Nursing Care of the Patient with a Pregnancy Complication

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1. Danger Signals Any bleeding from the vagina

of Pregnancy Gush of fluid from vagina (clear, not urine)
Regular contractions occurring before completion of 37
weeks
Severe headache or changes in vision
Epigastric pain
Vomiting that persists & is severe
Change in fetal activity patterns
Temperature elevation, chills, or "sick" feeling indicative of
infection
Swelling in upper body, especially face & fingers

2. First Trimester Abortion (Miscarriage)

Complications of Incompetent cervical OS
Pregnancy Ectopic pregnancy
Gestational trophoblastic disease (hydatidiform mole)

3. Abortion (Mis- Loss of pregnancy before viability of fetus, may be spon-

carriage) taneous (miscarriage), therapeutic or elective

4. Abortion (Mis- Vaginal bleeding

carriage) As- Contractions, pelvic cramping, backache
sessment Find- Lowered hemoglobin if blood loss is significant
ings Passage of fetus/tissue

5. Nursing Inter- Save all tissue passed

vention for Abor- Keep patient at rest & teach reason for bed rest
tion (Miscar- Increase fluids PO or IV
riage) Prepare patient of surgical intervention if needed
Provide discharge teaching about limited activities &
coitus after bleeding ceases
Observe reaction of mother & others, providing emotional
support & give opportunity to express feelings of grief &
loss

6. Therapeutic Depends on situation:

Management of Inevitable abortion
Abortion Incomplete abortion
(Miscarriage)

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7. Inevitable Abor- Vacuum curettage or dilation & curettage (D&C)
tion (Miscar-
riage)

8. Incomplete D&C with Pitocin or methergine

Abortion
(Miscarriage)

9. Incompetent *Painless* condition in which cervix dilates without uterine

Cervical OS contractions & allows passage of fetus, usually the result
of prior cervical trauma/biopsy

10. Medical Manage- May be treated with cerclage

ment of Incom-
petent Cervical
OS

11. Cerclage Suturing of the cervix closed until patient is ready to give
birth to term baby
When the patient goes into labor, the suture is removed
for vaginal delivery

12. Incompetent History or repeated, relatively *painless* abortions

Cervical OS Early & progressive effacement & dilation of cervix
Assessment Bulging of membranes through cervical OS
Findings

13. Nursing Inter- Continue observation for contractions, rupture of mem-

ventions for In- branes & monitor fetal heart tones
competent Cervi- Position patient to minimize pressure on cervix
cal OS

14. Ectopic Preg- Any gestation outside the uterine cavity

nancy Most frequently in the fallopian tubes, where the tissue is
incapable of the growth needed to accommodate preg-
nancy, so rupture of the site usually occurs before 12
weeks
Any condition that diminishes the tubal lumen may predis-
pose a woman to ectopic pregnancy

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15. Classic Signs Missed menstrual period
of Ectopic Preg- Positive pregnancy test
nancy Abdominal *pain*
Vaginal spotting

16. Other Assess- History of missed periods & symptoms of early pregnan-
ment Findings cy
of Ectopic Preg- Abdominal *pain*, may be localized to one side
nancy Rigid, tender abdomen, sometimes abnormal pelvic
mass
Bleeding, if severe may lead to shock
Low hemoglobin & hematocrit, rising WBC
HCG titers usually lower than in intrauterine pregnancy

17. Nursing Inter- Giving Methotrexate to dissolve the tubal pregnancy if

ventions & Med- possible, least invasive
ical Management Surgical intervention may be required
of Ectopic Preg-
nancy

18. Methotrexate Folic acid antagonist that interferes with the proliferation
of trophoblastic cells

19. Nursing Inter- Prepare patient for surgery

ventions & Surgi- Institute measures to control/treat shock if hemorrhage is
cal Management severe, continue to monitor postoperatively
of Ectopic Preg- Allow patient to express feelings about loss of pregnancy
nancy & concerns about future pregnancies

20. Gestational Tro- Proliferation of trophoblasts, embryo dies

phoblastic Dis- Unusual chromosomal patterns seen (either no genetic
ease (Hydatidi- material in ovum or 69 chromosomes)
form Mole or Mo- The chronic villi change into a mass of clear, fluid-filled
lar Pregnancy) grapelike vessels
Complete or partial
Cause is essentially unknown
Seems like a pregnancy but no fetus occurs
Can set the patient up for cancer later in life

21.
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Gestational Tro- Absence of fetal heart sounds in the presence of other
phoblastic Dis- signs of pregnancy is a classic sign
ease (Hydatidi- A uterus that is larger than expected for gestational age
form Mole or High levels of HCG with excessive nausea & vomiting
Molar Pregnan- (also seen in twins)
cy) Assessment Dark red to brownish vaginal bleeding (common signs)
Findings after 12th weeks (resembles prune juice)
Anemia often accompanies bleeding
Symptoms of preeclampsia before usual time of onset
No palpation of normal fetal parts
Ultrasound shows no fetal skeleton

22. Gestational Tro- Provide pre-and postoperative care for evacuation of

phoblastic Dis- uterus
ease (Hydatidi- *Teach contraceptive use so that pregnancy is delayed for
form Mole or at least one year due to increase risk of cancer*
Molar Pregnan- Teach patient need for follow up lab work to detect rising
cy) Nursing Inter- HCG levels indicative of choriocarcinoma
ventions Teach about risk of future pregnancies, if indicated

23. Second There are few unique causes of bleeding in the second
Trimester trimester
Pregnancy
Complications

24. Third Trimester Placenta previa

Pregnancy Com- Abruptio placenta
plications Preterm labor
Premature rupture of membranes
Rupture of membranes
Oligohydramnios
Hydramnios (polyhydramnios)

25. Preterm Labor Labor that occurs before the end of the 37th week of
pregnancy
Cause is frequently unknown

26. Preterm La- Minimize or stop smoking (a major factor of preterm labor
bor Prevention & birth)
(Causes) Minimize or stop substance abuse/chemical dependency
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Early & consistent prenatal care
Appropriate weight gain
Minimize psychological stressors
Learn to recognize signs & symptoms of preterm labor

27. Medical Manage- Unless labor is irreversible, or a condition exists which the
ment of Preterm mother or fetus would be jeopardized by the continuing
Labor of the pregnancy, or the membranes have ruptured, the
usual medical intervention is to attempt to arrest the pre-
mature labor

28. Tocolysis Use of medication in an attempt to stop labor

May delay birth for 24-48 hours
Important to administer betamethasone or transfer moth-
er to a tertiary care facility

29. Medication Treat- Magnesium sulfate

ments for the Nifedipine
Medical Manage- Indomethacin
ment of Preterm Beta-Adrenergic Drugs
Labor Betamethasone

30. Magnesium Sul- Stops uterine contractions with fewer side effects than
fate beta-adrenergic drugs & interferes with muscle contrac-
tility
Magnesium sulfate acts upon the myoneural junction,
diminishing neuromuscular transmission
It promotes maternal vasodilation, better tissue perfusion
& have anticonvulsant effect

31. Magnesium Sul- Magnesium toxicity

fate Risks PPH

32. Magnesium Sul- Must be 1:1 with the nurse

fate Administra- Give magnesium sulfate on an IV pump as secondary with
tion fluids running as primary

33. Magnesium Sul- Monitor patients respirations, blood pressure & reflexes
fate Nursing Re- as well as I&O, flushing & other signs and symptoms of
sponsibilities magnesium sulfate toxicity
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34. Magnesium Sul- Few serious side effects

fate Side Effects Initally patient feels hot, flushing, may cause headache,
nausea, diarrhea, dizziness & lethargy
*hypotonia & flushing* are the most common side effects

35. Magnesium Toxi- Monitor respiratory rate *(<12 breaths/minute)* & hourly
city urine output *(<30 mL/hr)*

36. Magnesium Sul- Calcium gluconate

fate Antidote

37. nifedipine (Adalat/Procardia)

38. nifedipine Drug Calcium Channel Blocker

Class

39. nifedipine Action Relax smooth muscles including the uterus by blocking
calcium entry

40. nifedipine Side Hypotension

Effects Flushing

41. indomethacin (Indocin)

42. indomethacin Prostaglandin synthetase inhibitor

Drug Class

43. indomethacin Relaxes smooth muscle by inhibiting prostaglandins

Action

44. indomethacin Nausea

Side Effects Vomiting
Dyspepsia

45. Beta-Adrenergic ritodrine (Yutopar)

Drugs terbutaline (Brethine)

46. ritodrine (Yu-

topar)

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Only beta-adrenergic approved by the FDA for tocolysis
but it is infrequently used because of side effects & mini-
mal increase in length of pregnancy

47. terbutaline Not approved by the FDA for tocolysis but is more widely
(Brethine) used

48. Betamethasone Given when premature labor cannot or should not be

arrested & fetal lung maturity needs to be improved
Stimulates fetal lung maturation
Used to cause fetal surfactant induction which helps to
open the babies airways upon delivery

49. Betamethasone IM to the mother usually every 12 hours times 2 then

Administration weekly until 34 weeks gestation

50. Nursing Inter- Keep patient at rest, side-lying position

ventions for Hydrate the patient & maintain weight IV or PO fluids
Preterm Labor Maintain continuous maternal/fetal monitoring (mater-
nal/fetal vital signs every 10 minutes) be alert for abrupt
changes
Monitor maternal I&O
Monitor urine for glucose (diabetes) & ketones (dehydra-
tion)
Watch cardiac & respiratory status carefully
Evaluate lab test results carefully

51. Oligohydram- Decrease amount of amniotic fluid between 32 to 36

nios weeks
May be associated with placental insufficiency or fetal
urinary tract abnormalities

52. Oligohydram- Perinatal morbidity & mortality

nios Risks

53. Oligohydram- Amniofusion

nios
Interventions

54. Fetal well being

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Oligohydram-
nios
Assessments

55. Potter's Syn- Lack of urine into amniotic cavity

drome Bilateral renal agenesis (BRA) or complete absence of
the kidneys
Fetus does not survive long after birth

56. Hydramnios Too much amniotic fluid between 32 to 36 weeks

(Polyhydram- Associated with fetal anomalies
nios) Increased incidence of preterm births, fetal malpresenta-
tion & cord prolapse
Could indicate large baby

57. Some Possibili- Prenatal Bartter's Syndrome

ties for Hydram- Poorly-controlled maternal diabetes
nios Twin or multiple gestations
Fetal abnormalities which make it difficult for the baby to
swallow & process the fluid normally
Rh blood incompatibility which can bring on fetal anemia
& other factors

58. Neonatal Bartter The condition is caused by a defect in the kidney's ability
Syndrome to reabsorb sodium
In most cases, Neonatal Bartter syndrome is seen be-
tween 24 & 30 weeks of gestation with excess amniotic
fluid

59. Characteristics Hypokalemia

of Neonatal Metabolic alkalosis
Bartter Increased urinary excretion of sodium, potassium & chlo-
Syndrome ride
Normal blood pressure (?)

60. Rupture of Mem- Loss of amniotic fluid, prior to term, unconnected with
branes labor

61.

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Dangers of Rup- Prolapsed cord
ture of Mem- Infection
branes Potential need for premature delivery

62. PPROM Premature prolonged rupture of membranes

Less than 37 weeks, longer than 18 hours

63. Nursing Assess- Report from mother/family of discharge fluid

ment for Rupture Sterile speculum
of Membranes Nitrozene paper
Ferning
Pooling
Monitor maternal/fetal vital signs on continuous basis,
especially for maternal temperature (hourly)
Calculate gestational age
Observe for signs of infection & signs of onset of labor
(may induce if there are signs of an infection)
Observe & record color, odor, amount of fluid
Delay vaginal exam unless fetal distress (prolapsed cord)
Provide explanations of procedures & findings
Support mother & family
Prepare mother/family for early birth if indicated

64. Nitrozene Paper Change of color to dark blue if positive

65. Ferning Wiping fluid on slide to see if "ferns" appear when dried

66. Possible Chorioamnionitis

Cause/Result of
Rupture of
Membranes

67. Placenta Previa Low implantation of the placenta so that it overlays some
or all of the internal cervical OS
Amount of cervical OS involved classifies placental previa
as marginal, partial or complete

68. Placenta Previa Cause is uncertain but uterine factors may be involved
Etiology (scaring)

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69. Placenta Pre- *Bright red* vaginal bleeding after 7th month is cardinal
via Assessment indicator
Findings Bleeding may be intermitten, in gushes or continuous
Uterus remains soft
Fetal heart rate usually stable unless maternal shock
present
No vaginal exam by nurse
Diagnosed by sonography

70. Placenta Previa Ensure complete bed rest

Nursing Inter- Maintain sterile conditions for any invasive procedures
vention Make provisions for emergency C-section
Continue to monitor maternal/fetal vital signs
Measure blood loss carefully
Assess uterine tone regularly

71. Abruptio Placen- Separation of placenta from part or all of the normal
ta implantation site, usually accompanied by *pain*
Usually occurs after 20th week of pregnancy
Seen frequently in women with hypertension, previous
abruptio placentae, late pregnancies & multigravidas but
cause essentially unknown

72. Abruptio Placen- *Painful* vaginal bleeding

ta Assessment *Tender board like uterus*
Findings Fetal bradycardia & late decelerations, absent fetal heart
tones in complete abruption
Additional signs of shock

73. Abruptio Placen- Ensure bed rest

ta Nursing Inter- Check maternal/fetal vital signs frequently
ventions Prepare for IV infusions of fluids/blood as indicated
Monitor urinary output
Anticipate coagulation problems
Provide support to parents as outlook for fetus can be
poor
Prepare for emergency surgery as indicated

74. Hyperemesis gravidarum

Preeclampsia
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Other Complica- Diabetes
tions with Preg- Placental Abnormalities
nancy Rh sensitization

75. Hyperemesis Excess nausea & vomiting of early pregnancy leads to

Gravidarum dehydration & electrolyte disturbances

76. Hyperemesis Possible severe reaction to HCG

Gravidarum Not psychological
Causes Greater risk in conditions where HCG levels are in-
creased
HCG levels peak around 6 weeks after conception,
plateau then begin to decline after 12th week
Symptoms often improve later in pregnancy but may last
entire time

77. Hyperemesis Nausea & vomiting, progressing to retching between

Gravidarum meals
Assessment Weight loss
Findings

78. Hyperemesis Begin NPO & IV fluid & electrolyte replacement

Gravidarum IV anti-nausea medication
Nursing Monitor I&O
Interventions Gradually re-introduce PO intake, monitor amounts taken
& retained
Monitor TPN & central line placement if unable to eat
Provide mouth care
Offer emotional support
Refer to home health as appropriate for continued IV or
TPN therapy

79. Preeclampsia Refers to a condition unique to pregnancy where hyper-

tension is accompanied by proteinuria & edema
Maternal or fetal condition may be compromised

80. Preeclampsia After 12th week of pregnancy, may appear in labor up to

Onset 48 hours post partum

81. Wide spread vasospasm

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Preeclampsia
Characterization

82. Preeclampsia Essentially unknown

Probable Cause High in primigravidas, multiple pregnancies, hydatidiform
mole, poor nutrition, essential hypertension, familial ten-
dency
Gradual loss of normal pregnancy related resistance to
angiotensin 2
May also be related to decrease production of some
vasodilating prostaglandins

83. Usual Clini- Preeclampsia

cal Classifica- Preeclampsia-Eclampsia
tion of Hyperten- Chronic hypertension
sive Disorders in Preeclampsia superimposed on chronic hypertension
Pregnancy Gestational hypertension (does not become preeclamp-
sia)

84. Mild Preeclamp- Appearance of symptoms after 20th week of pregnancy

sia Assessments Blood pressure >140 but <160 and >90 but <110
Proteinuria of >0.3g but <2g in 24 hour specimen (1+ or
higher on dipstick) (?)
All other assessments normal

85. Nursing Inter- Promote bed rest as long as signs of edema or proteinuria
ventions for Mild are minimal, preferably side-lying
Preeclampsia Provide well balanced diet with adequate protein &
roughage, no sodium restrictions
Explain need for close follow up weekly or twice weekly
visits to physician

86. Severe Blood pressure of >160/110 or higher on 2 occasions at

Preeclampsia least 6 hours apart while on bedrest
Assessments Proteinuria >5g/24 hours (3+ on dipstick)
Pulmonary edema/heart failure
Cyanosis may be present
Headaches, nausea & vomiting, visual disturbances &
irritability

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Epigastric or right quadrant pain
Growth restriction, reduced amniotic fluid & fluid volume

87. Severe Minimize all stimuli/restrict visitors

Preeclampsia Check vital signs & lab values frequently
Nursing Have airway, suction & oxygen equipment available
Interventions Assess deep tendon reflexes & clonus
Administer medication as ordered
Continue observation for 24 to 48 hours postpartum
Most likely start of magnesium sulfate up to 24 hours after
delivery
Promote best res, side-lying
Carefully monitor fetal vital signs
Monitor I&O
Take daily weights
Initiate seizure precautions
Monitor for magnesium sulfate toxicity
Administer sedatives as ordered

88. Deep Tendon Re- Grade reflexes

flexes 4+
3+
2+
1+
0

89. 4+ Hyperactivity, very brisk, jerky or clonic response, abnor-

mal

90. 3+ Brisker than average, may not be abnormal

91. 2+ Average response, minimal

92. 1+ Diminished response; low normal

93. 0 No response, abnormal

94. Clonus With a normal response, the foot returns to its normal
position of plantar flexion
Clonus is present if the foot "jerks" or "taps" against the
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examiner's hand
Record the number of taps or beats of clonus, if none than
indicate: no clonus

95. HELLP Syn- Laboratory diagnosis for a variation of severe preeclamp-

drome sia, not a separate illness
Possible life threatening complication
*H*emolysis
*E*levated *l*iver *e*nzymes
*L*owered *p*latelets

96. HELLP Syn- Delivery is the only known cure

drome Cure

97. HELLP Syn- Non specific

drome Presenta-
tion

98. Eclampsia As- Increased hypertension precedes convulsion followed by

sessment Find- hypotension & collapse
ings Coma may ensue
Labor may begin, putting fetus in great jeopardy
Convulsions may recur

99. SEIZURE Safety (bed railing pads)

Establish/maintain airway
IV bolus
Zealous observation
Uterine activity
Rapid resuscitation
Evaluate fetus

100. Chronic Hyper- Associated with increased incidence of abruptio placenta

tension & increased perinatal mortality
Ideally management begins before pregnancy or when
women is hypertensive before 20 weeks
No signs preeclampsia (?)

101. aldomet (Methyldopa)

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Chronic Hy-
pertension Treat-
ment

102. aldomet (Methyl- Most often recommended for chronic hypertension after
dopa) lifestyle changes

103. Chronic Hy- Maintain a diastolic below 90 mmHg

pertension Treat-
ment Goal

104. Chronic In women with hypertension before 20 weeks & new-on-

Hypertension set proteinuria
with In women with both hypertension & proteinuria before 20
Superimposed weeks & significant increase in hypertension plus one of
Preeclampsia the following: new onset of symptoms, thrombocytopenia,
elevated liver enzymes
Increased morbidity for both the mother & fetus

105. Gestational Hy- Transient elevation of blood pressure occurs for the first
pertension time after mid pregnancy without proteinuria or other
signs of preeclampsia
If preeclampsia does not develop & blood pressure re-
turns to normal by 12 weeks post partum
If blood pressure elevation persists after 12 weeks post
partum, the women is diagnosed with chronic hyperten-
sion

106. Diabetes Mellitus Gestational diabetes mellitus is any degree of glucose

intolerance with its onset or first recognition during preg-
nancy

107. Gestational Di- Onset during pregnancy & reversal after termination of
abetes Mellitus pregnancy
Onset & Reversal

108. Gestational Di- Increased risk of adult onset diabetes later in life
abetes Mellitus
Risks

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109. Significance of Interaction of estrogen, progesterone & cortisol raise ma-
Diabetes in Preg- ternal resistance to insulin
nancy If the pancreas cannot respond by producing additional
insulin, excess glucose moves across the placenta to
fetus where fetal insulin metabolizes it & acts as growth
hormone, promoting macrosomia
Maternal insulin needs to be carefully monitored during
pregnancy to avoid widely fluctuating levels of blood glu-
cose
Dose may drop during first trimester then rise during
second & third trimesters
Higher incidence of fetal anomalies & maternal hypo-
glycemia

110. Assessment Polyuria

Findings for Polydipsia
Gestational Weight loss
Diabetes Mellitus Polyphagia
Elevated glucose levels in blood & urine
1 hour glucose tolerance test at 24 to 28 weeks
3 hours glucose tolerance test used if results from 1 hours
GTT>180 mg/dl

111. Gestational Di- Teach patient the effects & interactions of diabetes &
abetes Mellitus pregnancy & signs of hyper & hypoglycemia
Nursing Inter- Teach patient how to control diabetes in pregnancy
ventions Monitor fetal status throughout pregnancy & usually will
be referred to endocrinologist
Assess status of mother & baby frequently
Monitor carefully fluids, calories, glucose & insulin during
labor & delivery
May start on insulin drip during labor & delivery
Continue careful observation in post delivery period
High risk for hypoglycemia for newborn

112. Infections Toxoplasmosis

(TORCH) Other infections
Rubella
Cytomegalovirus

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Herpes
Devastating to the fetus causing abortions, malformations
& even fetal death

113. Infections Nurs- Instruct the pregnant woman in signs & symptoms that
ing Interventions indicate infections
Caution women to avoid obviously infected persons &
other sources of infections
May affect delivery options

114. Placental Abnor- *Developmental problems of the placenta:*

malities Placental lesions
Succenturiate placenta
Circumvallate placenta
Battledore placenta
*Degenerative changes:*
Infarcts
Placental calcifications

115. Succenturiate One or more accessory lobes of fetal villi will develop on
Placenta the placenta

116. Succenturiate Post partum hemorrhage if placenta is retained

Placenta
Maternal
Complications

117. Succenturiate No fetal-neonate complications as long as all parts of the

Placenta Fetal placenta remain attached until after birth of the fetus
Complications

118. Circumvallate A double fold of chorion & amnion form a ring around the
Placenta umbilical cord, on the fetal side of the placenta

119. Circumvallate Increased incidence of late abortion, antepartum hemor-

Placenta rhage & preterm labor
Maternal
Complications

120.
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Circumvallate Intrauterine growth restriction
Placenta Fetal Prematurity and/or fetal death
Complications

121. Battledore Pla- The umbilical cord is inserted at or near the placental
centa margin

122. Battledore Pla- Increased incidence of preterm labor & bleeding compli-
centa Maternal cations
Complications

123. Battledore Pla- Prematurity & fetal stress

centa Fetal Com-
plication

124. Velamentous In- The vessels of the umbilical cord divide some distance
sertion of the from the placenta in the placental membranes
Umbilical Cord

125. Velamentous In- Hemorrhage if one vessel is torn

sertion of the
Umbilical Cord
Maternal Compli-
cations

126. Velamentous In- Fetal stress

sertion of the Hemorrhage
Umbilical Cord
Fetal Complica-
tions

127. Placental Accre- Abnormal adherence

ta Placenta grows into the uterine wall
The incidence of placenta accrete also significantly in-
creases in women with previous C-section compared to
those without prior surgical delivery

128. Rh Sensitization Rh-negative women who become pregnant with an Rh

positive fetus may become sensitized to the Rh antigen if
there is any accidental contact between maternal & fetal
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blood
Can occur also during amniocentesis of other invasive
procedure

129. Complications of Sensitized Rh negative women develop anti-Rh antibod-

Rh Sensitization ies which may cross the placenta in subsequent Rh-pos-
itive pregnancies & attack & destroy the fetal RBC's

130. Newborn Effects Progressively severe

of Rh Incompati- Erythroblastosis fetalis
bility & Sensitivi- Hydrops fetalis
ty

131. Erythroblasto- The antibodies from the mom cross the placenta & attach
sisi Fetaslis to fetal red blood cells & destroy them

132. Hydrops Fetalis Severe anemia that results in heart failure

133. Rh Sensitization All pregnant women should be tested for blood group,
Assessment Rh factor & antibody screening, a history of previous
miscarriage, blood transfusions or infants experiencing
jaundice should be noted

134. Rh Sensitization Unsensitized Rh-negative patients should be given

Intervention 300mg of Rh immune globulin (RhoGAM) IM at *28 weeks
& within 72 hours of delivery*
RhoGAM is not given to mothers who are already sensi-
tized & have antibodies
Rh immune globulin is also given after abortion, ectopic
pregnancy, amniocentesis & any other situation that might
result in maternal exposure to the fetal Rh antigen
Kleihauer-Betke test

135. Kleihauer-Betke Test to see if there has been any maternal & fetal blood
Test mixing

136. Fetal Demise First trimester fetal loss

Fetal anomaly
Neonatal death
Stillbirth or intrauterine fetal demise
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137. First Trimester Ectopic pregnancies

Fetal Loss Elective termination

138. Fetal Anomaly The loss of their "perfect child"

Intensity of grief may be affected by the type & severity of
the anomaly
Anticipatory grieving

139. Neonatal Death Death within the first month of life

Typically related to congenital defect, sepsis, prematurity
or SIDS

140. Stillbirth/In- Fetal demise in utero after 20 weeks gestation

trauterine Fetal
Demise

141. Delivery of Most mothers spontaneously begin labor within 2 weeks

Stillbirth/In- after IUFD, if labor does not ensue, they need to go to the
trauterine Fetal labor & delivery unit
Demise

142. First Symptom of Absent movement (?)

Fetal Death

143. Nursing Care Planning & implementation with grieving parents

during Perinatal Follow up after discharge
Loss

144. Induction of La- Prostaglandins

bor

145. Prostaglandins Vaginal suppositories 12 to 24 weeks

dinoprostone (Prostin E2/Cervidil)
misoprostol (Cytotec)

146. dinoprostone Suppositories for 14 to 28 weeks

(Prostin E2)

147.
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misoprostol (Cy- Intravaginal tablets for 2nd & 3rd trimester fetal demises
totec) & for termination of 2nd & 3rd trimester pregnancies

148. Nursing Care for Communicating & caring techniques

Fetal Demises Options for parents

149. Communicating Actualize the loss

& Caring Provide time to grieve
Techniques Allow for individual differences, cultural, spiritual & physi-
cal needs of the parents

150. Options for Par- Seeing & holding

ents Bathing & dressing
Privacy
Visitation with other family members
Religious rituals/funeral arrangements
Special memories
Memory box & pictures

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