or
without uterine contractions.
Preterm babies
Administer dexamethasone.
lasts>42 weeks
wrinkled baby
PRETERM LABOR
after 20 weeks and before 38 weeks
gestation
main risks= problems of immaturity in
newborn
Risk factors:
• Age extremes
• Chronic illness
• Previous preterm labor
• Previous pregnancy loss
• Uterine or cervical abnormalities
• Multifetal pregnancy
• Chronic stress
• Substance abuse
Diagnosed
based
on
cervical
effacement and dilation of more than
2cm.
Medical treatment= uterine relaxants
(tocolytic therapy)
• GOAL= stop uterine contractions
and keep fetus in utero until
lungs are mature enough to
adapt to extrauterine life.
• May need intubation.
• Intubation
can
cause
pneumonia for the baby
UTERINE RUPTURE
o
Tear in uterine wall, occurs when muscle
cannot withstand pressure inside organ.
• Major risk factor= previous
uterine surgery (C-section).
o
The uterus turns inside out after infant
is born; partial or complete; more likely
if not firmly contracted.
May be able to repair in OR; may require
hysterectomy if unable.
Administer oxytocin for contraction.
Monitor the uterus every one 1 if it is soft
or hard to palpate.
UTERINE INVERSION
o
o
o
AMNIOTIC FLUID EMOBOLISM
o
o
o
o
o
Restrict activity.
Hydration
Identify and treat any infections.
o
o
PROLAPSED UMBILICAL CORD
o
o
o
Cord slips down into pelvis after ROM.
Can be compressed between fetal head
& women’s pelvis - ↓ fetal blood supply.
Treatment:
• Displace
fetus
upward
—
Trendelenburg, side-lying with
hips elevated.
• Fetus may be held upward by
hand.
• Oxygen
Blood loss> 500ml after vaginal delivery
or >1000ml after cesarean delivery.
Can occur any time during the
postpartum period.
Most common sources:
• Uterine atony
• Retained placental fragments
• Perineal lacerations
Major risk of postpartum hemorrhage=
hypovolemic shock.
POSTPARTUM INFECTIONS
IMPROVING FETAL LUNG MATURITY
Give steroid injection to mother:
Betamethasone.
o Thyroid releasing hormone
o Give fetus surfactant after birth (prevent
distress lung disorder)
COMPLICATIONS DURING LABOR
Amniotic fluid with particles enters
woman’s circulation and obstructs
small blood vessels.
• More likely in very strong labor
due to rupture of small blood
vessels with cervical dilation.
POSTPARTUM COMPLICATIONS
POSTPARTUM HEMMORHAGE
Drug of Choice= Magnesium sulfate
INITIAL MEASURES TO STOP PRETERM LABOR:
o
o
o
Tocolytic drugs
Deliver by quickest means —
usually C-section.
Risk factors:
• Tissue trauma
• Open wound of placental site
• Surgical incisions
• Cracked nipples
• ↑ pH of vagina
POSTPARTUM WOUND INFECTIONS
o
o
Redness, edema, heat, pain, separation
of suture line, purulent danger.
• C&S of danger; antibiotic therapy.
• Sterile technique for wound care,
proper perineal hygiene, may use
sitz bath.
Administration of antibiotics 1 hour
prior the operation then every 4 hours
after the surgery; if CS 3 days for IV every
8 hours; If for discharged, oral
medications, 7 days.
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
o
Standard antibiotic completion is 7
days. Can be extended to 14 days
depending on consultants discretion.
o
ENDOMETRITIS
o
Tender enlarged uterus, prolonged
cramping, foul smelling lochia, fever,
subinvolution of uterus.
INTERVENTION
•
•
C&S of uterine cavity, antibiotics
Fowler’s position, analgesics,
assess lochia.
MASTITIS
o
reddened, tender, hot area of breast,
edema, fullness, may have purulent
danger.
• Antibiotics,
if
developed
abscess— I&D (Incision and
Drainage)
• Moist heat, massage affected
area, regular and frequent
nursing or pumping, teach
effective
breastfeeding
techniques.
SUBINVILUTION OF THE UTERUS
Slower than expected return of the
uterus to its nonpregnant condition.
• Most common causes= infection
and
retained
placental
fragments.
COMPLICATIONS RELATED TO
POSTPARTUM MENTAL HEALTH DISORDER
o
MOOD DISORDERS
o
o
o
o
Mild depression or "baby blues;" some
may have postpartum depression
(PPD) = nonpsychotic depressive
illness usually occurring within 2
weeks after delivery)
A prominent feature of PPD is rejection
of the infant.
Attitudes toward the infant may include
disinterest,
annoyance
with care
demands, and blame because of
mother's lack of maternal feeling.
Postpartum psychosis = impaired sense
of reality; more serious than PPD;
mother may endanger herself & infant
during manic episodes; may commit
suicide & infanticide during depressive
episodes.
MEDICAL MANAGEMENT
o
o
The
natural
course
is
gradual
improvement over the 6 months after
birth.
Support treatment alone is not effective
for major PPD.
o
o
Pharmacologic
interventions
are
needed
in
most
instances:
antidepressants, anxiolytic agents, and
electroconvulsive therapy.
Psychotherapy focuses on the mother's
fears and concerns and monitoring for
suicidal thoughts.
Post partum depression can last up to
6 months.
NURSING CARE OF A PREGNANT CLIENT
STAGES OF PREGNANCY
o First Trimester- weeks 1-13
o Second Trimester- weeks 14-27
o Third Trimester- weeks 28-40
DANGER SIGNS OF PREGNANCY
o Vaginal bleeding
o Persistent vomiting
o Fever and chills
o Leaking per vagina
o Abdominal / chest pain
o Pregnancy induced hypertension.
• Vasospasms on arteries
o Increased / decreased fetal movements.
• Fetal tachycardia
SIGNS OF PIH
o Rapid weight gain (>900gm in 2nd tri /
450 gm in 3rd trimester
o Swelling of fingers and face
o Flashes of lights/ dots before eyes
o Dimness/ blurring of vision
o Severe continuous headache
o Decreased urine output.
PROMOTING FETAL AND MATERNAL WELLBEING
SELF-CARE NEEDS
o
o
o
o
Bathing
Breast care
Dental care
• Administration of anesthesia can
penetrate in the placenta that
can increase the heart rate of
the baby.
Perineal hygiene
CLOTHING
o
o
Loose and comfortable
Low heel shoes
SEXUAL ACTIVITY
o
Should be avoided in 1st trimester.
• It can cause cervical trauma.
• Semen has prostaglandin that
promotes abortion.
• Prostaglandins
are
potent
oxytocic agents and that they
may play a physiological role in
labor and abortion.
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
CONTRAINDICATED IN
o
o
o
History of spontaneous miscarriage
Ruptured membranes
Placenta previa and vaginal spotting
EXERCISE
o
o
o
3 times weekly for 30 minutes
Walking or swimming is best
Extreme exercise leads to low birth
weight.
SLEEP
o
o
o
o
8 +2 hours
• Our kidney cleans every 2-3 am
Sim’s position with top leg forward
Avoid resting on back
Don’t bent knee / cross legs
EMPLOYMENT
o
o
o
Discontinue hazardous occupations
Prolonged standing
Avoid interference with adequate sleep
and nutrition
TRAVEL
o
o
o
o
o
Avoid jerky vehicles
Take drugs for motion sickness only
with prescription
In long journey, walk a short distance
every hourly
Bottom strap of seatbelt should be
below the abdomen
Live vaccines are contraindicated
ANTE-NATAL CHECK-UP
o
o
o
Monthly up to 7 months
Twice monthly in 7-9 months
Weekly up to EDC ( expected date of
confinement)
o
o
o
Well balanced
Small and frequent
Rich in iron and folic acid
• If you lack in iron and B9
supplements= SPINA BIFIDA or
MENINGOCELE
20 glass fluid
2500 kcal + 71 gm of protein
Iron, folic acid and calcium tablets.
NUTRITION
o
o
o
AVOID
o
o
o
o
o
Caffeine
• It sticks on the urethral lining that
increases the pus cells resulting
to UTI.
Artificial sweeteners
Weight reduction diet
Fasting
Skipping of meals
PROTEINS
o
For growth of fetus, placenta and
accessory tissues
o
o
Animal protein
Vegetable protein
FATS
o
o
o
o
o
Important source of energy
Provide fat soluble vitamins
Needed for surfactant production, CNS,
cell membranes
Animals fats
Vegetable fats
CARBOHYDRATES
o
Important source of energy sources:
cereals, roots, tuber
o
o
o
Prevents constipation
lower cholesterol
May remove carcinogens from intestine
o
o
o
calcium and phosphorus
Formation of teeth and skeleton of fetus
Prevents maternal osteoporosis
FIBERS
MINERALS
SOURCES
1.
-
IODINE
Formation of thyroxine
Function of thyroid gland
Sources: Seafoods, iodized salt
IRON
o
Fetal hemoglobin production
SOURCES
1.
2.
-
Heme Iron
Liver
Meat
Poultry
Fish
Non-Heme Iron
Leafy vegetables
Legumes
Beans
Cereals
Milk
ZINC
o for synthesis of DNA and RNA
o source: Liver, meat, egg, seafood
MANAGEMENT OF MINOR DISORDERS
BACKACHE
CAUSES
o
o
lumbar lordosis
lax abdominal muscles
MANAGEMENT
o
o
o
o
o
o
Shoes with low to moderate heels
Hot application
Squat to pick up objects
lift objects holding them close to the
body
Firm mattress
pelvic rocking / tilting exercise
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
o
adequate rest
MUSCLE CRAMPS
CAUSES
o
o
o
LOW Calcium
HIGH Phosphorus
Interference with circulation
CONSTIPATION
CAUSES
o
o
o
o
o
o
Progesterone
weight of the uterus
oral iron
low fiber and fluid
more tea and coffee
no exercise
TREATMENT
o
o
o
o
Bowel retraining
Correct poor habits and painful lesions.
Brisk walking after a hot drink
Regular time for toileting
DIETARY REFORMATION
o
o
o
o
increase fiber and fluid intake
Reduce tea, coffee and sugar
Prune juice
No gas forming foods
SPECIFIC DRUGS
o
o
o
iron in empty stomach with juice
no mineral oils/ enemas/ OTC laxatives
can use psyllium/ docusate sodium/
Dulcolax
FREQUENT URINATION
CAUSES
o
o
o
Pressure of uterus / fetal head
Polyuria
Bladder mucosa congestion
MANAGEMENT
o
o
o
reduce caffeine
kegel’s exercise
• to increase pelvic floor strength.
Rule out UTI