Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 11
Caring for the Woman
Experiencing Complications
During Pregnancy
Edited by Catherine Marin,
MSN/Ed(c), WHCNP, RN
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Early Pregnancy Complications
 Perinatal loss
 Ectopic pregnancy
 Gestational trophoblastic disease
 Signs/symptoms: vaginal bleeding, excessive
nausea/vomiting, abdominal pain, size/date
discrepancy
 Management: remove uterine contents
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Spontaneous Abortion
 Before 20 weeks of gestation
 Signs/symptoms: bleeding, cramping,
abdominal pain, decreased symptoms of
pregnancy
 Management: D & C
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Incompetent Cervix
 Painless dilation and cervical effacement
 Second trimester
 Management
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hyperemesis Gravidarum
 Criteria: persistent vomiting, measure of
acute starvation, and weight loss
 Management
 Rest
 Small frequent meals (dry, bland foods)
 High-protein snacks
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hemorrhagic Disorders
 Placenta previa
 Signs/symptoms: painless vaginal bleeding
 Management: stabilization and fetal
monitoring
 Abruptio placentae
 Signs/symptoms: third-trimester bleeding
associated with severe abdominal pain
 Management: monitoring, delivery
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Preterm Labor
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Morbidity and mortality
Subtle signs/symptoms
Biochemical markers
Management goals
 Inhibit/reduce contraction strength/frequency
 Optimize fetal status
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Premature Rupture of
Membranes
 Signs/symptoms: gush/trickle of fluid from
vagina
 Management factors
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Establish gestational age
Ultrasound to assess fetus
Assess for advanced labor, infection
If advanced labor or infection, deliver fetus
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hypertensive Disorders
 Classifications:
 Chronic
 Preeclampsia-eclampsia
 Chronic hypertension with superimposed
preeclampsia
 Gestational/transient
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Preeclampsia
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Multisystem, vasopressive
Disease of placenta
SPASMS
Morbidity and mortality
Management
 Delivery of fetus only cure
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Nursing Assessments—
Preeclampsia
 Identify hypertension
 Proteinuria- 24 hr urine collection for Total
Protein
 Edema- especially facial edema, hands
and feet
 CNS alterations
 Eclampsia: seizures
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
HELLP Syndrome
 Complication of preeclampsia
 Treatment
 Improve platelets with FFP
 Delivery of fetus as soon as feasible
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Disseminated
Intravascular Coagulopathy (DIC)
 External or internal bleeding
 Nursing care
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Meticulous maternal and fetal assessment
Place indwelling catheter
Oxygen—rebreathing mask
Blood and blood products
Emotional support
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Multiple Gestation
 High-risk pregnancy
 Morbidity and mortality
 Management
 Delivery at Level III facility
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Infections
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UTI
Group B streptococcus
TORCH
STIs
HIV and AIDS
Tuberculosis
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Inflammatory Disease
& Pregnancy
 Systemic lupus erythematosus (SLE)
 Increased risk of pregnancy complications
 Management
 Immunosuppression of SLE flare
 Careful fetal surveillance
 If flare-up during pregnancy, rapid implementation
of treatment
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hemoglobinopathies
 Sickle cell disease
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Promote good dietary habits
Early detection of infection and treatment
Prevent dehydration
Prompt treatment of sickle cell crises
Fetal surveillance
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hemoglobinopathies
 Thalassemia
 Close maternal and fetal surveillance
 Rh0(D) isoimmunization
 Admininster RhoGAM to prevent antibody
formation
 ABO
 Coombs test
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Respiratory Complications
 Pneumonia
 Aggressive management
 Asthma
 Maternal and fetal risks
 Careful monitoring
 Adjustments in therapy
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Cystic Fibrosis
 Fetus at risk for uteroplacental
insufficiency and IUGR
 Monitor nutritional status
 Early recognition and treatment of
pulmonary infections
 Maternal and fetal surveillance
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cardiovascular Disease
 Symptoms similar to normal pregnancy
physiological changes
 Labor, birth, immediate postpartum period
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Lateral recumbent position
Administer IV fluids with caution
Invasive hemodynamic monitoring
Medications –e.g. prophylatic antibiotics
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Other Cardiovascular Disorders
 Mitral valve prolapse
 Pregnancy may alleviate murmur and
symptoms
 Peripartum cardiomyopathy
 No history of cardiac disease
 Signs/symptoms: dyspnea, fatigue,
peripheral/pulmonary edema
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Diabetes Mellitus
 Morbidity and mortality
 Screening and diagnosis
 Management
 Home blood glucose monitoring
 Adjust diet, medication, physical activity
 Ongoing maternal-fetal surveillance
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Thyroid Conditions
 Hyperthyroidism
 Signs/symptoms
 Depressed TSH and elevated free T4
 Antithyroid medications
 Hypothyroidism
 Symptoms
 Elevated TSH and low to normal T3 and T4
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Venous Thrombosis
and Pulmonary Embolism
 Symptoms
 Diagnosis
 Doppler ultrasound
 Ventilation-perfusion (VQ) scan
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Psychiatric Complications
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Depression
Bipolar disorder
Anxiety disorders
Eating disorders
Substance addiction
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Antepartum Fetal Assessment
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Chorionic villus sampling
PUBS
Amniocentesis
Amnioscopy or fetoscopy
Ultrasonography
Fetal kick counts
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Assessment of Fetal
Well-Being (cont.)
 Doppler ultrasound
 Fetal biophysical profile (ultrasound and
NST
 Non-stress test
 Vibroacoustic stimulation
 Contraction stress test
 Electronic fetal heart rate monitoring
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Special Conditions and
Circumstances that may
Complicate Pregnancy
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Antenatal Bedrest
 Regular community health nurse home
visits
 Involve various community resources
 Support groups
 Provide emotional support
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Other Special Conditions
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Adolescent
Advanced age
Trauma
Cancer
Obesity
Disability
Susan Ward
Shelton Hisley