CARE OF MOTHER AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC)
DEMOGRAPHIC FACTORS Severe social problems
Unplanned pregnancy especially
1. MATERNAL AGE
among adolescents
YOUNG AGE pregnant teens are OBSTETRIC HISTORY
more likely to develop pregnancy-
related high blood pressure and History of infertility or multiple
anemia and to go through pre-term gestation
labor and delivery than women who Grand multiparity
are older. Previous abortion or ectopic
pregnancy
Previous loses, fetal death, stillbirth,
FIRST TIME PREGNANCY AFTER
neonatal or prenatal deaths
AGE 35 Women over 35 are more
Previous operative OB: cesarean
likely to have complications commonly
section
associated with pregnancy regardless
Previous uterine or cervical
of age including:
abnormality
Previous abnormal labor: pre-mature
An increased risk of developing high
labor, prolonged labor.
blood pressure or gestational
Previous low birth weight (LBW),
diabetes.
macrosomic (LGA), with neurologic
Being more likely to have a multiple
deficit, birth injury or malformation.
pregnancy (twins or triplets.)
Higher likelihood of low birth weight. MATERNAL MEDICAL HISTORY/
Needing a cesarean delivery. STATUS
2. WEIGHT Cardiac and pulmonary disease
Being either overweight or underweight Metabolic disease’; diabetes, thyroid
can lead to complication during disease
pregnancy. Endocrine disorders: pituitary, adrenal
Chronic renal disease: repeated UTI,
OBESITY women who are obese are bacteuria
at higher risk than normal weight Chronic hypertension
women of having with certain birth Veneral and other infectious disease
defects including: Major congenital anomalies of the
* spina bifida * hydrocephaly reproductive tract
* heart problems * cleft palate and lip Hemoglobinopathies
Seizure disorder
UNDERWEIGHT women who weighs Malignancy
less than 100 pounds are more likely Major emotional disorders, mental
to deliver prematurely or give birth to retardation
an underweight baby. HABITS/HABITUATION
3. HEIGHT less than 5 feet Smoking during pregnancy
Regular alcohol intake
Drug use/abuse
SOCIOECONOMIC STATUS
Inadequate finances
Overcrowding standards of housing
Poor hygiene
Nutritional deprivation
CARE OF MOTHER AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC)
DIAGNOSTIC TESTS IN HIGH-RISK 5. Psychological support is given to the
PREGNANCY mother/father (couple)
Explain the reasons for the
ULTRASONOGRAPHY procedures together with its
benefits and the preparations.
A non-invasive diagnostic procedure
Explain that there is no known risk
utilizing high frequency sound waves to
with infrequent and brief exposure
detect intrabody structures.
to high frequency of sound waves.
PURPOSE Encourage verbalization of fears
and concerns
1. In early pregnancy: to confirm Procedure is non-invasive and
pregnancy safe for mother and fetus
2. To detect the fetus’s: Confinement is not needed
Viability, growth No need for dye and there is no X-
Number (multiple pregnancy) ray irradiation
Heart tones Procedure takes a short time to
Abnormalities accomplish
Position, presentation
Age of gestation by determining NON-STRESS TEST
the biparietal diameter of the fetal
Observation of FHT related to fetal
head
movement
Most accurate at 12 to 24 weeks
A test of fetal well being
Biparietal diameter of 9.5
cm=mature fetus PREPARATION
3. Detects placental location (placenta
previa) or placental abnormality (H- A. Position semi-fowler’s or left lateral
mole) position slightly turned to the left
4. An important aid in high risk B. Blood pressure is checked first
procedures like amniocentesis
Procedure takes 30-60 minutes to
PREPARATION finish
Mother needs to activate “mark
1. Advise mother to drink one quart of
button” with each fetal movement
water 2 hours before the procedure.
Does not need hospitalization-
2. Instruct not to void
ambulatory basis
3. In amniocentesis with ultrasound to
Requires external electronic
offer visualization, the mother should
monitoring of FHT with ultrasound
not void to prevent injuring the
transducer and tocodynamometer
distended bladder with needle
to trace fetal activity and/or uterine
insertion
activity.
4. Transmission of gel is spread over
maternal abdomen
CARE OF MOTHER AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC)
No late decelerations of FHR with
each of three contractions during a 10
minutes interval
Abnormal: Positive
With late deceleration of FHR with
INTERPRETATION: three contractions in 1o minutes
Normal: Reactive
IMPLICATIONS OF RESULT
Increased FHT (acceleration) greater
than 15 bpm above baseline-lasting 15 Normal results
seconds or more in a 10-20 minutes
pregnancy continues; normal results of
period with fetal movement
OCT may require weekly tests
Abnormal: Non-Reactive
Abnormal results
No FHR acceleration with fetal
may indicate a need for cesarean
movement
section or continues observation
IMPLICATIONS OF RESULT:
NIPPLE STIMULATION CONTRACTION
Abnormal result: Mother needs another TEST
test, may be a biophysical profile.
1. Determines fetoplacental function/well-
OXYTOCIN CHALLENGE TEST being
PURPOSE: 2. Breast are stimulated with rolling of
nipples or warm towel application.
1. Observation of response of the fetus to
induced uterine contraction Stimulation of the nipple causes
2. A test of fetoplacental well being stimulus to be sent to the posterior
pituitary gland which in turn secretes
PREPARATION: oxytocin. This oxytocin, in addition to
a. Semi- fowler’s or left lateral position causing contraction of the breast
b. BP is checked priorly and every 15 tubules, also has a direct effect on
minutes during the test uterine musculature causing it to
c. Explain: contract.
Procedure takes 1-3 hours to finish, 3. The baseline data are obtained through
mother receives oxytocin of increasing monitoring as in OCT procedure.
dosage “piggybacked” to the mainline
and aimed to cause 3 uterine 4. Interpretations: same as OCT: the
contractions in 10 minutes. May be absence of late decelerations in three
done on outpatient basis contractions in 10 minutes is the desired
d. Requires external electronic FHT result
monitoring with ultrasound transducer BIOPHYSICAL PROFILE (BPP)
and tocodynamometer to detect
uterine activity. 1. A scoring combining ultrasound
assessment of:
INTERPRETATION:
Fetal breathing
Normal: Negative
Amniotic fluid volume
Fetal tone
Fetal movement
CARE OF MOTHER AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC)
Reactivity of heart rate Suspected cephalopelvic disproportion
BPP could be used to predict fetal History of injury/disease of the pelvis
well- being in a high risk pregnancy. and spine
Previous difficult delivery
Cases of Maternal deformity or limp
AMNIOCENTESIS
CHORIONIC VILLI SAMPLING (CVs)
PREPARATION:
Chorionic villus sampling (CVS) is a
a. Secure an informed consent. prenatal test in which a sample of
chorionic villi is removed from the
b. Prepare for ultrasonography: to locate placenta for testing.
placenta and to provide visualization to a The sample can be taken through the
blind procedure. cervix (transcervical) or the abdominal
Ultrasound in amniocentesis: client wall (transabdominal).
needs to void Chorionic villus sampling can reveal
Pelvic ultrasound only: client should whether a baby has a chromosomal
not void. condition, such as Down syndrome, as
well as other genetic conditions, such
c. Increase oral fluids: take 1 quart water 2 as cystic fibrosis
hours before.
PERCUTANEOUS UMBILICAL BLOOD
d. Prepared needle: g 20-22 (3"- 6") SAMPLING (PUBs)
e. Prepare for administration of local Used in 2nd and 3rd trimesters.
anesthesia of the abdomen. Uses ultrasound to locate umbilical
f. Provide psychological support. cord
Cord blood aspirated and tested.
AFTERCARE HIGH-RISK PREGNANCY
Monitor for 30 - 60 minutes High-risk pregnancy is one in which the
health of the mother, baby or both are in
Observe for side effects such as:
danger before, during or after birth.
Vaginal discharge
- Samuel T. Bauer, M.D-
Increased urine/fetal activity
Fever and chills OB-GYN maternal-fetal medicine
specialist
Analysis of Amniotic Fluid
Most commonly used today to determine
fetal lung maturity FACTORS THAT PLACE A PREGNANCY
AT HIGH RISK
existing health conditions
X-RAY: LATERAL PELVIMETRY
genetic background
Indicates for radiography to determine age
pelvic size and shape: lifestyle choices
CARE OF MOTHER AT RISK OR WITH PROBLEMS (ACUTE & CHRONIC)
history of pregnancy complications
conditions that may develop with
pregnancy
A WOMAN WITH RIGH-SIDED HEART
FAILURE
Right-sided failure occurs when the
output of the right ventricle is less than
the blood volume received by the right
atrium from the vena cava.
Back-pressure from this results in
congestion of the systemic venous
circulation and decreased cardiac
output to the lungs.
RIGHT SIDE HEART FAILURE
Backflow of the blood to the body
Decrease amount of blood to the lungs
Jugular vein distension
Edema
SIGNS AND SYMPTOMS
Blood pressure decreases in the aorta
Jugular venous distention and
increased portal circulation
Distention of liver and spleen.
Dyspnea and pain
Ascites
Peripheral edema
