CARE OF MOTHER & CHILD

AT RISK OR WITH PROBLEMS

(ACUTE & CHRONIC)
REYNOLD O. BRAZA,
RN,MN,CSE
FRAMEWORK FOR MATERNAL AND
CHILD HEALTH NURSING (MCN)
FOCUSING ON AT- RISK, HIGH RISK,
AND SICK CLIENTS

A. National Health
Situation on MCN

B. Statistics on MCN

C. Genetics and
Genetic Counseling
 Several Health People 2030 goals are aimed
at reducing complications of pregnancy that
arise from existing or newly acquired
disorders.
 Reduce the rate of fetal deaths to 5.7 per
1,000 live births from a baseline of 5.9 per
1,000 live births.
 Reduce the rate of maternal deaths to 15.7
per 100,000 live births from a baseline of
17.4 per 100, 000 live births
 Reduce the rate of sever maternal
complications during delivery
hospitalizations to 61.8 per 10, 000 births
from a baseline of 68.7 per 10, 000 births
(U.S. Department of Health and Human
Services, 2020).
 CARE OF AT- RISK/ HIGH
RISK AND SICK MOTHER
AND CHILD
 A. Nursing Care of the Pregnant
Client

IDENTIFYING A HIGH- RISK

PREGNANCY:
High- risk pregnancy- is one in which
a concurrent disorder, pregnancy-
related complication, or external
factor jeopardizes the health of the
pregnant person, the fetus, or both.
**In most instances, more than one
factor contributes to the
classification of a pregnancy as high
risk
 FACTORS

 AGE <18 and >40 years old

 NUTRITIONAL HABITS AND STATUS
 ABUSE OF TOBACCO, ALCOHOL,
DRUGS
 Presence of a disability or trauma,
or substance abuse
 Lifestyle: hyperglycemia
B. FACTORS ARISING FROM THE
HEALTH STATUS AND LIFESTYLE OF THE
FATHER OF THE BABY

 ABUSE OF DRUGS, ALCOHOL, TOBACCO

 HARMFUL SEXUAL PRACTICES (multiple

sex partners)

 EXPOSURE TO ENVIRONMENTAL

HAZARDS
C. PRE EXISTING HEALTH
PROBLEMS
 Health problems present prior to the

onset of pregnancy

 Pregnancy effects the health problem and

the health problem effects the pregnancy

 Preconception care and counseling is

critical
D. HEALTH PROBLEMS THAT
ARISE DURING PREGNANCY
 Includes: PIH, anemia, hyperemesis

gravidarum, hemorrhage, gestational diabetes

 Occur as a result of ineffective adaptation to

the changes that occur with pregnancy

 More likely to occur among women who are

already at risk
E. OBSTETRICAL –
GYNECOLOGICAL FACTORS
 Number of pregnancies (gravid) and birth
(para)
 Pelvic and uterine malformation and
abnormalities
 History of STDs and pelvic inflammatory
disease (PID)
 History of complications with previous
pregnancies (abortion, hemorrhage)
 History of infertility
 Exposure to DES (diethylstilbestrol)as a fetus
F. PSYCHOSOCIAL RISK
FACTORS
 Instability of family relationship
 Inadequate economic resources
 Limited access to nearby culturally sensitive
prenatal care or a high risk pregnancy center
 Minority status in terms of race-ethnicity-
experience higher rates of maternal-infant
morbidity as well as low birth weight (LBW)
 History of mental health disorders including
depression and psychosis
 DIAGNOSTIC TESTS AND
LABORATORY EXAMS
1. Complete blood count
 Hemoglobin, hematocrit and red cell index- determine the
presence of anemia

HGB- 120-180 G/L

HCT- 0.37-0.54
 WBC count-to determine infection

WBC 4.5-11X10/L
 Platelet count-to estimate clotting ability

PLT CT- 150-450X10/L

 Sickle cell anemia screen-to detect sickle cell trait or disease
2. VDRL-VENEREAL
DISEASE RESEARCH
LABORATORY

SCREENING TEST FOR

SYPHILIS
3. BLOOD TYPING (RH
FACTOR)-TO DETERMINE
BLOOD TYPE AND RH
STATUS OF MOTHER
4. MSAFP (MATERNAL
SERUM ALFA FETO
PROTEIN- TO SCREEN FOR
OPEN NEURAL TUBE
DEFECTS
5. INDIRECT COOMB’S TEST-THE
INDIRECT COOMBS TEST LOOKS FOR
FREE-FLOWING ANTIBODIES AGAINST
CERTAIN RED BLOOD CELLS. IT IS IS
MOST OFTEN DONE TO DETERMINE IF
YOU MAY HAVE A REACTION TO A
BLOOD TRANSFUSION.
6. RUBELLA TITER- VERIFY THAT ALL
PREGNANT WOMEN AND THOSE
PLANNING TO BECOME PREGNANT
HAVE A SUFFICIENT AMOUNT (TITER)
OF RUBELLA ANTIBODIES TO
PROTECT THEM FROM INFECTION
7. HEPATITIS B SURFACE
ANTIGEN (HBSAG)- TO
SCREEN FOR HEPATITIS B
INFECTION (NON-
REACTIVE)
8. HIV TEST- TO SCREEN FOR HIV. GENERAL
RECOMMENDATIONS FOR SCREENING INCLUDES
WOMEN WHO
1. HAVE USED OR ARE USING INTRAVENOUS DRUGS
2. HAVE ENGAGED IN SEX WITH MULTIPLE PARTNERS
3. HAVE SEXUAL PARTNERS WHO ARE INFECTED OR
ARE AT RISK
4. RECEIVED A BLOOD TRANSFUSION BETWEEN
1977 AND 1985
9. ORAL GLUCOSE
TOLERANCE TEST (OGTT)-
TO SCREEN FOR
GESTATIONAL DIABETES
10. URINALYSIS- TO
DETERMINE THE PRESENCE
OF BACTERIA, ALBUMIN AND
GLUCOSE IN THE URINE
11. TUBERCULINE SKIN
TEST/PURIFIED PROTEIN
DERIVATIVE TEST- TO
SCREEN FOR
TUBERCULOSIS
12. ULTRASONOGRAPHY- TO
CONFIRM THE PREGNANCY
LENGTH OR DOCUMENT
HEALTHY FETAL GROWTH
13. PAP SMEAR- TO SCREEN FOR THE
PRESENCE OF ATYPICAL CELLS

14. TESTING OF CERVICAL AND

VAGINAL SECRETIONS- TO SCREEN FOR
REPRODUCTIVE TRACT INFECTION
CARDIAC DISEASE IN PREGNANCY

PREGNANCY PLACES STRESS O THE

CARDIOVASCULAR SYSTEM AS A
RESULT OF PLASMA VOLUME
EXPANSION WHICH INCREASES
CARDIAC OUTPUT AND WORKLOAD
 A PREGNANT PATIENT WITH
CARDIAC DISEASE

Cardiac disease
can affect
pregnancy in
different ways
depending on
whether it
involves the left
or the right side
CLASSIFICATION OF HEART DISEASE
 A PREGNANT PATIENT WITH
LEFT- SIDED HEART FAILURE
mitral stenosis (obstruction to left ventricular flow)

Mitral insufficiency

Aortic coarctation
--The left ventricle cannot move the large volume of blood forward
that it has received by the left atrium from the pulmonary circulation.
This causes back pressure- the left side of the heart becomes
distended, systemic BP decreases in the face of lowered cardiac
output, and pulmonary hypertension occurs.
-Due to limited oxygen exchange, those with left-sided heart failure
are at an extremely high risk for spontaneous miscarriage, preterm
labor, or even death.
SIGNS AND SYMPTOMS

 -fatigue

-cough
-tachycardia
-increased RR
-poor fetal heart tone
variability
-decreased amniotic fluid
-edema
MANAGEMENT:
ANTEPARTAL PERIOD

1. ADEQUATE NUTRITION
2. PROMOTION OF REST
3. PROTECTION FROM INFECTION
4. DRUG THERAPY
5. RESTRICTION OF ACTIVITY
6. CONTINUOUS MONITORING OF PREGNANCY
7. PSYCHOLOGICAL SUPPORT
INTRAPARTAL PERIOD
1. CONTINUOUS MONITORING OF VITAL
SIGNS
2. ASSESSMENT OF PULMONARY FUNCTION
3. PROPER POSITIONING (SIDE LYING)
4. SUPPORTIVE THERAPIES
5. ASSISTANCE DURING DELIVERY
6. PSYCHOLOGICAL SUPPORT
POSTPARTAL PERIOD
1. ASSESSMENT OF POST DELIVERY HEART
STATUS
2. PROPER POSITIONING
3. PLANNING OF SCHEDULED ACTIVITY
4. PSYCHOLOGICAL SUPPORT
5. EDUCATION AND ASSISTANCE OF
MOTHER IN INFANT CARE
6. PREPARATION FOR DISCHARGE
GESTATIONAL DIABETES
1. OCCURS IN PREGNANCY (DURING THE
SECOND OR THIRD TRIMESTER) IN
CLIENTS NOT PREVIOUSLY DIAGNOSED
AS DIABETIC AND OCCURS WHEN THE
PANCREAS CANNOT RESPOND TO THE
DEMAND FOR MORE INSULIN
2. PREGNANT WOMEN SHOULD BE
SCREENED FOR GESTATIONAL DIABETES
BETWEEN 24 TO 28 WEEKS OF
3. A 3 HOUR OGTT IS PERFORMED TO CONFIRM
GESTATIONAL DIABETES MELLITUS
4. GESTATIONAL DIABETES FREQUENTLY CAN BE
TREATED BY DIET ALONE, HOWEVER SOME CLIENTS
MAY NEED INSULIN
5. MOST WOMEN WITH GESTATIONAL DIABETES
RETURN TO EUGLYCEMIC STATE AFTER DELIVERY,
HOWEVER, THESE INDIVIDUALS HAVE AN
INCREASED RISK OF DEVELOPING DM IN THEIR
LIFETIMES
PREDISPOSING CONDITIONS TO
GESTATIONAL DIABETES
1. OLDER THAN 35 YEARS
2. OBESITY
3. MULTIPLE GESTATION
4. FAMILY HISTORY OF DIABETES
MELLITUS
ASSESSMENT
-EXCESSIVE THIRST
-HUNGER
-WEIGHT LOSS
-FREQUENT URINATION
- BLURRED VISION
-RECURRENT UTI AND VAGINAL YEAST INFECTION
-GLYCOSURIA AND KETONURIA
-SIGNS OF GESTATIONAL HYPERTENSION
-POLYHYDRAMNIOS
-LARGE FETUS FOR GESTATIONAL AGE
1. EMPLOY, DIET, INSULIN (IF
DIET CANNOT CONTROL
BLOOD GLUCOSE LEVELS),
EXERCISE, AND BLOOD
GLUCOSE DETERMINATIONS
TO MAINTAIN BLOOD
GLUCOSE LEVELS BETWEEN
2. OBSERVE FOR SIGNS OF
HYPERGLYCEMIA,
GLYCOSURIA AND
KETONURIA AND
HYPOGLYCEMIA
3. MONITOR WEIGHT
4. INCREASE CALORIE INTAKE
AS PRESCRIBED, WITH
ADEQUATE INSULIN THERAPY
SO THAT GLUCOSE MOVES
INTO THE CELLS
5. ASSESS FOR SIGNS OF

MATERNAL COMPLICATIONS
SUCH AS PREECLAMPSIA
(HYPERTENSION,
PROTEINURIA, AND EDEMA)
6. MONITOR FOR SIGNS OF
REPORT BURNING AND PAIN
ON URINATION, VAGINAL
DISCHARGE OR ITCHING, OR
ANY OTHER SIGNS OF
INFECTION TO THE HEALTH
CARE PROVIDER
8. ASSESS FETAL STATUS AND
WOMAN WHO IS DRUG
DEPENDENT
SUBSTANCE ABUSER- IS
ONE WHO USES DRUGS
FOR PLEASURE

DRUG DEPENDENT-
SOMEONE WHO CRAVES A
PARTICULAR DRUG FOR
PSYCHOLOGICAL AND
PHYSICAL WELL-BEING
CHARACTERISTICS IF A DRUG
DEPENDENT WOMAN
-WOMAN IS IN THE YOUNGEST AGE GROUP
-THEY MAY HAVE LESS TRADITIONAL
LIFESTYLE THAN OTHERS
-THEY MAY COME LATE FOR PRENATAL CARE
-THEY MAY HAVE DIFFICULTY FOLLOWING
PRENATAL INSTRUCTIONS
1. ANTICIPATORY GUIDANCE
AND NURSING SUPPORT
DURING PREGNANCY
2. INTERDISCIPLINARY TEAM
APPROACH
3. DISCOURAGED
BREASTFEEDING (DRUGS IS
DRUGS COMMONLY USED DURING
PREGNANCY

Cocaine- derived from erythrxylon coca, a

plant grown almost exclusively in south
america
alkaloidal cocaine-a concentrated mixture,
produces an even more rapid and intense
“high” when it is inhaled
MANIFESTATIONS:
-Vasoconstriction
-increased respiratory and
cardiac rate
-increase blood pressure
-severely compromise placental
circulation
EFFECTS TO INFANTS
-Intracranial hemorrhage
-withdrawal syndrome of
tremulousness, irritability and
muscle rigidity
-learning deficits
Amphetamines- has a
pharmacologic effect similar
to cocaine. It is a drug easily
and cheaply manufactured.

Effects to infants:
-signs of jitteriness
-poor feeding at birth
Marijuana and hashish-are
obtained from the hemp
plant, cannabis

Manifestations
-tachycardia
-sense of well being
-loss of short term memory
-increase respiratory infection
-reduce milk production
EFFECTS TO
INFANTS
-LEARNING
DEFICITS
 SEXUALLY TRANSMITTED
DISEASES AND PREGNANCY
THE WOMAN WITH CANDIDIASIS

SIGNS AND SYMPTOMS

-Thick, cream cheese like vaginal
discharge
-extreme pruritus
-vagina appears red and irritated
CANDIDIASIS-Causes vaginal
infection spread by the fungus
candida
RISK FACTORS:
-Women being treated with an
antibiotic for another infection
-women with gestational diabetes
-women with HIV
MANAGEMENT
1. Treat the infection during pregnancy
2. Local application of an antifungal
cream: miconazole (monistat) or
clotrimazole (gyne-lotrimin)
3. Caution the women to telephone their
primary health care provider before
using over the counter preparation for
candidiasis
THE WOMAN WITH
TRICHOMONIASIS
TRICHOMONAS VAGINALIS-
IS A SINGLE-CELL
PROTOZOAN SPREAD BY
COITUS

SIGNS AND SYMPTOMS

-YELLOW GRAY FROTHY
VAGINAL DISCHARGE
MANAGEMENT
1. ASSESS FOR THE
PRESENCE OF
TRICHOMONIASIS
INFECTIONS
2. ADMINISTER
MEDICATION.
METRONIDAZOLE
(FLAGYL), TOPICAL
CLOTRIMAZOLE
THE WOMAN WITH
BACTERIAL VAGINOSIS
BACTERIAL VAGINOSIS- IS
A LOCAL INFECTION OF
THE VAGINA BY THE
INVASION, MOST
COMMONLY OF
GARDNERELLA
ORGANISMS

SIGNS AND SYMPTOMS

-GRAY AND FISH-LIKE
ODOR DISCHARGES
-INTENSE PRURITUS
MANAGEMENT
1. APPLICATION OF
VAGINAL TOPICAL CREAM
THE WOMAN WITH
CHLAMYDIA TRACHOMATIS
CHLAMYDIA INFECTION- IS
ONE OF THE MOST
COMMON TYPE OF VAGINAL
INFECTIONS SEEN DURING
PREGNANCY. IT IS CAUSED
BY GRAM-NEGATIVE
INTRACELLULAR PARASITE
SIGNS AND SYMPTOMS
-HEAVY GRAY-WHITE
VAGINAL DISCHARGE
MANAGEMENT
1. ADMINISTRATION OF
ERYTHROMYCIN OR
AMOXICILLIN
THE WOMAN WITH
SYPHILIS
SYPHILIS IS A SYTEMIC
DISEASE CAUSED BY THE
SPIROCHETE TREPONEMA
PALLIDUM

SIGNS AND SYMPTOMS

-PAINLESS ULCER (CHANCRE)
ON THE VULVA OR VAGINA
-PLACENTA APPEARS
IMPERVIOUS TO THE DISEASE
ORGANISM BEFORE 18 WEEKS
OF PREGNANCY
MANAGEMENT
1. INFECTION OF BENZATHINE
PENICILLIN G IS THE DRUG OF
CHOICE FOR THE TREATMENT
OF SYPHILIS DURING
PREGNANCY. AFTER THERAPY,
THE WOMAN MAY EXPERIENCE
A SUDDEN EPISODE OF
HYPOTENSION, FEVER,
TACHYCARDIA AND MUSCLE
ACHES, THIS IS CALLED A
JARISCH-HERXHEIMER
REACTION
THE WOMAN WITH A
HERPES INFECTION
GENITAL HERPES
INFECTION-IS A SEXUALLY
TRANSMITTED DISEASE
CAUSED BY THE HERPES
SIMPLEX VIRUS (HSV) TYPE
2
SIGNS AND SYMPTOMS
-PAINFUL, SMALL,
PINPOINT VESICLES
SURROUNDED BY
ERYTHEMA ON THE VULVA
OR IN THE VAGINA 3 TO 7
DAYS AFTER EXPOSURE
MANAGEMENT:
1. HOT SITZ BATH
2. APPLICATION OF WARM, MOIST
TEA BAGS TO THE LESIONS
3. ADMINISTRATION OF ACYCLOVIR
(ZOVIRAX) IN AN OINTMENT OR
ORAL FORM
4. WOMEN WITH ACTIVE LESIONS
FROM A PRIMARY INFECTION MAY
BE SCHEDULED FOR A
CEASAREAN BIRTH. IF NO LESION
ARE PRESENT, A VAGINAL BIRTH IS
PREFERABLE
THE WOMAN WITH
GONORRHEA
GONORRHEA- IS A
SEXUALLY TRANSMITTED
DISEASE CAUSED BY THE
GRAM-NEGATIVE COCCUS
NEISSERIA GONORRHOEAE
SIGNS AND SYMPTOMS
-YELLOW GREEN VAGINAL
DISCHARGE
MANAGEMENT
1. TRADITIONALLY BEEN
TREATED WITH AMOXICILLIN
AND PROBENECID, THE
INCIDENCE OF PENICILLINASE-
PRODUCING STRAINS HAS
MADE THIS TRADITIONAL
THERAPY INEFFECTIVE
2. ORAL CEFIXIME AND
CEFTRIAXONE SODIUM IM ARE
NOW THE DRUG OF CHOICE
3. SEXUAL PARTNER SHOULD
BE TREATED AS WELL TO
PREVENT REINFECTION
THE WOMAN WITH HUMAN
PAPILLOMA VIRUS
INFECTION
HUMAN PAPILLOMA VIRUS-
CAUSES FIBROUS TISSUE
OVERGROWTH ON THE
EXTERNAL VULVA
(CONDYLOMA
ACUMINATUM)
SIGNS AND SYMPTOMS
-LESION APPEAR AS
DISCRETE PAPILLARY
STRUCTURE
-LARGE CULIFLOWER-LIKE
LESIONS
MANAGEMENT
1. APPLICATION OF
TRICHLOROACETIC ACID
(TCA) OR BICHLOROACETIC
ACID (BCA) TO THE
LESIONS WEEKLY
2. LARGE LESIONS MAY BE
REMOVED BY LASER
THERAPY, CRYOCAUTERY
OR KNIFE EXCISION
3. HOT SITZ BATH AND
APPLICATION OF LIDOCAINE
CREAM MAYBE SOOTHING
DURING THE POSTPARTAL PERIOD
4. CAESEAREAN DELIVERY MAYBE
PERFORMED WHEN VULVAR
LESION IS PRESENT AT THE TIME
OF BIRTH
5. WOMEN WHO HAVE HAD ONE
EPISODE OF INFECTION SHOULD
BE CONSCIENTIOUS ABOUT
HAVING YEARLY PAPSMEAR FOR
THE REST OF THEIR LIVES
THE WOMAN WITH A
GROUP B STREPTOCOCCI
INFECTION
STREPTOCOCCUS B INFECTION
PERHAPS OCCURS AT A HIGHER
INCIDENCE DURING
PREGNANCY THAN HERPES
TYPE 2 OR GONORRHEA.
INFECTION DEVELOPS WITHIN
THE CERVIX OR VAGINA AND
THE MOTHER USUALLY
EXPERIENCES NO SYMPTOMS.
CONSEQUENCES CAN BE
URINARY TRACT INFECTION AND
INTRA-AMNIOTIC INFECTION.
MANAGEMENT
1. WOMEN ARE SCREENED FOR
THE INFECTION AT 35 TO 38
WEEKS OF PREGNANCY BY A
VAGINAL CULTURE AND TREATED
WITH BROAD SPECTRUM
PENICILLIN SUCH AS AMPICILLIN
2. WOMEN WHO EXPERIENCE
RUPTURE OF MEMBRANES AT
LESS THAN 37 WEEKS OF
PREGNANCY ARE TREATED WITH
INTRAVENOUS IV AMPICILLIN
THE WOMAN WITH HUMAN
IMMUNODEFICIENCY VIRUS
INFECTION
A. DESCRIPTION
1. HIV IS THE CAUSATIVE
AGENT OF AIDS
2. WOMEN INFECTED WITH HIV
MAY FIRST SHOW SYMPTOMS
AT THE TIME OF PREGNANCY
OR POSSIBLY DEVELOP LIFE-
THREATENING INFECTIONS
BECAUSE NORMAL
PREGNANCY INVOLVES
SUPPRESSION OF THE
MATERNAL IMMUNE SYSTEM
3. ZIDOVUDINE (RETROVIR)
IS RECOMMENDED FOR THE
PREVENTION OF MATERNAL-
TO-FETAL HIV TRANSMISSION
AND IS ADMINISTERED
ORALLY BEGINNING AFTER
14 WEEKS GESTATION,
INTRAVENOUSLY DURING
LABOR, AND IN THE FORM
OF SYRUP TO THE NEWBORN
FOR 6 WEEKS AFTER BIRTH
B. TRANSMISSION
1. SEXUAL EXPOSURE TO
GENITAL SECRETIONS OF
AN INFECTED PERSON
2. PARENTERAL EXPOSURE
TO INFECTED BLOOD AND
TISSUE
3. PERINATAL EXPOSURE OF
AN INFANT TO INFECTED
MATERNAL SECRETIONS
THROUGH BIRTH OR
BREAST-FEEDING
C. RISK TO THE MOTHER:
A MOTHER WITH HIV IS
MANAGED AS HIGH RISK
BECAUSE SHE IS
VULNERABLE TO
INFECTIONS
D. DIAGNOSIS
1. TEST USED TO
DETERMINE THE
PRESENCE THE PRESENCE
OF ANTIBODIES TO HIV
INCLUDE ENZYME-LINKED
IMMUNOSORBENT ASSAY
(ELISA), WESTERN BLOT
AND
IMMUNOFLUORECENCE
ASSAY (IFA)
2. A SINGLE REACTIVE
ELISA TEST BY ITSELF
CANNOT BE USED TO
DIAGNOSE HIV AND THE
TEST SHOULD BE
REPEATED WITH THE SAME
BLOOD SAMPLE, IF THE
RESULT IS AGAIN
REACTIVE, FOLLOW UP
TESTS USING WESTERN
BLOT OR IFA SHOULD BE
DONE
3. POSITIVE WESTERN BLOT
OR IFA IS CONSIDERED
CONFIRMATORY FOR HIV
4. A POSITIVE ELISA THAT
FAILS TO BE CONFIRMED BY
WESTERN BLOT OR IFA
SHOULD NOT BE
CONSIDERED NEGATIVE
AND REPEAT NEGATIVE AND
REPEAT TESTING SHOULD
BE DONE IN 3 TO 6 MONTHS
STAGE 1
-FEVER
-HEADACHE
-LYMPHADENOPATHY
-MYALGIA
STAGE 2
-INFECTION IS ACTIVE BUT
ASYMPTOMATIC AND MAY
REMAIN SO FAR YEARS
-CLIENTS MAY EXPERIENCE
OUTBREAK OF HERPES
ZOOSTER (SHINGLES)
-CLIENT MAY EXPERIENCE
TRANSIENT
THROMBOCYTOPENIA
STAGE 3
-CLIENT IS SYMPTOMATIC
-IMMUNE DYSFUNCTION IS
EVIDENT
-ALL BODY SYSTEMS CAN
SHOW SIGNS OF IMMUNE
DYSFUNCTION
-INTEGUMENTARY AND
GYNECOLOGICAL
PROBLEMS ARE COMMON
STAGE 4
-ADVANCED INFECTION
-CLIENT VULNERABLE TO
COMMON BACTERIAL
INFECTIONS
DEVELOPMENT OF
OPPORTUNISTIC
INFECTIONS
-SERIOUS IMMUNE
COMPROMISE
INTERVENTIONS
- PREVENT OPPORTUNISTIC
INFECTIONS
-AVOID PROCEDURES THAT
INCREASE THE RISK OF
PERINATAL TRANSMISSION,
SUCH AS AMNIOCENTESIS
AND FETAL SCALP
SAMPLING
-IF THE FETUS HAS NOT
BEEN EXPOSED TO HIV IN
UTERO, THE HIGHEST RISK
EXIST DURING DELIVERY
THROUGH THE BIRTH
CANAL
THE NEWBORN AND HIV
NEONATES BORN TO HIV
POSITIVE CLIENTS MAY
TEST POSITIVE BECAUSE
ANTIBODIES RECEIVED
FROM THE MOTHER MAY
PERSIST FOR 18 MONTHS
AFTER BIRTH, ALL
NEONATES ACQUIRE
MATERNAL ANTIBODY TO
HIV INFECTION, BUT NOT
ALL ACQUIRE INFECTION
INTERVENTIONS:
-BATH THE BABY
CAREFULLY BEFORE ANY
INVASIVE PROCEDURE,
SUCH AS THE
ADMINISTRATION OF
VITAMIN K, HEEL STICKS,
OR VENIPUNCTURES,
CLEAN THE UMBILICAL
CORD STUMP
METICULOUSLY EVERY DAY
UNTIL HEALED
-THE NEWBORN CAN
ROOM WITH THE MOTHER
ADMINISTER ZIDOVUDINE
TO THE NEWBORN AS
PRESCRIBED FOR THE
FIRST 6 WEEKS OF LIFE
RH INCOMPATIBILITY
THE RH FACTOR (IE, RHESUS
FACTOR) IS A 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.
THE MOST COMMON CAUSE OF
RH INCOMPATIBILITY IS EXPOSURE
FROM AN RH-NEGATIVE MOTHER
BY RH-POSITIVE FETAL BLOOD
DURING PREGNANCY OR
DELIVERY. AS A CONSEQUENCE,
BLOOD FROM THE FETAL
CIRCULATION MAY LEAK INTO THE
MATERNAL CIRCULATION, AND,
AFTER A SIGNIFICANT EXPOSURE,
SENSITIZATION OCCURS LEADING
TO MATERNAL ANTIBODY
PRODUCTION AGAINST THE
FOREIGN RH ANTIGEN.
ONCE PRODUCED, MATERNAL RH
IMMUNOGLOBULIN G (IGG)
ANTIBODIES MAY CROSS FREELY
FROM THE PLACENTA TO THE FETAL
CIRCULATION, WHERE THEY FORM
ANTIGEN-ANTIBODY COMPLEXES
WITH RH-POSITIVE FETAL
ERYTHROCYTES AND EVENTUALLY
ARE DESTROYED, RESULTING IN A
FETAL ALLOIMMUNE-INDUCED
HEMOLYTIC ANEMIA. ALTHOUGH THE
RH BLOOD GROUP SYSTEMS CONSIST
OF SEVERAL ANTIGENS (EG, D, C, C,
E, E), THE D ANTIGEN IS THE MOST
IMMUNOGENIC; THEREFORE, IT MOST
COMMONLY IS INVOLVED IN RH
INCOMPATIBILITY.
ANEMIA IN PREGNANCY
IRON DEFICIENCY ANEMIA-
IS CHARACTERISTICALLY A
MICROCYTIC AND
HYPOCHROMIC ANEMIA
CAUSES
1. DIET LOW IN IRON
2. HEAVY MENSTRUAL
PERIOD
3. SHORT PERIOD
BETWEEN PREGNANCIES
4. WOMEN FROM LOW
SOCIO-ECONOMIC STATUS
SIGNS AND SYMPTOMS

1.PICA-EATING NON
NUTRITIOUS FOOD
RESULTS TO LOW FETAL
BIRTH WEIGHT AND
PRETERM BIRTH
2. EXTREME FATIGUE
3. POOR EXERCISE
TOLERANCE
4. DECREASED
HEMOGLOBIN (BELOW 11
MANAGEMENT
1. TAKE 120 TO 180 MG OF
ELEMENTAL IRON PER DAY
2. EAT FOODS HIGH IN
IRON
3. INCREASE ROUGHAGE
IN DIET
FOLIC DEFICIENCY
ANEMIA-DEFICIENCY IN
FOLIC ACID WHICH IS
NECESSARY FOR BOTH
THE NORMAL FORMATION
OF RBC’S IN THE MOTHER
AND HAS BEEN
ASSOCIATED WITH A
DECREASE IN NEURAL
TUBE DEFECTS IN THE
FETUS
RISK FACTORS
1. MULTIPLE PREGNANCIES
2. WOMEN WITH A
SECONDARY HEMOLYTIC
DISEASE
3. WOMEN WHO ARE
TAKING HYDANTOIN- DRUG
THAT INTERFERES WITH
FOLIC ACID ABSORPTION
COMPLICATIONS
1. EARLY ABORTION
2. ABRUPTIO PLACENTA
MANAGEMENT
1. TAKE A SUPPLEMENT OF
400UG OF FOLIC ACID
DAILY
2. EAT FOODS RICH IN
FOLIC ACID
SICKLE CELL ANEMIA- IS A
RECESSIVELY INHERITED
HEMOLYTIC ANEMIA
CAUSED BY AN ABNORMAL
AMINO ACID IN THE BETA
CHAIN OF HEMOGLOBIN
SIGNS AND SYMPTOMS
-RBC’S ARE IRREGULAR OR
SICKLE SHAPE
-HEMOGLOBIN LEVEL OF 6-
8 MG/100 ML
-INCREASE INDIRECT
BILIRUBIN
-ASYMPTOMATIC
BACTERIURIA
COMPLICATIONS:

1. DIRECT FETAL
COMPROMISE WITH LOW
BIRTH WEIGHT
2. DEATH
MANAGEMENT
1. MIO
2. PROPER POSITIONING
3. EXCHANGE TRANSFUSION
PERIODICALLY
4. ADMINISTER IVF
5. ADMINISTER FOLIC ACID
SUPPLEMENT, AVOID IRON
SUPPLEMENT
6. ADMINISTER OXYGEN
7. ADMINISTRATION OF MEDS
(ACETAMINOPHEN, NSAIDS,
NARCOTICS)
GESTATIONAL CONDITION
HYPEREMESIS
GRAVIDARUM- IS
NAUSEA AND
VOMITING OF
PREGNANCY THAT IS
PROLONGED PAST 12
WEEKS OF
PREGNANCY
CAUSATIVE FACTORS
1. HORMONAL FACTORS
2. GASTROINTESTINAL
FACTORS
3. PSYCHOLOGICAL-
EMOTIONAL FACTOR
SIGNS AND SYMPTOMS
-WEIGHT LOSS
-FLUID VOLUME DEFICIT
-ACID BASE IMBALANCE
-NUTRITIONAL DEFICIT
-ELECTROLYTE DEFICIT
-ACTIVITY INTOLERANCE,
FATIGUE, WEAKNESS
-FEAR
-HYPOXIA AND
INTRAUTERINE GROWTH
MANAGEMENT
1. HOSPITALIZATION-MONITOR IO
AND BLOOD CHEMISTRY AND
PREVENT DEHYDRATION
2. REST GASTROINTESTINAL
TRACT
3. RESTORE ABILITY TO TAKE AND
RETAIN ORAL FLUIDS AND FOOD
4. MAINTAIN INTEGRITY OF ORAL
CAVITY
5. PROMOTE REST AND
RELAXATION
6. PREPARE FOR DISCHARGE
ECTOPIC PREGNANCY-
PREGNANCY IN WHICH
IMPLANTATION OCCURS
OUTSIDE UTERINE CAVITY
CAUSES:
1. ADHESION OF THE FALLOPIAN
TUBE FROM PREVIOUS
INFECTION (CHRONIC
SALPINGITIS OR PID)
2. CONGENITAL MALFORMATION
3. SCARS FROM TUBAL
SURGERY OR A UTERINE TUMOR
4. USE OF IUD
5. PROGESTIN-ONLY ORAL
CONTRACEPTIVES,
POSTCONCEPTUAL OR OVARIAN
INDUCTION DRUGS
6. SMOKING
CLINICAL CLASSIFICATION
1. TUBAL PREGNANCY
2. ABDOMINAL
PREGNANCY
3. OVARIAN PREGNANCY
4. CERVICAL PREGNANCY
SIGNS AND SYMPTOMS
-AMENORRHEA
-NAUSEA AND VOMITING
-+PREGNANCY TEST FOR
HCG
-BREAST TENDERNESS
-FATIGUE
-INCREASE URINATION
-SEVERE UNILATERAL PELVIC
PAIN OFTEN REFERRED TO
THE SHOULDER
-SEVERE SHARP-LIKE
STABBING PAIN EITHER
RIGHT OR LEFT LOWER
QUADRANT
-RIGID ABDOMEN
-(+) CULLEN’S SIGN
-EXCRUCIATING PAIN OF
CERVIX IF MOVED ON IE
-SIGNS OF SHOCK
CULLEN’S SIGN-
UMBILICUS MAY DEVELOP
A BLUISH TINGED IF
BLOOD IS SLOWLY
SEEPING INTO THE
PERITONEAL CAVITY
MANAGEMENT
1. CAREFUL HISTORY
TAKING
2. RECORD AMOUNT OF
BLOOD DISCHARGE
3. MONITOR V/S
4. POSITION PATIENT FOR
SHOCK
5. PELVIC EXAM
6. CULDOCENTESIS
7.LAPARATOMY
8. ULTRASONOGRAPHY
9. SALPINGOTOMY
10. SALPHINGECTOMY
11. BLOOD TRANSFUSION
PELVIC EXAM- TO CHECK
FOR THE SIZE OF UTERUS
AND FEEL FOR GROWTH
AND TENDERNESS

CULDOCENTESIS-
INVOLVES PASSING A
NEEDLE THROUGH THE
CUL-DE-SAC OF DOUGLAS
TO ASPIRATE FLUIDS FROM
THE PERITONEAL CAVITY
LAPAROTOMY- TO LIGATE
BLEEDING VESSELS AND
TO REMOVE OR REPAIR
DAMAGED FALLOPIAN
TUBE

ULTRASONOGRAPHY- TO
VISUALIZE THE
PERITONEAL CAVITY FOR
AN ECTOPIC IMPLANTED
PREGNANCY
SALPINGOTOMY- SURGICAL
INCISION OF UTERINE
TUBE

SALPINGECTOMY-
SURGICAL EXCISION OF
UTERINE TUBE

BLOOD TRANSFUSION- TO
REPLACE BLOOD LOSS
GESTATIONAL
TROPHOBLASTIC
DISEASE/HYDATIDIFORM
MOLE-IS A PROLIFERATION
AND DEGENERATION OF THE
TROPOBLASTIC VILLI AS THE
CELLS DEGENERATE, THEY
DEGENERATE, THEY BECOME
FLUID FILLED WITH FLUID,
APPEARING AS FLUID,
APPEARING AS FLUID-FILLED,
GRAPE SIZED VESICLES
ETIOLOGY:UNKNOWN
TYPES OF MOLAR PREGNANCY
1. PARTIAL MOLE
-VESICULAR DEGENERATION OF
THE CHORIONIC VILLI AFFECTS
ONLY PARTS OF THE PLACENTA
-FETAL PARTS AND NORMAL
PLACENTA ARE PRESENT
ALONG WITH ABNORMAL
TROPHOBLASTIC TISSUE
-LOW RISK OF SUBSEQUENT
DEVELOPMENT OF
MALIGNANCY
2. COMPLETE MOLE
-NO NORMAL PLACENTA
-BULKY MASS WHICH CAN
FILL THE UTERINE CAVITY
-NO FETAL PARTS OR
NORMAL PLACENTA VILLI
-LOW RISK OF
SUBSEQUENT
DEVELOPMENT OF
MALIGNANCY
SIGNS AND SYMPTOMS
-(+) PREGNANCY TEST
-VAGINAL BLEEDING
(BROWNISH, PRUNE JUICE)
CONTAINING GRAPELIKE
TISSUE
-UTERINE ENLARGEMENT,
FUNDAL HEIGHT GREATER
THAN EXPECTED FOR
LENGTH OF PREGNANCY
-NAUSEA AND VOMITING
-SYMPTOMS OF PIH
EARLIER THAN 24 WEEKS
OF GESTATION
-ABSENCE OF FETAL HEART
TONES/ACTIVITY
-ABSENCE OF FETAL PART
UPON PALPATION OR
RADIOLOGIC EXAM
LABORATORY TEST
-ROUTINE URINALYSIS
-BLOOD VALUES/EXAM
A. HEMATOCRIT,
HEMOGLOBIN, RBC
B. HCG TITERS ARE
ELEVATED UP TO 1-2M IN
24 HOURS
C. ULTRASONOGRAPHY
MANAGEMENT
1. INDUCED ABORTION
FOLLOWED BY D AND C IN
A FEW DAYS
2. HYSTERECTOMY
3. FOLLOW-UP
SUPERVISION FOR 1 YEAR
A. HCG TITER-ONCE A
WEEK UNTIL RESULTS ARE
NEGATIVE FOR 3
CONSECUTIVE WEEKS
-ONCE A MONTH FOR 6
MONTHS
-EVERY 2 MONTHS FOR 6
MONTHS
-EVERY 6 MONTHS
B. CHEST X-RAY- DONE
EVERY MONTH UNTIL HCG
TITER IS NEGATIVE, THEN
EVERY 2 MONTHS FOR 1
YEAR
C. ORAL CONTRACEPTIVES
TO PREVENT
PREGNANCIES
D. PREGNANCY IS NOT
ADVISED UNTIL 1 YEAR
TEST ARE NEGATIVE
INCOMPETENT CERVIX- IS
A CERVIX THAT DILATES
PREMATURELY AND
THEREFORE CANNOT
HOLD A FETUS UNTIL
TERM. THE DILATATION IS
USUALLY PAINLESS
ETIOLOGY
1. INCREASE MATERNAL
AGE
2. TRAUMA TO CERVIX
(REPEATED D AND C)
SIGNS AND SYMPTOMS
-PRESENCE OF SHOW
-INCREASE PELVIC
PRESSURE
-RUPTURE OF MEMBRANES
-DISCHARGED OF
AMNIOTIC FLUID
-UTERINE CONTRACTION-
FETUS IS BORN
MANAGEMENT
1. CERVICAL CERCLAGE-
PURSE STRING SUTURES
ARE PLACED IN THE
CERVIX BY A VAGINAL
ROUTE
A. MCDONALD
B. SHIRODHAR BACTER
2. EMERGENT CERCLAGE-
SUTURE ARE PLACED IN
THE CERVIX AS
PROPHYLAXIS PRETERM
BIRTH
W
ABORTION-IS DEFINED
AS ANY INTERRUPTION
OF A PREGNANCY
BEFORE THE FETUS IS
VIABLE
TYPES OF ABORTION
A. SPONTANEOUS
ABORTION-ALSO CALLED
MISCARRIAGE, HAPPENS IN
15% TO 30% OF ALL
PREGNANCIES AND
OCCURS FROM NATURAL
CAUSES
CAUSES:
1. ABNORMAL FETAL
FORMATION
2. IMPLANTATION
ABNORMALITIES
3. CORPUS LUTEUM FAILS
TO PRODUCE ENOUGH
PROGESTERONE
4. INFECTIONS IN THE
WOMAN
TYPES OF SPONTANEOUS
ABORTION
1. THREATENED
ABORTION-
CHARACTERIZED BY
SPOTTING AND BLEEDING
IN THE 1ST TRIMESTER OF
PREGNANCY
SIGNS AND SYMPTOMS
-SPOTTING, SCANT
BLEEDING
-BLEEDING, BRIGHT
RED IN COLOR
-SLIGHT CRAMPING,
BACKACHE
-NO CERVICAL
DILATATION
MANAGEMENT
1. LIMITING ACTIVITY TO
NO STRENOUS ACTIVITY
FOR 24-48 HOURS
2. CONVEY CONCERNED
REASSURANCE
3. COITUS IS RESTRICTED
FOR 2 WEEKS
2. IMMINENT (INEVITABLE)
ABORTION-PREGNANCY
CANNOT BE SAVED
SIGNS AND SYMPTOMS
-MODERATE BLEEDING
-MODERATE UTERINE
CRAMPING, BACKACHE
-CERVIX DILATION
MANAGEMENT
1. PROMPT TERMINATION
OF PREGNANCY
THROUGH D AND C
2. TISSUE FRAGMENT
SHOULD BE SAVED FOR
EXAMINATION FOR
ABNORMALITY (H-MOLE)
3. COMPLETE ABORTION-
THE ENTIRE PRODUCTS OF
CONCEPTION ARE
EXPELLED
SPONTANEOUSLY
SIGNS AND SYMPTOMS
-SLIGHT BLEEDING
-MILD UTERINE CRAMPING
-TISSUE IS PASSED-
COMPLETE PRODUCTS OF
CONCEPTION
-CERVIX CLOSED
MANAGEMENT
1. NO MEDICAL
INTERVENTION IS
REQUIRED IF:
-BLEEDING AND CRAMPING
SUBSIDE AFTER PASSAGE
-TISSUE PASSED IS
EVALUATED TO BE
COMPLETE
-INFECTION DOES NOT
OCCUR
2. PROVIDE EMOTIONAL
SUPPORT
4. INCOMPLETE ABORTION-
PART OF THE FETUS IS
EXPELLED, BUT
MEMBRANE OR PLACENTA
IS RETAINED IN THE
UTERUS
SIGNS AND SYMPTOMS
-HEAVY BLEEDING
ASSOCIATED WITH
RETAINED PLACENTA
-MODERATE TO SEVERE
UTERINE CRAMPING
-TISSUE IS PASSED WITH
THE BLEEDING
-CERVIX IS OPEN AND
DILATED
MANAGEMENT
1. D AND C
2. PROVIDE EMOTIONAL
SUPPORT
5. MISSED ABORTION-
FETUS DIES BUT
PRODUCTS OF
CONCEPTION ARE NOT
PASSED OR ABORTED
SIGNS AND SYMPTOMS
-SLIGHT BLEEDING,
BROWNISH DISCHARGE
-NO UTERINE CRAMPING
-NO TISSUE PASSED
-CERVIX CLOSED
-SIGNS OF PREGNANCY
SUBSIDE, PREGNANCY
TEST BECOMES NEGATIVE
MANAGEMENT
1. SONOGRAM TO
ESTABLISH DEATH OF THE
FETUS
2. D AND C
3. PROVIDE EMOTIONAL
SUPPORT
6. HABITUAL ABORTION-
WOMEN WHO HAVE 3 OR
MORE CONSECUTIVE
SPONTANEOUS ABORTION
CAUSES:
1. DEFECTIVE
SPERMATOZOA OR OVA
2. ENDOCRINE FACTORS
3. DEVIATION OF THE
UTERUS
4. INFECTION
5. AUTOIMMUNE
DISORDERS
B. INDUCED ABORTION
 Is one which is artificially brought about or pregnancy
may be interrupted for medical or for social reason
 Social reason: unwanted pregnancy due to rape or incest,
want to maintain body figure
TYPES OF INDUCED
ABORTION
1. Therapeutic abortion- 2. Criminal abortion- done
termination of pregnancy illegally outside of the
with legal justification due hospital or without proper
to some maternal disease medical supervision
which extremely
endanger the fetus and
mother
COMPLICATIONS OF
ABORTION
1. Hemorrhage- excessive bleeding (a rule of thumb is
more than 1 sanitary napkin per hour)
Management:
2. Position patient flat on bed and massage fundus of
the uterus to aid contraction
3. Emotional support
4. Monitor v/s every 15 minutes
5. D and C (to empty uterus that is preventing it from
contracting and achieving hemostasis)
6. Blood transfusion
7. Direct replacement of fibrinogen (to aid coagulation
8. Oral medication (methergin) to aid with contraction
2. infection- the organism responsible for infection after
abortion is usually E. coli
Management
1. Observe the woman closely for signs of infection such
as fever, abdominal pain or tenderness, foul vaginal
discharge
2. Administer antibiotics as ordered
3. Proper perineal care
4. Caution mother not to use tampons
3. Septic abortion- abortion that is complicated by
infection
-usually happens after spontaneous abortion especially
those who have tried to self-abort using a non-sterile
environment
-if left untreated it can lead to toxic shock syndrome,
septicemia, kidney failure and death
Signs and symptoms:
Fever
Crampy abdominal pain
Uterus feels tender to palpation
MANAGEMENT:
1.D and C- removal of all infected/ necrotic tissue from
uterus
2. Antibiotics usually broad spectrum is used
3. Tetanus toxoid or tetanus immune globulin IM
4. isoimmunization- whenever a placenta is dislodge
either by spontaneous birth or by D and C at any point in
pregnancy, some blood from placental villi enter maternal
circulation
Management:
All women with Rh negative blood should receive Rh (D
antigen) immune globulin (RHIG) in the event the
conceptus is Rh positive
5. powerlessness- a
feeling of sadness and
grief over the loss or that
they have lost control of
their lives is to be
expected.
Management:
Provide emotional support
PLACENTA PREVIA- THE
PLACENTA IS IMPLANTED
IN THE LOWER UTERINE
SEGMENT INSTEAD OF A
THE UPPER THIRD OF THE
UTERUS
CLASSIFICATION
1. LOW LYING PLACENTA-
IMPLANTATION IN THE LOWER
RATHER THAN IN THE UPPER
PORTION OF THE UTERUS
2. MARGINAL IMPLANTATION-
PLACENTA EDGE APPROACHES
THAT OF THE CERVICAL OS
3. PARTIAL PLACENTA PREVIA-
IMPLANTATION THAT PARTIALLY
OCCLUDES CERVICAL OS
4. TOTAL PLACENTA PREVIA-
IMPLANTATION THAT TOTALLY
OBSTRUCT CERVICAL OS
CAUSES:

1. INCREASED PARITY
2. ADVANCED MATERNAL
AGE
3. PAST CEASAREAN
SECTION
4. PAST UTERINE
CURETTAGE
5. MULTIPLE GESTATION
SIGNS AND SYMPTOMS
-ABRUPT PAINLESS
BLEEDING AND BRIGHT
RED IN COLOR
-BLEEDING AFTER SEXUAL
INTERCOURSE AND
VAGINAL EXAM
-PREMATURE LABOR
IMMEDIATE NURSING CARE
1. COMPLETE BEDREST
2. ASSESS THE
FOLLOWING
-DURATION OF
PREGNANCY
-TIME BLEEDING BEGINS
-ESTIMATION OF AMOUNT
OF BLOOD
-WHETHER THERE WAS
ACCOMPANYING PAIN
-COLOR OF BLOOD
-WHAT SHE HAD DONE
FOR THE BLEEDING?
-WHETHER THERE WERE
PREVIOUS BLEEDINGS?
-WHETHER SHE HAD PRIOR
CERVICAL SURGERY?
3. MONITOR VITAL SIGNS
4. STAT LABORATORY TO BE
DONE- (CBC, TYPING,
PROTHROMBIN TIME, TO
ESTABLISH BASELINE AND
DETECT A POSSIBILITY OF
CLOTTING DISORDER)
5. BEGIN IVF STAT/DOCTORS
ORDER (TO REPLACE FLUID
LOSS)
6. PREPARE OXYGEN AND
BLOOD TRANSFUSION
CONTINUING CARE
1. BED REST AND CLOSE
WATCH
2. IF BLEEDING STOPS-
HOME CARE
3. CAREFUL ASSESSMENT
OF FHR AND LABORATORY
TEST
4. REASSURANCE
5. INFORM MOTHER OF A
POSSIBLE CS DELIVERY
ABRUPTIO PLACENTA-
PREMATURE SEPARATION
OF A NORMALLY
IMPLANTED PLACENTA
ETIOLOGY: UNKNOWN
PREDISPOSING FACTOR:
1. HIGH PARITY
2. CHRONIC
HYPERTENSION DISEASE
3. HYPERTENSION OF
PREGNANCY OR TOXEMIA
4. DIRECT TRAUMA
5. VASOCONSTRICTION
FROM COCAINE USE
6. CIGARETTE SMOKING
7. ACUTE EMOTIONAL
STRESS
8. STRENUOUS PHYSICAL
ACTIVITY
9. NUTRITIONAL
DEFICIENCY
DEGREES OF
SEPARATION
Grade 0- no symptoms of
separation were apparent from
maternal or fetal signs. The
diagnosis that a slight
separation did occur is made
after delivery when the
placenta shows a recent
adherent clot on the maternal
surface
GRADE 1
 Minimal separation, but enough to
cause marginal bleeding and
changes in the maternal vital signs,
no fetal distress or hemorrhagic
shock occurs
GRADE 2
Moderate separation, there is
no evidence of fetal distress,
the uterus is tense and painful
on palpation
GRADE 3
Extreme separation, without
immediate intervention
maternal death and fetal
death will occur
TYPES OF ABRUPTIO
PLACENTA
1. COVERT/CENTRAL
ABRUPTIO PLACENTA-
SEPARATION BEGINS AT
THE CENTER OF PLACENTA
ATTACHMENT RESULTING
IN BLODD BEING TRAPPED
BEHIND THE PLACENTA,
BLEEDING, THEN IS
INTERNAL AND NOT
OBVIOUS
2. OVERT OR MARGINAL
ABRUPTIO PLACENTA-
SEPARATION BEGINS AT
THE EDGES OF THE
PLACENTA ALLOWING
BLOOD TO ESCAPE FROM
THE UTERUS CAVITY.
BLEEDING IS INTERNAL
SIGNS AND SYMPTOMS
-SHARP STABBING PAIN HIGH
IN THE UTERINE FUNDUS (AS
THE INITIAL SEPARATION
OCCURS)
-HEAVY BLEEDING (USUALLY
ACCOMPANIES PREMATURE
SEPARATION OF THE
PLACENTA)
-HARD BOARD-LIKE UTERUS
(RESULTS IF SEPARATION
OCCURS FROM THE CENTER
RATHER THAN THE MARGIN)
MANAGEMENT:

1. HOSPITALIZATION
2. COMBAT BLOOD SHOCK AND
BLOOD LOSS
-LARGE GAUGE IV CATHETER
INSERTED FOR FLUID
REPLACEMENT AND OXYGEN BY
MASK TO LIMIT FETAL ANOXIA
-MONITOR VITAL SIGNS OF
MOTHER AND FHR EVERY 5-15
MINUTES
-FIBRINOGEN
DETERMINATION AND CBC
-IF IT OCCURS IN ACTIVE
LABOR-RUPTURING OF
MEMBRANES AND
AUGMENTING LABOR WITH IV
OXYTOCIN MAYBE METHOD
OF CHOICE
-IF DELIVERY IS NOT
IMMINENT-CS IS THE
DELIVERY METHOD OF
CHOICE
COMPLICATIONS:
1. HYPOVOLEMIC SHOCK
2. FETAL HYPOXIA
3. COUVELAIRE UTERUS- IS A
LIFE-THREATENING CONDITION
IN WHICH LOOSENING OF THE
PLACENTA (ABRUPTIO
PLACENTAE) CAUSES BLEEDING
THAT PENETRATES INTO THE
UTERINE MYOMETRIUM FORCING
ITS WAY INTO THE
PERITONEAL CAVITY.
4. INFECTIONS
SPONTANEOUS RUPTURE
OF THE MEMBRANE
BEFORE THE ONSET OF
LABOR
TYPES
-PREMATURE RUPTURE OF THE
MEMBRANES (PROM)-RUPTURE
OF MEMBRANES AFTER THE
COMPLETION OF THE 37TH WEEK
OF GESTATION WITH LABOR
USUALLY BEGINNING WITH 12
TO 24 HOURS
-PRETERM PREMATURE
RUPTURE OF THE MEMBRANES
(PPROM)-RUPTURE OF
MEMBRANES BEFORE THE 38TH
WEEK OF GESTATION
ETIOLOGY: UNKNOWN
CONTRIBUTING FACTORS
-REPRODUCTIVE TRACT
INFECTIONS
-INCREASED
INTRAUTERINE PRESSURE
-LIFESTYLE HABITS
-FETAL ANOMALIES AND
MALPRESENTATIONS
SIGNS AND SYMPTOMS
-SUDDEN GUSH OF CLEAR
FLUID FROM THE VAGINA
-VAGINAL POOLING OF
FLUID
COMPLICATIONS:

-RISK FOR INFECTION

-FETAL HYPOXIA AS A RESULT OF
CORD COMPRESSION
-PROLAPSE OF THE
CORD
-DECREASED AMOUNTS
OF AMNIOTIC FLUID TO
CUSHION CORD
-DEVELOPMENT OF A POTTER-
LIKE SYNDROME OF DISTORTED
FACIAL FEATURES AND
PULMONARY HYPOPLASIA FROM
MANAGEMENT
1. DETERMINE
A. EXACT TIME OF
RUPTURE
B. CHARACTERISTICS
OF FLUID-AMOUNT,
COLOR, AND ODOR,
CONFIRM THAT FLUID IS
AMNIOTIC BY PERFORMING
A.1 NITRAZINE TEST-
ALKALINE REACTION
A. 2 FERN TEST- FERNING
PATTERN APPEARS WHEN
FLUID DRIES ON A GLASS
SLIDE
A.3 SONOGRAM- TO ASSESS
AMNIOTIC FLUID INDEX

C. GESTATIONAL AGE OF
THE PREGNANCY
DISSEMINATED
INTRAVASCULAR
COAGULATION- IS AN
ACQUIRED
DISORDER OF BLOOD
CLOTTING

RISK FACTORS
1. PREMATURE
SEPARATION OF PLACENTA
2. HYPERTENSION OF
PREGNANCY
3. AMNIOTIC FLUID
EMBOLISM
4. PLACENTAL RETENTION
5. SEPTIC ABORTION
6. RETENTION OF A DEAD
FETUS
7. SALINE ABORTION
SIGNS AND SYMPTOMS
-EARLY BRUISING
-BLEEDING, POSSIBLY
FROM MULTIPLE SITES IN
THE BODY
-BLOOD CLOTS
-DROP IN BLOOD
PRESSURE
DIAGNOSTIC TEST
-EXAMINATION OF A
BLOOD SAMPLE UNDER A
MICROSCOPE
-FIBRIN DEGRADATION
PRODUCTS
-PARTIAL
THROMBOPLASTIN TIME
(PTT)
-PLATELET COUNT
-PROTHROMBIN TIME
-SERUM FIBRINOGEN
MANAGEMENT:
1. TREAT THE INITIATING
CAUSE
2. IV ADMINISTRATION OF
HEPARIN
3. BLOOD TRANSFUSION
4. DELIVERY OF THE FETUS
AND PLACENTA
PREGNANCY INDUCED
HYPERTENSION
–IS A FORM OF HIGH
BLOOD PRESSURE IN
PREGNANCY
-ALSO CALLED TOXEMIA
OR PREECLAMPSIA. IT
OCCURS MOST OFTEN IN
YOUNG WOMEN WITH A
FIRST PREGNANCY.
WHO IS AFFECTED BY PIH?
PREGNANCY-INDUCED
HYPERTENSION (PIH) AFFECTS
APPROXIMATELY ONE OUT OF EVERY
14 PREGNANT WOMEN. ALTHOUGH
PIH MORE COMMONLY OCCURS
DURING FIRST PREGNANCIES, IT CAN
ALSO OCCUR IN SUBSEQUENT
PREGNANCIES. PIH IS ALSO MORE
COMMON IN PREGNANT TEENS AND
IN WOMEN OVER AGE 40. MANY
TIMES, PIH DEVELOPS DURING THE
SECOND HALF OF PREGNANCY,
USUALLY AFTER THE 20TH WEEK,
BUT IT CAN ALSO DEVELOP AT THE
TIME OF DELIVERY OR RIGHT AFTER
PIH?
A WOMAN IS MORE LIKELY TO DEVELOP
PIH IF SHE:
IS UNDER AGE 20 OR OVER AGE 35
HAS A HISTORY OF CHRONIC
HYPERTENSION
HAS A PREVIOUS HISTORY OF PIH
HAS A FEMALE RELATIVE WITH A
HISTORY OF PIH
IS UNDERWEIGHT OR OVERWEIGHT
HAS DIABETES BEFORE BECOMING
PREGNANT
HAS AN IMMUNE SYSTEM DISORDER,
SUCH AS LUPUS OR RHEUMATOID
ARTHRITIS
HAS KIDNEY DISEASE
HAS A HISTORY OF ALCOHOL, DRUG, OR
TOBACCO USE
WHAT ARE THE SYMPTOMS OF
PIH?
RAPID OR SUDDEN WEIGHT GAIN,
HIGH BLOOD PRESSURE, PROTEIN IN
THE URINE, AND SWELLING (IN THE
HANDS, AND FACE) ARE ALL SIGNS
OF PIH.
OTHER SYMPTOMS OF PIH INCLUDE
ABDOMINAL PAIN, SEVERE
HEADACHES, A CHANGE IN
REFLEXES, SPOTS BEFORE YOUR
EYES, REDUCED OUTPUT OF URINE
OR NO URINE, BLOOD IN THE URINE,
DIZZINESS, OR EXCESSIVE VOMITING
AND NAUSEA
DURING ROUTINE PRENATAL
TESTS, YOUR WEIGHT GAIN, BLOOD
PRESSURE AND URINE PROTEIN
ARE MONITORED.
IF PIH IS SUSPECTED, A NON-
STRESS TEST MAY BE PERFORMED
TO MONITOR THE BABY. DURING
THE NON-STRESS TEST, AN
ULTRASOUND TRANSDUCER
RECORDS THE BABY'S HEART RATE,
AND A PRESSURE TRANSDUCER
(CALLED THE TOCO TRANSDUCER)
RECORDS UTERINE ACTIVITY.
MANAGEMENT
-REST
-LYING ON YOUR LEFT SIDE
TO TAKE THE WEIGHT OF THE
BABY OFF YOUR MAJOR
BLOOD VESSELS.
-INCREASE PRENATAL
CHECKUPS.
-CONSUME LESS SALT.
-DRINK 8 GLASSES OF WATER
A DAY.
HELLP SYNDROME
HELLP SYNDROME IS A SERIES OF
SYMPTOMS THAT MAKE UP A
SYNDROME THAT CAN AFFECT
PREGNANT WOMEN. HELLP
SYNDROME IS THOUGHT TO BE A
VARIANT OF PREECLAMPSIA, BUT
IT MAY BE AN ENTITY ALL ON ITS
OWN. THERE ARE STILL MANY
QUESTIONS ABOUT THE SERIOUS
CONDITION OF HELLP SYNDROME.
THE CAUSE IS STILL UNCLEAR TO
MANY DOCTORS AND OFTEN
HELLP SYNDROME IS
MISDIAGNOSED.
THE NAME HELLP
STANDS FOR:
H- HEMOLYSIS
( BREAKDOWN OF RED
BLOOD CELLS)
EL- ELEVATED LIVER
ENZYMES (LIVER
FUNCTION)
LP- LOW PLATELETS
COUNTS (PLATELETS HELP
THE BLOOD CLOT)
THE MOST COMMON
SYMPTOMS OF HELLP
SYNDROME INCLUDE:
HEADACHES
NAUSEA AND VOMITING THAT
CONTINUE TO GET WORSE
(THIS MAY ALSO FEEL LIKE A
SERIOUS CASE OF THE FLU.)
UPPER RIGHT
ABDOMINAL PAIN OR
TENDERNESS
FATIGUE OR MALAISE
HOW IS HELLP SYNDROME
DIAGNOSED?
HEMOLYSIS -RED BLOOD CELLS
ABNORMAL PERIPHERAL SMEAR
LACATATE DEHYDROGENASE >600
U/L
BILIRUBIN > 1.2 MG/DL
ELEVATED LIVER ENZYME LEVELS
SERUM ASPARTATE
AMNIOTRANSFERASE >70 U/L
LACATATE DEHYDROGENASE >600
U/L
LOW PLATELETS
PLATELET COUNT
TREATMENT’S THAT MAY BE USED
TO MANAGE HELLP UNTIL BABY IS
DELIVERED INCLUDE:
BED REST AND ADMISSION INTO A
MEDICAL FACILITY TO BE MONITORED
CLOSELY
CORTICOSTEROID ( TO HELP BABIES
LUNGS DEVELOP MORE RAPIDLY)
MAGNESIUM SULFATE ( TO HELP
PREVENT SEIZURES)
BLOOD TRANSFUSION IF PLATELET
COUNT GETS TOO LOW
BLOOD PRESSURE MEDICATION
FETAL MONITORING AND TESTS
INCLUDING BIOPHYSICAL TESTS,
SONOGRAMS, NON STRESS TESTS AND
FETAL MOVEMENT EVALUATION
A MULTIPLE
BIRTH OCCURS WHEN
MORE THAN ONE FETUS IS
CARRIED TO TERM IN A
SINGLE PREGNANCY. THE
PRECEDING PREGNANCY IS
CALLED A MULTIPLE
PREGNANCY.
CAUSES
 Heredity (family history)
 Older age (women over 30 y.o)
 High parity
 Race (African American have more twins than Asian and
Native American
 Ovulation (Clomiphene Citrate and FSH help produce
many eggs, if fertilized can result to multiple birth)
 Assisted reproductive technologies (In vitro fertilization)
CLASSIFICATIONS
1. MONOZYGOTIC
 When a single ovum is  Always of the same sex
fertilized but in the  1 placenta, 2 umbilical
process of fusion or in
one of the first cell cord, 1 chorion and 2
divisions, the zygote amnion
divides into 2 identical
individual
2. DIZYGOTIC
 Two separate ova  May or may not be of the
fertilized by 2 different same sex
sperms.  2 placentas, 2 umbilical
 They are actually siblings cord, 2 chorions, 2
growing at the same time amnions
in the uterus
FAMOUS IDENTICAL TWINS
MARY KATE AND ASHLEY
OLSEN
SIGNS AND SYMPTOMS
 Uterine size is greater than expected
 On quickening there are several flurries of action in
different portion of abdomen
 On auscultation, 2 sets of fetal heart tone are heard
 There is marked weight gain, not due to toxemia or
obesity
COMPLICATIONS
 Premature delivery (the higher the number of fetus, the
greater risk for early birth)
 Postpartum hemorrhage (due to abnormal uterine
stretching
 Hypertensive disorders (pre-eclampsia, eclampsia)
 hydramnios
 Maternal anemia
 Nausea and vomiting throughout pregnancy
 Dyspnea (due to the pressure in the diaphragm
 Pedal edema (Na retention)
 Abruptio placenta/ placenta previa
 Ceasarean delivery
 Twin to twin transfusion syndrome- is a condition of the
placenta that develops only with identical twins that
share placenta connect with in the placenta and divert
blood from one fetus to the other. Recipient fetus
receives too much blood which lead to cardiovascular
overload. Donor fetus, does not get enough blood and
decrease amount of amniotic fluid.
MANAGEMENT

Prenatal care
Balanced diet
Rest period
Anticipatory guidance
and support
TWINS WHO MARRIED
TWINS AND HAD TWINS