Question

Essentials of Maternity, Newborn, and Women's Health Nursing

Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1 and 2)

Why is Teresa’s pregnancy considered a high-risk pregnancy?

Discuss potential pregnancy-related complications for Teresa.

Discuss the potential risks to the babies.

2. Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5)

Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.

Answer 1

1.

Teresa "s pregnancy is high risk because:-

• She is elderly primigravida
• She has Twin pregnancy
• Precious pregnancy witch is conceived after invitro fertilization

Pregnancy related complication

• Hyperemesis gravidarum
• Increase girth of abdomen causing difficulty in breathing
• Increase foetal movements
• premature labour pains
• Babies may be low birth weight
• Increased risk of casarean section Premature rupture of membranes
• Prematute babies
• Risk oh preeclampsia and eclampsia
• Risk of anaemia

Risk to the babies

• Prematurity :- If premature labour pains occur babies may be low birth weight
• ncreased chance of infection because of increased handling during delivery.or PROM.\

2. Sarah:s plan of care

Sarah Is showing signs of preeclampsia. Her BP is raised, Reflexes are brisk , increased heart rate, intence headache and epigastric tenderness.

Plan of care for the woman experiencing preeclampsia

If it is mild preeclampsia the condition is   monitored and treated with medication to prevent it from turning into eclampsia. Medications and monitoring will help keep blood pressure within a safer range until the baby is mature enough to deliver..

Preeclampsia and eclampsia affect the placenta, which is the organ that delivers oxygen and nutrients from the mother’s blood to the fetus. When high blood pressure reduces blood flow through the vessels, the placenta may be unable to function properly. This may result in baby being born with a low birth weight or other health problems.

Treatment

• aspirin
• calcium supplementation
• Exercise during pregnancy may also be useful.
• Antihypertensives to low BP such as hydralazine
• sedative
• complete bed rest

Plan of care for the woman experiencing eclampsia

In severe eclampsia delivering the baby and placenta are the recommended treatment .Problems with the placenta often require preterm delivery for the health and safety of the baby. In rare cases, these conditions cause stillbirth.

Medications to prevent seizures, called anticonvulsants drugs may be necessary. Medication to lower blood pressure if high blood pressure . Steroids, are given to help baby’s lungs mature prior to delivery. Intravenous or intramuscular magnesium sulfate improves outcomes in those with eclampsia and is generally safe.Breathing may need to be supported.^] Blood pressure medications such as hydralazine and emergency delivery of the baby either vaginally or by cesarean section.

Plan of care for the woman experiencing HELLP Syndrome

HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of preeclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth.

It means

H (hemolysis, which is the breaking down of red blood cells)

EL (elevated liver enzymes)

LP (low platelet count)

The mortality rate of HELLP syndrome has been reported to be as high as 30%. That's why it's critical for expecting mothers to be aware of the condition and its symptoms so they can receive early diagnosis and treatment.

• Most often, the definitive treatment for women with HELLP Syndrome is the delivery of their baby.
• During pregnancy, many women suffering from HELLP syndrome require a transfusion of some form of blood product (red cells, platelets, plasma).
• Corticosteroids can be used in early pregnancy to help the baby's lungs mature.