Topic:

"GESTATIONAL

CONDITIONS AFFECTING

PREGNANCY OUTCOMES"
Student: Quindala, Liz G.
Clinical Instructor: Mrs. Erlinda Guzman, RN, MAN..
 Content
A. Hyperemesis Gravidarum B. Ectopic Pregnancy

C. Gestational Trophoblastic Disease (H-Mole)

D. Incompetent Cervix E. Spontaneous Abortion F. Placenta Previa

G. Abruptio Placenta H. Premature Rupture of Membrane

I. Pregnancy Induced Hypertension

Treatments A. Hyperemesis
Lifestyle changes. If you can eat,

have smaller, more frequent meals.

Gravidarum
Drink smaller drinks, but drink more
Is the medical term for severe nausea and

often, and through a straw. Try cold

foods if hot ones trigger nausea.

vomiting during pregnancy. The symptoms

Your doctor may want you to drink

can be severely uncomfortable. It can lead to

electrolyte-replacement sports
dehydration, weight loss, and electrolyte

drinks and nutritional supplements.

Get enough sleep and try to manage

imbalances. Morning sickness is mild nausea

your stress. and vomiting that occurs in early pregnancy.

Ginger. Taking 1 to 1.5 grams a day

in several small doses may help

some women. You can get it in tea,

Causes
lollipops, or supplements.
Most women have some nausea or vomiting (morning sickness),

Pyridoxine. This vitamin, known as

vitamin B6, is often prescribed for

particularly during the first 3 months of pregnancy. The exact

nausea in pregnancy. Typical doses

cause of nausea and vomiting during pregnancy is not known.

are 10 mg to 25 mg, 3 times a day.

However, it is believed to be caused by a rapidly rising blood level

Taking more may lead to temporary

of a hormone called human chorionic gonadotropin (HCG). HCG is

nerve damage.
Thiamine. This vitamin (also called

released by the placenta. Mild morning sickness is common.

vitamin B1) in doses of 1.5 milligrams

Hyperemesis gravidarum is less common and more severe.
a day may ease vomiting.

 B. Ectopic

Pregnancy
An ectopic pregnancy is one in which implantation occurs outside

the uterine cavity. The implantation may occur on the surface of

the ovary or in the cervix. The most common site (in approximately

95% of such pregnancies) is in a fallopian tube. Of these fallopian

tube sites, approximately 80% occur in the ampullar portion, 12%

occur in the isthmus, and 8% are interstitial or fimbrial (Yates &

King, 2007). With ectopic pregnancy, fertilization occurs as usual in

the distal third of the fallopian tube. Immediately after the union of

ovum and spermatozoon, the zygote begins to divide and grow.

Unfortunately, because an obstruction is present, such as an

adhesion of the fallopian tube from a previous infection (chronic

salpingitis or pelvic inflammatory disease), congenital

malformations, scars from tubal surgery, or a uterine tumor

pressing on the proximal end of the tube, the zygote cannot travel

the length of the tube. It lodges at a strictured site along the tube

and implants there instead of in the uterus.

 ASSESSMENT
With ectopic pregnancy, there are no unusual symptoms at the time of

implantation. The corpus luteum of the ovary continues to function as if the

implantation were in the uterus. No menstrual flow occurs. A woman may

experience the nausea and vomiting of early pregnancy, and a pregnancy

test for hCG will be positive. Many ectopic pregnancies are diagnosed by an

early pregnancy ultrasound. Magnetic resonance imaging (MRI) is also

effective to use for this.

If not revealed by an ultrasound, at weeks 6 to 12 of pregnancy (2 to 8 weeks

after a missed menstrual period), the zygote grows large enough to rupture

the slender fallopian tube or the trophoblast cells actually break through the

narrow base. Tearing and destruction of the blood vessels in the tube result.

The extent of the bleeding that occurs depends on the number and size of

the ruptured vessels.

If implantation is in the interstitial portion of the tube (where the tube joins

the uterus), rupture can cause severe intraperitoneal bleeding. Fortunately,

the incidence of tubal pregnancies is highest in the ampullar area (the distal

third), where the blood vessels are smaller and profuse hemorrhage is less

likely. However, continued bleeding from this area may, in time, result in a

large amount of blood loss. Therefore, a ruptured ectopic pregnancy is

serious regardless of the site of implantation.

Therapeutic Management

Some ectopic pregnancies spontaneously end before they rupture and

are reabsorbed over the next few days, requiring no treatment. It is

difficult to predict when this will happen,

so when an ectopic pregnancy is revealed by an early ultrasound, some

action is taken. An unruptured ectopic pregnancy can be treated

medically by the oral administration of methotrexate followed by

leucovorin (Hajenius et al., 2009). Methotrexate, a folic acid antagonist

chemotherapeutic agent, attacks and destroys fast-growing cells.

Because trophoblast and zygote growth is so rapid, the drug is drawn to

the site of the ectopic pregnancy.

Mifepristone, an abortifacient, is also effective at causing sloughing of

the tubal implantation site. The advantage of these therapies is that the

tube is left intact, with no surgical scarring that could cause a second

ectopic implantation.

The therapy for a ruptured ectopic pregnancy is laparoscopy to ligate

the bleeding vessels and to remove or repair the damaged fallopian

tube. A rough suture line on a fallopian tube may lead to another tubal

pregnancy, so either the tube will be removed or suturing on the tube is

done with microsurgical technique

 C. Gestational

ASSESSMENT Trophoblastic

Because proliferation of the trophoblast cells occurs so rapidly with

this condition, the uterus tends to expand faster than normally. This
Disease (H- Mole)
causes the uterus to reach its landmarks (just over the symphysis

brim at 12 weeks, at the umbilicus at 20 to 24 weeks) before the

Gestational trophoblastic disease

is abnormal proliferation

usual time. This rapid development is also diagnostic of multiple

and then degeneration of the trophoblastic villi (Garg &

pregnancy or a miscalculated due date, however, so this finding

Giuntoli, 2007). As the cells degenerate, they become filled

must be evaluated carefully. Because hCG is produced by the

with fluid and appear as clear fluid-filled, grape-sized

trophoblast cells that are overgrowing, a serum or urine test of hCG

vesicles. The embryo fails to develop beyond a primitive

for pregnancy will be strongly positive (1 to 2 million IU compared

with a normal pregnancy level of 400,000 IU). start. Abnormal trophoblast cells must be identified because

they are associated with choriocarcinoma, a rapidly

At approximately week 16 of pregnancy, if the structure was not

metastasizing malignancy.
identified earlier by ultrasound, it will identify itself with vaginal

bleeding. This may begin as spotting of dark brown blood or as a

The incidence of gestational trophoblastic disease is

profuse fresh flow. As the bleeding progresses, it is accompanied by

approximately 1 in every 1500 pregnancies. The condition

discharge of the clear fluid-filled vesicles. This is why it is important

tends to occur most often in women who have a low

for any woman who begins to miscarry at home to bring any clots or

tissue passed to the hospital with her. The presence of clear fluid-
protein intake, in women older than age 35 years, in

filled cysts changes the diagnosis from miscarriage to gestational

women of Asian heritage, and in blood group A women who

trophoblastic disease. marry blood group O men (Aghajanian, 2007).

THERAPEUTIC MANAGEMENT

Therapy for gestational trophoblastic disease is suction

curettage to evacuate the mole. Following mole extraction,

women should have a baseline pelvic examination, a

chest radiograph, and a serum test for the beta subunit

of hCG. After surgery, hCG levels remain high. Half of women

still have a positive reading at 3 weeks; one-fourth still have a

positive test result at 40 days. The hCG is then analyzed every

2 weeks until levels are again normal. After that, serum hCG

levels are assessed every 4 weeks for the next 6 to 12 months.

Gradually declining hCG titers suggest no complication is

developing. Levels that plateau for three times or increase

suggest that a malignant transformation is occurring. A

woman should use a reliable contraceptive method such as

an oral contraceptive agent for 12 months so that a positive

pregnancy test (the presence of hCG) resulting from a new

pregnancy will not be confused with increasing levels and a

developing malignancy. After 6 months, if hCG levels are still

negative, a woman is theoretically free of the risk of a

malignancy developing. By 12 months, she could plan a

second pregnancy.
 D. INCOMPETENT

CERVIX

An incompetent cervix, also called a cervical insufficiency,

occurs when weak cervical tissue causes or contributes to

premature birth or the loss of an otherwise healthy

pregnancy.

Before pregnancy, your cervix — the lower part of the uterus

that opens to the vagina — is normally closed and firm. As

pregnancy progresses and you prepare to give birth, the

cervix gradually softens, decreases in length (effaces) and

opens (dilates). If you have an incompetent cervix, your cervix

might begin to open too soon — causing you to give birth too

early.

 SYMPTOMS

If you have an incompetent cervix, you may not have any

signs or symptoms during early pregnancy. Some women

have mild discomfort or spotting over the course of several

days or weeks starting between 14

and 20 weeks of pregnancy. Be on the lookout for:

A sensation of pelvic pressure

A new backache

Mild abdominal cramps

A change in vaginal discharge

Light vaginal bleeding

 PREVENTION

You can't prevent an incompetent cervix — but there's much you can do to

promote a healthy, full-term pregnancy. For example:

Seek regular prenatal care. Prenatal visits can help your doctor

monitor your health and your baby's health. Mention any signs

or symptoms that concern you, even if they seem silly or

unimportant.
Eat a healthy diet. During pregnancy, you'll need more folic acid,

calcium, iron and other essential nutrients. A daily prenatal

vitamin — ideally starting a few months before conception —

can help fill any dietary gaps.

Gain weight wisely. Gaining the right amount of weight can

support your baby's health. A weight gain of 25 to 35 pounds

(about 11 to 16 kilograms) is often recommended for women

who have a healthy weight before pregnancy.

Avoid risky substances. If you smoke, quit. Alcohol and illegal

drugs are off-limits, too. In addition, get your doctor's OK before

taking any medications or supplements — even those available

over-the-counter.

 E. SPONTANEOUS Types Of Spontaneous

ABORTION

Abortion is the medical term for any interruption

Abortion
of a preg- nancy before a fetus is viable (able to

survive outside the uterus if born at that time).

Spontaneous miscarriage occurs in 15% to 30% of all pregnancies and

arises from natural causes (Uzelac & Garmel, 2007). A spontaneous

miscarriage is an early miscarriage if it occurs before week 16 of

pregnancy and a late miscarriage if it occurs between weeks 16 and 24.

For the first 6 weeks of pregnancy, the developing placenta is tentatively

attached to the decidua of the uterus; during weeks 6 to 12, a

moderate degree of attachment to the myometrium is present. After

week 12, the attachment is penetrating and deep. Because of the

degrees of attachment achieved at different weeks of pregnancy, it is

important to attempt to establish the week of the pregnancy at which

bleeding has become apparent. Bleeding before week 6 is rarely severe;

bleeding after week 12 can be profuse because the placenta is

implanted so deeply. Fortunately, at this time, with such deep placental

implantation, the fetus tends to be expelled as in natural childbirth

before the placenta separates. Uterine contractions then help to

control placental bleeding as it does postpartally. For some women,

then, the stage of attachment between weeks 6 and 12 can lead to the

most severe, even life-threatening, bleeding.

 ASSESSMENT F. Placenta Previa

Is a condition of pregnancy in which the placenta is implanted

Because routine ultrasounds are performed so frequently

abnormally in the uterus. It is the most common cause of painless

during pregnancy, most instances of placenta previa are

diagnosed today before any symptoms occur. Although many

bleeding in the third trimester of pregnancy (Scearce & Uzelac, 2007).
low-lying placentas detected on early ultrasounds migrate

upward to a noncervical position, the condition is explained

It occurs in four degrees: implantation in the lower rather than in the

to a woman and she is cautioned to avoid coitus, to get

upper portion of the uterus (low-lying placenta); marginal implantation

adequate rest, and to call her health care provider at any sign
(the placenta edge approaches that of the cervical os); implantation

of vaginal bleeding. that occludes a portion of the cervical os (partial placenta previa); and

Bleeding with placenta previa begins when the lower uterine

implantation that totally obstructs the cervical os (total placenta

segment starts to differentiate from the upper segment late

previa).
in pregnancy (approximately week 30) and the cervix begins

to dilate.
The bleeding results from the placenta’s inability to stretch to

accommodate the differing shape of the lower uterine

segment or the cervix. The bleeding that occurs is usually

abrupt, painless, bright red, and sudden enough to frighten a

woman. It is not associated with increased activity or

participation in sports. It may stop as abruptly as it began, so

that by the time a woman is seen at the health care site she is

no longer bleeding, or it may slow after the initial

hemorrhage but continue as continuous spotting.

 Immediate
Therapeutic Management
Care Measures.

To ensure an adequate blood supply to a woman and

immediately on bed rest in a

fetus, place the woman

The bleeding of placenta previa, like that of ectopic

pregnancy, is an emergency situation. The site of bleeding, the

side-lying position. Be sure to assess: open vessels of the uterine decidua (maternal blood), places

·Duration of the pregnancy the mother at risk for hemorrhage. Because the placenta is

·Time the bleeding began loosened, the fetal oxygen supply may be compromised,

·Woman’s estimation of the amount of blood—ask her

placing the fetus at risk also. With the placental loosening,

to estimate in terms of cups or tablespoons (a cup is

preterm labor (labor that occurs before the end of week 37 of

240 mL; a tablespoon is 15 mL) gestation) may begin, posing the additional threat of preterm

birth to the fetus.
·Whether there was accompanying pain

·What she has done for the bleeding (if she inserted a

tampon to halt the bleeding, there may be hidden

bleeding)

·Whether there were prior episodes of bleeding during

the pregnancy
· Whether she had prior cervical surgery for premature

cervical dilation.

 Immediate Care Measures.

Inspect the perineum for bleeding. Estimate the present rate of blood loss. Weighing

perineal pads before and after use and calculating the difference by subtraction is a

good method to determine vaginal blood loss.

Obtain baseline vital signs to determine whether symptoms of shock are present.

Continue to assess blood pressure every 5 to 15 minutes or continuously with an

electronic cuff. Other necessary actions are intravenous fluid therapy using a large-

gauge catheter and monitoring urine output frequently, as often as every hour, as an

indicator of blood volume adequacy.

Continuing Care Measures. The point at which a diagnosis of placenta previa is made

and the age of the gestation dictate the final management. If labor has begun, bleeding

is continuing, or the fetus is being compromised (measured by the response of the

fetal heart rate to contractions), birth must be accomplished regardless of gestational

age.

 G. Abruptio ASSESSMENT
Placenta A woman experiences a sharp, stabbing pain high in the uterine

fundus as the initial separation occurs. If labor begins with the

separation, each contraction will be accompanied by pain over

placenta (also called abruptio

placentae; appears to have

Unlike placenta previa, in premature separation of the

and above the pain of the contraction. In some women,

additional pain is not evident with contractions but tenderness

been implanted correctly. Suddenly, however, it begins to

can be felt on uterine palpation. Heavy bleeding usually

accompanies premature separation of the placenta, like

separate and bleeding results. Premature separation of

placenta previa, although it may not be readily apparent. There

the placenta occurs in about 10% of pregnancies and is

will be external bleeding only if the placenta separates first at

the most frequent cause of perinatal death (Arquette &

the edges and blood escapes freely.
Holcroft, 2007).

The separation generally occurs late in pregnancy; it

may occur as late as during the first or second stage of

labor. Because premature separation of the placenta

may occur during an otherwise normal labor, it is

important always to be alert to the amount and kind of

virginal bleeding a woman is having in labor. Listen to her

description of the kind of pain she is experiencing to

help detect this grave complication.

 Therapeutic
For better prediction of fetal and maternal outcome, the

degrees of placental separation can be graded (Table 21.5).

Unless the separation is minimal (grades 0 and 1), the

Management pregnancy must be terminated because the fetus cannot

obtain. adequate oxygen and nutrients. If vaginal birth does

not seem imminent, cesarean birth is the birth method of

Separation of the placenta is an emergency situation

choice. If DIC has developed, cesarean surgery may pose a

(Neilson, 2009). A woman needs a large-gauge

grave risk because of the possibility of hemorrhage during

intravenous catheter inserted for fluid replacement and the surgery and later from the surgical incision.
oxygen by mask to limit fetal anoxia. Monitor fetal heart

sounds externally and record maternal vital signs every

5 to 15 minutes to establish baselines and observe

progress. The baseline fibrinogen determination is

followed by additional determinations up to the time of

birth. Keep a woman in a lateral, not supine, position to

prevent pressure on the vena cava and additional

interference with fetal circulation. It is important not to

disturb the injured placenta any further. Therefore, do

not perform any abdominal, vaginal, or pelvic

examination on a woman with a diagnosed or

suspected placental separation.

G. Abruption Placenta VS. F. Placenta Previa

Chronic Hypertention
Causes > 35 age

Preeclampsia PROM Scaring due to surgery

Cocaine, smoking
More than one child
Carrying more than baby
Cocaine, smoking
Trauma
G. Abruption Placenta VS. F. Placenta Previa

D- ark red bleeding

Signs and Symptoms
E- extended fundal height
P- ianless bright re bleeding (Vaginal)
T-ender uterus
R- elaxed soft non-tender uterus
A- bdominal pain/contractions
E- pisodes of bleeding
C- oncealed bleeding
V- isible bleeding
H- ard abdomen
I- ntercourse post bleeding
E- xperience DIC
A- bnormal Fetal position
D- istressed baby
 H. Premature Rupture of

Membrane
ASSESSMENT
Is rupture of fetal membranes
with loss of amniotic fluid during

Rupture of the membranes is suggested by the history. A

woman usually describes a sudden gush of clear fluid from her

pregnancy before 37 weeks (Mercer et al., 2007). The cause of

vagina, with continued minimal leakage. Occasionally, a woman

preterm rupture is unknown, but it is associated with infection of

mistakes urinary incontinence caused by exertion for rupture

the membranes (chorioamnionitis). It occurs in 5% to 10% of

of membranes. Amniotic fluid cannot be differentiated from

pregnancies. If rupture occurs early in pregnancy, it poses a major

urine by appearance, so a sterile vaginal speculum examination

threat to the fetus as, after rupture, the seal to the fetus is lost and

is done to observe for vaginal pooling of fluid. If the fluid is

uterine and fetal infection may occur.

tested with Nitrazine paper, amniotic fluid causes an alkaline

reaction on the paper (appears blue) and urine causes an

A second complication that can result from preterm membrane

acidic reaction (remains yellow).

rupture is increased pressure on the umbilical cord from the loss

The fluid can also be tested for ferning, or the typical

of amniotic fluid, inhibiting the fetal nutrient supply, or cord

appearance of a high-estrogen fluid on microscopic

prolapse (extension of the cord out of the uterine cavity into the

examination (amniotic fluid shows this; urine does not). The

vagina), a condition that could also interfere with fetal circulation.

presence of a high level of alpha-fetoprotein (AFP) in the vagina

Cord prolapse is most apt to occur when the fetal head is still too

is also diagnostic (Shahin & Raslan, 2007). If there is still a

small to fit the cervix firmly. Yet another risk to the fetus of

question regarding whether the membranes have ruptured, an

remaining in a non-fluid-filled environment is the development of a

ultrasound may be ordered to assess the amniotic fluid index.

Potter-like syndrome or distorted facial features and pulmonary

Because preterm rupture of membranes is associated with

hypoplasia from pressure (Hofmeyr, 2009). Preterm labor may

vaginal infection, cultures for Neisseria gonorrhoeae,

follow rupture of the membranes and end the pregnancy.

Streptococcus B, and Chlamydia are usually taken.

 Therapeutic
Management
If labor does not begin and

the fetus is not at a point of

viability, a woman is placed on bed rest either in the

hospital or at home and administered a corticosteroid to

hasten fetal lung maturity. Prophylactic administration of

broad-spectrum antibiotics during this period may both

delay the onset of labor and reduce the risk of infection

in the newborn sufficiently to allow the corticosteroid to

have its effect. Women positive for Streptococcus B

need intravenous administration of penicillin or

ampicillin to reduce the possibility of this infection in the

newborn. A woman with no signs of infection may be

administered a tocolytic agent if labor contractions begin

(Mercer, 2007).

 I. PREGNANCY
Pathophysiologic Events
INDUCED

HYPERTENSION

The symptoms of PIH affect almost all organs. The

vascular spasm may be caused by the increased

Pregnancy-induced hypertension (PIH) is a condition in which

cardiac output that occurs with pregnancy and

vasospasm occurs during pregnancy in both small and large arteries.

injures the endothelial cells of the arteries or the

Signs of hypertension, proteinuria, and edema develop. It is unique to

action of prostaglandins (notably decreased

pregnancy and occurs in 5% to 7% of pregnancies (Bailis & Witter, 2007).

prostacyclin, a vasodilator, and excessive production

Despite years of research, the cause of the disorder is still unknown

although it is highly correlated with the antiphospholipid syndrome or

of thromboxane, a vasoconstrictor and stimulant of

the presence of antiphospholipid antibodies (Clark, Silver, & Branch,

platelet aggregation). Normally, blood vessels during

2007). pregnancy are resistant to the effects of pressor

Originally it was called toxemia because researchers pictured a toxin of

substances such as angiotensin and norepinephrine,

some kind being produced by a woman in response to the foreign

so blood pressure remains normal during pregnancy.

protein of the growing fetus, the toxin leading to the typical symptoms. A

With PIH, this reduced responsiveness to blood

condition separate from chronic hypertension, PIH tends to occur most

frequently in women of color or with a multiple pregnancy, primiparas

pressure changes appears to be lost.

younger than 20 years or older than 40 years, women from low

Vasoconstriction occurs and blood pressure

socioeconomic backgrounds (perhaps because of poor nutrition), those

increases dramatically.
who have had five or more pregnancies, those who have hydramnios

(overproduction of amniotic fluid; refer to discussion later), or those who

have an underlying disease such as heart disease, diabetes with vessel

or renal involvement, and essential hypertension.

 Gestational

Hypertension
Eclampsia
This is the most severe classification of PIH. A

A woman is said to have gestational

woman has passed into this stage when cerebral

hypertension when she develops an elevated

edema is so acute that a grand-mal seizure (tonic-

blood pressure (140/90 mm Hg) but has no

proteinuria or edema. Perinatal mortality is

clonic) or coma occurs. With eclampsia, the maternal

not increased with simple gestational

mortality rate is as high as 20% from causes such as

hypertension, so no drug therapy is

cerebral hemorrhage, circulatory collapse, or renal

necessary failure (Bailis & Witter, 2007).

The fetal prognosis with eclampsia is also poor

Mild Pre-eclampsia because of hypoxia and consequent fetal acidosis. If

If a seizure from PIH occurs, a woman has eclampsia, but

premature separation of the placenta from

any status above gestational hypertension and below a

vasospasm occurs, the fetal prognosis is even

point of seizures is pre-eclampsia. A woman is said to be

graver. If a fetus must be born before term, all the

mildly pre-eclamptic when she has proteinuria and blood

risks of immaturity will be faced. In pre-eclampsia,

pressure rises to 140/90 mm Hg, taken on two occasions

at least 6 hours apart. The diastolic value of blood

the fetal mortality rate is approximately 10%. If

pressure is extremely important to document because it

eclampsia develops, the mortality rate increases to

is this pressure that best indicates the degree of

as high as 20% (Bailis & Witter, 2007).
peripheral arterial spasm present.
 Nursing Interventions for a
Promote Good Nutrition.
A woman needs to continue her usual pregnancy

Woman With Mild PIH nutrition. At one time, stringent restriction of salt was

Clients with mild pre-eclampsia can be managed at home

advised to reduce edema. This is no longer true

with frequent follow-up care. Regardless of the setting, the

because stringent sodium restriction may activate the

care is similar. reninangiotensin-aldosterone system and result in

increased blood pressure, compounding the problem.

Monitor Antiplatelet Therapy.
Because of the increased tendency for platelets to cluster along
Provide Emotional Support.
arterial walls, a mild antiplatelet agent, such as low-dose aspirin,
It is difficult for a woman with pre-eclampsia to

may prevent or delay development of pre-eclampsia (Duley et al.,

appreciate the potential seriousness of

2009). Because aspirin is such a common, over-the-counter drug,

symptoms because they are so vague. Neither

women may not appreciate that this is a serious drug prescription

high blood pressure nor protein in urine is

for them. Be certain they are taking low-dose aspirin (50–150 mg)

as excessive salicylic levels can cause maternal bleeding at the time

something she can see or feel. She may be

of birth. aware that edema is present, but it seems

unrelated to the pregnancy: It is her hands

Promote Bed Rest. that are swollen, not a body area near her

When the body is in a recumbent position, sodium tends to be

growing child.
excreted at a faster rate than during activity. Bed rest, therefore,
Health care providers cannot solve financial problems, but be certain to ask

is the best method of aiding increased evacuation of sodium and

enough questions at health care visits so that financial need, if present, can be

encouraging diuresis. Rest should always be in a lateral

determined. Questions such as, “What will it mean to your family if you have to be

recumbent position to avoid uterine pressure on the vena cava

on bed rest?” and “How long a maternity leave does your work allow?” bring

and prevent supine hypotension syndrome concerns out into the open.
 Monitor Fetal Well-being.
Nursing Interventions for a Generally, single Doppler auscultation at approximately 4-hour intervals

Woman With Severe PIH is sufficient at this stage of management. However, the fetal heart rate

may be assessed continuously with an external fetal monitor. A woman

may have a nonstress test or biophysical profile done daily to assess

Support Bed Rest. uteroplacental sufficiency. Oxygen administration to the mother may be

necessary to maintain adequate fetal oxygenation and prevent fetal

With severe pre-eclampsia, most women are hospitalized so that bed

bradycardia.
rest can be enforced and a woman can be observed more closely

than she can be on home care. Visitors are usually restricted to

support people such as a husband, father of the child, mother, or

Support a Nutritious Diet.

older children.
A woman needs a diet moderate to high in protein and moderate in

sodium to compensate for the protein she is losing in urine. An

intravenous fluid line is usually initiated and maintained to serve as an

emergency route for drug administration as well as to administer fluid to

reduce hemoconcentration and hypovolemia.

Monitor Maternal Well-being. Administer Medications to Prevent Eclampsia.

Take blood pressure frequently (at least every 4 hours) or with a
A hypotensive drug such as hydralazine (Apresoline), labetalol

continuous monitoring device to detect any increase, which is a

(Normodyne), or nifedipine may be prescribed to reduce hypertension.

warning that a woman’s condition is worsening. Obtain blood studies

These drugs act to lower blood pressure by peripheral dilatation and thus

such as a complete blood count, platelet count, liver function, blood

do not interfere with placental circulation. They can cause maternal

urea nitrogen, and creatine and fibrin degradation products as ordered

tachycardia. Therefore, assess pulse and blood pressure before and after

to assess renal and liver function and the development of DIC, which
administration. Diastolic pressure should not be lowered below 80 to 90

often accompanies severe vasospasm. mm Hg or inadequate placental perfusion could occur.

 Thank

you for

listening!