Maternal Chpt 5
Hypertension previously to pregnancy is a high risk pregnancy
One very common high risk is diabetes that places the mother and baby at risk
Know that high risk can disrupt family roles, can cause financial pressure om a family , it can be
very frustrating with activity restrictions if the mom is on bed rest , there can be altered child
care practices as well
Ectopic happens in the fallopian tubes vs upper uterus
o Manifestations, lower abdominal pain and light abdominal bleeding , shoulder pain may
be present as well
Priority in ectopic pregnancy is control bleeding , and treat pain , there are psychological
manifestations with the mother as this is considered a loss
A mother can go into hypovolemic shock as a result of ectopic pregnancy
o Increased heart rate
o Decreased BP
o Increased respiration
o Shallow breathing
o Diaphoresis
o Results from too much blood or fluid loss
o Pale skin
Nurse role, monitor VS, heart rate, BP, RR, assess lungs and bowel sounds, provide IV fluids , if it
is a blood loss then will assist in giving blood, they may need blood or ABX , give pain meds as
ordered , pt will be NPO until after surgery, there may be a foley ordered and strict I&O and
check if there is blood in the urine, lastly pay attention and make sure they get plenty of bed rest
Treatment of Molar pregnancy, vacuum dilation and evacuate the uterus
Placenta Previa- happens when placenta develops in lower part of the uterus
When this happens the mom will have bright red bleeding and cervix will start to dialate
Three degrees of placenta previa
o Marginal- placenta approaches but not reach cervical opening
o Partial- partially covers cervical opening
o Total – complete cover the cervical opening
Placenta Previa requires Cesarean
Placenta Abruption- where the plecenta comes from the wall of the uterus , premature
separation of placenta
o The mother can have dark red bleeding because it can be pooling
o Enlarged uterus
o Mom will have back pain with placenta abruption
Predisposing factors
o Hypertension,
o cocaine or alcohol use, Cigarette smoking and poor nutrition , mom suffer blow to
abdomen , folate deficiencies
Type of detachment
o Partial
o Marginal- detachment is the edge of placement
, o Central- where the center of placenta is detached
o Total- whole placenta is completely detached
Observe
o Back pain
o Blood loss
o Abdomen tenderness
o Pregnancy needs immediate Cesarean
o Mom at risk for shock, clotting disorder or death of fetus
DIC- disseminated Intravascular coagulation – you can see this in placenta abruption due to large
blood clots that form then they will clot and take over the clotting factor , it can also happen in
cancer patients it is a medical emergency
Table 5.2
Spontanous abortions- non intentional and referred to as miscarriages
o Threatened abortion.
o incomplete abortion
o inevitable abortion
o Complete abortion-
o Missed abortion- fetus dies in utero
o Recurrent abortion- two or more happen at consecutive times
Induced abortion- intentional for therapeutic or elective reasons
o Therapeutic – intentional to preserve the health of the mother
o Elective abortion intentional termination of the pregnancy for reasons other than the
health of the mother
Post abortion teaching
o Report increase bleeding
o Report temperature changes
o Continue iron supplements
o Resume sexual activity only when MD recommends
o Return to health care at check ups
o Discuss contraceptives.
Gestational Hypertension
o Preeclampsia – when increase in blood pressure occurs after 20 weeks, will have
proteinuria
o Eclampsia- increase in blood pressure and effects CNS and makes mom high risk of
seizures and convulsions
Risk factors with preeclampsia
o First time pregnancy
o Obesity
o A family history of Gestational hypertension
o Women older than 40 or younger than 19
o Multi fetal pregnancy
o Chronic hypertensions
o Chronic renal disease
Hypertension previously to pregnancy is a high risk pregnancy
One very common high risk is diabetes that places the mother and baby at risk
Know that high risk can disrupt family roles, can cause financial pressure om a family , it can be
very frustrating with activity restrictions if the mom is on bed rest , there can be altered child
care practices as well
Ectopic happens in the fallopian tubes vs upper uterus
o Manifestations, lower abdominal pain and light abdominal bleeding , shoulder pain may
be present as well
Priority in ectopic pregnancy is control bleeding , and treat pain , there are psychological
manifestations with the mother as this is considered a loss
A mother can go into hypovolemic shock as a result of ectopic pregnancy
o Increased heart rate
o Decreased BP
o Increased respiration
o Shallow breathing
o Diaphoresis
o Results from too much blood or fluid loss
o Pale skin
Nurse role, monitor VS, heart rate, BP, RR, assess lungs and bowel sounds, provide IV fluids , if it
is a blood loss then will assist in giving blood, they may need blood or ABX , give pain meds as
ordered , pt will be NPO until after surgery, there may be a foley ordered and strict I&O and
check if there is blood in the urine, lastly pay attention and make sure they get plenty of bed rest
Treatment of Molar pregnancy, vacuum dilation and evacuate the uterus
Placenta Previa- happens when placenta develops in lower part of the uterus
When this happens the mom will have bright red bleeding and cervix will start to dialate
Three degrees of placenta previa
o Marginal- placenta approaches but not reach cervical opening
o Partial- partially covers cervical opening
o Total – complete cover the cervical opening
Placenta Previa requires Cesarean
Placenta Abruption- where the plecenta comes from the wall of the uterus , premature
separation of placenta
o The mother can have dark red bleeding because it can be pooling
o Enlarged uterus
o Mom will have back pain with placenta abruption
Predisposing factors
o Hypertension,
o cocaine or alcohol use, Cigarette smoking and poor nutrition , mom suffer blow to
abdomen , folate deficiencies
Type of detachment
o Partial
o Marginal- detachment is the edge of placement
, o Central- where the center of placenta is detached
o Total- whole placenta is completely detached
Observe
o Back pain
o Blood loss
o Abdomen tenderness
o Pregnancy needs immediate Cesarean
o Mom at risk for shock, clotting disorder or death of fetus
DIC- disseminated Intravascular coagulation – you can see this in placenta abruption due to large
blood clots that form then they will clot and take over the clotting factor , it can also happen in
cancer patients it is a medical emergency
Table 5.2
Spontanous abortions- non intentional and referred to as miscarriages
o Threatened abortion.
o incomplete abortion
o inevitable abortion
o Complete abortion-
o Missed abortion- fetus dies in utero
o Recurrent abortion- two or more happen at consecutive times
Induced abortion- intentional for therapeutic or elective reasons
o Therapeutic – intentional to preserve the health of the mother
o Elective abortion intentional termination of the pregnancy for reasons other than the
health of the mother
Post abortion teaching
o Report increase bleeding
o Report temperature changes
o Continue iron supplements
o Resume sexual activity only when MD recommends
o Return to health care at check ups
o Discuss contraceptives.
Gestational Hypertension
o Preeclampsia – when increase in blood pressure occurs after 20 weeks, will have
proteinuria
o Eclampsia- increase in blood pressure and effects CNS and makes mom high risk of
seizures and convulsions
Risk factors with preeclampsia
o First time pregnancy
o Obesity
o A family history of Gestational hypertension
o Women older than 40 or younger than 19
o Multi fetal pregnancy
o Chronic hypertensions
o Chronic renal disease
