Complications of

Pregnancy

Complications of pregnancy are the

symptoms and problems that are associated with
pregnancy. There are both routine problems and
serious, even potentially fatal problems. The
routine problems are normal complications, and pose no significant danger to either
the woman or the fetus. Serious problems can cause both maternal death and fetal
death if untreated.

A. Abortion

• expulsion of the fetus before it is viable;

• may be spontaneous or induced
• the most common bleeding disorder of early pregnancy
• Occur in 15-20% of recognized pregnancy

1. Fetal Causes – The most common cause of early spontaneous abortion is

abnormal development of the zygote, embryo or fetus. These abnormalities
are incompatible with life and would have resulted in severe congenital
anomalies had pregnancy not been aborted spontaneously.

2. Maternal Factors – These are congenital or acquired conditions of the

mother and environmental factors that had adversely affected pregnancy
outcome and led to abortion. Such conditions include diabetes mellitus,
incomplete cervix, exposure to radiation and infection.

3. Placental Factors – Placental factors usually cause abortion around the 14th
week of gestation. These factors includes premature separation of the
normally implanted placenta and abnormal placental implantation.

Abortion Types Characteristics Management

• occurring before the 1. Bedrest
Threatened 20th week of gestation 2. No coitus up to 2
Abortion • characterized by weeks after bleeding
cramping and vaginal stopped
bleeding with no
cervical dilation.
• it may subside or an
incomplete abortion
 may follow.
1. Hospitalization
• membranes rupture
2. D and C
Imminent or and the cervix dilates
3. Oxytocin after D and C
Inevitable • characterized by lower
4. Sympathetic
Abortion abdominal cramping
5. Understanding and
and bleeding.
emotional support
• is characterized by
expulsion of only part
of the products of 1. D and C
conception (usually the 2. Oxytocin after D and C
Incomplete
fetus). 3. Sympathetic
Abortion
• severe uterine 4. Understanding and
cramping emotional support
• bleeding occur with
cervical dilation.

• characterized by
complete expulsion of
all products of
conception
Complete
• light bleeding
Abortion
• mild uterine cramping
• passage of tissue
• closed cervix
1. There is no treatment
other than rest is
usually needed.
2. All of the tissues that
came out should be
saved for examination
by a doctor to make
sure that the abortion
is complete.
3. The laboratory
examination of the
saved tissue may
determine the cause
of abortion.

• intrauterine pregnancy
is present but is no
longer developing
normally 1. Usually treated by
• the cervix is closed, induction of labor by
Missed Abortion
and the client may dilation (or dilatation)
report dark brown and curettage (D & C).
vaginal discharge.
• pregnancy test findings
are negative.
• characterized by
Recurrent or spontaneous abortion
1. Trace the cause of
Habitual of three or more
recurrent abortion
Abortion consecutive
pregnancies
 • abortion complicated
by infection
1. Antibiotics as
• foul smelling vaginal
Septic Abortion prescribed by your
discharge
Obstetrician
• uterine cramping
• fever

B. Ectopic Pregnancy

• a pregnancy that develops outside of the uterus; 90 percent are tubal

• the second leading cause of bleeding in early pregnancy

Types of Ectopic Pregnancy

• Tubal
• Ovarian
• Cervical
• Abdominal
• Broad Ligaments
• Tubo-uterine
• Tubo-abdominal
• Tubo-ovarian
• Heterotypic pregnancy

Assessment findings

• Amenorrhea
• Abnormal menses (after fallopian tube implantation)
• Slight vaginal bleeding
• Unilateral pelvic pain over the mass
 • If fallopian tube ruptures, sharp lower abdominal pain, possibly radiating to
the shoulders and neck.
• Possible extreme pain when cervix is moved and adnexa palpated.
• Boggy and tender urine
• Possible enlargement of adnexa

Test Results

• Serum hCG is abnormally low; when repeated in 49 hours, the level remains
lower than the levels found in a normal intrauterine pregnancy.
• Ultrasonography may show an intrauterine pregnancy or ovarian cyst.
• Culdocentesis shows free blood in the peritoneum
• Laparoscopy may reveal a pregnancy outside the uterus.

Treatment

• Initially, in the event of pelvic-organ rupture, management of shock

• Diet determined by clinical status
• Activity determined by clinical status
• Transfusion with whole blood or packed red blood cells
• Broadspectrum I.V. antibiotics
• Methotrexate (Rheumatrex)
• Laparotomy and salpingectomy if culdocentesis shows blood in the
peritoneum; possibly after laparoscopy to remove affected fallopian tube and
control bleeding.
• Micro-surgical repair of the fallopian tube for patients who wish to have
children.
• Oophorectomy for ovarian pregnancy
• Hysterectomy for interstitial pregnancy
• Laparotomy to remove the fetus for abdominal pregnancy.

Nursing Interventions

• Determine the date and description of the patient’s last menstrual period.
• Monitor vital signs for changes.
• Assess vaginal bleeding, including amount and characteristics
• Assess pain level
 • Monitor intake and output
• Assess for signs of hypovolemia and impending shock
• Prepare the patient with excessive blood loss for emergency surgery.
• Administer prescribed blood transfusions and analgesics.
• Provide emotional support.
• Administer Rh (D) immune globulin (RhoGAM), as ordered, if the patient is Rh
negative.
• Provide a quiet, relaxing environment
• Encourage the patient to express feelings of fear, loss, and grief.
• Help the patient develop effective coping strategies.
• Refer the patient to a mental health professional, if necessary, prior to
discharge.

C. Hyperemesis Gravidarum

• severe, persistent vomiting during pregnancy

• or excessive nausea and vomiting which leads to electrolyte, metabolic and
nutritional imbalances in the absence of other medical problems

Causative Factors

• High levels of hCG in early pregnancy

• Metabolic or nutritional deficiencies
• More common in unmarried white women and first pregnancies
• Ambivalence toward the pregnancy of family-related stress
• Thyroid dysfunction

Assessment

• pale, dry, waxy, and possibly jaundiced skin, with decreased skin
turgor
• dry, coated tongue
• subnormal or elevated temperature
• rapid pulse
• fetid, fruity breath odor from acidosis

Nursing Interventions

• Promote resolution of the complications.

• Make sure the client receives nothing by mouth until cessation of vomiting.
• Administer intravenous fluids as prescribed: they may be given on an
ambulatory basis when dehydration is mild.
• Measure and record fluid intake and output.
• Encourage small frequent meals and snacks once vomiting has subsided.
• Administer antiemetics as prescribed.
D. Placenta Previa

• the placenta partially or completely covers the internal os of the cervix

• the most common bleeding disorder of the third trimester

Types of Placenta Previa

1. Complete or Total Placenta Previa – the placenta completely covers the

internal os when the cervix is fully dilated.
2. Partial Placenta Previa – the placenta partially covers the internal os.
3. Marginal Placenta Previa – the edge of the placenta is lying at the margin of
the internal os.
4. Low lying Placenta Previa – the placenta implants near the internal os, its
edges can be felt by the examining finger on IE.

Predisposing Factors

• Multiparity (80% of affected clients are multiparous)

• Multiple Pregnancy
• Advanced maternal age (older than 35 years old in 33% of cases)
• Previous cesarean section and abortion
• Uterine incisions
• Prior placenta previa
Clinical Manifestations

• Bleeding that is painless, sudden and profuse during the end of second
trimester, or during third trimester.
• Soft, nontender abdomen; relaxes between contractions, if present.
• FHR stable and within normal limits.
• Normal uterine tone
• Leopold’s maneuver: the fetus is in breech, oblique or transverse position.
Laboratory and Diagnostic Study Findings:

• Transabdominal ultrasonography confirms suspicion of placenta previa.

• CBC: decreased Hb and HCT levels if bleeding is present.
Nursing Management:

• Take and record vital signs, assess bleeding, and maintain a perineal pad
count. Weigh saturated perineal pads to assess maternal blood loss.
• Maintain bedrest and elevate the head of the bed.
• Provide fluid administration, usually with lactated Ringer’s solution, through a
large-bore IV line to maintain fluid balance.
• Consider cesarean delivery if the placenta previa is more than 30% or if
excessive bleeding occurs.
• Measure fundal height to assess for rising fundus, which may reveal
concealed bleeding.
• Disallow rectal or vaginal examinations, to minimize the danger of bleeding.
• Prepare the patient and family emotionally and physically for delivery.
• Observe for meconium in the amniotic fluid; may indicate fetal distress.
• Provide emotional support to the patient and family.

E. Abruptio Placentae
• separation of the placenta from the uterus before the baby’s birth
• also called placental abruption and accidental hemorrhage
Causes of Abruptio Placentae

• Uterine anomalies
• Multiparity
• Preeclampsia
• Previous cesarean delivery
• Renal or vascular disease
• Trauma to the abdomen
• Previous third trimester bleeding
• Abnormally large placenta
• Short umbilical cord

Types of Abruptio Placentae

1. Covert/Central Abruptio Placentae – Separation begins at the center of

placenta attachment resulting in blood being trapped behind the placenta,
bleeding, then, is internal and not obvious.
2. Overt or Marginal Abruptio Placentae – Separation begins at the edges
of the placenta allowing blood to escape from the uterus cavity. Bleeding is
external.

Classification of abruptio placentae is based on extent of separation (ie,

partial vs complete) and location of separation (ie, marginal vs central).

1. Grade 0: asymptomatic. Diagnosis is made retrospectively by finding an

organized blood clot or a depressed area on a delivered placenta.
2. Grade 1: mild and represents approximately 48% of all cases.
o No vaginal bleeding to mild vaginal bleeding
o Slightly tender uterus
o Normal maternal BP and heart rate
o No coagulopathy
o No fetal distress
 3. Grade 2: moderate and represents approximately 27% of all cases.
Characteristics include the following:
o No vaginal bleeding to moderate vaginal bleeding
o Moderate-to-severe uterine tenderness with possible tetanic
contractions
o Maternal tachycardia with orthostatic changes in BP and heart rate
o Fetal distress
o Hypofibrinogenemia (ie, 50-250 mg/dL)
4. Grade 3: severe and represents approximately 24% of all cases.
Characteristics include the following:
o No vaginal bleeding to heavy vaginal bleeding
o Very painful tetanic uterus
o Maternal shock
o Hypofibrinogenemia (ie, <150 mg/dL)
o Coagulopathy
o Fetal death

Management
• Begin continuous external fetal monitoring for both the fetal heart rate and
contractions.
• Obtain intravenous access using 2 large-bore intravenous lines.
• Institute crystalloid fluid resuscitation for the patient.
• Type and crossmatch blood.
• Begin a transfusion if the patient is hemodynamically unstable after fluid
resuscitation.
• Correct coagulopathy, if present.
• Administer Rh immune globulin if the patient is Rh-negative.

F. Pregnancy Induced Hypertension

• preeclampsia is a hypertensive disorder of pregnancy developing after 20
weeks gestation and characterized by edema, hypertension and proteinuria
• eclampsia is an extension of preeclampsia and is characterized by the client
experiencing seizures
Predisposing Factors of PIH

1. Primigravida status – higher incidence in primiparas below 20 and above 35

years old.
2. Low socioeconomic status
3. Previous hypertension of pregnancy, hydatidiform mole, diabetes mellitus,
multiple pregnancy, polyhydramnios, renal disease, heart disease
4. Genetic or immunologic

Mild Preeclampsia

Severe Preeclampsia

Eclampsia

Increased BP (systolic increase 30 mm hg convulsions over baseline;

diastolic 15

1+ Proteinuria

Edema especially of hands and face

BP 160/110

Proteinuria 3-4+

Very edematous
Elevated BUN, serum
creatinine, uric acid

Oliguria (. 400cc/24 hrs)

Cerebral or visual
disturbances

Epigastric pain, vomiting

Tonic-clonic

Possible coma

Renal shutdown

Diagnostic Evaluation

• Based on the presenting symptoms. Often the disease process has been
developing and affecting the renal and vascular system
• Frequently a sudden weight gain will occur, of 2 lb. or more in 1 week, or 6 lb.
or more within 1 month. This often occurs before the edema is present.
Medical Treatment and Evaluation:

• Magnesium Sulfate (Pregnancy risk category B)

muscle relaxant, prevent seizures
loading dose 4-6g, maintenance dose 1-2g/h IV
infuse IV dose slowly over 15-30 min.
•Always administer as a piggy back infusion.
•Assess PR, urine output, DTR, and clonus every hour.
•Observe for CNS depression and hypotonia in infant at birth.

• Hydrazaline (Apresoline) Pregnancy risk category C

anti hypertensive (peripheral vasodilator) use to decrease hypertension
5-10mg/IV
Administer slowly to avoid sudden fall of BP
•Maintain diastolic pressure over 90 mmHg to ensure adequate placental
filling.

• Diazepam (Valium) Pregnancy risk category D

halt seizures
5-10mg/IV
administer slowly. Dose may be repeated every 10-15 min. (up to 30mg/hr)
•Observe for respiratory depression for both mother and infant at birth

• Calcium Gluconate (Pregnancy risk category C)

antidote for Magnesium Sulfate
1g/IV (10 mL of a 10% solution)
 have prepared at bed side when administering Magnesium Sulfate
administer at 5mL/min.
Nursing Interventions
Intervention for mild PIH:
1. Assess maternal VS and
fetal heart rate.
2. Encourage elevation of
edematous arms and legs.
3. Encourage compliance
with bed rest in a lateral
recumbent position.
4. Provide emotional
support.
5. Support patient with bed
rest and darken the room if
possible.
6. Obtain daily hematocrit
levels as ordered.
7. Obtain blood studies
(CBC, platelets count, liver
function, BUN and
creatinine, and fibrin
degregation).
8. Obtain daily weights at
the same time each day.
9. Raise side rails.
10. Support nutritious diet
of moderate to high in
protein and moderate in
sodium.
11. An indwelling catheter
may be inserted as ordered.
12. Oxygen administration
to the mother may be given
as ordered.
13. Administer medication
for seizures and
hypertension episodes as
ordered.
Intervention for severe
Rationale:
-to detect any increase which is warning that a
women’s condition is worsening.
-to increase venous blood return.
-to increase evacuation of sodium and
encouraging diuresis and lateral recumbent
position can avoid uterine pressure on the vena
cava and prevent supine hypotension syndrome.
-this can make a women underestimate the
severity of the situation.
-because a bright light can trigger seizures.
-to monitor blood concentration and help to the
extent of plasma loss to interstitial space or
extent of the edema.
-to assess for renal and liver function and the
development of disseminated intravascular
coagulation which often accompanies severe
vasospasms.
-to evaluate tissue fluid retention.
-to help prevent injury if seizure should occur.
-to compensate for protein she is losing in her
urine.
-to allow accurate recording of output and
comparison with intake.
-to maintain adequate fetal oxygenation and
prevent fetal bradycardia.
-to prevent seizures and hypertension.
Rationale:
 PIH:
1. Maintain patient’s -to prevent broken of teeth which could then be
airway by not putting a aspirated.
tongue blade between
a women’s teeth during
seizures.
2. Turn a woman on her -to allow secretions to drain from her mouth.
side.

Health Teaching

• Encourage patient foe sodium restriction.

• Encourage to avoid foods rich in oil and fats.
• Encourage patient to limit her daily activities and exercises.

Diet

• low fats and sodium diet, restriction if possible.

• high in protein, calcium and iron.
• Adequate fluid intake

Sex

• limit sexual activity

• sexual intercourse at 2nd trimester should be avoided.

G. Gestational Diabetes
• diabetes diagnosed during pregnancy
• it is a disorder of late pregnancy (typically) caused by the increased
pancreatic stimulation associated with pregnancy.
• babies born to mothers with gestational diabetes are at increased risk of
problems typically such as being large for gestastional age (which may lead
to delivery complications), low blood sugar, and jaundice
 2 Subtypes of Gestational Diabetes (diabetes which began during
pregnancy)

• Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood
glucose levels during fasting and 2 hours after meals; diet modification is
sufficient to control glucose levels
• Type A2: abnormal OGTT compounded by abnormal glucose levels during
fasting and/or after meals; additional therapy with insulin or other
medications is required

Predisposing Factors of Gestational Diabetes

• A previous diagnosis of gestational diabetes or prediabetes, impaired glucose

tolerance, or impaired fasting glycaemia
• A family history revealing a first degree relative with type 2 diabetes
• Maternal age – a woman’s risk factor increases as she gets older (especially
for women over 35 years of age)
• Ethnic background (those with higher risk factors include African-Americans,
Afro-Caribbeans, Native Americans, Hispanics, Pacific Islanders, and people
originating from the Indian subcontinent)
• Being overweight, obese or severely obese increases the risk by a factor 2.1,
3.6 and 8.6, respectively.[7]
• A previous pregnancy which resulted in a child with a high birth weight
(>90th centile, or >4000 g (8 lbs 12.8 oz))
• Previous poor obstetric history

Diagnosis
Gestational Diabetes Screening: Glucose Challenge Test
 Sample drawn 1 hour after a 50-gram glucose drink.
Glucose Level I
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Less than 140* mg/dL (7.8 mmol/L) N
o
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140* mg/dL (7.8 mmol/L) and over A
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* Some use a cutoff of 130 mg/dL (7.2 mmol/L) because that identifies 90%
of women with gestational diabetes, compared to 80% identified using the
threshold of 140 mg/dL (7.8 mmol/L).

Gestational Diabetes Diagnostic: Oral Glucose Tolerance Test

Sample drawn after 100-gram glucose drink (glucose load).

Time of Sample Collection

Fasting* (prior to glucose load)
1 hour after glucose load
2 hours after glucose load
3 hours after glucose load*
INDICATION: If two or more values meet or exceed the target level,
gestational diabetes is diagnosed.

Glycosylated Hemoglobin Test

Glycosylated hemoglobin is a test that indicates how much sugar has been in
a person's blood during the past 4-6 weeks. It is used to monitor the effectiveness
of diabetes treatment.
Diabetes treatment should achieve glycosylated hemoglobin levels of less
than 7.0%. Normal value for a non-diabetic person is 4.0-6.0%.

Effects on the baby

• being born very large and with extra fat; this can make delivery difficult and
more dangerous for your baby
• low blood glucose right after birth
• breathing problems

Effects on the mother

• increase risk of high blood pressure during pregnancy

• increase risk of a large baby and the need for cesarean section at delivery

Management

• a meal plan(50% carbohydrates, 30% fats, 20%protein)

• physical activity(swimming, walking)
• insulin (if needed)
H. Anemia (Iron deficiency)
• iron deficiency anemia is the most common anemia of pregnancy affecting
15-50% of pregnant women.
• also called the physiologic anemia of pregnancy
• hemoglobin value of less than 11 mg/dL or hematocrit value less than 33%
during the 2nd and 3rd trimester.

Predisposing factors of Anemia:

1. Poor diet and poor nutrition
2. Heavy menses
3. Pregnancies at close intervals; successive pregnancies
4. Unwise reducing programs

I. Hydatidiform Mole
• a benign disorder characterized by degeneration of the chorion and death of
the embryo
• the chorionic villi rapidly proliferate and become grape like vesicles that
produce large amount of hCG

Predisposing Factors of Hydatidiform Mole:

 1. Higher incidence in asian women
2. Low socioeconomic status
3. Below 18 years old and above 40 years old.
4. Two types of moles:
a. Complete moles – neither an embryo nor an amniotic sac. It is
characterized by swelling and cystic formation of all trophoblastic cells. No
fetal blood is present. If an embryo did develop, it was most likely only 1
to 2 mm in size and died early on. A complete mole is highly associated
with the development of choriocarcinoma.
b. Partial mole – embryo (usually with multiple anomalies) and amniotic sac.
It is characterized by edema of a layer of the trophoblastic villi with some
of the villi forming normally. Fetal blood may be present in the villi, and an
embryo up to the size of 9 weeks gestation may be present. Typically, a
partial mole has 69 chromosomes in which there are three chromosomes
for every one pair.

Assessment findings

• Disproportionate enlargement of the uterus; possible grapelike clusters noted

in the vagina on pelvic examination.
• Excessive nausea and vomiting, abdominal cramping.
• Intermittent or continuous bright red or brownish vaginal bleeding
• Passage of tissue resembling grapelike clusters.
• Symptoms of gestational hypertension before 20 weeks’ gestation.
• Absence of fetal heart tones.

Test Results:

• Radioimmunoassay of human chorionic gonadotropin (hCG) levels reveals

extremely elevated levels of early pregnancy.
• Histologic examination may reveal the presence of vesicles.
• Ultrasonography performed after 3 months’ gestation reveals grapelike
clusters rather than a fetus, an absence of fetal skeleton, and evidence of a
snowstorm-like pattern.
 • Hemoglobin level, hematocrit, red blood cells (RBC) count, prothrombin time,
partial thromboplastin time, fibrinogen levels, and hepatic and renal function
findings are all abnormal.
• White blood cells count and erythrocyte sedimentation rate are increased.

Treatment:

• Suction and curettage; if indicated.

• Weekly monitoring of beta-hCG levels until normal 3 consecutive weeks.
• Periodic follow-up for 1 to 2 years.
• Pelvic examinations and chest X-rays at regular intervals.
• Emotional support.
• Avoidance of pregnancy until hCG levels are normal (may take up to 1 year).

Nursing Interventions:

• Obtain baseline vital signs.

• Preoperatively observe the patient for signs of complications, such as
hemorrhage, uterine infection, and vaginal passage of vesicles.
• Save any expelled tissue for laboratory analysis.
• Prepare the patient physically and emotionally for surgery, if indicated.
• Postoperatively, monitor vital signs and fluid intake and output, and assess
for signs of hemorrhage.
• Encourage the patient and her family to express their feelings.
• Offer emotional support, and help them through the grieving process.
• Help the patient and her family develops effective coping strategies, referring
them to a mental health professional, if needed.

J. Incompetent cervix
• characterized by a painless dilation of the cervical os without contractions of
the uterus
• commonly occurs at about the 20th week of pregnancy
Predisposing Factors of Incompetent Cervix:

1. History of traumatic birth

2. Repeated dilatation and curettage
3. Client’s mother treated with diethylstilllbestrol (DES) when pregnant with the
client
4. Congenitally short cervix
5. Uterine anomalies
6. Unknown etiology

K. Polyhydramnios
• characterized by excessive amount of amniotic fluid, more than 2000 ml
 Predisposing Factors of Polyhydramnios:

1. Multiple pregnancy
2. Fetal abnormalities-esophageal atresia, anencephaly, spina bifida
3. Diabetes mellitus

Kinds/Degrees of Polyhydramnios

Mild Polyhydramnios – when amniotic fluid pockets is between 8 to 11 cm in

vertical dimensions. (85%)
Moderate Polyhydramnios – when amniotic fluid pockets is between 12 to 15
cm in vertical dimensions. (17%)

Assessment Findings

• Depend on the length of gestation, the amount of amniotic fluid, and whether
the disorder is chronic or acute.
 • Mild signs and symptoms; maternal abdominal discomfort, slight dyspnea,
and edema of feet and ankles.
• Severe signs and symptoms; severe dyspnea, orthopnea, and significant
edema of the vulva, legs, and abdomen.
• Symptoms common to mild and severe cases: uterine enlargement greater
than expected for the length of gestation, and difficulty in outlining the fetal
parts and in detecting fetal heart sounds.

Test Results

• Ultrasonography shows evidence of excess amniotic fluid as well as

underlying conditions.
• Amniotic fluid index is 20 cm or greater.

Treatment

• High protein, low sodium diet

• Mild sedation
• Indomethacin therapy – a drug that decreases the fetal urine formation. The
side effect of indomethacin, as with other prostaglandin synthase inhibitors,
is the potential premature closure of the ductus arteriosus.
• Amniotomy – The fluid is removed by a needle inserted through the cervix.
The danger of this procedure is cord proplapse and abruptio placenta. to
prevent these complications, amniotic fluid must be removed gradually.Watch
closely for hemorrhage after delivery, prevent uterine relaxation by
massaging the uterus and administering oxytoxin as ordered.
• Induction of labor if the fetus is mature and symptoms are severe.

Nursing Interventions

• Mild to moderate degrees usually does not require treatment.

• Hospitalization if symptoms are severe dyspnea, abdominal pain and difficult
ambulation.
• Maintain bed rest with sedation to make the situation endurable.
• Monitor the patient for signs and symptoms of premature labor.
• Monitor maternal vital signs and fetal heart rate frequently; report changes
immediately.
• Prepare the patient for amniocentesis and possible labor induction, as
appropriate; keep in mind that amniocentesis for fluid removals is only
temporary and may need to be done repeatedly.

Top of Form

Bottom of Form

L. Oligohydramnios
 • amniotic fluid is less than 300 ml or amniotic fluid index less than 5 cm

Causes of Oligohydramnios:

1. Fetal renal anomalities that results in anuria

2. Premature rupture of membranes
3. Exposure to angiotensin converting enzyme inhibitors

Assessment

• Asymptomatic
• Lagging fundal height growth.

Test result

• Ultrasonography reveals no pockets of amniotic fluid larger than 1 cm.

Treatment

• Close medical supervision of the mother and fetus.

• Fetal monitoring
• Amnioinfusion (infusion of warmed sterile normal saline or lactated Ringer’s
solution) to treat or prevent variable decelerations during labor.

Nursing Interventions

1. Monitor maternal and fetal status closely, including vital signs and fetal heart
rate patterns.
2. Monitor maternal weight gain pattern, notifying the health care provider if
weight loss occurs.
3. Provide emotional support before, during, and after ultrasonography.
4. Inform the patient about coping measures if fetal anomalies are suspected.
5. Instruct her about signs and symptoms of labor, including those she’ll need to
report immediately.
6. Reinforce the need for close supervision and follow up.
7. Assist with amnioinfusion as indicated.
8. Encourage the patient to lie on her left side.
9. Ensure that amnioinfusion solution is warmed to body temperature.
10.Continuously monitor maternal vital signs and fetal heart rate during the
amnioinfusion procedure.
11.Note the development of any uterine contractions, notify the health care
provider, and continue to monitor closely.
12.Maintain strict sterile technique during amnioinfusion.

M. Premature Labor

• labor that begins after 20 weeks gestation and before 37 weeks gestation.
Causes of Preterm Labor:

1. PROM
2. Preeclampsia
3. Hydramnios
4. Placenta previa
5. Abruptio placentae
6. Incompetent cervix
7. Trauma
8. Uterine structural anomalies
9. Multiple gestation
10.Intrauterine infection (chorioamnionitis)
11.Congenital adrenal hyperplasia
12.Fetal death
13.Maternal factors, such as stress (physical and emotional)
14.Urinary tract Infection
15.Dehydration

N. Rh Incompatibility

Rh incompatibility is a condition which develops when a pregnant woman has

an Rh-negative blood type and the fetus she carries has Rh-positive blood type.
The Rh factor (ie, rhesus factor) is an red blood cell surface antigen that was
named after the monkeys in which it was first discovered. Rh incompatibility, also
known as Rh disease, is a condition that occurs when a woman with Rh-negative
blood type is exposed to Rh-positive blood cells, leading to the development of Rh
antibodies.

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