Developed by
D. Ann Currie, R.N., M.S.N.
Begins prior to pregnancy for those women with
disease processes or conditions such as Cardiac
disease, Diabetes Mellitus, Systemic Lupus
Erythematosus, etc.
 It may also will begin with the first prenatal
visit and will continue throughout the
pregnancy, into the intrapartum , and
postpartum periods.
 Many factors may influence the Outcome of a
Pregnancy.
 The nurse should be able to assess and identify
those factors that place the the Antepartum
Client at risk.

 Age-under
17 or over 30-35
 Lower Socioenomic
 Race-Afro-American or Hispanic
 Nutritional Status
 Environmental Factors
 Pregestational Conditions
 Substance Abuse
 Infections-STI’s, TORCH, and other
 No Prenatal Care
 See text for complete list
 Pregnancy
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–induced Hypertension disorders:
Preeclampsia
Eclampsia
HELLP syndrome
Pregnancy-induced hypertension( Gestational
Hypertension
 Chronic
Hypertension
A
hypertension condition which may occur
in pregnancy starting in the third trimester
of pregnancy, and/or the intrapartum,
and/or postpartum periods.
 The clinical manifestations include:
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Hypertension- B/P over 140/90
Proteinuria
? Edema( if client has generalized edema with
other clinical manifestations
Others …. Depending on severity
Types- mild, moderate, and severe
 Risk
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Factors:
Nulliparity
Maternal age-teens under 19 or over 30
Race-Afro-American and Hispanics
Lower Socioeconomic status
Family history of preeclampsia
Chronic hypertension
Diabetes mellitus
Systemic Lupus Erythematosus
Multigestation
Gestational Trophoblastic disease
Fetal hydrops
 Complications
Preeclampsia
of
Hypertensive Crisis
Pulmonary edema
Renal Failure
HELLP
DIC
Eclampsia
Cerebral Vascular
Accident
 Blindness
 Hepatic Failure
 Hepatic Rupture
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Abruptio placenta
Uteroplacental
insuffiency
IUGR
Preterm delivery
Fetal Death
Maternal Death-3th
leading cause of
maternal mortality in
USA
 Mild
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Preeclampsia:
Hypertension over 140-/90 –MAP-over 105
Proteinuria( over 1+)0.3grams/liter in a 24 hour
urine collection
Weight gain(2-2.5 pounds/week)
?edema
Other
 Moderate
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Preeclampsia:
B/P-160/100
Proteinuria-+3
Edema facial and finger
Visual Problems
 Severe
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Preeclampsia::
B/P – Over 180/110 ,MAPProteinuria- 3+to4+ or more than 500grams in a
24 hour specimen.
Oliguria-less 400-500ml/day or less than 30
ml/hour
Sudden large weight gain
Generalize edema-facial, lung may have crackles
Central nervous system irritability:
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Headaches
Hyperreflexia-DTR’s greater than +3-+4 with clonus
Visual disturbances-scotomata or burred vision
 Cont-Severe
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Preeclampsia
Hepatic involvement- upper right quadrant pain
or epigastric pain.
Pulmonary edema
others
Nursing Assessment guidelines for the client with
preeclampsia:
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Obtain a thorough history
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Past medical history-check risk factors
Past Obstetrical history
Current pregnancy history
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Assessment of the various systems
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Cardiovascular assessment:
Vital signs and B/P frequency will depend of severe of
preeclampsia
Ausculate heart sounds and lung sounds
Assess for edema-generalized pitting and pulmonary edema
Daily weight-A.M. same scale
Check capillary refill
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CONT. -Nsg. Assessment
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Respiratory Assessment:
Assess respiratory rate, quality, and pattern
Ausculate lung sounds
Assess skin color.
Monitor oxygenation with pulse oximetry if
indicated
Renal Assessment:
Assess Strict Urinary Output- frequency will
depend on severity of preeclampsia maybe as
often as every hour.
Assess for Protienuria-dipstick
Maintain 24 hour urine collect
Monitor laboratory valves-Electrolytes, BUN,
Creatine, Serum protein, Uric acid
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Cont. Nsg. Assessment•
Hematologic•
Monitor Laboratory Studies
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CBC-RBC, PLT, Hg, and Hct
Coagulation profile-fibrogen, fibrin split products, coagulation
factors, PT ,and PTT
Monitor client for bleeding-in urine, bruises, etc.
Central Nervous System Assessment
Assess DTR’s
Assess level of consciousness
Pain- headaches
Visual changes
Assess for clinical manifestation of ICP-H/A, N/V, etc.
Change in behavior
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Liver Assessment
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Assess for pain-epigastric or upper right quadrant pain
Monitor Liver Functions:
 LDH
 SGOT
 SGPT
 Alkaline phosphate
 Bilirubin
Assess Skin Color
Fetal Assessment
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Fetal movement
NST
Biophysical Profile
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Uterine Assessment
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Monitor for uterine contractions
Assess for Uterine bleeding-Placental abruption.
Assess for clinical manifestations of uteroplacental
insufficiency- AFI under 5cm or Decrease FM
 Nursing
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Diagnoses:
Alt.Tissue Perfusion-Cerebral, Uterine, Renal ,
etc relate to Vasospasms
Risk for Injury
Fluid Volume Deficient
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Nursing Care for the client who has
Preeclampsia: depends on the severity of the
disorder.
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Mild Preeclampsia:
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Bedrest at home-BRP- Bed exercises
Frequent rest periods or naps
Diet high in protein-70grams-100grams
and no added salt/ no salty foods-2-4grams of sodium
Daily Weights- A.M.
Assessment of B/P , dipstick urine for protein.
Fetal movement counts
Teach client/family signs to report to health care
provider that may indicate complications
Client will frequent visits will the doctor-discuss the
importance of these visits
Provide support for client’s/family’s concerns and fears.
 Moderate
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Preeclampsia:
The client with moderate and severe
Preeclampsia will be admitted to the hospital.
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SEVERE PREECLAMPSIA:
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Bed rest
Decrease CNS stimulation:
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A quiet calm environment:
 Lights low
 Limit visitors
Prepare Room/equipment for emergencies :
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Pad side rails
Oxygen and suction setups
IV equipment that can handle several kind of medications or lines
Dinomap and pulse oximeter
Fetal Monitor for continuous monitoring
Foley catheter
Preeclampsia tray:
 Emergency equipment and drugs including :
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Calcium gluconate
Valium
 SEVERE
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PREECLAMPSIA:
Complete initial and continuous assessment( see
guideline for assessment)
Diet – maybe high in protein or NPO
Vital signs- B/P, HR, RR, and FHR every 15 minutes
Intake and output every hour-strict
Deep tendon reflexes every 15 minutes
Daily Weights
Position client in lateral position
Monitor IV infusions
Monitor laboratory tests
 SEVERE
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Magnesium Sulfate-Antidote-Calcium gluconate
Hypertensive agents:
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PREECLAMPSIA: Medications
Methyldopa-Aldomet
Hydralazine- Apresoline
Labetalol-Normodyne
Nifedipine-Procardiac xl
Nitroprusside sodium-Nitropride
Glucorticosteriods-solu-medrol
Diazepam-Valium and/ or Phenytoin- Dilantin
Diuretics- Lasix-only with CHF or pulmonary
edema
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ECLAMPSIA is the development of:
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Convulsions(seizures) Tonic-Clonic seizures
Coma
in the client who has clinical manifestations of
preeclampsia.
 It can occur in the antepartum, intrapartum, or
postpartum periods.
 Nursing Care:
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Seizure care- refer to med-surg. text
Monitor fetal status and prepare for delivery
Prevent complications
 Administer Medications
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 HELLP
Syndrome is a multisystem condition,
a severe form of preeclampsia in which the
client may present with a variety of clinical
manifestations.
 Exhibits common laboratory markers:
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H: Hemolysis.-Low RBC, present of burr cells
EL: Elevated Liver enzymes .- All liver functions
will be high
LP: Low Platelets.-PLT.-less than 100,000
The progression from severe preeclampsia to the
development of multiple organ involvement and
damage leads to HELLP.
The client may complain of malaise, epigastric
or upper right quadrant pain, nausea and
vomiting, or vague symptoms ( not feeling well).
She may be pale or jaundice.
 Nursing Care
Assessments and management of care is the same as
severe preeclampsia.
 Monitor laboratory values:
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CBC
Liver Function Tests
Coagulation Studies
Type and Crossmatch
Possible Blood Transfusions and /or Platelet
 Cont.
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NSG. Care:
Prepare for delivery
Notify Charge nurse ,Anesthesia staff, and INC
Client will go to a Intensive Care Unit
Clint will have a Central line placed.
Medical or surgerical physicians maybe called in.
Equipment maybe needed from the surgery unit.
 Pregestational
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Maintain B/P within normal limits
Observe for complications
Medications:
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Hypertension
The pregnant client should not take ACE Inhibitors or
Beta Blockers for antihypertension agents.
Also Diuretics are usually not given except with the
client will CHF
Monitor Fetal Well Being
Assist client to use non- pharmacological
methods to help to control blood pressure.
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ECTOPIC PREGNANCY
GESTATIONAL TROPHOBLASTIC DISORDER
ABORTIONS
PLACENTA PREVIA
ABRUPTIO PLACENTA
 ECTOPIC
PREGNANCY is one in which the
fertilized ovum implants in a location other
than the endometrial cavity of the uterus.
 The Fallopian Tube is the most common site.
 The risk of an ectopic pregnancy increases
with STI’s and with increase age(35-45)
 Ectopic pregnancy is a significant cause of
first trimester maternal deaths.
 Clinical
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manifestations:
Mild vaginal bleeding
Abdominal pain
Palpable mass
Signs of blood loss
Ultrasound will confirm an extrauterine
pregnancy
 Management
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of the ectopic pregnancy:
Surgerical involves laparoscopy or laparotomy for
salingectomy with the partial or complete
removal of the fallopian tube or removal of the
ectopic pregnancy from other sites. –Prep for
surgery
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Alternate method to surgery is administer of
Methotrexate
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Only if the fetus is under 2.5-3.5 cm.
Single dose
Follow-up with ultrasounds and beta-hCG
Start IV as soon possible- be prepare to give blood
Provide emotional support to the client
If client is Rh-negative administer RhoGam
Monitor client for hemorrhage and infection
Discharge Instructions :
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Teach client to report signs of infection and/or blood loss
to the health provider
Anemic clients should take iron supplements
Importance of follow up care.
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GESTATIONAL TROPHOBLASTIC DISEASE is also know
as Hydatidiform Mole or Molar pregnancy.
It is an abnormal growth of the trophoblasitc tissue
including the placenta and chorion.
Risk Factors:
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Clients of Southeast Asia- Japanese or Taiwan descent
Mothers over 40
Possibly Vitamin A deficiency
Previous GTD.
Complications:
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Hemorrhage
Infection
Choriocarcinoma
DIC
 Clinical
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Manifestations:
Vaginal Bleeding- red to prune color
Severe nausea and vomiting
Uterine size greater than dates
Passing on grape-like vesicles
No fetal parts palpated and no FHR heard
Abnormal labs :
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Very high hCG levels
Very low MSAFP
Possible low Rbc, Hct, and Hg
 Clinical
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Preeclampsia prior than 20 weeks
Ultrasound will have characteristic “snow storm” pattern
with no fetus
 Nursing
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Manifestations:
Care for client who has GTD:
Monitor Vital Signs
Insert IV catheter and maintain IV infusion
Prepare the client for surgery-suction uterine evacuation
of mole.
Administer RhoGam is client is Rh-negative.
Administer chemotherapy as order- Methotrexate
 Cont.
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Teach client:
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NSG. Care:
About the disease process, and treatment
The need for follow up care for a year
Weekly hCG testing at first, than every 3monthsfor a year
No pregnancies for at least one year and the use of
contraception
Signs of problems to report to the health care provider
About the Medications being used
Acknowledge and support the need to grieve the loss of
the pregnancy
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An ABORTION is the termination of a pregnancy
prior to 20 weeks. In Texas a fetus must have two
of the three criteria’s; be under 20 weeks, or under
500 grams, or under 14 inches, to be considered an
abortion.
Types of Abortions:
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Spontaneous- lay term is Miscarriage
Elective or Therapic-surgically or medically induce
termination of the pregnancy.
 TYPES
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of SPONTANEOUS ABORTIONS:
Threatened Abortion
Inevitable Abortion
Incomplete Abortion
Complete Abortion
Missed Abortion
Reoccurring Abortions (Habitual Abortion)
Septic Abortion
 Risk
Factors: vary
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Clinical manifestations:
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May vary
Vaginal bleeding
Cramping
May have cervical dilation
May pass tissue and/or clots
Dull backache
Regression of signs of pregnancy
Falling hCG levels
No fetal heart tone
Smaller uterine size
Signs of infection in infection is present
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Nursing Care:
Depends on the type of spontaneous abortion
Bedrest and no sexual activity if threaten abortion
 Save any tissue pass
 Prepare for surgery: dilatation and curettage(D&C)
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Assess client
Insert IV catheter and maintain IV infusion
Obtain lab specimens and sent to lab:
 CBC
 Type and Rh- Type and cross match
 Serum beta-hCG
 Possible coagulation studies
Prepare for ultrasound
Administer RhoGam if client is Rh-negative
Provide emotional support remember this a loss
Refer to pregnancy –loss or grief support groups
 If
client spontaneous loses baby 0r it is an
intrauterine death and if the client/family would
like to view and/or visit with baby, Provide the
opportunity in a private area
 Allow the client to name the baby
 Take pictures
 Give something for the client to take home
 Clean the baby with soft cloth or cotton
 Never give a cold baby…Wrap in warm blankets
 Allow family to visit
 Provide the opportunity for religion beliefs
 Elective
Abortion is the intentional termination of
pregnancy before 20-24weeks.
 Therapeutic Abortion is the termination of the
pregnancy for medical reasons.
 The termination of the pregnancy is done by
surgery – Dilatation and Curettage (D&C) or with
medications called abortifacts
 The nurse should be aware of the state’s specific
regulations governing abortions.
 Abortions have many ethical issues. The nurse
should know beliefs concerning this issue.