Sickle Cell Anemia

Nursing Care:
Monitor fetal status
Provide emotional support

RH Sensitization
RH Sensitization is a condition in which a Rh-negative
women becomes pregnant with a Rh-positive fetus
and may become sensitized to Rh antigen and
develops anti-Rh antibodies which may cross the
placenta in subsequent pregnancies with Rh-positive
fetuses and destroy the RBCs.
Complications:
Erythroblastosis fetalis
Hydrops fetalis
Hyperbilirubinemia /Kernicterus
Fetal dead

RH Incompatibility
Rh Sensitization
All pregnant women should have a Type and Rh and
an indirect Coombs.
Pregnant women who are Rh-negative should have :
Serial Indirect Coombs
Unsensitized Rh-negative clients should have RhoGam:
During pregnancy at 28-32 weeks gestation
After any invasive procedures.
In the Postpartum period within 72 hours.





RH Incompatibility
Nursing Care:
Teach Client about the importance of complying with
prenatal visits, laboratory testing, and RhoGam
injection
Check Laboratory results on all pregnant clients . Report
findings of the client having Rh-negative blood and
indirect Coombs results. Follow through if invasive
procedures are done or after delivery about RhoGam.
Support client who has developed fetal complications
from Rh incompatibility
Hyperthyroidism and Pregnancy
HYPERTHYROIDISM is an endocrine disorder in
which there is a excessive amount of the thyroid
hormone produced.
Complications in pregnancy:
Thyrotoxicosis(Thyroid storm)
Cardiac Dysrrhythmias
Preeclampsia
Malnutrition
Fetal complications: abortion, premature delivery
Neonatal complications: Prematurity, hyperthyroidism


Hyperthyroidism In Pregnancy
Review of the clinical manifestation of Hyperthyroidism
Tachycardia and Palpitations
Nervousness
Weakness
Tremors
Heat intolerance
Weight loss despite eating regular diet,
Hair loss
Diarrhea
Hyperemesis gravidarum
T4 and T3 are elevated an TSH decreased
Hyperthyroidism and Pregnancy
NSG. DX: Alt. Nutrition, less than body requirements
Risk for injury
Knowledge deficit
Nsg Care-
Assess the client for clinical manifestation of
complications of the hyperthyroidism or pregnancy
Monitor lab tests- thyroid function tests
Administer antithyroid medications- Propylthiouracil
(PTU)
Assist the client to meet her nutritional needs during
the pregnancy with education and evaluation of diet .


Hyperthyroidism in Pregnancy
Nsg. Care-
Daily weights
Monitor fetal status
Emotional support


Hypothyroidism in Pregnancy
Hypothyroidism is a condition where thyroid does not
produce enough thyroid hormone
Complications
Decreased fertility
Abortions
Stillborns
And congenital malformations
Review of the clinical manifestations of hypothyroidism
Cold intolerance
Weight gain
Dryness of skin
Puffy face
Constipation
Mental dullness

Hypothyroidism in Pregnancy
Laboratory Findings
Low T4 and T3 and elevated TSH levels
Nsg. Diagnosis
Risk for Maternal/Fetal Injury
Knowledge deficit
Nsg Care
Preconception Care- treatment of Thyroxine prior to getting
pregnant
Administer Levothyroxine
Monitor TSH levels and T4 levels
Instruct the client about the importance of medical therapy
Monitor fetal status with FMC or NSTs

Systemic Lupus Erythematosus in
Pregnancy
Systemic Lupus Erythematous(SLE) is a chronic,
multisystem autoimmune disorder
Complications in pregnancy
Renal Failure
Cardiac Problems
CNS Problems
Preeclampsia
Abortions
Fetal Loss
Newborn- prematurity, congenital heart block, and neonatal
lupus
IUGR
Exacerbation of SLE


Systemic Lupus Erythematosus in
Pregnancy
Review of the clinical manifestations of SLE
Joint pain
Skin rash
nephritis
Pericarditis
Anemia
Leukopenia
Thrombosis of multiorgans
Fever
neuropsychiatric


Systemic Lupus Erythematosus in
Pregnancy
Laboratory Findings with SLE
Leukopenia- WBC under 4,500
Thrombocyctopenia- PLt- under 100,000
Anemia- Hg- under 10
Positive direct Coombs test
Positive Anticardiolipin antibodies
Positive tests for rheumatic factors
False Positive test for syphilis
Positive antinuclear antibodies Increased serum creatine
and decreased creatine clearance and proteinuria

Cont. SLE in Pregnancy
NSG Diagnosis
Risk for Maternal and Fetal Injury
Knowledge Deficit
Anxiety or Fear
NSG Care
Preconceptation Care
Instruct the client to see her health care providers frequently
and to follow the medical therapy
Monitor the client and the fetus and neonate for
complications
Administer Medications as order
Prednisone
Aspirin
Cyclophosphamide( Cytoxan)- only for life-threatening conditions
Azathioprine (Imuran)
Anticardiolipin Antibody Syndrome
Anticardiolipin Antibody Syndrome is an autoimmune
disorder which the client has the Anticardiolipin
antibodies. It can be seen in clients with or without SLE. It
can produce negative outcomes in pregnancy and fetal loss
Complications of Anticardiolipin antibody syndrome in
Pregnancy
Maternal
Thrombosis
Cerebral vascular accidents,
Amaurosis fumax
Transient ischemic attacks
SLE
Autoimmune thrombocytopenia
Anticardiolipin Antibody Syndrome
Cont. Complications
Fetal Complications
Abortions
Fetal loss
IUGR
Placental insufficiency
Clinical Manifestations
Several Fetal Losses
Spontaneous Abortions
Laboratory findings
Positive serum Anticardiolipin antibody titer
Other abnormal immunologic studies


Anticardiolipin Antibody Syndrome
Nsg Diagnosis
Risk for Maternal and Fetal Injury
Anxiety or Fear
Nsg Care
Administer medications
Immunosuppressant drugs- corticosteroids and others
Aspirin
Anticoagulants-Heparin
Instruct on medication therapy
Monitor client and fetus for complications
Emotional support
Myasthenia gravis in Pregnancy
Myasthenia gravis (MG)is a complex autoimmune
disorder that affects the neuromuscular system .
Complication of MG in Pregnancy
Exacerbation of the myasthenia gravis or a myasthenic
crisis
Maternal mortality because of respiratory arrest
Pregnancy loss
Premature labor
Transient Neonatal Myasthenia Gravis
Pulmonary Hypoplasia of the neonate

Myasthenia Gravis in Pregnancy
Review of the clinical manifestations of MG
Progressive muscle weakness
Difficulty in swallowing
Ptosis
Slurred speech
Fatigue
Problems breathing
NSG Diagnosis
Risk for Maternal and Fetal Injury
Anxiety or Fear
Fatigue
Alter nutrition
Risk for aspiration

Myasthenia Gravis in Pregnancy
NSG Care
Monitor client and fetus for complications
Administer medications Many medications will
exacerbate MG .Check any medication prior to give it.
See chart
Acetylcholinesterase drugs
Pyridostigmine bromide ( Mestinon) po or parental if client
can not swallow Check that client can swallow first
Anticholinergics ( Atropine)for drug over dose
Corticosteroids- Prednisone
Instruct client on therapy regimen and compliance with
the therapy and seeing health care providers regularly.
Monitor client closely in Labor.



Myasthenia Gravis In pregnancy
Note Magnesium sulfate is absolutely contraindicated
for clients who have Myasthenia Gravis
Prepare room with suction ,oxygen, and ambu bag and
check emergency equipment.
Check infant at time of birth and in nursery for
sucking and muscle tone. Watch when the baby feeds.
Provide frequent rest periods for mother

Deep Vein Thrombosis in
Pregnancy
Deep Vein Thrombosis (DVT)is a condition where
blood clots form in the veins.
Complications of DVT in Pregnancy
Vascular occlusion
Embolism
Pulmonary embolus
Hypoxia
Acidosis
death

Deep Vein Thrombosis in
Pregnancy
Clinical Manifestations of DVT
Muscle pain
Tenderness and swelling of calf
Positive Homans sign
Diagnostic parameters
Doppler ultrasonography
Venography may cause risk to fetus
Impedance plethysmorgraphy



Deep Vein Thrombosis in
Pregnancy
NSG Diagnosis
Alter. Tissue Perfusion
Risk for Injury
NSG Care
Maintain bedrest during the acute phase
Apply Ted hose
Monitor fetal status
Administer Anticoagulation therapy
Heparin-IV the Subcutaneous
Follow protocols for anticoagulant therapy
NO Warfarin Coumadin


Deep Vein Thrombosis In
Pregnancy
NSG Care
No heparin therapy once labor starts.
Monitor laboratory testing
PT, APTT, INR, Blood clotting times
Infections
Types of infections:
TORCH
STIs
Other
TORCH
TORCH is a group of infections which can cause
serious problems to the fetus

T= Toxoplasmosis
O= Other- Hepatitis -HIV
R= Rubella
C= Cytomegalovirus (CMV)
H= Herpes
Toxoplasmosis
Toxoplasmosis is a protozoan infection which is
acquired by the infestation of raw meat and handling
of raw meat in mass qualities, cat feces and handling
cat litter. If the pregnant acquires toxoplasmosis
during pregnancy it can be passed the fetus via the
placenta.
Maternal effects are mild-flu-like symptoms
Fetal-abortion, and congenital effects
Neonatal effects- CNS lesions which could lead to
hydrocephy, microcephaly, seizures and chronic
retinitis

Toxoplasmosis
Pregnant Clients should not handled cat litter or cat
feces. When handling cats wash hands afterwards
Pregnant clients should not eat raw meat and when
handling large amounts of raw meat they should wear
gloves. Wash hands after handling raw meat
Other
Hepatitis is a viral infection. There are several different
types. HAV and HBV are the must common seen in
the fetus. HAV is acquired through fecal commination.
HBV is acquired through body secretions-blood and
genital secretions
HBV effects on the client are fever, malaise, nausea,
and abdominal discomfort and maybe liver failure.
HBV effects on the fetus preterm birth and fetal death.
The Neonate can be born with the infection
Rubella
Rubella is a viral infection that is spread by droplets or
cross the placenta. It is also called the German
Measles.
Rubella titers are drawn on all pregnant women
Rubella titer of 1:8 or more indicated immunity
Rubella less than 1:8-example a titer of 1:6 or 1:4
indicates the client is non-immune. The client will need
a Rubella immunization after delivery.
Rubella effects on the client are fever, rash and mild
lymphedema.
Fetal effects are abortion, congenital anomalies and
death


Cytomegalovirus
Cytomegalovirus (CMV) is a viral infection through
respiratory droplets and body fluids and cross the
placenta.
CMV effects on the pregnant client are asympotomatic
illness, cervical discharge, or mononucleosis-like
syndrome.
CMV effects on the fetus are fetal death or severe
generalized disease, hemolytic anemia, jaundice,
hydrocephaly, microcephy.
CMV effects on the neonate are pneumonia,
hepatosplenomegaly and deafness
Herpes Simplex Virus
Herpes Simplex Virus (HSV)is a viral infection that is
spread by exposure to the vesicular lesions.
HSV effects on the pregnant client are blisters which
are painful, rash, fever, malaise, nausea, and
headaches.
HSV effects on the fetus are abortion, preterm labor,
stillborn, IUGR- transplacental spread of infection is
rare.
HSV effects on the neonate are skin lesions, mental
retardation, and microcephaly
STIs
Human Immunodeficiency Virus (HIV)
Chlamydia
Syphilis
Hepatitis B
Group Beta Streptococci (GBS)
Herpes
Gonorrhea
Human papillomavis (HPV)
Urinary Tract Infections in
Pregnancy
Lower UTIs Cystitis
Can cause preterm labor and pyelonephritis
Upper UTIs- Pyelonephritis
Can cause preterm labor , sepsis, and renal failure
Medications
Cephalosporin's
Ampicillins or Amoxicillin
No Sulfonamide within 4 weeks of delivery can cause
kernicterus in the neonate
No Trimethoprim in early pregnancy
No Tetracyclines
Epilepsy in Pregnancy
Epilepsy is a neurologic disorder in which there is
recurrent seizure activity.
The client who is pregnant and has epilepsy could
have an increased risk for seizures , abortions,
premature labor, and stillborn infants.
Many anticonvulsants can produce teratogenic effects
Phenytoin(Dilantin)
Carbamazepine
Dapakote
The pharmokenetics of the seizure medication is effect
by the changes in physiology during pregnancy.



Trauma in Pregnancy
Trauma in pregnancy
Abdominal Trauma can be caused by
Accidents such as falls or automobile accidents (MVA)
Assault
With weapons
Abuse/violence
Complications unique to pregnancy of abdominal
trauma
Placenta abruption
Preterm labor
Uterine trauma or rupture
Bladder trauma or rupture
Maternal or Fetal death
Trauma in Pregnancy
Clinical Manifestations
History of trauma or accident
Visible injuries
Pain
Signs of Shock
Uterine activity
Abdominal swelling or firmness
Nonreassuring fetal Heart Pattern
Nsg diagnosis
Risk for Injury Anxiety
Alt. Tissue Perfusion Fear


Trauma in Pregnancy
NSG Care
Assess and triage the serious of injures
ABCs
Start Iv with Large bore catheter
Monitor for clinical manifestations of shock and /or
hemorrhage
Monitor uterine activity
Monitor fetal heart pattern
I&O-hourly
Be Prepare for a delivery of the baby
Notify ICN staff
Emotional support



Cholcycstitis and Cholelithiasis in
Pregnancy
Cholcycstitis and Cholelithiasis are common during
pregnancy.
Clinical manifestations
Right upper quadrant tenderness and pain
Murphy Sign
Attacks after meals
Pain with nausea and vomiting
Medical Treatment during pregnancy
Low Fat Diet

Cont.
NSG Care
Monitor for signs of Gall bladder obstruction
Instruct client on low fat diet
Less than 20 grams of fat
Calories such come mainly from carbohydrates
Plenty of fruit and vegetables
Lean meats
Only 10-12 % of calories such be protein
A pregnant client will not be able to have lipotripesy
or drugs to dissolve gall stones.

Surgery in
Pregnancy
The problem with surgery in pregnancy will vary
depending on the surgery.
Complications that are unique with pregnancy
preterm labor, and fetal injury from various cause such
as hypoxia, medications, and trauma.
Close monitoring for labor and the fetal status are
required
SUBSTANCE ABUSE in Pregnancy
Substance Abuse is a major problem in the United
States . It is estimated that 10% of pregnant abuse 0r
use some substance during pregnancy. (Tobacco,
alcohol or other drugs)
All pregnant women should be screened for substance
abuse.
See text for the effects of drugs on the fetus and
neonate and pregnancy
For now