NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)

ABORTION ➢ Mild fever

- Abortion is a method of terminating a Advantages
pregnancy. The embryo or fetus, as well as the
placenta, are removed from the uterus using ➢ It does not involve surgery
medicine or surgery. The procedure is performed ➢ Available for the first trimester
by a licensed healthcare professional. ➢ Does not require anesthetic

Etiology/Cause Disadvantages:
About 50% cases of early pregnancy loss is believed to be ➢ Not available in the 2nd trimester
due to fetal chromosomal abnormalities. ➢ Only part of the treatment takes
Most common risks factors also include: place in a clinic
➢ May cause painful cramping
- Maternal age 2. Vacuum Aspiration
- Alcohol consumption • A type of surgical abortion in which a
- Smoking pregnancy is terminated by using gentle
- Substance abuse suction.
- Chronic diseases (diabetes, autoimmune • The procedure begins by inserting a a
conditions) speculum into the woman’s vagina. The
- Structural uterine abnormalities healthcare professionals will then open
- Infections the cervix with thin rods called dilators
Types before inserting a tube into the uterus.
The following are the types of abortion according to a The uterus is then emptied using either
certain trimester: a manual or mechanical suction device.

In the first trimester, options for abortion include: Recovery:

1. Medical Abortion ➢ Rest for an hour after treatment

• This type requires the woman to take ➢ Taking antibiotics to prevent
two types of medication: mifepristone infection
and misoprostol. ➢ Avoid sex for 1 week
• Mifepristone inhibits the development Risks:
of a pregnancy. Misoprostol causes the
uterus to empty, which occurs 1–4 hours ➢ Bleeding and cramping
after the pill is taken. Advantages:
• Cramping and bleeding will then take
place as the woman’s uterus empties. ➢ Available in the first 12 weeks of
pregnancy
Risks: ➢ Quick procedure (5-10 minutes)
Some women experience side effects of the ➢ Pain-free
medication. These include: ➢ Does not require a general
anesthesia
➢ Nausea
➢ Heavy vaginal bleeding Disadvantages:
➢ Dizziness ➢ Not available in the 2nd trimester
➢ Diarrhea
➢ Fatigue For the second trimester,

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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
1. Dilation and evacuation
• A type of surgical abortion that is
commonly used by doctors. Usually
recommended between 14 and 24
weeks.
• A general anesthesia may be given as
this type of anesthetic ensures that a
person does not feel anything during the
procedure.
• The doctor begins by inserting a
speculum into the woman’s vagina.
Then, they use dilators to open the
cervix. Next, they remove the pregnancy
tissue with small forceps. Lastly, they use
suction to remove any remaining tissue.
This procedure takes about 10-20
minutes.
Recovery:
3. Incomplete release of pregnancy tissue
➢ A few hours of rest is advised
Risks:
➢ Infection
➢ Heavy bleeding
➢ Injury to the uterus
Advantages:
➢ It is safe and effective
Disadvantages:
➢ Requires a general anesthesia
2. Labor induction abortion
• A late-term method of ending a
pregnancy in the second or third
trimester. A procedure reserved for
when there is a medical complication/s
detected to the fetus or the mother that
may pose a threat to their life.
• Labor induction involves using
medications to start labor, which causes
the uterus to empty over a period of
around 12–24 hours. A woman can take
these medications by mouth or the
doctor may place them into the vagina
or inject them into the uterus.
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Recovery:
➢ Remain in the clinic or hospital for
anywhere from a few hours to 1–2
days
Risks:
The medication that induce labor may cause
side effects, such as:
➢ Nausea and vomiting
➢ Fever
➢ Diarrhea
Complications are rare but includes:
➢ Hemorrhage
➢ Cervical injury
➢ Infection
➢ Rupture of the uterus
• This type of abortion is commonly
performed for pregnancies with birth
defects or pregnancy complications.
• The process often begins with an
injection to stop the fetal heartbeat. The
skin on the abdomen is numbed with a
painkiller, and then a needle is used to
inject a medication (digoxin or
potassium chloride) through the
abdomen into the fluid around the fetus
or the fetus to stop the heartbeat.
• Medication is then given to start
contractions and to cause the cervix to
dilate. One medication (Misoprostol)
can be taken by mouth or put in the
vagina. Another medication (Pitocin)
which is administered through IV.
Recovery:
➢ The length of stay in the hospital
after the induction is complete will
depend on the client’s health and
other factors. Some women stay for
a few hours and other women stay
for 1-2 days.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Risks:
➢ Infection
➢ heavy bleeding
➢ Hole or tear in the wall of the uterus
➢ Injury to the cervix
➢ Failed induction
Signs and Symptoms
❖ Vaginal spotting
❖ Scant and bright red vaginal bleeding
❖ Slight cramping
❖ Cervical dilatation
❖ Fever
❖ Depression
Management
Nursing Management:
Nurses must also have their own independent functions
to ensure the safety and well-being of the patient. The
following are measures that would allow the nurse to act
independently.
• The presenting symptom of an abortion is always
vaginal spotting, and once this is noticed by the
pregnant woman, she should immediately notify
her healthcare provider
• As nurses, we are always the first to receive the
initial information so we should be aware of the
guidelines in assessing bleeding during
pregnancy.
• Ask of the pregnant woman’s actions before the
spotting or bleeding occurred and identify the
measures she did when she first noticed the
bleeding.
• Inquire of the duration and intensity of the
bleeding or pain felt.
• Lastly, identify the client’s blood type for cases of
Rh incompatibility.
Medical Management:
• Medical interventions should also be
incorporated in the patient’s care plan to
reinforce his treatment. These are physician’s
orders wherein nurses and other caregivers
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would assist or take into action, thus ensuring
the recovery of the patient.
• Aside from our own nursing management,
physicians would also have to order a series of
therapeutic management for the pregnant
woman.
• Administration of intravenous fluids. Such as
Lactated Ringer’s, IV therapy should be
anticipated by the nurse as well as
administration of oxygen regulated at 6-
10L/minute by a face mask to replace
intravascular fluid loss and provide adequate
fetal oxygenation.
• Avoid vaginal examinations. The physician would
also avoid further vaginal examinations to avoid
disturbing the products of conception or
triggering cervical dilatation.
• The physician might also order an ultrasound
examination to glean more information about
the fetal and also maternal well-being.
Our role as nurses in these medical interventions would
be to assist in every aspect possible, and ensure the
wellbeing of both the mother and the fetus. Through our
nursing interventions, we could initiate care without
needing to run after the physicians and ask for their
orders. We should be able to function independently as
caregivers and promote their wellness in our own way as
nurses. The most vital pieces of information are always
handed to us first, so it would be up to us to initiate the
first intervention to make or break the condition of the
client before a doctor arrives. Nurses are the first line of
defense of every hospital, and we should live up to that
expectation.
Pharmacologic Management:
• Oral mifepristone (Mifeprex) and oral
misoprostol (Cytotec). This is the most common
type of medical abortion. These medications are
usually taken within seven weeks of the first day
of your last period. Mifepristone (mif-uh-PRIS-
tone) blocks the hormone progesterone, causing
the lining of the uterus to thin and preventing
the embryo from staying implanted and growing.
Misoprostol (my-so-PROS-tol), a different kind of
medication, causes the uterus to contract and
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
expel the embryo through the vagina. If you
choose this type of medical abortion, you'll likely
take the mifepristone in your doctor's office or
clinic. Then you will probably take the
misoprostol at home, hours or days later. You'll
need to visit your doctor again about a week
later to make sure the abortion is complete. This
regimen is approved by the Food and Drug
Administration (FDA).
• Oral mifepristone and vaginal, buccal or
sublingual misoprostol. This type of medical
abortion uses the same medications as the
previous method, but with a slowly dissolving
misoprostol tablet placed in your vagina (vaginal
route), in your mouth between your teeth and
cheek (buccal route), or under your tongue
(sublingual route). The vaginal, buccal or
sublingual approach lessens side effects and may
be more effective. These medications must be
taken within nine weeks of the first day of your
last period.
• Methotrexate and vaginal misoprostol.
Methotrexate (Otrexup, Rasuvo, others) is rarely
used for elective, unwanted pregnancies,
although it's still used for pregnancies outside of
the uterus (ectopic pregnancies). This type of
medical abortion must be done within seven
weeks of the first day of your last period, and it
can take up to a month for methotrexate to
complete the abortion. Methotrexate is given as
a shot or vaginally and the misoprostol is later
used at home.
• Vaginal misoprostol alone. Vaginal misoprostol
alone can be effective when used before nine
weeks of gestation of the embryo. But vaginal
misoprostol alone is less effective than other
types of medical abortion.
Surgical Management:
Aside from the medical interventions ordered by
physicians, incidences might occur which would lead to a
surgical operation.
• Dilatation and evacuation. This is to make sure
that all products of conception would be
removed from the uterus. However, before
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undergoing this intervention, the physician must
be sure that no fetal heart sounds could be heard
anymore and the ultrasound must show an
empty uterus.
• Dilation and curettage. This is most commonly
performed for incomplete abortions to remove
the remainder of the products of conception
from the uterus. Since the uterus would not be
able to contract effectively, the contents might
be trapped inside and could cause serious
bleeding and infection.
INCOMPETENT CERVIX
- Incompetent cervix, also called cervical
insufficiency, occurs when weak cervical tissue
causes or contributes to premature birth or the
loss of an otherwise healthy pregnancy. Before
pregnancy, the lower part of the uterus or the
cervix that opens to the vagina is normally closed
and firm. The cervix softens, shrinks and length
and opens as the pregnancy advances and the
mother is prepared to give birth. The cervix may
open too quickly if the mother has an
incompetent cervix which may force them to
deliver their child early.
Etiology/Cause
Incompetent cervix usually occurs during the middle or
early third trimester, depending on the severity of the
insufficiency. Cervical incompetence may be congenital
or acquired. The most common congenital cause is a
defect in the embryological development of Mullerian
ducts, while the most common acquired cause of cervical
trauma such as cervical lacerations during childbirth,
cervical conization, or forced cervical dilatation during
the uterine evacuation in the first or second trimester of
pregnancy.
Below are also conditions that cause incompetent cervix.
These include:
- Abnormally formed uterus or cervix.
- Previous cervix surgery.
- Short cervix.
- Damaged uterus from previous miscarriage or
childbirth.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
- Exposure to diethylstilbestrol (DES), a synthetic Medical Management:
(human-made) hormone given to some women
• With the help of the physician, he/she will not
in the past to help them have successful
include medications that could prevent the
pregnancies.
dilation of a woman’s cervix. Therefore, surgical
Signs and Symptoms procedures are immediately conducted to avoid
No signs or symptoms during early pregnancy, although a compromised pregnancy
some women may experience spotting and feel
Pharmacologic Management:
discomfort starting between the 14th-20th week of
pregnancy. • There is possible treatments in managing an
A few signs and symptoms are starting between the incompetent cervix that might include
14th-20th week of pregnancy Progesterone supplementation. Having a history
of premature birth, the physician could suggest
A few signs and symptoms are the following: the the patient to take weekly shots of the hormone
following: progesterone in a form called
hydroxyprogesterone caproate (Makena) during
❖ A sensation of pelvic pressure A new backache
the second and third trimester. Moreover,
❖ Mild abdominal cramps
further research is still in demand to determine
❖ A change in vaginal discharge
the best use of progesterone in cervical
❖ Light vaginal bleeding
insufficiency.
Management
Surgical Management:
Nursing Management:
• There is two options of surgical management in
Upon assessment, the nurse must conduct an interview
addressing incompetent cervix. First is
to ask the patient, who is experiencing painless bleeding,
McDonald’s Cervical Cerclage. The nylon sutures
if she is having an intense pressure on her pelvis.
are placed horizontally and vertically across the
Determine next if the woman is experiencing true
cervix. They are pulled back together until the
contractions to prepare for the birth of the fetus. Lastly,
cervical canal is only a few millimeters in
inspect and save pads used by the woman during
diameter. Another one is Shirodkar Cervical
bleeding to determine any clots or tissues that already
Cerclage in where a sterile tape is used for this
passed out.
technique, where it is threaded in a purse-string
In conducting the nursing interventions, the nurse must manner under the submucous layer of the cervix.
perform the following: Then, it is sutured in place so it would close the
cervix.
1. Determine certain factors that can further
• The sutures in both procedures mentioned are
contribute to the anxiety of the patient so that it
then removed on the 37th or 38th week of
can be avoided.
pregnancy for the fetus to be born vaginally.
2. Monitor vital signs in order to determine any
Cervical cerclage is not appropriate for everyone
physical responses of the patient that could
at risk of premature birth and the procedure is
affect her current condition.
not recommended for women carrying twins or
3. Show empathy and establish a therapeutic
more.
nurse-client relationship so that the patient will
be able to express her feelings freely.
4. Provide simple and accurate information about
the situation to aid the patient in addressing her
concerns.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
ECTOPIC PREGNANCY
- An ectopic pregnancy occurs when a fertilized
egg implants and grows outside the main cavity
of the uterus. In most cases, an ectopic
pregnancy occurs in a fallopian tube. This is a life-
threatening condition as the pregnancy cannot
be carried to term and can be dangerous for the
mother if not immediately treated.
Etiology/Cause
Usually an ectopic pregnancy happens when a fertilized
egg gets stuck on its way to the uterus because of an
obstruction due to:
- Adhesion of the fallopian tube from a previous
infection (chronic salpingitis or pelvic
inflammatory disease)
- Congenital malformations
- Scars from tubal surgery
- Uterine tumor pressing on proximal end of tube
- Hormonal imbalances
- Endometriosis
- Abnormal development of the fertilized egg,
Types
1. Tubal Ectopic Pregnancy
• This type is the most common and
makes up 95% of ectopic pregnancies It
occurs in the Fallopian tube.
2. Interstitial Pregnancy
• 3% of ectopic pregnancies are
interstitial. This type occurs in the part of
the Fallopian tube that crosses into the
uterus.
3. Cesarean Scar Pregnancy
• Cesarean scar ectopic pregnancies are a
rare case and occur when the fertilized
egg implants into the gap in the muscle
of the uterus caused by a previous
Cesarean section. The pregnancy may
then grow out of the uterus or onto the
cervix and cause torrential internal or
vaginal bleeding.
4. Cervical Pregnancy
• Cervical pregnancies occur on the cervix
and are one of the rarest forms of
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ectopic pregnancy. This type is thought
to be of special concern because of the
risk of life-threatening vaginal
hemorrhage.
5. Cornual Pregnancy
• This is another rare type of ectopic that
only occurs in a uterus that has not
formed as expected. It is also known as
Rudimentary Horn pregnancy because it
happens on the side of the irregularly
shaped uterus that is not connected to
the cervix or vagina, called the
rudimentary horn.
6. Ovarian Pregnancy
• This rare type of ectopic pregnancy
occurs on the ovary. These are difficult
to diagnose as they look very similar to a
tubal ectopic pregnancy that is stuck to
the ovary or a ‘corpus luteum’ which is
the place that the egg was released
from. This can mean that ovarian
pregnancies are often not diagnosed
until surgery.
7. Intramural Pregnancy
• Intramural type is a pregnancy that
implants outside the cavity of the uterus,
but within its muscular wall. These
pregnancies are thought to occur when
the uterus has been scarred by previous
surgery or a condition called
adenomyosis.
8. Abdominal Pregnancy
• Abdominal pregnancies, in most
instances, are thought to have begun in
the Fallopian tube and then separated
from the wall of the fallopian tube,
floating into the abdominal cavity to
then reattach to one of the structures in
the abdomen.
9. Heterotopic Pregnancy
• Heterotopic pregnancy is when there is
the coexistence of an intrauterine
pregnancy with an ectopic pregnancy.
Although it is rare, it is possible to have
a twin pregnancy with one embryo to
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implant in the uterus and another
elsewhere.
Signs and Symptoms
❖ A missed or late period
❖ Positive hCG pregnancy test
❖ Vaginal bleeding
❖ Pain in lower abdomen, pelvis, lower back -
Dizziness or weakness.
❖ Shoulder tip pain
❖ Diarrhea
❖ Pain while urinating or defecating
❖ shooting/sharp vaginal pain
Management
Nursing Management:
Upon arrival of the patient
• A woman with a ruptured ectopic pregnancy
may show signs of shock when she arrives at the
hospital, such as a rapid, thread pulse, rapid
respirations, and low blood pressure.
• Once a rupture has occurred, the woman will
likely experience sharp, stabbing pain in the
lower region, followed by scant vaginal bleeding.
Nursing Interventions
• Upon arrival of the patient, place the woman in
a supine position on a bed
• Assess the vital signs to establish baseline data
and determine if the patient is under shock.
• Maintain accurate intake and output to establish
the patient’s renal function.
Medical Management:
• Blood sampling or withdrawal of blood is
ordered wherein a large amount of blood would
be lost when there is a rupture of ectopic
pregnancy, thus, blood typing and crossmatching
must be done in anticipation of a blood
transfusion. The pregnant woman's hemoglobin
levels would also be determined using the blood
sample.
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Pharmacologic Management:
• A woman who is diagnosed early of ectopic
pregnancy without unstable bleeding is often
treated with a medication of methotrexate. This
stops rapidly growing cells such as trophoblasts
and the zygote.
Surgical Management:
Following the rupture of the ectopic pregnancy, surgical
treatments would be conducted to ensure that the
reproductive system remained functional and that no
complications arose.
• Laparoscopy
→ The bleeding blood vessels will be
ligated, and the injured fallopian tube
will be repaired or removed.
• Salpingectomy
→ If the fallopian tube is fully destroyed,
this procedure would be performed. The
damaged tube would be removed, and
the remaining portion would be sutured
appropriately.
HYPEREMESIS GRAVIDARUM
- Hyperemesis gravidarum is extreme, persistent
nausea and vomiting during pregnancy. It can
lead to dehydration, weight loss, and electrolyte
imbalances. Morning sickness is mild nausea and
vomiting that occurs in early pregnancy.
Etiology/Cause
- Most women have some nausea or vomiting
(morning sickness), particularly during the first 3
months of pregnancy. The exact cause of nausea
and vomiting during pregnancy is not known.
However, it is believed to be caused by a rapidly
rising blood level of a hormone called human
chorionic gonadotropin (HCG). HCG is released
by the placenta. Mild morning sickness is
common. Hyperemesis gravidarum is less
common and more severe.
- Women with hyperemesis gravidarum have
extreme nausea and vomiting during pregnancy.
It can cause a weight loss of more than 5% of
body weight. The condition can happen in any
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
pregnancy, but is a little more likely if you are
pregnant with twins (or more babies), or if you
have a hydatidiform mole. Women are at higher
risk for hyperemesis if they have had the
problem in previous pregnancies or are prone to
motion sickness.
Types
1. Mild
A woman can function somewhat but is still
feeling miserable with mild *HG:
• Usually ends by mid-pregnancy
• Weight loss is about 5%
• Requires medications and sometimes IV
fluids
• Mother can continue some daily
activities
• Recovery may take a few months or
more
Nursing Management:
2. Moderate
A woman struggles to function and is very
miserable with moderate HG:
• May continue beyond mid-pregnancy
but severity lessens
• Weight loss is 5-10% (less with early
treatment)
• Requires medications, and sometimes
fluids and/or nutrition therapy
Medical Management:
• Mother is extremely fatigued and only
able to do a few tasks
• Recovery may take several months
• Signs of trauma and changes in family
planning may occur
3. Severe
A woman is unable to function and constantly
Pharmacologic Management:
sick with severe HG:
• Symptoms are often difficult to control
with medications
• Weight loss is 10% or more (less with
early treatment)
• Requires fluids, medications, and
sometimes nutrition support for months
• Mother is exhausted, malnourished, and
unable to care for herself
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• Recovery can take 1-2 months for every
month sick
• Signs of trauma and changes in family
planning are common
• Delivery may be complicated and
difficult due to debility
• Without treatment, the life of mother
and baby are at risk
Signs and Symptoms
❖ Feeling nearly constant nausea
❖ Loss of appetite
❖ Vomiting more than three or four times per day
❖ Becoming dehydrated
❖ Feeling light-headed or dizzy
❖ Losing more than 10 pounds or 5 percent of your
body weight due to nausea or vomiting
Management
• Reestablishing normal fluid and electrolyte levels
often relieves nausea and vomiting. Encourage
the patient to eat, and tell her to avoid going for
a long period without eating. Advise her to eat
when she feels hungry, starting with small,
frequent low fat meals. She should avoid
drinking fluids with meals.
• Treatment methods include a range of options,
including maternal diet and lifestyle alterations,
administration of intravenous fluids, antiemetics
or steroids, and alternative therapies such as
acupuncture and hypnosis.
• Treatment methods include:
o Intravenous fluids (IV) – to restore
hydration, electrolytes, vitamins, and
nutrients
Tube feeding:
o Nasogastric – restores nutrients through
a tube passing through the nose and into
the stomach
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
• Medications – metoclopramide, antihistamines,
and antireflux medications*
Surgical Management:
• Percutaneous endoscopic gastrostomy – a
surgical procedure that restores nutrients
through a tube passing through the abdomen
and into the stomach
HYDATIDIFORM MOLE
- A hydatidiform mole (also known as a molar
pregnancy) is a gestational trophoblastic disease
(GTD), which originates from the placenta and
can metastasize. It is unique in that the tumor
originates from gestational tissue rather than
from maternal tissue. Hydatidiform moles (HM)
are categorized as complete and partial and are
usually considered the noninvasive form of
gestational trophoblastic disease. While
hydatidiform moles are typically deemed benign,
they are premalignant and do have the potential
to become malignant and invasive.
Etiology/Cause
- HM, or molar pregnancy, results from abnormal
fertilization of the oocyte (egg). It results in an
abnormal fetus. The placenta grows normally
with little or no growth of the fetal tissue, and
the placental tissue forms a mass in the uterus.
Types
• Hydatidiform moles are divided into 1) Complete
moles, and 2) Partial moles. Complete mole is
the most common type and does not contain
fetal parts, whereas in a partial mole there might
be identifiable fetal residues. Complete moles
are typically diploid, whereas partial moles are
triploid. Complete moles tend to cause higher
levels of the human chorionic gonadotropin
(hCG), which is one of the main clinical features
of this process. In complete moles, the karyotype
is 46,XX 90% of the time and 46,XY 10% of the
time. It arises when an enucleated egg is
fertilized either by two sperms or by a haploid
sperm that then duplicates and therefore, only
paternal DNA is expressed. On the other hand, in
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partial moles, the karyotype is 90% of the time
triploid and either 69,XXX or 69,XXY. This
karyotype arises when a normal sperm
subsequently fertilizes haploid ovum duplicates
and or when two sperms fertilize a haploid
ovum. In partial moles, both maternal and
paternal DNA is expressed.
• Under normal circumstances, the fertilised
empty ovum would die and not implant in the
uterus. But rarely, the ovum doesn't die and
implantation takes place. The trophoblast cells
grow and develop as a disorganised mass of
tissue but the embryo does not develop. This is a
complete hydatidiform mole. There is no tissue
resembling an unborn baby (a fetus) at all.
• A partial hydatidiform mole is also possible if
conception doesn't take place normally. It is
usually due to two sperm fertilising one normal
ovum (which should not usually happen). This
means that there is too much genetic material
present. There is also too much trophoblastic
tissue. The growth of the trophoblastic tissue
overtakes the growth of any fetal tissue and the
fetus does not develop normally.
• Partial and complete hydatidiform moles will not
produce a live baby. (They are 'non-viable'
pregnancies.)
To summarize, Molar pregnancy can be of two types:
● Partial molar pregnancy: There is an abnormal
placenta and some fetal development.
● Complete molar pregnancy: There is an abnormal
placenta and no fetus.
Signs and Symptoms
Women with a hydatidiform mole usually have higher-
than-average levels of the pregnancy hormone human
chorionic gonadotrophin (hCG) compared with women
with a normal pregnancy. This hormone is produced by
the trophoblastic tissue. It is the hormone that is
detected in a standard pregnancy test. The high levels of
hCG occur because there is an excessive amount of
trophoblastic tissue with a hydatidiform mole. The high
hCG levels are responsible for some of the symptoms.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
❖ Pregnancy symptoms. The woman may have
signs of pregnancy, including periods stopping,
feeling sick (nausea), being sick (vomiting),
breast tenderness, etc. They may feel bigger
than expected for the number of weeks they are
pregnant. This is because a molar pregnancy
grows more quickly than a normal pregnancy
would, due to the abnormally developing
trophoblastic tissue.
❖ Bleeding. Vaginal bleeding may occur early in the
pregnancy. This is the most common symptom.
Many women suspect that they are having a
miscarriage.
❖ No symptoms. Some women with a hydatidiform
mole have no symptoms. The molar pregnancy is
diagnosed after a routine pregnancy ultrasound
scan
❖ Rare symptoms. Very rarely, problems with high
blood pressure may occur, as well as very bad
nausea and vomiting (hyperemesis gravidarum)
or symptoms of an overactive thyroid gland may
develop.
Management
Nursing Management:
• Remember to assess the BP, check if the patient
is bleeding profusely, and make sure to notify the
doctor immediately.
• Teach deep breathing techniques to alleviate the
pain. Use diversional activities if possible.
• Check for abdominal pain, assess the abdominal
area for signs of internal bleeding (e.g. Cullen’s)
• If nausea and vomiting are present, make sure
the patient would not aspirate it.
• After dilate and curettage patient is at risk for
infection. Make sure the patient has good
perineal hygiene.
• Administer all medications as ordered. Observe
the 10 Rs
• Remember that this might very hard for the
patient to accept, make sure to provide
emotional support. Explain to the patient that it
is not her fault this happened.
MODULE 1M: ANTENATAL COMPLICATIONS
• Discussed the family planning methods available
for her. Remember to reiterate the importance
of
• monitoring the hCG level and follow-ups.
Medical Management:
• After D&C the specimen will be sent for a
histopath. Management will then be based on
the findings. If it is an H. Mole which is benign,
the patient will then be monitored by getting the
hCG serum level that should fall to 0. Usually, the
serum hCG test will be for 6 to 12 months.
Pharmacologic Management:
• A contraceptive method such as implants or pills
is necessary during the hCG monitoring period to
avoid pregnancy for accurate monitoring. H.
mole patients are not eligible for IUDs to lessen
the risk of bleeding and infection.
• Chemotherapy will be done if the hCG levels are
not decreasing even though there is no
conceptus left in the uterus. The most commonly
used drug is Methotrexate, but the drug
Dactinomycin is also used.
Surgical Management:
• Suction curettage is the standard treatment for
both complete and partial molar pregnancies.
Sometimes the doctor will use medical
evacuation if the mass is with fetal parts that are
hard to remove.
• A hysterectomy is performed if the patient no
longer wants kids and opts for this surgery
instead of a dilate and curettage.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
PLACENTA PREVIA
- When a pregnant woman’s placenta blocks the
opening to the cervix, this is referred to as
placenta previa. It is important that the cervix’
opening should be unblocked as this is where the
baby passes through as it is born. According to
Porter and Kaplan (2011), this commonly occurs
during the 3rd trimester of the pregnancy. In
cases such as these, instances of severe bleeding
have been noted. Bleeding can happen
spontaneously or trigger due to digital
examination or onset of labor. It has also been
documented those mothers experiencing
placenta previa may be at risk of delivering
prematurely. Due to the risk of bleeding, women
with placenta previa will undergo a cesarean
section operation to avoid such from happening.
Etiology/Cause
- What exactly causes placenta previa is unknown.
However, it is speculated that pregnant women
end up experiencing this due to past uterine
surgeries or past pregnancies with placenta
previa. Factors such as age, smoking, and
presence of fibroids in the uterus are also
considered. Once again, the earlier mentioned
conditions are not the exact cause of placenta
previa happening during a pregnancy but are
speculated to contribute to its manifestation.
Types
Cases of placenta previa are classified in regards to how
they cover the placenta. Thus, they are identified
accordingly:
• A total placenta previa means that the placenta
is completely covering the internal os
• A partial placenta previa means that the placenta
is only covering part of the os
• A marginal placenta previa means that the
placenta is at the edge of the os and not covering
it. This is also referred to as a low-lying placenta
and may resolve itself before labor.
MODULE 1M: ANTENATAL COMPLICATIONS
Signs and Symptoms
❖ The mother will start noticing symptoms as they
are halfway through their pregnancy. During this
time, vaginal bleeding occurs but without
contractions. Blood is usually of a bright red
color. However, bleeding may be heavy and this
may lead the client into experiencing
hemorrhagic shock. This can also lead the client
into manifesting symptoms of blood loss such as
anemia and low blood pressure. Despite some
clients experiencing no pain, there are cases
wherein uterine contractions happen with the
bleeding. Patients have reported the
contractions to have a tightening pain which
radiates to the back.
Management
Nursing Management:
• Assess fetal heart sounds so the mother would
be aware of the health of her baby.
• Monitor uterine contractions to establish the
progress of labor of the mother.
• Weigh perineal pads used during bleeding to
calculate the amount of blood lost.
• Assist the woman in a side lying position when
bleeding occurs.
Medical Management:
• Determine the following
• The amount of bleeding
• Whether the bleeding has stopped
• How far along your pregnancy is
• Your health
• Your baby's health
• The position of the placenta and the baby
For little bleeding- Rest is recommended which means
avoiding activities that can trigger bleeding, such as sex
and exercise.
For heavy bleeding- Immediate medical attention at
your nearest emergency health facility. Severe bleeding
might require a blood transfusion.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
For bleeding that won’t stop- If your bleeding can't be 4. Concealed placental abruptions - Vaginal
controlled or your baby is in distress, you'll likely need an bleeding is little or non-existent. Between the
emergency C-section even if the baby is premature. placenta and the uterine wall, blood is trapped.

Pharmacological Management: Signs and Symptoms

❖ Vaginal bleeding, although there might not be
• No medication is of specific benefit to a patient
any
with placenta previa. There is no improvement in
❖ Abdominal pain
perinatal outcome with prolonged tocolytics,
❖ Back pain
and tocolysis beyond 48 hours is not clinically
❖ Uterine tenderness or rigidity
indicated. Maintain intake of iron and folate as a
❖ Uterine contractions, often coming one right
safety margin in the event of bleeding.
after another
Surgical Management:
Management
• There is no medical or surgical treatment to cure Nursing Management:
placenta previa, but there are several options to
• Continuously evaluate maternal and fetal
manage the bleeding caused by placenta previa.
physiologic status, particularly
Management of the bleeding depends on
Vital signs
various factors.
Bleeding
• These include: The amount of bleeding and
Electronic fetal and maternal monitoring
whether the bleeding has stopped.
tracings
Signs of shock-rapid pulse, pallor, cold
ABRUPTIO PLACENTA
and most skin, decrease in -blood
- Abruptio Placenta is a complication of pregnancy
pressure
that develops when the placenta separates from
Decreasing urine output
your uterus before the baby is born. The
Never perform a vaginal or rectal
placenta may detach fully or partly during
examination or take any action that
placental abruption. This can lower the quantity
would stimulate uterine activity.
of oxygen and nutrients to the baby and cause
• Assess the need for immediate delivery
excessive bleeding in the mother.
If the client is in active labor and the
Etiology/Cause bleeding cannot be controlled with bed
- In most cases, the cause is unknown, but risk rest, an emergency cesarean delivery
factors include maternal hypertension, may be recommended.
abdominal trauma (e.g., from fall or accidents), • Provide appropriate management.
and substance abuse. Place the woman on bed rest in a lateral
position upon admission to avoid putting
Types
pressure on the vena cava.
1. Partial Placental Abruption - when the placenta
Insert a large gauge intravenous
does not fully separate from the uterine wall
catheter into a large vein for fluid
2. Complete or Total Placental Abruption - when
replacement. Obtain a blood sample for
the placenta separates from the uterine wall
fibrinogen level.
entirely. This form of abruption is frequently
Monitor the FHR externally and measure
accompanied by increased vaginal bleeding.
maternal vital signs every 5 to 15
3. Revealed placental abruption - have moderate
minutes. Administer oxygen to the
to severe vaginal bleeding that you can see.
mother by mask.
• Provide client and family teaching.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
• Address emotional and psychosocial needs.
Outcome for the mother and fetus
depends on the extent of the separation,
amount of fetal hypoxia, and amount of
bleeding.
Medical Management:
To help identify possible sources of vaginal bleeding,
your provider will likely recommend blood and urine
tests and ultrasound.
• Blood Test - a standard part of routine and
preventive healthcare.
• Urine Test - is a test that examines the visual,
chemical and microscopic aspects of your urine.
• Ultrasound - is an imaging method that uses
high-frequency sound waves to produce images
of structures within your body.
Pharmacologic Management:
• Large gauge IV catheter for fluid replacement
• Oxygen administration
Surgical Management:
Once the condition has reached a stage that mightily
endangers the life of both patients, then surgical
management is put into action.
• Cesarean delivery. If the baby's born quickly, it is
best to have a caesarean section.
• Hysterectomy. The worst-case situation is that
the woman develops DIC, in which event a
hysterectomy is required to prevent
exsanguinations.
MODULE 1M: ANTENATAL COMPLICATIONS
HYPERSENSITIVITY DISORDER OF
PREGNANCY
- Hypersensitivity disorder of pregnancy refers to
undesirable reactions produced by the normal
immune system, including when there is altered
reactivity where the body reacts with an
exaggerated immune response to what is viewed
as a foreign substance that is normally harmless
called allergens.
Etiology/Cause
- Hypersensitivity syndrome is caused by a
complex set of interactions between a
medication, your own immune system, and
viruses in your body, especially herpes viruses.
- Caused by excessive antigen-antibody response
when the invading organism is an allergen rather
than an immunogen
- Environmental allergy: Dust, Pollen
- Reaction from taking of meds: Antibiotics
Types
The four types of hypersensitivity are:
• Types I, II, III = mediated by antibodies (humoral
response)
• Type IV = cell-mediated (T lymphocytes)
Type I: Immediate → IgE and Anaphylaxis
• Exposure to allergen
• Allergies, asthma, dermatitis
• Extreme vasodilation ➡circulatory shock
• Extreme bronchoconstriction
Type II: cytotoxic reaction mediated by:
• IgG or IgM
• Hemolytic anemia
• Transfusion reaction
• Erythroblastosis fetalis
Type III: reaction mediated by immune complexes.
• IgG or IgE
• Rheumatoid arthritis
• Systemic lupus erythematosus
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Type IV: delayed reaction mediated by cellular Medical Management:
response.
• Medication: Insert epinephrine related to
• T lymphocytes constriction of airway.
• Calls lymphokines → calls macrophages • Immunotherapy/ hyposensitization
• Contact dermatitis Continuous exposure to reduce
• Transplant graft reaction sensitization to allergen.

Signs and Symptoms Pharmacologic Management:

Here’s a list of the more common symptoms:
• Rx Commercial preparation of passive Rh (D)
❖ a pink or red rash with or without pus-filled antibodies against the Rh factor
bumps or blisters • RhIG (RhoGAM) given again via injection in the
❖ scaly, flaky skin first 72 hours after birth of a Rhpositive child to
❖ fever prevent formation of natural antibodies.
❖ facial swelling • Pharmacologic therapy
❖ swollen or tender lymph nodes Intranasal steroids
❖ swollen saliva glands 2nd & 3rd generation antihistamines
❖ dry mouth (Cetirizine/ Zyrtec, Loratadine/ Claritin)
❖ abnormalities in your white blood cell counts Decongestants (pseudoephedrine)
❖ difficulty moving normally
Surgical Management:
❖ headache
❖ seizures • No surgical interventions are needed as the
❖ coma interventions listed above should suffice.
Management ISOIMMUNIZATION
Nursing Management:
- Isoimmunization is an immune response of the
• Reduce exposure to allergen (food, etc.) mother to foreign antigen of the same species.
• Environmental Control One occurrence of this is Rh incompatibility
Replacing carpets with hardwood which occurs when the pregnant woman’s blood
Goal is to decrease allergic triggers in the protein is incompatible with the baby’s blood
environment. protein. Rh factor is a red blood cell surface
• Promote good nutrition, since the woman has antigen which could be negative or positive.
still to continue her usual pregnancy nutrition. When a pregnant woman with Rh-negative
Pay particular attention in lowering sodium blood type is exposed to the fetal Rh-positive
intakes. blood cells, this can lead to sensitization–the
• Assess the patient for the presence of edema on development of antibodies to D antigen (anti-D).
the face, fingers, and upper extremities. Anti-D would cross the placenta and attack the
• Provide information about signs/symptoms fetal Rh-positive blood cells resulting in mild to
indicating worsening of condition, and instruct severe effects such as hemolytic anemia,
patients to notify health care providers. kernicterus, hydrops fetalis and many other fetal
problems.

Etiology/Cause
- Rh incompatibility occurs when the fetal Rh-
positive blood cells escape and expose the
circulatory system of the mother who has Rh-
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
negative blood cells. This sensitizes the mother
to produce antibodies called antigen D. Antigen
D or anti-D is well known for causing severe
immunogenic response as well as its ability to
cross the placenta. Anti-D would be formed
during the first pregnancy and in the next
pregnancy, these antibodies would cross the
placenta to attack the baby's Rh-positive red
blood cells leading to anemia and hemolysis.
Types
An Rh incompatibility occurs when a mother is Rh-
negative and her unborn child is Rhpositive.
Potential birth injuries that result from an untreated Rh
incompatibility can range from mild to fatal:
• Mild injuries: Might include jaundice, low
muscle tone and lethargy.
• Severe injuries: Might include stillbirth, heart
failure, a brain syndrome called kernicterus as a
result of high bilirubin levels, fluid buildup in the
body, seizures and other movement or cognitive
impairments.
Signs and Symptoms
Symptoms will only be in the baby. They can be mild to
severe, such as:
❖ Anemia—red blood cells are destroyed faster
than they are made
❖ Jaundice—a buildup of a substance in the blood
that causes the skin to look yellow
❖ Swelling of the body, which can lead to heart
failure or breathing problems.
❖ Lethargy
❖ low muscle tone
Management
Nursing Management:
1. All pregnant women should be screened for
blood ABO & Rh groups at the first antenatal
visit.
2. If negative, she is advised to obtain her
husband’s ABO & Rh group.
3. At 35wks, repeat maternal blood for Rh
antibodies. If negative, observe her until
MODULE 1M: ANTENATAL COMPLICATIONS
delivery. If positive, treat her like any Rh
sensitized patient.
4. Collect previous history.
5. The prevention of maternal sensitization due to
Rh positive fetal rbcs that leak into the maternal
circulation, when the placenta separation at
delivery, is achieved by the administration of
HUMAN Rh ANTI-D within 72 hrs. Of the event.
6. Send grouping & Rh typing of baby after delivery
as well as serum bilirubin to detect neonatal
jaundice.
7. Observe for anemia, jaundice, sucking reflex,
irritability, etc.
8. Observe the child for change in color of urine &
stool.
9. Counsel the patient party before phototherapy &
exchange blood transfusion.
10. Phototherapy care should be provided.
11. Prevent from complications of phototherapy
Medical Management of Isoimmunization Antenatal
Management:
• Detection of maternal sensitization. Detection of
maternal sensitization is confirmed by the
detection of Rh antibodies in maternal
circulation, it is done by titre technique. Titre
below 4IU/ml are unlikely to produce severe
fetal disease. All Rh-negative pregnant women
should have their blood tested for Rh antibodies
at the 1st antenatal visit and again at 28th & 34th
weeks of gestation. .[acc. To DC Dutta, textbook
of obstetrics, 16th edition]
• Management of affected fetus by intrauterine
intravascular transfusion. Blood may be given to
the baby by a needle introduced through
mother’s abdomen. Blood is given either
intravascularly [into the umbilical vein] or
intraperitoneally. The first method is preferable,
as blood enters the fetal circulation directly and
severely anemic fetuses may be saved.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
IRON DEFICIENCY ANEMIA
- Iron deficiency anemia is a common type of
anemia that occurs when the body has a low
level of iron and hemoglobin. To produce
hemoglobin that functions to carry oxygenated
blood throughout the body, a sufficient amount
of iron is needed. And if the body has a low
amount of iron, this will fail in producing enough
hemoglobin. Pregnant mothers must intake
double the amount of iron compared to non-
pregnant mothers to also supply oxygen to the
baby.
Etiology/Cause
- In order to nourish and accommodate the
developing child, the pregnant woman goes
through significant anatomical and physiological
changes throughout pregnancy. Because of the
changes occurring to the body, there will be an
increase in blood volume and also an increased
requirement for iron for the fetus and
hemoglobin production. If the increased
requirement of iron will not be met, this will
result in iron deficiency anemia.
Signs and Symptoms
Signs and symptoms of iron deficiency anemia may
include:
❖ Extreme fatigue
❖ Weakness
❖ Pale skin
❖ Chest pain, tachycardia or shortness of breath
❖ Headache, dizziness or lightheadedness
❖ Cold hands and feet
❖ Inflammation or soreness of your tongue
❖ Brittle nails
❖ Unusual cravings for non-nutritive substances,
such as ice, dirt or starch
❖ Poor appetite
MODULE 1M: ANTENATAL COMPLICATIONS
Management
Nursing Management:
• Administer medications as prescribed
When oral iron is poorly absorbed,
administer IM or IV iron. Intravenous
iron is extremely effective in treating
iron deficiency anemia and should be
utilized when oral iron is ineffective.
Perform sensitivity testing of IM iron
injection to minimize the risk of
anaphylaxis.
Advise the patient to take iron
supplements an hour before meals for
optimal absorption; if gastric distress
arises, suggest taking the supplement
with meals; if symptoms subside,
continue to the between meal schedule.
Advise the patient to take liquid forms of
iron with a straw and to rinse his or her
mouth with water.
• Reduce fatigue
Assist the client or caregivers in
establishing a daily activity and rest
regimen, and emphasize the significance
of having frequent rest periods.
Monitor hemoglobin, hematocrit, RBC
count, and reticulocyte counts of the
patient
Teach patients on energy-conservation
techniques
• Educate the client and caregivers on iron
deficiency anemia
Explain the significance of diagnostic
procedures, bone marrow aspiration,
and iron replacement/supplementation.
Educate the client and his or her family
on iron-rich diets
• Prevent infection
Examine for signs of infection, either
local or systemic, such as fever, chills,
edema, discomfort, and malaise.
WBC count should be monitored, and
antibiotic, antiviral, and antifungal
therapy should be considered.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Instruct the client to avoid contact with
others with existing infections, and
emphasize the necessity of daily
hygiene, mouth care, and perineal care.
• Prevent bleeding
Platelet count should be monitored, and
the client or caregivers should be
informed about bleeding precautions.
When the platelet count falls to a
severely low level, expect a platelet
transfusion.
Examine the patient's skin for bruising
and petechiae.
Medical Management:
The first approach in this type of management is to
determine the cause and diagnosis of the iron deficiency.
• Iron Therapy
o Oral ferrous iron salts are by far the most
inexpensive and effective treatment for
iron deficiency anemia. Ferrous sulfate is
the most widely used of the numerous
iron salts available.
• Diet
o Nonheme iron supplementation has
been undertaken in several parts of the
world for the treatment of patients with
iron deficiency anemia.
Pharmacological Management:
The following are the medications administered to
patients with iron deficiency anemia:
• Iron Products
o These medicines are used to provide
sufficient iron for hemoglobin
production as well as to restore iron
stores in the body.
• Parenteral Iron
o Parenteral iron should be reserved for
patients who are unable to absorb oral
iron or who have progressive anemia
despite adequate doses of oral iron; it is
more expensive and has a higher
morbidity than oral iron preparations.
MODULE 1M: ANTENATAL COMPLICATIONS
Surgical Management:
Management of Hemorrhage
• Surgical treatment includes preventing the
bleeding and treating the underlying defect so
that it does not reoccur; which may include
surgery for the treatment of either neoplastic or
non-neoplastic disease of the gastrointestinal
tract, genitourinary tract, uterus, and the lungs.
PIH (PREGNANCY-INDUCED
HYPERTENSION)
- Pregnancy-induced hypertension (PIH) also
called toxemia or preeclampsia, is a form of high
blood pressure in pregnancy. It occurs most
often in young women with a first pregnancy. It
is more common in twin pregnancies, and in
women who had PIH in a previous pregnancy.
Etiology/Cause
- Some conditions may increase the risk of
developing PIH such as pre-existing hypertension
(high blood pressure), kidney disease, diabetes,
PIH with a previous pregnancy, mother's age
younger than 20 or older than 40, multiple
fetuses (twins, triplets).
Types
There are three main types of high blood pressure during
pregnancy:
1. Chronic Hypertension
◼ This is high blood pressure you had before
you became pregnant. It can also refer to
high blood pressure you get before the 20th
week of pregnancy. Sometimes you may
have high blood pressure for a long time
before becoming pregnant but don’t know it
until your first prenatal visit with your
doctor. Chronic hypertension can lead to
serious problems, including preeclampsia.
This type of high blood pressure continues
after you have your baby.
2. Gestational Hypertension
◼ This is high blood pressure you get after your
20th week of pregnancy. Most of the time,
this hypertension doesn’t hurt you or your
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
baby. You may not even have other
symptoms. However, sometimes this type of
hypertension is severe. It can cause your
baby to be born smaller than normal (born in
a low birth weight). Your baby may even be
born early because of it. It can lead to
preeclampsia. And while it usually goes away
within three months of giving birth, it can
raise your risk of getting high blood pressure
in the future.
3. Preeclampsia
◼ This is a sudden rise in your blood pressure
after your 20th week of pregnancy, typically
in your third trimester. It also may cause
damage to your liver, kidneys, or brain. You
may have seizures. You may have significant
swelling in your legs and sometimes your
arms and face. This condition is serious. It
can hurt both you and your baby, and even
be life threatening. Some women get
preeclampsia after they deliver their baby.
This calis led postpartum preeclampsia.
Signs and Symptoms
❖ Increased blood pressure
❖ Protein in the urine
❖ Blurred or double vision
❖ Nausea and vomiting
❖ Right sided abdominal pain
❖ Edema
❖ Sudden weight gain
❖ Changes in liver or kidney function
❖ Urinating small amounts
Management
Nursing Management:
• Promote bed rest
• Medication
• Good nutrition
• (For mild and severe preeclampsia); No sodium,
emotional support, monitor maternal and fetal
well being.
• (For Eclampsia); Maintain patient airway,
Magnesium sulfate, check for vaginal bleeding
and contractions
MODULE 1M: ANTENATAL COMPLICATIONS
• Monitor deep tendon reflexes
• Patellar reflex
Pharmacologic Management:
• Magnesium sulfate
• Hydralazine
• Diazepam
• Calcium Gluconate
PREECLAMPSIA
- Preeclampsia is a serious blood pressure
condition that occurs during pregnancy and is
characterized by high blood pressure and
symptoms of injury to another organ system,
most commonly the liver and kidneys.
Preeclampsia commonly starts after 20 weeks of
pregnancy in women whose blood pressure has
been normal.
Etiology/Cause
- Preeclampsia is thought to be caused by a
problem with the health of the placenta, the
organ that nourishes the fetus throughout
pregnancy. New blood vessels form and evolve
early in pregnancy to efficiently transport blood
to the placenta.
- In women with preeclampsia, these blood
vessels don't seem to develop or function
properly. They are narrower than normal blood
vessels and respond differently to hormonal
signaling, limiting the amount of blood that can
pass through them.
- Causes of this abnormal development may
include:
A problem with the immune system
Damage to the blood vessels
Insufficient blood flow to the uterus
Certain genes
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Types
Preeclampsia is one of four types of high blood pressure
that can arise during pregnancy. The other three are as
follows:
1. Gestational hypertension
◼ This occurs when your blood pressure rises
in the second half of your pregnancy, or
earlier if you're pregnant with twins. Women
with gestational hypertension have high
blood pressure but no excess protein in their
urine or other signs of organ damage.
2. Chronic hypertension
◼ Chronic hypertension is defined as high
blood pressure that existed before
pregnancy or that occurs before 20 weeks of
pregnancy. However, because high blood
pressure normally has no symptoms, it may
be difficult to pinpoint when it started.
3. Chronic hypertension with superimposed
preeclampsia
◼ This condition occurs in women who had
chronic high blood pressure prior to
pregnancy but later developed worsening
high blood pressure, protein in the urine, or
other health issues during pregnancy.
Signs and Symptoms
❖ Excess protein in urine( proteinuria) or additional
signs of kidney problems
❖ Severe headaches
❖ Changes in vision , including temporary loss of
vision , blurred vision or light sensitivity
❖ Upper abdominal pain, usually under the ribs on
the right side
❖ Nausea or vomiting
❖ Decreased levels of platelets in the blood (
thrombocytopenia)
❖ Impaired liver function
❖ Shortness of breath , caused by fluid in the lungs
MODULE 1M: ANTENATAL COMPLICATIONS
Management
Nursing Management:
Without severe features
• Monitor Antiplatelet Therapy
• Promote bed rest
• Promote good nutrition
• Provide Emotional support
With severe features
• Support bed rest
• Monitor maternal well-being
• Monitor fetal well-being
• Support a nutritious intake
• Administer medication to prevent eclampsia
Medical Management:
• Most sufficient treatment for preeclampsia is
delivery as long as the pregnancy is in term.
• Patient with severe preeclampsia feature is
required for hospitalization for careful
monitoring.
• Treatment goals are fluid management, seizure
prevention , lowering BP to prevent maternal
end-organ damage.
• Urine output should be maintained above 30 ml
per hour and Foley catheter should be used to
monitor urine output.
• Administering of medications to prevent
eclampsia.
Blood Pressure Management:
• Patient with severe preeclampsia is unknown.
Excessive lowering of BP may lead to
uteroplacental insufficiency. It is recommended
that systolic BP be maintained at less than 160
mmHg and diastolic at less than 110 mmHg.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Pharmacological Management:
Drugs used in preeclampsia
Drug : Magnesium sulfate ( pregnancy risk category B)
Indication: Muscles relaxant ; prevents seizures
Dose : loading dose 4-6g
Maintenance dose 1-2g/hr IV
• Infuse loading dose slowly over 15-30 minutes.
• Always administer as a piggyback infusion.
• Assess respiratory rate. Urine output, deep
tendon reflexes, and clonus every hour.
Drug : Hydralazine ( Apresoline ) pregnancy risk category
C
Indication: Antihypertensive ( peripheral vasodilator)
used to decrease hypertension
Dosage: 5-10mg IV
• Administer slowly to avoid sudden fall in blood
pressure. Maintain diastolic pressure over 90
mmHg to ensure adequate placental filling.
Drug : Diazepam ( Valium) pregnancy risk category D
Indication : Halt seizures Dosage: 5-10 mg IV
• Administered slowly. Dose may be repeated q5-
10 minutes (up to 30 mg/hr)
• Observe for respiratory depression or
hypotension in mother and respiratory
depression and hypotonia in infant at birth.
Drug: Calcium gluconate ( pregnancy risk category C)
Indication: Antidote for magnesium intoxication Dosage
: 1g IV ( 10 ml of 10% solution)
• Have prepared at bedside as the antidote when
administering magnesium sulfate.
• Administer at 5ml/min.
Surgical Management:
• Attempted vaginal delivery is recommended in
women who have preeclampsia with severe
features if it is not otherwise contraindicated
MODULE 1M: ANTENATAL COMPLICATIONS
• Indications for cesarean delivery include
recurrent seizures refractory to medical
management, severely elevated BP that is
resistant to antihypertensive medications, and
maternal or fetal deterioration remote from
delivery.
• Some experts recommend cesarean delivery in
preeclamptic patients with severe features and
an unfavorable cervix who require delivery
before 30 weeks' gestation
ECLAMPSIA
- Eclampsia is the onset of fits/seizures in a
woman whose pregnancy is usually complicated
by pre-eclampsia. The fits may occur in
pregnancy after 20 weeks gestation, in labor, or
during the first 48 hours of the postpartum
period.
Etiology/Cause
- The definitive cause of eclampsia is still
unknown. However, eclampsia is known to
follow preeclampasia as a severe complication
which is characterized by high blood pressure
occurring in pregnancy affecting the brain that
leads to seizures.
Signs and Symptoms
❖ convulsions
❖ diastolic blood pressure 90mmHg or more after
20 weeks gestation
❖ proteinuria 2+ or more
❖ coma
❖ hyper-reflexia
❖ severe headache (increasing frequency,
unrelieved by regular analgesics)
❖ Vision problems, such as temporary blindness
❖ oliguria (passing less than 400ml urine in 24
hours)
❖ upper abdominal pain (epigastric pain or pain in
right upper quadrant)
❖ Generalized edema
❖ Nausea and vomiting
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Management
Nursing Management:
• Monitor blood pressure.
• Assess fetal heart rate
• Send blood and urine for testing.
• Administer prescribed medications.
• Monitor reflexes on patients on magnesium
sulfate.
• Neurologic checks regularly.
• Seizure precautions if ordered
Medical Management:
• Controlling fits/seizures
o ABCDE assessment and intervention as
appropriate.
o Patients should lie in the left lateral
position to reduce the risk of aspiration
of secretions, vomit and blood
o Give oxygen if available and continue for
five minutes after each fit, or longer if
cyanosis persists
o After a convulsion, aspirate the mouth
and throat as necessary to clear the
airway ○ Stay with the woman and
ensure that her airway is clear
o Fits are controlled by giving the woman
anticonvulsant drugs. The drug of choice
for both the prevention and treatment
of eclampsia is magnesium sulfate. If
magnesium sulfate is not available,
diazepam may be given, but there is a
greater risk of neonatal depression
because diazepam crosses the placenta
freely.
Pharmacologic Management:
• Cessation of Seizures
o Eclamptic seizures are treated with
magnesium sulfate. The patient should
be assessed for signs of
hypermagnesemia (hyper-reflexia,
respiratory depression), and the fetus
monitored via continuous CTG.
MODULE 1M: ANTENATAL COMPLICATIONS
• Magnesium sulfate loading dose:
o Give 4g of 20% magnesium sulfate IV
slowly over 5 minutes. Magnesium
sulfate should not be given as a bolus.
Follow immediately with 10g of 50%
magnesium sulfate solution, 5g in each
buttock as deep IM injection, with 1ml of
2% lignocaine in the same syringe.
o If convulsions recur after 15 minutes,
give 2g magnesium sulfate (50%
solution) IV over 5 minutes.
• Maintenance dose:
o Give 5g magnesium sulfate (50%
solution) together with 1ml lignocaine
2% in the same syringe every 4 hours
into alternate buttocks. Continue the
treatment with magnesium sulfate for
24 hours after delivery or the last
convulsion, whichever occurs last.
Observations which must be made before giving repeat
doses of magnesium sulfate:
• respiratory rate
• patellar reflexes (knee jerk)
• urinary output
Repeat doses of magnesium sulfate must be withheld or
delayed if:
• the respiratory rate is less than 16 per minute
• patellar reflexes are absent
• urinary output is less than 30ml per hour over
the preceding 4 hours.
Antidote:
In cases of respiratory arrest:
• give calcium gluconate 1g (10ml of 10% solution)
IV slowly until respirations satisfactory
• assist ventilation using mask and bag, anesthetic
apparatus or intubation.
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• Blood Pressure Control
o Antihypertensive drugs should be given
if the diastolic blood pressure is
110mmHg or more. The aim is to keep
the diastolic blood pressure between
90–100mmHg to prevent cerebral
hemorrhage. The two most commonly
used intravenous antihypertensives are
labetalol and hydralazine. A rapid
decrease in maternal blood pressure can
cause fetal heart rate abnormalities.
Therefore, continuous CTG monitoring is
used during and for 30 minutes after
giving IV antihypertensives.
Surgical Management:
• The only definitive treatment of eclampsia is
delivery of the fetus. However, the mother must
be stable before delivery – with any seizures
controlled, severe hypertension treated and
hypoxia corrected. This is the case regardless of
any fetal compromise.
• Cesarean section is the ideal mode of delivery.
However, intrapartum seizures in established
labor may be managed by vaginal delivery. After
delivery, the patient will require high
dependence unit care until she is stable – well
controlled blood pressure, adequate urine
output, and discontinuation of magnesium
sulfate. This usually takes a minimum of 24
hours.
GESTATIONAL DIABETES
- Gestational diabetes is a temporary form of
diabetes that occurs during pregnancy when the
body stops producing or responding to insulin
adequately. It is a condition in which a hormone
made by the placenta prevents the body from
using insulin effectively. Glucose builds up in the
blood instead of being absorbed by the cells.
Etiology/Cause
- Diabetes occurs during pregnancy because
hormones produced in a pregnancy make the
body resistant to insulin's effects. These
hormones include growth hormone and human
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placental lactogen. Both of these hormones are
essential to a healthy pregnancy and fetus, but
they partially block the action of insulin. In most
women, the pancreas reacts to this situation by
producing enough additional insulin to
overcome the insulin resistance. In women with
gestational diabetes, not enough extra insulin is
produced, so sugar accumulates in the
bloodstream.
Types
Gestational diabetes is divided into two classes:
• Class A1 is used to describe gestational diabetes
that can be managed through diet alone.
• Class A2 is used to describe gestational diabetes
where insulin or oral medications are needed to
manage the condition.
Signs and Symptoms
❖ Increased, frequent urination
❖ Increased thirst
❖ Fatigue
❖ Nausea and vomiting
❖ Blurred vision
❖ Yeast infections
Management
Nursing Management:
• Assess urine for glucose during prenatal visits
glucose starts to leak into the urine and assess
for burning during urination which could indicate
infection.
• Recommend dietary changes and increased
physical exercise.
Medical Management:
• Screening for GDM should occur after 24 weeks
of gestation in all women without known
diabetes mellitus.
• Glucose monitoring, pregnant mother will
monitor her blood glucose on a daily basis.
Pharmacologic Management:
• Pharmacologic therapy with metformin
(Glucophage), glyburide, or insulin is appropriate
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for women with GDM whose glucose values are
above goal despite lifestyle modifications.
Surgical Management:
• A C-section is an operation to deliver the baby
through the mother’s belly. Complications
caused by gestational diabetes may lead to a c-
section being advised. A woman who has
diabetes that is not well controlled has a higher
chance of needing a C-section to deliver the
baby.
HELLP SYNDROME
- HELLP is a life-threatening pregnancy
complication syndrome characterized by
Hemolysis, Elevated Liver enzymes and Low
Platelets. This is usually considered to be a
variant of preeclampsia, however the risk factors
for HELLP syndrome differ from those associated
with preeclampsia that occur during the later
stages of pregnancy or sometimes develop in the
week after a baby is born.
Etiology/Cause
- The cause of HELLP syndrome is still unknown as
it can be difficult to diagnose because all the
typical signs of preeclampsia may not be
apparent and is frequently misdiagnosed at
initial presentation. Early detection is important
because the morbidity and mortality rates
associated with the syndrome have been
reported to be as high as 25 percent.
Types
HELLP syndrome is classified according to the severity of
certain blood test values which reflect the condition of
the mother’s blood vessels, liver and other organ
systems.
• Class I (severe thrombocytopenia): AST ≥ 70
IU/L, LDH ≥ 600 IU/L, platelets ≤ 50,000/uL
• Class II (moderate thrombocytopenia): AST ≥ 70
IU/L, LDH ≥ 600 IU/L, platelets > 50,000 ≤
100,000/uL
• Class III (mild thrombocytopenia): AST ≥ 40 IU/L,
LDH > 600 IU/L, platelets > 100,000 ≤ 150,000/uL
MODULE 1M: ANTENATAL COMPLICATIONS
Signs and Symptoms
❖ Blurry vision
❖ Chest pain or pain in the upper right or middle
part of the belly
❖ Headache, fatigue (feeling really tired)
❖ Nausea (feeling sick to your stomach) or
throwing up that gets worse
❖ Quick weight gain
❖ Nosebleed or other bleeding that doesn’t stop
❖ Swelling (Hands or face)
❖ Breathing problems
Management
Nursing Management:
• Assist the client to a setting with intensive care
facilities available.
• To Administer magnesium sulfate per doctor’s
order to control seizures.
• Control the blood pressure, give Hydralazine as
ordered.
• Manage prescribed fluid replacement accurately
to avoid worsening the woman’s reduced
intravascular tone.
Medical Management:
• blood transfusions to treat anemia and low
platelet levels.
• magnesium sulfate to prevent seizures
• antihypertensive medication to control blood
pressure
• corticosteroid medication to help your baby’s
lungs mature in case an early delivery is needed
Pharmacologic Management:
• Patients with HELLP syndrome should be treated
prophylactically with magnesium sulfate to
prevent seizures, whether hypertension is
present or not. A bolus of 4 to 6 g of magnesium
sulfate as a 20 percent solution is given initially.
This dose is followed by a maintenance infusion
of 2 g per hour. The infusion should be titrated
to urine output and magnesium level. Patients
should be observed for signs and symptoms of
magnesium toxicity. If toxicity occurs, 10 to 20
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mL of 10 percent calcium gluconate should be
given intravenously.
Surgical Management:
• Delivery of patients with HELLP syndrome was
routinely accomplished by cesarean section.
Patients with severe HELLP syndrome, a
gestation of less than 32 weeks should be
delivered by cesarean section. A trial of labor is
appropriate in patients with mild to moderate
HELLP syndrome who are stable, have a
favorable cervix and are at 32 weeks of gestation
or greater.
CARDIAC DISEASE
- Also known as Cardiovascular Disease (CVD), is
the general term used to call diseases or
complications that affect the structures and
functions of the heart and blood vessels.
According to the World Health Organization
(2019), it represents 32% of all global deaths
making it the leading cause of death in the world.
Cardiac disease may occur rarely in pregnancy
but, according to the NHS, it is the leading cause
of death in pregnancy.
Etiology/ Cause
- Cardiac disease may directly arise from different
etiologies such as emboli in a patient with atrial
fibrillation resulting in ischemic stroke,
rheumatic fever causing valvular heart disease,
among others. During pregnancy, increased
cardiac output may lead to heart failure and may
also lead to ischemic events during the third
trimester. Risk factors attributed to cardiac
disease of pregnancy include drug use, alcohol
abuse, hypertension, diabetes mellitus, pre-
existing heart disease, myocarditis, and familial
heart disease of pregnancy.
Types
The common cardiovascular diseases of pregnancy are
the following:
• Coronary artery disease - This happens when the
heart’s blood supply is blocked or interrupted
due to the build-up of fatty-substances within
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the coronary arteries thus making it unable to
deliver enough oxygen-rich blood to the heart.
• Pregnancy-associated myocardial infarction -
Commonly called as a heart attack, this happens
when blood flow is blocked and the heart doesn’t
get enough oxygen.
• Valvular disease - This happens when one or
more valves of the heart doesn’t work properly
caused by changes in its structure due to aging,
Myxomatous degeneration, or a birth defect,
among others.
• Left-sided heart failure - This happens when the
left side of the heart is failing and can’t handle
the blood and it wouldn’t pump efficiently.
• Right-sided heart failure - This happens when
the right chamber of the heart becomes too
weak or loses its ability to pump enough blood to
the lungs.
• Peripartum Cardiomyopathy - The weakening of
the heart muscle that may begin sometime
during the final month of pregnancy through
about five months after delivery, without any
other known cause. The heart may even be at
higher susceptibility to the aforementioned risk
factors. It is a rare condition that can carry mild
or severe symptoms.
Signs and Symptoms
❖ Decreased Exercise capacity and Fatigue -
Pumping ability of the heart reduces that causes
lesser chance of blood to reach the muscles and
tissues. Heart action is effective in resting state.
❖ Palpitations - Palpitations can be a symptom of a
greater heart condition
❖ Dyspnea - Pulmonary edema hinders gas
exchange resulting to shortness of breath
❖ Peripheral edema - Blood enters backward,
forcing fluids out resulting in an edema of the
legs, ankles and feet.
❖ Physiologic systolic murmur
❖ 3rd Heart sound
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Management Pharmacologic and Medication Measures:
Pregnant women should be closely monitored by nurses
Medication therapy include:
and a continuous assessment is needed. Nurses should
assess the women’s health status, health education and • Prenatal vitamins and iron
health-promotion activities. In addition, documentation • Stool softeners
and assessment are necessary to attain a baseline data • Prophylactic Antibiotics with any invasive
for the pregnant woman. procedures and before delivery
Nursing Management: • Cardiac glycosides (digitals)
• Anti-dysrhythmia agents
Assessment and Documentation • Furosemide (Lasix) - only with CHF (Congestive
• Health history to prepregnancy cardiac status Heart Failure)
• Vital signs • Heparin as needed with anticoagulant therapy
• Level of exercise performance • No warfarin (Coumadin)
• Assess for cough and edema Surgical Management:
• Nail bed filling
• Additional Cardiac status assessment: • Cardiac surgery is a rare occurrence. Cardiac
Electrocardiogram (ECG) for periodic points of surgical therapy must be considered when the
pregnancy underlying cardiac disease immensely influences
the cardiovascular changes of pregnancy.
Fetal Assessment • During pregnancy, Stanford type A dissection is a
surgical emergency that would necessitate
• Monitor Fetal well being with FMC
cardiothoracic surgical intervention to rapidly
Health Teaching deliver the fetus and repair the dissection.

Teach client to adhere to a healthy lifestyle: DRUG ABUSE

• Nutrition for pregnancy - Drug abuse is the excessive, maladaptive, or
• Head of bed elevated as necessary addictive use of drugs for nonmedical purposes
• Prompt to take prenatal vitamins and iron as despite social, psychological, and physical
prescribed problems that may arise from such use.
• Avoid getting extra weight gain Etiology/Cause
• Manage Stress Biological Factors:
• Exercise (e.g walking)
- The genes that people are born with account for
• Avoid overexertion and longer resting time
about half of a person's risk for addiction.
periods.
- Gender, ethnicity, and the presence of other
• Remind to attend appointments with the
mental disorders may also influence risk for drug
physicians
use and addiction.
Medical Management:
Environmental Factors:
• Electrocardiogram (ECG or EKG).
- A person’s environment includes many different
• Holter monitoring
influences, from family and friends to economic
• Echocardiogram
status and general quality of life.
• Stress test
- Factors such as peer pressure, physical and
• Cardiac Catheterization sexual abuse, early exposure to drugs, stress,
• Cardiac magnetic resonance imaging (MRI)

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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
and parental guidance can greatly affect a
person’s likelihood of drug use and addiction.
Developmental Factors
- Genetic and environmental factors interact with
critical developmental stages in a person’s life to
affect addiction risk.
Types
1. Alcohol Abuse
◼ Alcohol abuse, also called alcohol misuse is a
serious problem. It is a pattern of drinking
too much alcohol too often.
2. Marijuana Abuse
◼ Marijuana refers to the leaves, flowers, and
extracts of the plant Cannabis sativa and
several closely related species commonly
known as hemp. Marijuana is the most
commonly used illicit drug in the United
States and is known by a large variety of
names including cannabis, pot, weed, grass,
hash, and many others.
3. Prescription Drug Abuse
◼ Prescription drug abuse is the use of a
prescription medication in a way not
intended by the prescribing doctor.
Prescription drug abuse or problematic use
includes everything from taking a friend's
prescription painkiller for your backache to
snorting or injecting ground-up pills to get
high.
4. Methamphetamine Abuse
◼ Methamphetamine (meth) is a commonly
abused, potent stimulant drug that is part of
a larger family of that is an amphetamine
derivative with similar stimulant properties.
It is sometimes referred to a poor man's
cocaine.
5. Cocaine Abuse
◼ Cocaine is a white powdery substance that
reacts with the body’s central nervous
system, producing energy and euphoria. It is
most commonly snorted, but can also be
smoked (also known as “freebasing”) or
dissolved in water and injected. Cocaine is
also referred to as coke, blow, or powder.
MODULE 1M: ANTENATAL COMPLICATIONS
6. Hallucinogen Abuse
◼ Hallucinogens are Psychoactive drugs that
are widely abused around the world,
sometimes with alarming and dangerous
side effects.
7. Inhalant Abuse
◼ Inhalant abuse, also known as volatile
substance abuse, solvent abuse, sniffing,
huffing and bagging, is the deliberate
inhalation of a volatile substance to achieve
an altered mental state. Inhalant abuse is a
worldwide problem that is especially
common in individuals from minority and
marginalized populations, and is strongly
correlated with the social determinants of
health.
Signs and Symptoms
❖ Bloodshot eyes
❖ Sudden weight loss
❖ Interrupted sleep patterns
❖ Change in complexion
❖ Depression and anxiety
❖ Irritability and mood swings
❖ Secretive behavior
Management
Nursing Management:
• produce a list of screening methods used to
identify drug use in pregnant women
• Identify complication s caused to the mother and
fetus by drug use
• Provide treatments for pregnant women with
drug use
• Plan nursing care for the woman with drug abuse
during pregnancy
Medical Management:
• For mothers who are taking opioid pain relievers
(narcotics), the mother can pass the drug from
her bloodstream through the placenta to the
fetus.
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Pharmacologic Management:
• Methadone and buprenorphine ne are
prescription drugs, sometimes called
pharmacotherapy. They are used to help treat
heroin and opioid dependency. The risks to the
fetus and pregnancy associated with heroin use
are greatly reduced with both of these
treatments
Surgical Management:
• Infants with organ damage, birth defects or
development al issues may need medical or
surgical therapy and long-term therapies.
UTI
- Urinary tract infection (UTI) is a clinical condition
that may involve the urethra and bladder (lower
urinary tract) and the ureters, renal pelvis,
calyces, and renal parenchyma (upper urinary
tract).
Etiology/Cause
- A variety of organisms can be responsible for
UTI. Escherichia coli (85% of cases) and other
gram-negative enteric organisms are most
commonly implicated; all are common to the
anal, perineal, and perianal region. Other gram-
negative organisms associated with UTI include
Proteus, Enterobacter, Citrobacter,
Pseudomonas, and Klebsiella. Gram-positive
bacterial pathogens include Staphylococcus
saprophyticus, Enterococcus, and, rarely,
Staphylococcus aureus. Viruses and fungi are
uncommon causes of UTI in children. Most
uropathogens originate in the gastrointestinal
tract, migrate to the periurethral area, and
ascend to the bladder. A number of factors
contribute to the development of UTI, including
anatomic, physical, and chemical conditions or
properties of the host’s urinary tract.
MODULE 1M: ANTENATAL COMPLICATIONS
Types
1. Upper urinary tract infection
◼ Upper tract UTIs affect the kidneys. These
can be potentially life-threatening if bacteria
move from the infected kidney into the
blood. This condition, called urosepsis, can
cause dangerously low blood pressure,
shock, and death. These are often rarer but
more severe.
2. Lower urinary tract infection
◼ A lower urinary tract infection refers to the
inflammation and infection of the bladder
and the urethra, which is the tube that leads
from the bladder, enabling urine to exit the
body. Women are more prone to lower UTIs
than men. Cystitis refers to inflammation of
the bladder and urethritis refers to
inflammation of the urethra.
Signs and Symptoms
Signs and symptoms of a kidney infection can include:
❖ Fever
❖ Chills
❖ Lower back pain or pain in the side of your back
❖ Nausea or vomiting
Signs and symptoms of a bladder infection can include:
❖ Pain or burning while urinating
❖ Frequent urination
❖ Feeling the need to urinate despite having an
empty bladder
❖ Bloody urine
❖ Pressure or cramping in the groin or lower
abdomen
Management
Nursing Management:
• Identification of children with UTI and education
of parents and children regarding prevention
and treatment of infection
• Encouragement of good toilet habits and dietary
intake of fluid and fiber
• Instruct parents to observe for signs of UTI
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
• Take every precaution to obtain acceptable,
clean voided specimens in order to avoid using
other collecting procedures
Medical Management:
Urinalysis
- It's used to detect and manage a wide range of
disorders, such as urinary tract infections
Urine culture and sensitivity
- Collection of sterile specimen which helps
determine presence of pathogens
Cystoscopy
There are three major causes of STDs:
- Is a procedure that lets the healthcare provider
view the urinary tract, particularly the bladder,
the urethra, and the openings to the ureters.
Pharmacologic Management:
Antibiotics such as the following are used in the
treatment of UTI:
• Trimethoprim- sulfamethoxazole
• Amoxicillin
• Nitrofurantoin
• Cephalexin
• Ceftazidime
• Gentamicin
Surgical Management:
While surgeries are not normally recommended for
treating UTI, a surgery may be required when there is an
anatomical defect or a physical blockage in the urinary
tract. The surgical interventions may include the
following:
• Bladder neck incision (B.N.I.) and a
urethrotomy
these are operations for men who have
a decreased urinary stream and
problems passing urine because of a
bladder neck stenosis or a urethral
stricture.
MODULE 1M: ANTENATAL COMPLICATIONS
• Transurethral resection of prostate (TURP)
this is a surgery used to treat urinary
problems that are caused b y an
enlarged prostate, which may be the
cause of UTI for men usually o ver the
age of 50.
STD
- Sexually transmitted diseases are infections that
are passed from one person to another through
sexual contact. The contact is usually vaginal and
oral sex. But sometimes they can spread through
other intimate physical contact.
Etiology/Cause
- Bacteria - chlamydia, gonorrhea, and syphilis are
STDs that are caused by bacteria.
- Viruses -including HIV/AIDS, herpes simplex
virus, human papillomavirus, hepatitis B virus,
cytomegalovirus (CMV), and Zika
- Parasites - STDs caused by parasites include
trichomonas vaginalis, or insects such as crab lice
or scabies mites.
Types
1. Chlamydia
◼ It is caused by bacteria called Chlamydia
trachomatis. It can infect both men and
women. Women can get chlamydia in the
cervix, rectum, or throat. Men can get
chlamydia in the urethra (inside the penis),
rectum, or throat.
2. Gonorrhea
◼ It is caused by the bacterium Neisseria
gonorrhoeae. This common STI tends to
target warm, moist areas of the body,
including the urethra, eyes, throat, vagina.
Gonorrhea can affect people of any age or
gender, but it’s particularly among teens and
young adults between the ages of 15 and 24.
3. Genital Herpes
This STD causes herpetic sores, which are painful
blisters (fluid-filled bumps) that can break open
and ooze fluid.
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4. Syphilis
◼ Syphilis is a bacterial infection usually spread
by sexual contact. The disease starts as a
painless sore — typically on the genitals,
rectum or mouth. Syphilis spreads from
person to person via skin or mucous
membrane contact with these sores.
5. HIV (human immunodeficiency virus)
◼ Is a virus that attacks the body's immune
system. It can be spread by contact with
infected blood or from mother to child
during pregnancy, childbirth or breast-
feeding.
6. Trichomoniasis.
◼ Is a sexually transmitted disease caused by a
parasite. It spreads from person to person
during sex.
7. Human papillomavirus (HPV)
◼ Is a viral infection that’s passed between
people through skin-to-skin contact.
Signs and Symptoms
❖ Sores or bumps on the genitals or in the oral or
rectal area
❖ Painful or burning urination
❖ Discharge from the penis
❖ Unusual or odorous vaginal discharge
❖ Unusual vaginal bleeding
❖ Pain during sex
❖ Sore, swollen lymph nodes, particularly in the
groin but sometimes more widespread
❖ Lower abdominal pain
❖ Fever
❖ Rash over the trunk, hands or feet
Management
Nursing Management:
• Adopt a nonjudgmental attitude. When taking
history, be honest and straightforward.
• Assure clients that all information will be treated
in the strictest confidence. Compile a complete
sexual history.
Sexual orientation
Sexual practices
Type of protection (barrier used)
Contraceptive practices
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Previous history of STDs
• Develop teaching Plan include:
sign and symptom of STDs.
STD transmission mode
A reminder that sexual contact with
anybody should be avoided when
infected.
Brief written instructions about therapy;
seek a verbalization of these instructions
in order to confirm the client has heard
and understood them.
• Encourage the client to disclose all sexual
relations.
• Notify relevant health authorities and
departments about STD incidents.
Medical Management:
• Abstinence
Avoiding sexual contact with other
persons is one of the most effective
strategies to prevent STD transmission.
• Barrier contraceptive
such as condoms, operate as a barrier to
the transmission of STDs from an
infected person. Condoms, on the other
hand, must be used appropriately in
order to avoid transmission. To avoid the
transmission of infection, used condoms
must be removed and properly disposed
of.
• Sexual health screenings
Getting a sexual health screening before
having sexual contact with a partner may
help avoid new infections. If a partner
has had contact with someone else, it is
also necessary to check before resuming
sexual interactions. This procedure isn't
always flawless, since many illnesses
may go unnoticed for long periods of
time.
Pharmacologic Management:
• Vaccination
Important vaccinations that protect
against hepatitis B and certain strains of
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the human papillomavirus are now
available (HPV).
• Nonoxynol-9
is a spermicidal and microbicidal
chemical that is used to lubricate
condoms and may kill certain vaginal
microorganisms. The combination,
however, does not provide
comprehensive protection against all
STDs.
TORCH
- TORCH Syndrome refers to infection of a
developing fetus or newborn by any of a group
of infectious agents. TORCH is an acronym
meaning (T)oxoplasmosis, (O)ther Agents,
(R)ubella (also known as German Measles),
(C)ytomegalovirus, and (H)erpes Simplex.
Infection with any of these agents may cause a
constellation of similar symptoms in affected
newborns.
Etiology/Cause
- The TORCH infections include causative
organisms Toxoplasma gondii, rubella virus,
cytomegalovirus, HSV 1 and 2, hepatitis B virus,
HIV, and others like syphilis, parvovirus, and
varicella. Transmission of the pathogens may
occur prenatally by the transplacental route,
perinatally by blood or vaginal secretions.
Postnatal infections tend to be less impactful.
Others, such as HIV, hepatitis B, and syphilis, can
be transmitted via sexual contact to a
susceptible mother. Rubella and varicella can be
prevented by properly immunizing mothers.
Types
1. Toxoplasmosis
◼ The primary manifestations of congenital
toxoplasmosis include intrauterine growth
restriction and low birth weight,
hepatosplenomegaly, jaundice,
chorioretinitis, intraparenchymal
calcifications, and anemia. Less commonly,
petechiae, hydrocephalus, and microcephaly
can be found.
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2. Congenital Rubella Syndrome
It includes low birth weight,
hepatosplenomegaly, cataracts, congenital heart
disease (patent ductus arteriosus, and
ventricular septal defect), and a petechial rash.
Congenital sensorineural hearing loss is very
common.
3. Herpes Simplex Virus
◼ It rarely presents with in utero infection but
instead presents due to perinatal exposure.
Therefore, clinical manifestations normally
will present ten to twenty-one days after
infection. There are three major
manifestations: Skin-eye-mucous
membranes (SEM), central nervous system
(CNS), and disseminated disease.
4. Cytomegalovirus
◼ CMV is the most common congenital
infection. It will present with intrauterine
growth restriction and low birth weight,
hepatosplenomegaly, jaundice,
paraventricular calcifications, cataracts, and
sensorineural hearing loss and bone marrow
suppression that will present with
thrombocytopenia and anemia. Patients
often have a petechial rash at birth.
5. HIV
◼ Patients with congenital HIV rarely have any
evidence of outward manifestations at birth.
They may have a low birth weight and
hepatosplenomegaly at birth.
6. Syphilis
◼ In utero, there may be fetal loss or hydrops
fetalis. In the neonatal period, children with
primary syphilis may present with cutaneous
lesions on the palms and soles,
hepatosplenomegaly, jaundice,
inflammation of the umbilical cord (funisitis)
and discharge from the nose (sniffles).
Periostitis may be found on x-rays of the
bones. Late findings include frontal bossing,
high palatal arch, sensorineural hearing loss,
a saddle nose, perioral fissures, and
Hutchinson teeth.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Signs and Symptoms
❖ listlessness (lethargy)
❖ fever
❖ difficulties feeding
❖ enlargement of the liver and spleen
(hepatomegaly)
❖ and decreased levels of the oxygen-carrying
pigment (hemoglobin) in the blood (anemia)
In addition, affected infants may develop areas of
bleeding, resulting in reddish or purplish spots or areas
of discoloration visible through the skin (petechiae or
purpura); yellowish discoloration of the skin, whites of
the eyes, and mucous membranes (jaundice);
inflammation of the middle and innermost layers of the
eyes (chorioretinitis); and/or other symptoms and
findings. Each infectious agent may also cause additional
abnormalities that may vary in degree and severity,
depending upon the stage of fetal development at time
of infection and/or other factors.
Management
Nursing Management:
• Advice the patient not to eat uncooked meat or
raw eggs
• Encourage the patient to always wash their
hands with soap and water often
• Avoid being around sick people
• Advice the patient to get vaccinated
• Advice the client to visit their doctor to talk
about their concern
Medical Management:
TORCH SCREEN
• A doctor usually performs some component s of
the TORCH screen routinely when a woman has
her first prenatal visit. They may perform other
components if a woman shows symptoms of
certain diseases during the pregnancy. These
diseases can cross the placenta and cause birth
defects in the newborn.
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Pharmacologic Management:
• treatment may include administration of the
medication pyrimethamine with sulfadiazine.
Herpes simplex may be treated with the antiviral
agent acyclovir. The treatment of newborns and
infants with rubella or cytomegalovirus primarily
includes symptomatic and supportive measures.
MULTIPLE PREGNANCY
- A pregnancy with more than one fetus is called
multiple pregnancy, where a mother is carrying
more than one baby. If you’re carrying two
babies, they are called twins. Three babies that
are carried during one pregnancy are called
triplets. You can also carry more than three
babies at one time called high-order multiples.
There are typically more risks linked to a multiple
pregnancy than a singleton (carrying only one
baby) pregnancy.
Etiology/Cause
There are many factors related to having a multiple
pregnancy. Naturally occurring factors include the
following:
• heredity - A family history of multiple pregnancy
increases the chances of having multiple
pregnancy.
• older age - Women over 30 years old have a
greater chance of multiple conception. Many
women today are delaying childbearing until
later in life, and may have twins as a result.
• high parity - Having one or more previous
pregnancies, especially a multiple pregnancy,
increases the chances of having multiples.
• race - African-American women are more likely
to have twins than any other race. Asian and
Native Americans have the lowest twinning
rates. Caucasian women, especially those over
age 35, have the highest rate of higher-order
multiple births (triplets or more).
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Other factors that have greatly increased the multiple
birth rate in recent years include reproductive
technologies, including the following:
• Ovulation stimulating medications such as
clomiphene citrate and follicle stimulating
hormone (FSH) help produce many eggs, which,
if fertilized, can result in multiple babies.
• Assisted reproductive technologies such as in-
vitro fertilization (IVF) and other techniques help
couples conceive. These technologies often use
ovulation stimulating medications to produce
multiple eggs which are then fertilized and
returned to the uterus to develop.
Types
1. Fraternal twins
◼ Two separate eggs are fertilized and
implanted in the uterus. The babies are
siblings who share the same uterus — they
may look similar or different, and may either
be the same gender (2 girls or 2 boys) or of
different genders. A pregnancy with
fraternal twins is statistically the lowest risk
of all multiple pregnancies since each baby
has its own placenta and amniotic sac. Some
fraternal twins are referred to as 'dizygotic'
twins, referring to 2 zygotes (fertilized eggs).
2. Identical twins
◼ Identical twins are formed when a single
fertilized egg is split in half. Each half
(embryo) is genetically identical, so the
babies share the same DNA. That means the
babies will share many characteristics.
However, because their appearance is
influenced by the environment as well as by
genes, sometimes identical twins can look
quite different. Identical twins may share the
same placenta and amniotic sac, or they may
have their own placenta and amniotic sac.
Some identical twins are referred to as
'monozygotic', referring to one zygote
(fertilized egg).
3. Triplets and 'higher order multiples' (HOMs)
◼ Triplets, quadruplets, quintuplets, sextuplets
or more can be a combination of both
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identical and fraternal multiples. For
example, triplets can either be fraternal
(trizygotic), forming from 3 individual eggs
that are fertilized and implanted in the
uterus; or they can be identical, when one
egg divides into 3 embryos; or they can be a
combination of both.
Signs and Symptoms
❖ Excessive weight gain at the start of the
pregnancy
❖ Severe morning sickness
❖ More than one heartbeat is picked up during a
prenatal examination
❖ Uterus is larger than expected
❖ Fetal movements can be felt in different parts of
the abdomen at the same time
❖ Increased breast tenderness
A multiple pregnancy is confirmed by an ultrasound scan,
usually in the first trimester (the first 12 weeks). The
ultrasound will confirm the type of multiple pregnancy,
whether there is one placenta or 2, and how many
amniotic sacs there are. These are all important factors
for later in the pregnancy and it's important to identify
them as early as possible.
Management
Nursing Management:
• Advocate healthy eating and physical activity to
the mother in her daily routine to improve
health.
• Refer to a dietitian for complete nutrition
assessment and methods for nutritional support.
• Advise the mother to avoid caffeine, alcohol, and
tobacco.
• Advise women to have proper amount of sleep.
• Refer to a perinatologist, a maternal-fetal
medicine specialist for special testing or
ultrasound evaluations, and to coordinate care
of complications.
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Medical Management:
• Ultrasound
Takes measurements of parts of the
baby's body, such as the head, abdomen
and femur to formulate an estimation of
the baby's weight.
• Blood studies
Determines the amount of glucose,
calcium, hematocrit and bilirubin.
Pharmacologic Management:
• Tocolytic medicines
Tocolytic drugs help slow or stop
contractions. These may be given orally,
by injection or intravenously . Tocolytic
medicines often include nifedipine.
Surgical Management:
• Cesarean birth
A cesarean section is usually considered
safest when there are 3 or more babies.
For twins, C-section is indicated
depending on the twins’ presentation.
Giving birth to triplets or more vaginally
is very rare and not recommended
because of the higher risk of labor
complication s and infant mortality.
HYDRAMNIOS
- Hydramnios is a condition that occurs when too
much amniotic fluid builds up during pregnancy.
It is an amount of amniotic fluid more than 2000
ml and the amniotic fluid index (AFI) is greater
than 20 to 25.
Etiology/Cause
This condition may happen for several reasons. Either
too much fluid is made or there’s a problem with the fluid
being taken away. Or both of these things may be
happening. Hydramnios may be caused by diabetes in
the mother.
Pregnant women normally have about one-half to 1
quart (500 to 1,000 ml) of amniotic fluid. Too much or
too little amniotic fluid can cause problems. These issues
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can affect how your baby develops. They can also cause
pregnancy complications. Or the amount of amniotic
fluid may be a sign of another issue
1. Fetal Cause:
➢ Congenital anomalies
➢ Single-ovum twins
➢ Increased placental mass: Edema of the
placenta due to Rh-incompatibility,
severe anemia, haemoglobinopathies
and cytomegalovirus infection
➢ True knot of the cord causes obstruction
of venous return with placental
congestion
➢ Fetal liver cirrhosis as in syphilis: Chorio-
angioma and large placenta 2
2. Maternal causes:
➢ Diabetes mellitus
➢ Pregnancy induced hypertension due to
edema of the placenta
➢ Severe generalised edema cardiac,
hepatic or renal
Types
1. Acute hydramnios
◼ This is very rare - Usually occurs at about 20
weeks and develops very suddenly - The
uterine size reaches the xiphisternum in
about 3 or 4 days - Is frequently associated
with monozygotic twins or severe fetal
malformation.
2. Chronic hydramnios
◼ This is gradual in onset, usually starting from
about the 30th week of pregnancy - The
most common type
Signs and Symptoms
Hydramnios symptoms are a result from pressure that is
being exerted within the uterus and nearby organs.
Symptoms can occur a bit differently in each pregnancy.
They can include:
❖ Fast growth of your uterus
❖ Stomach discomfort
❖ Uterus that is larger than normal for how far
along you are in pregnancy
❖ Labor pains (contractions)
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NCM 109: Care of Mother and Child at-risk or with Problems (Acute and Chronic)
Severe polyhydramnios may cause: Due to the risk of fetal heart problems. Other
side effects may include nausea, vomiting, acid
❖ Shortness of breath or the inability to breathe
reflux and inflammation of the lining of the
❖ Swelling in the lower extremities and abdominal
stomach (gastritis).
wall
❖ Uterine discomfort or contractions
❖ Fetal malposition, such as breech presentation
❖ Indigestion
❖ Difficulty with bowel movements (constipation)
❖ Enlargement of vulva
❖ Sensation of tightness in stomach

Management
Nursing Management:

• Prepare the patient for biophysical profile and

non-stress test.
• Place the mother on close monitoring.
• Expectant treatment if the fetus is healthy: rest ,
sedative, salt restriction.
• Obtain consent from the patient to perform
amniocentesis after explaining the procedure’s
purpose, benefits, and risks.
• Treat the underlying conditions related to
polyhydramnios, such as gestational/ maternal
diabetes and rhesus disease.

Medical Management:

• Utilization of Ultrasound would determine the

presence of hydramnios and also the reason for
the excessive amount of fluid.
• Non-stress test. This is done to check the
reaction of the baby’s heart rate when he/she
moves.
• Drainage of excess amniotic fluid. Utilization of
amniocentesis to drain excess amniotic fluid
from your uterus. This procedure carries a small
risk of complication s, including preterm labor,
placental abruption and premature rupture of
the membranes.

Pharmacologic Management:

• Prescription of oral medication indomethacin

(Indocin) to help reduce fetal urine production
and amniotic fluid volume. Indomethacin isn't
recommended beyond 31 weeks of pregnancy.

MODULE 1M: ANTENATAL COMPLICATIONS YUSON, DREA