High-Risk Pregnancy
Special Needs
Women With Special Needs
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Adolescent pregnancy slightly decreasing.
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Women pregnancy over age 40 is increasing.
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Women that are physically or cognitively challenged.
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Women that are pregnant and drug dependent.
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DHHS
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Assess:
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Strengths and weaknesses of individual clients.
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Physical limitations and abilities
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Psychosocial or emotional strengths.
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Main goal is to encourage prenatal care.
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Establish a trusting relationship.
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Establish realistic outcomes.
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Support people.
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Do not equate a woman’s knowledge with knowledge of prenatal care.
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Promote a healthy pregnancy and preventing pregnancy complications.
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Nonjudgmental
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Modifying a pelvic exam due to physical challenge.
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Pregnant Adolescent
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Has decreased by 3% to 6% with educational programs. 90% keep their baby.
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Developmental Crisis of Adolescents:
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Tasks:
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Self worth and value system
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Lasting relationships
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Emancipate from parents
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Choose a vocation
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May need financial help, insurance, making her own decisions.
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Emancipated minor-a pregnant adolescent or a person capable of health care
decisions. May sign permission for her own care.
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The pregnancy can be a “growing-up” revelation or a growth-producing
experience for her.
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Encourage her to continue school for her self-esteem, her future and the
future of the unborn child.
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Prenatal Assessment:
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Adolescents are considered high risk clients because they have a high
incidence of PIH and anemia. Preterm birth, low birth weight infants, partner
abuse, STD.
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Issues: transportation, lack of education on pregnancy, 6 months abortion on
longer possible, feel awkward in prenatal setting, fears, 1st pelvic exam.
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Health History:
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Parents not present.
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Present with other complaints.
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They do not voluntarily share information.
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Baby’s father does not have a legal right to participate in the girl’s decision
concerning pregnancy, abortion, or adoption.
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Teach father methods to prevent further pregnancies.
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Educate on every aspect of pregnancy.
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OTC
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Nest-building behavior.
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Difficulty telling their parents. Role playing technique.
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Family Profile:
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Adolescent may leave home, homeless, or runaway.
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Dysfunctional family or an incest relationship.
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Day History:
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Private people.
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Ask about nutrition, sleep, daily activities, use of drugs, friends that are
supportive, medications, OTC.
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Physical Examination:
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Concerned about body appearance.
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May be afraid to supply urine due to drug use.
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Weigh herself, note clothing.
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Health teaching, protein, iron.
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Changes and possible discomforts.
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Nutrition:
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May need to gain more weight.
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Protein, iron, folic acid, vitamin A and C.
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Switch to noncaffinated soft drinks.
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Activity and Rest:
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Assess sports activity and which to continue. Feeling of being part of a team.
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Pregnancy Information:
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Distorted beliefs about her body.
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Baby really grows in stomach.
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Childbirth Preparation:
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Strong need for peer companionship.
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Their friends cut them off and they are ready for a class on childbirth with
others.
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Birth Decisions:
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Cephalopelvic disproportion due to incomplete pelvis growth.
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May need a cesarean birth.
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Plans for the Baby:
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Keeping the baby, breast feeding, adoption.
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Complications of Adolescent Pregnancy
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Pregnancy Induced Hypertension:
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Baseline B/P, rest in side-lying position.
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Explain exactly what she can and cannot do
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Give tasks, reading about birth , nutrition, school assignments.
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Bedrest does not mean she is ill.
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Low dose aspirin
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If after 2 weeks and no change she may be admitted to the hospital to
enforce rest.
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Iron-Deficiency Anemia:
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Due to low protein intake.
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Fatigue, pale, hemoglobin < 11 g/dl
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Increase iron and folic acid.
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Obtain reticulocyte count in 2 weeks.
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Preterm Labor:
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Review signs of labor by 3rd month.
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Complications of labor, birth and postpartum:
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Cephalopelvic Disproportion
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Postpartal Hemorrhage
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Inability to Adopt Postpartally
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Lack of Knowledge about Infant Care
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Pregnant Woman Over age 40
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7% of women are age 35 years or older.
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Risk of chromosomal abnormality.
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Other physical illness; hypertension, varicosities, hemorrhoids.
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Lack support.
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Developmental Tasks and Pregnancy:
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Ambivalent feelings, crossing 2 life phases, caring for her parents.
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Prenatal Assessment
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May mistake lack of menstruation is early menopause.
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Health History:
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May have self-medicated not knowing she was pregnant.
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Medications and herbs
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Family Profile:
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Married, long term relationship, or decided to have a child without a partner.
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Working, income, other children.
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Day History:
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Ask about job and walking or back strain, exercise, diet, health club, smoking,
alcohol
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Physical Examination:
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Circulatory disturbances, breast exam, FHR, hydatidiform mole risk in women
over 40.
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Chromosomal Assessment:
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Chorionic villi sampling at 8 to 10 weeks or amniocentesis at 14 to 16 weeks.
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Triple screen -AFP, hCG, unconjugated estriol level at 15 weeks (open spinal
cord or chromosomal defects).
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Nutrition
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Prenatal classes
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Complications of Pregnancy:
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Circulatory system is not as competent and body not as elastic.
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Pregnancy induced hypertension-rest.
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Complications of Labor, Birth, Postpartal
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Failure to progress in labor:
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Decreased elasticity in cells
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Difficulty accepting the event:
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Balancing their life.
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Postpartal hemorrhage:
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Uterus may not contract as readily.
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Physically or Cognitively Challenged
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general areas of care. Transportation, counseling, support, work…
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Rights of the Physically or Cognitively Challenged Person:
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Federal law; assess to public buildings.
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Full rights to her child.
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Cannot be forced to terminate pregnancy or undergo sterilization.
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Modifications for Pregnancy:
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Nature of disability and general self image.
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Equal with other women.
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Safety Measures to Explore:
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Emergency contacts
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Transportation
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Mobility-WC raise up off seat 5 sec/hour
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Elimination
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Autonomic Responses-dysreflexia-severe hypertension, throbbing headache,
flushing of the skin, profuse diaphoresis, nausea, bradycardia.(elevate head,
find source).
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Prenatal Care Modifications:
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Exam table to high, contractures.
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Cognitively challenged may have been raped.
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Guide dog is protector.
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Pregnancy Education:
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Modify health teaching to meet the woman’s specific needs.
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Talk to her not the interpreter.
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Modifications for Labor and Birth:
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Spinal cord injuries may not feel contractions or be able to push.
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Can not assume lithotomy position.
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Braille watches may not have a second hand.
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Hearing impaired needs interpreter.
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Modifications for Postpartum Care
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Contraceptive information
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Follow up care
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Modifications for Planning Child Care:
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Allow extra time for interaction.
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Safety, feeding, can baby see, spinal cord,
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Breastfeeding, equipment changes, home health aide, lower crib, carrying
the infant, turning on lights for infant even though mother is blind, feel
vibrations if hearing impaired, DHHS.
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Substance Dependent
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Increasing-10 to 20% use illegal drugs.
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Adolescents use inhalants more.
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Dependent is when they have withdrawal symptoms following discontinuation
of the substance, combined with abandonment of important activities,
spending increased time in activities related to substance use, using
substances for longer time than planned, and continued use despite worsening
problems.
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Lack funds for both good food and drugs.
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Waiting for an appointment makes her late for drugs. Urine may reveal use.
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Cross the placenta readily. 50% concentration from mother to baby.
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Risk for STD, HIV, Hepatitis B.
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At birth the infant may experience withdrawal symptoms (nervousness,
irritability, lethargy, seizures.
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Breastfeeding is not encouraged.
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Reported to CPA and may be accused of child abuse and jailed. Know your
state policy.
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Drugs commonly Used During Pregnancy
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Cocaine:
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Sudden vasoconstriction
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Detected in urine for 1 week
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Amphetamines:
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Speed, cheap, same pharmacological effects as cocaine.
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Marijuana and Hashish:
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Produce tachycardia and sense of well-being.
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Loss of short term memory and increased RTI. Reduces milk production.
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Excreted in the milk.
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Phencyclidine PCP:
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Animal tranquilizer – causes increased cardiac output and sense of
euphoria. Long term hallucinations.
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Concentrates in fetal cells.
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Narcotic Agonists:
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Morphine, Demerol, codeine.
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Analgesia and euphoric effects.
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Heroin-immediate short lived euphoria followed by sedation.
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PIH, phlebitis, bacterial endocarditis, Hep B
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SS- nausea, vomiting, diarrhea, abdominal pain, hypertension, restlessness,
shivering, insomnia, body aches, muscle jerks.
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Begins within 6 hours after last drug use.
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Enroll in Methadone maintenance program.
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Inhalants:
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Aerosol drugs – airplane glue, cooking sprays, computer keyboard cleaners.
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Contain Freon – limits O2 supply to fetus.