NCM 109: MODULE 1 ii.

Malnutrition

High Risk Pregnancy o Anemia, vitamin

deficiency, excessive
o When there is an increase chance of
weight gain, toxemias,
morbidity or mortality to the mother or
prolonged labor,
her fetus or both.
fetopelvic
disproportion, drug
abuse, infections.
High Risk Infant
2. Social Problems
o Is one who is born with less ability or
chance to survive or a greater chance to a. Failure to complete education or
be left with a permanent handicap either vocational training
psychosocial or physiologic than the
b. Dependence on other for support
average child
c. Failure to establish stable family
Risk Factors:
d. High rate of marital failure
1. Maternal Age Factor
e. High incidence of repeated out-of
a. Age > 35 yrs. old
wedlock pregnancies
i.Tendency to have:
3. Socioeconomic factors (financial)
1. Heavier babies
a. Low income
2. High perinatal mortality
i. Predisposed to low health status
3. High incidence of infants – OB and neonatal complications
with down syndrome
ii. Balanced dietary intakes
b. Adolescent pregnancy <18 yrs. old
iii. Low birth weight
i. Lack of perinatal care
iv. Toxemia
1. Low socioeconomic
v. Malnutrition, mental
background
retardation
2. Lack of motivation
b. Use of elicit drugs
3. Denial, pride
i. No prenatal
4. Ignorance, rebellion
ii. Malnourished
against authority
iii. Drug addicted children
 c. Smoke and alcohol drink BLEEDING IN PREGNANCY
i. Low birth weight infants Bleeding - Occurs anytime

ii. Higher rate of abortions and o Never normal, no matter how slight
stillbirths o Frightening experience
o Need to be assessed
4. OB factors
o Threatens both mother and fetus
a. Previous difficult pregnancies, o Client needs reassurance
fetal loss, premature

b. Diabetic, hypertension, anemia,

Signs and Symptoms of Hemorrhagic Shock
cardiac, renal, or respiratory
disease Assessment Significance
Increased pulse Heart attempting to
c. Evidence of vaginal bleeding
rate circulate decreased blood
d. Rh negative, COPD volume
Less peripheral resistance
e. Exposed to teratogens, chemical, Decreased blood
because of decreased
pressure
environmental toxins, or radiation blood volume
Increased gas exchange to
f. Multiple pregnancy - close gap
Increased better oxygenate
pregnancy – 2 months from last
respiratory rate decreased red blood cell
delivery volume
Vasoconstriction occurs to
DANGER SIGNS THAT REQUIRE Cold, clammy skin maintain blood volume in
central bloody core
PROMPT REPORTING:
Inadequate blood is
Decreased urine
o Leaking of Amniotic Fluid entering kidney due to
output
o Vaginal Bleeding decreased blood volume
o Blurred Vision Dizziness or Inadequate blood is
o Rapid Weight Gain decreased level of reaching cerebrum due to
consciousness decreased blood volume
o Elevated BP
Decreased blood is
Decreased central
**Constipation, Breast Tenderness, Nasal returning to heart due to
venous pressure
Stuffiness are common discomforts associated reduced blood volume
with pregnancy.
Hypovolemic shock
o It is a life-threatening condition that
results when you lose more than 20
percent (one-fifth) of your body's blood
or fluid supply. This severe fluid loss
makes it impossible for the heart to
pump enough blood to your body.
Hypovolemic shock can lead to organ
failure.
o occurs as a result of either blood loss or
extracellular fluid loss.
o Hemorrhagic shock is hypovolemic shock
from blood loss.
FIRST TRIMESTER BLEEDING
Abortion
o Loss of fetus before age of viability <24
weeks of AOG
Types of Abortion:
1. Induced
a. Therapeutic – medically indicated
b. Criminal – intentionally done
c. Septic – infected abortion;
secondary to infection
o Deliberately terminating pregnancy
o Criminal, septic, therapeutic, medical,
and planned
Purposes:
o When there is threat to mother’s life
(heart disease)
o Fetal malformation (chromosomal
defects)  Psychological implication
(rape)
2. Therapeutic Abortion:
According to US Supreme court ruling (Jan. 22,
1973) Pregnancy may be terminated as follows:
o 1st trimester abortion – decision is left
to the women and her physician
o 2nd trimester – state may not prohibit
but may regulate practice for woman’s
health
o Final trimester – state may choose to
protect the potential life of the fetus by
prohibiting abortion except when there
is threat to the life or health of the
mother
**Religious belief of the mother is always
respected**
3. Septic Abortion
o is an infection of the placenta and fetus
(products of conception) of a previable
pregnancy. Infection is centered in the
placenta and there is risk of spreading
to the uterus, causing pelvic infection or
becoming systemic to cause sepsis and
potential damage of distant vital organs.
 d. Complete

4. Spontaneous o All products of conception leave the

body or are expelled.
a. Threatened
e. Missed
o Prior to end of 20th weeks of AOG
o cervix is closed
o Only abortion that can be saved
o foul-smelling discharge
o Vaginal bleeding is slight
o fetus dies in utero before 20 weeks
o Abdominal cramping is slight to
AOG and retained from 2 months or
moderate
longer
o Cervix is closed

o Complete bed rest without bathroom

Ectopic Pregnancy
privileges
o Refers to the implantation of the
o Diet: normal diet high vitamins and
products of conception in a site other
protein
than the endometrium.
b. Imminent (inevitable) o Extra-uterine (Does not occupy uterine
proper)
o Cervix is opened

o Bleeding is moderate to profuse

Types according to sites:
o Abdominal pain is moderate to severe
1.Tubal – most common
o Possibility of neurogenic shock (is most
commonly a consequence of traumatic a. Fimbriae
spinal cord injuries.) and hypovolemic
b. Ampullar 60%
shock (is a lifethreatening condition that
results when you lose more than 20 c. Isthmic
percent (one-fifth) of your body's blood
d. Interstitial
or fluid supply.)
2. Ovarian
c. Incomplete
a. Tubo-ovarian
o One of the products of conception has
not been expelled b. Ovarian

o Cervix is opened c. Cervical

o Severe bleeding and pain d. Abdominal/ peritoneal – rare

o Prepare for complete abortion – D/C

Causes:
 a. Adhesions in tubes – tubo-ovarian, o Amenorrhea or abnormal menses –
fallopian tubes spotting
o Cul-de-Sac mass
b. Infection – chronic salphingitis, PID

c. Congenital malformations – infantile

tubes Acute rupture

d. Scars of tubal surgery o Shock

o Referred shoulder pain- late sign
e. uterine tumors pressing the tubes
o Evidence of acute blood loss
f. endometriosis

g. tube spasms
Chronic rupture
Signs and Symptoms:
o Occurs 50% in tubal ectopic
Ruptured pregnancy
o Slow-internal bleeding
o Spotting or bleeding
o may or may not be present Atypical or inconclusive symptoms as
o Abdominal rigidity
o Slight, dark, vaginal bleeding
o Cullen’s sign – bluish discoloration
around umbilicus o Renal or pelvic pressure or fullness
o Shoulder pain
o Lower abdominal tenderness
o blood irritating the diaphragm
o Mass in Cul-de-Sac of Douglas o Slight fever
(pouch) may be palpated or bloody o Leukocytosis
fluid maybe aspirated by
CULDOCENTESIS o Cullen’s sign
o Excoriating pain at cervix when o Decrease Hct and Hgb
IE is done
o Knifelike pain in either lower
quadrant (affected site) Diagnosis
o WBC – 15,000/uL>, RBC –
decrease, ESR – Slightly elevated 1. Ultrasound – reveals site of Ectopic
 Signs and symptoms of shock pregnancy

2. Culdocentesis – yields free blood that will

not clot or is already clotted

3. Laparoscopy – discloses extrauterine

pregnancy
Early ectopic pregnancy Treatment
1. Culdotomy – release clotted blood and Gestational Trophoblastic Disease
product of extra-uterine pregnancy/ conception (Hydatidiform Mole)

2. Laparotomy – reveal correct diagnosis Is abnormal proliferation and the degeneration

of the trophoblastic villi. As the cells
degenerates, they become filled with fluid and
SECOND TRIMESTER BLEEDING appear as clear fluid-filled, grape-sized
vesicles. The embryo fails to develop beyond a
Premature cervical dilatation
primitive start. Abnormal trophoblast cells must
(cervical insufficiency)
be identified because they are associated with
o Previously termed as incompetent choriocarcinoma, a rapidly metastasizing
cervix, refers to a cervix that malignancy.
dilates prematurely and
therefore cannot retain a fetus
until term. The dilatation usually Signs and Symptoms
occurs painlessly. 1. Expanded uterus - trophoblast cells grow
Signs and Symptoms rapidly.

1. Show- the first symptom (a pink-stained 2. Ultrasound will show dense growth (typically
vaginal discharge) a snowflake pattern) but no fetal growth in the
uterus.
2. Increased pelvic pressure
3. No fetal heart sounds
3. Rupture of the membrane and discharge
of the amniotic fluid 4. Increased blood pressure, edema, and
proteinuria before the week 20 pregnancy.
4. Uterine contraction begins after a short
labor

Treatment Management

1. Cervical Cerclage - a surgical operation can 1.Suction and curettage - to evacuate the
be performed to prevent this from happening in abnormal trophoblast cells.
the next pregnancy. 2.The HCG is analyzed every 2 weeks until
2. Mcdonald or a Shirodkar procedure - if normal.
another pregnancy is confirmed via ultrasound,
nylon sutures are placed horizontally and
vertically across the cervix. The sutures serve
to strengthen the cervix and prevent it from
dilating until the end of pregnancy.

THIRD TRIMESTER BLEEDING

Placenta Previa
o Implantation of the placenta at the
lower uterine segment, causing painless
bleeding in the third trimester of
pregnancy.
o 30% > than average placenta implanted
at the fundus – site and size related
(surface area)
o Degree placenta covers the internal os is
estimated by 70 – 100%, 75% etc.
o 2nd trimester – 45% of placenta are
implanted at lower uterine segment
Cause of bleeding:
o Differentiation of the upper and lower
uterus segment late in pregnancy (30
weeks of AOG) – the inability of the
placenta to stretch to accommodate this
differing shape results to bleeding
Classification
Based on the degree the internal os is covered
by the placenta.
1. Complete or central or total
o Internal os is covered entirely by the
placenta and blocking the baby
2. Incomplete or partial
i. Marginal
o Edge of the placenta approaches the
internal os ii. Low-lying (low implantation)
o Placenta is situated in the lower uterine
segment but away from the os
Causes
o Unknown
o Can be attributed to the following
conditions.
Predisposing Factors:
1. Fibroid tumor in the uterus
2. Uterine scars from previous surgery os
3. Abnormal uterine position or shape
4. Multiparity – multiple gestation
5. Age – very young and very old
Assessment: (7 months AOG)
1. Uterine bright red bleeding – painless
2. Uterine tone - Normal but relax completely
between contractions
3. Pain
4. Painless non-tenderness uterus – may
experience labor contractions
5. Fetal position - Fundic height is greater;
placenta hinders descent of presenting parts
6. Leopold’s maneuver reveals malposition of
fetus – transverse or breech.
Diagnostic tests
1. Ultrasound
a. Static imaging – diagnostic method of
choice
2. Amniocentesis
a. Assess fetal lung maturity LS ratio 1:2
b. If lung maturity is reached, CS
delivery is done
3. No vaginal exam unless patient is place on Predisposing factors
double prep procedure (prepared for vaginal or
1.HPN
C/S delivery)
2.Mltiple gestation
4. Laboratory tests – hemoglobin, hematocrit,
Rh factor, urinalysis 3.Multiparity

4.Advanced Maternal age

Abruption Placenta 5.DM

o >20 weeks of AOG 6.Previous premature separation

o The premature separation of part
7.Hypotensive syndrome
or all of the placenta from its
site of implantation 8.Rare – abdominal trauma 5%; short cord 1%
o Can be an abnormal separation of
9.History of abortion; stillbirth; pre-natal
a normally implanted placenta.
hemorrhage; premature labor,
Types
10.Renal or Vascular disease and abdominal
1. Partial separation trauma

a. Concealed

b. Apparent – marginal separation Cause of Maternal death

2. Complete 1. Massive hemorrhage which leads to shock

a. Concealed 2. Circulatory collapse or renal failure

3. Infection

Problems

1. Mother Premature Labor/ Delivery or preterm labor

o Shock o unknown cause

o Placenta separation o occurs in approximately 10% of all
pregnancies
2. Infant
o occurs before the end of 37
o Perinatal death weeks AOG or before fetus weigh
o Hypoxia 2500 gms.
o Results in an immature infant, 2/3
neonatal death is due to low birth
weight **Birth beyond 40 weeks
is considered as post term.
**Birth at 38-40 weeks gestation is considered
full term.
**Birth from 20 weeks and before the
beginning of the 37 weeks is considered
Preterm.
**A spontaneous abortion occurred before 20
weeks AOG.
Post-Mature Infant
o Whose gestation age is 42 weeks or
longer
o May show signs of weight loss with
placental insufficiency
o Develop post-mature syndrome

POST-PARTUM BLEEDING

Conditions resulting to premature labor o Normal delivery average blood loss:

300 – 350 ml
1. Cervical surgery as cone biopsy
o Post-partal hemorrhage: >500 ml within
2. Chorioamnionitis 24 hours period
o Immediate: 1st 24 O bleeding
3. Hydramnios
o Late: occurring during the remaining
4. Multiple gestation days of the 6 weeks puerperium

5. Maternal age

6. Previous preterm labor Reasons of Post-Partum bleeding

7. Polynephritis, UTI 1. Uterine Atony

8. Short inter-pregnancy period Uterine Atony

9. Smoking o Loss of uterine muscle tone;

uterus fails to contract
10. Strenuous or shift work
completely; to seal off open
11. Uterine anomaly as tumor uterus vessel after delivery

Causes:

PREMATURE INFANT 1. Conditions that distended the uterus beyond

average capacity
o An infant viable – born before the
completion of 37 weeks AOG a. Multiple gestation
(premature in age)
b. Hydramnios (AF > 2000 cc)
o Weighs between 1500 – 2500
grams without regards to c. Large baby (>9 lbs.)
gestational age (premature in
d. Presence of uterus myomas
weight)
(fibroid tumor)
2. Conditions that leave the uterus too Classification of Perineal Tear
exhausted to contract readily
1st degree – vaginal mucosa, skin of perineum,
a. Deep anesthesia/ analgesics fourchette

b. Labor and oxytocin agent
c. Maternal age over 30 years
d. High parity
e. Dystocia
f. 2O illness as anemia
2nd degree - vagina, perineal skin, fascia,
levator anterior muscle and perineal body
3rd degree – entire perineum, external
sphincter of rectum
4th degree – entire perineum, rectal sphincter
and some mucous membranes of rectum

g. endometritis

3. Conditions with varied placental site or Management

attachment
1. Surgical Repair
a. placenta previa
2. Vaginal pack
b. placenta accreta
3. No enema/ suppositories/ rectal
c. placenta abruption temperature

4. Prevent constipation

2. Lacerations

Lacerations 3. Retained Placental Fragments

o Tearing at birth canal – expected Retained Placental Fragments

consequence of childbearing
o Placenta failed to be delivered
o More common in: primi, large
entirely and fragments or parts
babies >9 lbs, lithotomy used of
are left behind inside the uterus
instruments

Assessment
Structures affected:
1.Bleeding depends on size of placental
1. Cervical
fragments
2. Vaginal
a. Large – immediate uterus does not
3. Perineal contract

b. Small – 6th – 10th day post-partum –

abrupt discharge of blood clots

2.On examination, uterus not fully contracted

3.Doctor orders for serum HCG determination, 1. Primigravida and less than 18 and older than
U/S to determine presence of placenta 35 years

2. Low socioeconomic – poor nutrition and low

CHON intake, low B6 (Pyridoxine)
Management
3. Pregnancy >5x or more
1. Severe bleeding – Blood transfusion
4. Multiple pregnancy
2. Dilatation and Curettage
5. Hydramnios
3. Placenta accreta – methotrexate – to destroy
placental tissues 6. Heart disease, DM renal involvement

4. Advise patient to observe lochial discharge 7. Essential hypertension

(alba, serosa, rubra)
8. Poor calcium intake

9. Parasitic invasion
PREGNANCY INDUCED HYPERTENSION

o Main cause is unknown

Types of PIH
o 3rd leading cause of maternal
death in the US 1. Gestational Hypertension
o “TOXEMIA” – poison o B/P 140/90 mmHg
o Researchers pictured a toxin of o 30/15 mmHg – increase above
some kind released by the woman pre-pregnancy level
in response to the foreign protein o No proteinuria, no edema
of the growing fetus which leads o Woman may develop chronic
to the Triad Symptoms of PIH: hypertension later in life
2. Mild Pre-eclampsia MAP2 higher 90
1. Hypertension
mmHg; MAP3 higher 105 mmHg
2. Edema – Edema of hands and face is a classic o B/P 140/90mmHg
sign of PIH o Protein 1 – 2 + on RS (1 gm/L) –
orthostatic proteinuria – standing
**Many healthy pregnant woman experience
excrete CHON but not on bed
foot and ankle edema.
rest
3. Proteinuria o Weight gain >2lbs/ week (2nd
trimester); 1 lb./week (3rd
**A weight gain of 2lb or more per week
trimester)
indicates a problem.
o Mild edema on face
**Early morning headache is not a classic sign
of PIH.
3. Severe Pre-eclampsia
Predisposing Factors
o B/P 160/110 mmHg or higher
 o Protein 3-4 + on RS (5 gm/L) o Pregnancy <36 weeks LS ratio
o Oliguria 500 ml or < every 24 decreases l:2;
hours o Conservative management to bring
o Cerebral or visual disturbances fetus to term
(headache/ blurred vision)
Management
o Pulmonary edema; extensive
peripheral edema – pitting edema 1. Promote Bedrest
o Fetal mortality – 10%
a. Sodium is excreted rapidly and
o Hepatic dysfunction
recumbent than in activity
o Thrombocytopenia
o Evacuation of sodium
o Encouraging/ promoting sodium
Eclampsia
b. Labor and delivery need and spends
o Mark S/S of severe pre-eclampsia + more energy (save caloric expenditure)
convulsion
c. Always on left lateral recumbent
o BP - > 160 over 90 mmhg
position
o 15% maternal mortality due to: 
Cerebral hemorrhage o Prevent uterus pressure on vena
o Circulatory collapse cava
o Renal failure o Promote fetal circulation and
o Fetal prognosis poor – 25% prevent supine hypotension
mortality syndrome d. Patient confinement
o Hypoxia with acidosis o Home; if non-compliant-
hospitalization
Management
2. Promote good nutrition
1. Bedrest
o Increase protein diet with no salt
2. Monitor maternal well-being
restriction
3. Monitor fetal well being o Decrease salt or no salt in diet
may activate angiotensin system
4. Ensure safety measure
and increase B/P compounding the
5. Proper diet problem

6. Promote relaxation

7. Administer medications

Mild Pre-eclampsia 3. Provide emotional support with bed rest

 o Do not take instructions seriously o Side rails
o Medicines not bed rest o Padded tongue blade
o Stop work
o Assess to bring concerns to open
work, family, finances CONVULSIONS

4 phases
Severe Pre-eclampsia
1. Aura
Most important to include in the plan of care is
o Epigastric pain, sharp smell sight
prevention of seizure
of bright light
Management o Management: Tongue blade placed
in position promote safety
1. Bed Rest
2. Tonic
1. Admit to hospital
o All body muscles contract back
o Private room – undisturbed
arch, arms/leg stiffen; jaw closes
o No loud noises – triggers
abruptly (tongue maybe bitten);
convulsion
respiration halted (last 20
o Darkened room (no bright light)
seconds); cyanotic, cessation of
o No visitors – social visitors not
respiratory
support people
Management:
2. Monitor maternal well-being
a. Oxygen administration by mask
o B/P every 4 hours
o Blood studies – CBC, platelet, Hct, b. Place on side, allow secretion to drain
Hgb, Blood Typing, fibrinogen
c. Fetal monitor
o Urine - >30 ml/hr, insertion FBC
for accurate recording, test for 3. Clonic
protein, maternal estriol level
o Muscle relaxes, contract, ext.
o Weight – same time each day
flail
3. Fetal well-being o Respiratory – inhale/ exhales
irregularly; as thoracic muscle
o FHT – external monitor (Doppler
relax and contract may aspirate
auscultation every 4 hours)
saliva (place on sides) forming at
o Oxygen administration – face
the mouth (mouth breathing)
masks
incontinence of urine and feces
o Ineffective breathing – remain
cyanotic; oxygen therapy for
4. Safety fetus
o Last up to 1 minute
4. Postictal 2. Diastole – not lower than 80-90mmHg

o Semi-comatose, cannot be roused 3. Hypotensive drugs

except with painful stimuli
o Hydralazine (Apresoline)
o Last 1 – 4 hours
o Lowers BP by peripheral dilatation; DO
o Labor may begin – still
NOT interfere with placental perfusion 
unconscious; cannot report labor
Side Effect – Tachycardia
contractions painful labor
o Nursing Responsibility – Check BP and
contractions initiate another
pulse before and after administration
seizure
o Diazonidae
o Monitor FHT
o Hyper stat
o Check for vaginal bleeding every
o Crypt enamine
15 minutes (abruption placenta)
o Unite sin
o Anticipate delivery
o Produce rapid decrease in BP
o Condition may stabilize in 12 –24
o Do not use for long term; administration
hours; prepare for vaginal
causes hyperglycemia
delivery (preferred method);
o Cathartics
induce labor. Why? Fetus does
not continue to grow after
eclampsia (convulsion) occurs. DIABETES MELLITUS IN PREGNANCY
Fetal lung maturity appears to
Before 1921 – without insulin
advance rapidly due to
intrauterine stress. 1. Women failed to survive to reach
childbearing age
Proper diet and nutrition
2. Infertile
1. Increase protein – replace protein loss
(proteinuria) 3. DM causes spontaneous abortion

2. Moderate sodium – sodium restriction (4-6 After 1921 – with insulin

grams/ 24 hours) (synthetic insulin was discovered)

*Salty foods may increase sodium 1. Being women thru pregnancy with good
concentration, retention of fluids occur thereby control
can cause shifting of fluids from the ICF to 2. Care for newborn infant during 1st 24
Vascular compartments increasing blood hours after delivery
pressure, thus, should not be included in the
diet. 3. Protect infant in utero from adverse
effects of DM
Medications (to prevent eclampsia)

1. IV line – ER medication route; observe

insertion site carefully – infiltration triggers Signs and Symptoms
convulsions
1. Polydipsia - Constant, excessive drinking as a
result of thirst. Polydipsia occurs in untreated
or poorly controlled diabetes mellitus.
*Increase fluids to compensate fluids loss
2. Polyuria - defined as a urine output
exceeding 3 L/day in adults and 2 L/m2 in
children. *Decrease osmotic pressure, increase
amount of glucose in urine; decrease fluid
absorption in kidney
3. Polyphagia - excessive or extreme hunger
*Used up nutrients except glucose
4. Glucosuria - glucose in the urine, results
from the glomerular filtration of more glucose
than the renal tubule can absorb.
*Kidney attempt to lower glucose level excrete
large quantities into urine
Physiologic Changes
1. Increase insulin requirement in pregnancy
2. Hypoglycemia – 1st half of pregnancy;
acidosis; coma – last trimester
3. Decrease carbohydrate metabolism
4. Stress increase glucose tolerance
5. Increase estrogen level during predisposes
DM in pregnancy (gestational DM)
Management and Nursing Interventions
1. Educate on diet during pregnancy
o Good disease control
o Diet regularly should be started as soon
as DM is diagnosed in pregnancy
o Diet control is done to:
o 1800 – 2200 calories – 3 meals +3
snacks evenly (less than 1800
calories cause breakdown of
fats =Acidosis)
2. Educate on Exercise
a. Goals:
i. Reduce serum glucose
ii. Reduce insulin requirement
o Exercise program should begin
before pregnancy and not during
pregnancy  To avoid excessive
glucose fluctuations  Exercise
effect last – 12 hours after exercise
3. Educate on insulin
a. Hospital admission only for insulin
adjustments
b. Change of insulin done – change in
metabolism
i.Early pregnancy – less insulin –
fetal developing cells take more
glucose
ii.Late pregnancy – more insulin
c. Oral hypoglycemics not used during
pregnancy because it crosses placental
barrier and is potentially teratogenic
d. Humulin Insulin – provokes lesser
antibody response than beef and pork
e. Insulin peaks – makes monitoring
meaningful
f. Regular insulin – pre-breakfast 30
minutes to 1 hour or after breakfast
 g. Intermediate – given in the morning – 3. Hyperbilirubinemia
lunch or late in the afternoon; given in
4. Hypocalcemia
the afternoon peak reaches at rest day
before breakfast
Signs and symptoms:
h. Injection site – related – 5/8 inch
Latent tetany (Clinical Manifestations)
needle – 90O insulin syringe; arm
absorb – than thigh 1. Chvostek’s Sign
 Ear tapped and facial muscle contract
unilaterally
Infants of Diabetic Mother
2. Trousseau’s sign
o Will result if DM in pregnancy is  Constricts arm 2-3 cm with tourniquet and
poorly controlled blanched and results to carpal spasms

Characteristics 3. Peroneal Sign

 Fibular side of leg is tapped foot abducts and
1. Typically, longer and weighs more >9 lbs.
dorsiflexes
(infantile giants)
4. Erb’s sign
2. Greater to have congenital anomalies (cardiac
 Galvanic current is applied over peroneal
defects)
nerve, foot abducts and dorsiflexes
3. Caudal regression syndrome or hypoplasia of
Post-Partial Adjustments
L.E
1. Re-adjustment of insulin to non-pregnant
4. Cushingoid (fat and puffy)
requirement
5. Lethargic and limp – 1st few days of life
a. Gestational DM, glucose normalizes
6. Large size is deceptive after 24 hours post-delivery;

7. Polycythemia – to prevent: avoid clamping of BF - insulin does not pass to breast milk
cord early to prevent RBC overload from from bloodstream; hydramnios was
placenta present – watch for hemorrhage

8. Will show greater proportion of weight loss

from extra fluid accumulation – prevent
accumulation

Complications
b. Use contraceptives:
1. Macrosomia – C/S
Pill – high risk for hypertension –
2. Severe hypoglycemia
estrogen
 IUD - high risk for infection o Normal Value: Negative

*Plan for next pregnancy – disease must be 3. Estriol excretion studies

stabilized in good control +
Tests For Placental Function And
Fetal Maturity
o Normal Value: >12 mg/ 24O
o Continuous rising estriol values indicate
normal fetal growth
4. Non-stress test (NST) 99% reliable

1. Amniocentesis o Normal Value: Reactive fetus (heart rate

o L/S ratio – NV 2:1; in DM 3:1 90%
reliable lecithin/sphingomyelin – fetal
lung maturity synthesis of
phosphatidylglycerol compound that
stabilizes surfactant is delayed in DM
o Creatinine concentration – excreted in
fetal urine; assess fetal renal function
and fetal muscle mass; Normal Value >= 2
mg/dL = 36 weeks of AOG 60% reliable
o Bilirubin levels – measures liver maturity;
Increase level – abnormal; decrease –
normal
o Cytologic findings – staining of cells with
0.1% nile blue; nitrate – 20% fetal cells
stained
Contraindicated – Amniocentesis
a. Abruption placenta
b. Placenta previa
c. History of premature of labor
acceleration associated with fetal
movement)
5. Ultrasonography (OB echography)
o  Harmless, non-invasive, use of sound
waves  Uses:
o Diagnosis of pregnancy o Assess tumor,
molar pregnancy o Determine fetal age o
Measures fetal growth o Identify
placental abnormality o Determine fetal
position  Procedures:
o Fluid – water 3-4 glasses one hour
before study; ASK NOT TO VOID –
good transmission of waves better
visualization of uterus
o Apply conduction paste cream –
enhance transmission and reception o
Contraindicated: recent GI contrast
studies – causes distortion of reflected
sound waves

d. Incompetent cervix

Kleihaver-Boetke – test to determine whose

blood stained of the amniotic fluid; stains fetal
blood/cells Pink

2. OCT – oxytocin challenge test

o Use of temperature stress in a form of

uttered contractions is applied to the
fetus; FHB remain normal