Care of Mother and Child at Risk or With Problems - Acute and Chronic (Lecture)

Care of Mother and Child at
Risk or with Problems - Acute

and Chronic (Lecture)
💡 Wednesday I 4:00-6:00
💡 Ma’am Araos I [email protected]/ 0916-682-3813
💡 2 hours per week
Course Description
This course deals with the concept of disturbances and pre-existing health problems
of pregnant women and the pathologic changes during intrapartum and post-partum
periods. This course further deals with the common problems occurring during
infancy to adolescence stage.
Intended Learning Outcomes

1. utilize the nursing process in the holistic care of mother and child who are at risk
or with problems;
2. demonstrate leadership and management skills in promoting safe and quality

nursing care to clients;
Care of Mother and Child at Risk or with Problems - Acute and Chronic (Lecture) 1
3. relate effectively with clients, members of the health team in various settings;
4. ensure a well-organized recording and reporting system; and
5. observe bioethical principles, nursing standards and core values in the delivery
of care to mothers and children.
Course Outline
Nursing care of mothers who are at high-risk for harmful conditions before,
during, and after pregnancy.
Identifying prenatal clients at risk
Nursing care of mothers with Pre-gestational conditions
Nursing care of mothers with Gestational conditions
Nursing care management of the client with high-risk labor& delivery
Nursing care management of the high-risk post-partal client
Care of couple with problems of infertility
Nursing care of high-risk newborns
Nursing care of common health problems that develop during infancy stage.
Nursing care of common health problems that develop toddler stage
Nursing care of common health problems that develop during preschool stage
Nursing care of common health problems that develop during school-age
Nursing care of common health problems that develop during adolescence
Chapter 1 - Care of Mother, Child at Risk or

With Problems
MOTHER - High-Risk prenatal Client
a. Identifying Clients at Risk
1. Assessment of Risk factors
2. Screening procedures
3. Diagnostic tests and laboratory exams
b. Pre-gestational Conditions
1. Rheumatic heart disease
2. Diabetic mellitus
3. Substance abuse
4. HIV/AIDS
5. Rh Sensitization
6. Anemia
A dictionary definition of the word “risk” is hazard, danger, exposure to mischance or

peril. It implies that the probability of adverse consequences is increased by the
presence of some characteristics or factor.
Assessment
process for defining the nature of that problem, determining a diagnosis and
developing specific treatment
What is high risk prenatal client?

Pregnant women under 17 or over 35 are considered high-risk pregnancies.
A family history of genetic conditions
Being pregnant with multiple babies
Having a history of complicated pregnancies, such as preterm labor, C-section,

pregnancy loss or having a child with a birth defect.
What are the four types of genetic disorders (inherited)?

Single gene inheritance - also called Mendelian or monogenetic inheritance.
Multifactorial inheritance - also called complex or polygenic inheritance.

Multifactorial inheritance disorders are caused by a combination of environmental
factors and mutations in multiple genes
Chromosome abnormalities - Chromosomal abnormalities typically occur due

to a problem with cell division.
Mitochondrial inheritance - caused by mutations in the non-nuclear (

Deoxyribonucleic Acid)DNA of mitochondria
Multifactorial Inheritance Include:
heart disease
high blood pressure
Alzheimer's disease - progressive mental deterioration that can occur in middle

or old age, due to generalized degeneration of the brain. It is the most common
cause of premature senility.
Arthritis - painful inflammation and stiffness of the joints.
Diabetes - disease in which the body’s ability to produce or respond to the

hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates
and elevated levels of glucose in the blood and urine.
Cancer - a disease caused by an uncontrolled division of abnormal cells in a

part of the body.
Obesity - the condition of being grossly fat or overweight.
Preterm Labor
Preterm labour is defined by WHO as Onset of labour prior to the completion of
37 weeks of gestation, in a pregnancy beyond 20 weeks of gestation
The period of viability varies in different countries from 20 to 28 weeks
Preterm labour is considered to be established if regular uterine contractions can

be documented at least 4 in 20 minutes or 8 in 60 minutes with progressive change
in the cervical score in the form of effacement of 80% or more and cervical dilation
>1cm
Caesarean Section
also known as C-section, or caesarean delivery, is the surgical procedure by
which one or more babies are delivered through an incision in the mother's
abdomen, often performed because vaginal delivery would put the baby or mother
at risk.
kapag nag cs pati uterus tinatahi di lang abdomen
Why it's done?
Your labor isn't progressing. Stalled labor is one of the most common
reasons for a C-section. Stalled labor might occur if your cervix isn't opening
enough despite strong contractions over several hours.
Your baby is in distress. If your health care provider is concerned about
changes in your baby's heartbeat, a C-section might be the best option.
Your baby or babies are in an abnormal position. A C-section might be the

safest way to deliver the baby if his or her feet or buttocks enter the birth
canal first (breech) or the baby is positioned side or shoulder first
(transverse).
You're carrying multiples. A C-section might be needed if you're carrying twins

and the leading baby is in an abnormal position or if you have triplets or more
babies.
There's a problem with your placenta. If the placenta covers the opening of your
cervix (placenta previa), a C-section is recommended
3rd Trimester Bleeding
Abruptio Placenta - premature separation of placenta from uterine wall
Vaginal bleeding, abdominal pain, uterine tenderness,

contractions/increased uterine tone, fetal distress
US may miss early abruption
Placenta Previa - implantation of placenta over cervical OS
Large amount of BR vaginal bleeding, painless
US Diagnosis - no speculum or digital exam until placenta previa
rules out
Prolapsed umbilical cord - A C-section might be recommended if a loop of
umbilical cord slips through your cervix ahead of your baby
Health concern - A C-section might be recommended if you have a severe

health problem, such as a heart or brain condition. A C-section is also
recommended if you have an active genital herpes infection at the time of labor.
Genital herpes outbreaks usually look like a cluster of itchy or painful

blisters filled with fluid
Mechanical obstruction - You might need a C-section if you have a large fibroid
obstructing the birth canal, a severely displaced pelvic fracture or your baby has
a condition that can cause the head to be unusually large (severe
hydrocephalus).
Previous C-section - Depending on the type of uterine incision and other factors,
it's often possible to attempt a vaginal Birth after Cesarean(VBAC). In some
cases, however, your health care provider might recommend a repeat C-section.
What is the Cerebrospinal Fluid?

Cerebrospinal fluid (CSF) is a clear, colorless liquid found in your brain and
spinal cord. The brain and spinal cord make up your central nervous system.
Function: the cerebrospinal fluid supports the brain and provides lubrication
between surrounding bones and the brain and spinal cord. When an individual
suffers a head injury, the fluid acts as a cushion, dulling the force by distributing its
impact.
Screening Procedures of High Risk Prenatal Client

Screening
process of identifying apparently healthy people who may be at increased risk of
a disease or condition, offered as information, further tests and appropriate
treatment to reduce the risk.
Screening of High Risk Cases:

The cases are assessed at the initial antenatal examination, preferably in the
first semester of pregnancy.
This examination may be performed in a big institution (teaching or non-

teaching) or in a peripheral health center.
Some risk factors may later appear and are detected at the subsequent visits.
The cases are also reassessed near term and again in labor for any new risk
factors.
Screening for High Risk Pregnancy

Numerous international and national guidelines
Geographical, genetical and economical variation
Risk factor or univerdal approach
Individual or group antenatal care
History and physical examination, EDD
Test for immunity and infections, blood types and hemoglobinopathies, endocrine
and metabolic disorders
Ultrasound
Patient education
History
Age
Social Burden
Smoking
Past medical condition e.g D.M, HTN
Past obstetric history
Screening Test Diagnostic Test
Done on apparently healthy Done on those with sick or indications
Applied to groups Applied to single patient

Based on evaluation of number of symptoms, signs or
Based on one or cut off criteria
lab tests
Less accurate More accurate
Not a basis for treatment Basis for treatment
Initiative comes from the healthy

Initiative comes from patient with complaint
agency
Diagnostic Tests for High Risk Pregnancy

Noninvasive Invasive
Fetal Ultrasound or Ultrasonic testing Chorionic villus sampling

Cardiotocography Amniocentesis
Non stress test (NST) Embryoscopy
Contraction stress test (CST) Fetoscopy
Percutaneous umbilical cord blood sampling
Noninvasive
Procedures that do not involve tools that break the skin or physically enter the
body. Examples include x-rays, a standard eye exam, CT scan, MRI, ECG, and
Holter monitoring. Noninvasive devices include hearing aids, external splints, and
casts
Invasive
Is a test type of medical procedure that requires trained medical providers to use
instruments that cut skin or that are inserted into a body opening. Examples of
invasive tests include biopsy, excision, cryotherapy, and endoscopy
Noninvasive Diagnostic Test:
Antepartum Testing /Biophysical Assessment
Ultrasound
Indications for use
Fetal heart rate activity
Gestational age
Fetal growth
Fetal anatomy
Fetal genetic disorders
Placental position and function
Adjunct to other invasive tests
Cardiotocography (CTG)
Is a test used in pregnancy to monitor both the fetal heart pattern as well as the
uterine contractions
It should only used in the 3rd trimester when fetal neural reflexes are present
Its purpose is to monitor fetal well-being & allows early detection of fetal distress
antenatal or intra-partum
An abnormal CTG indicates the need for further invasive investigation &
ultimately may lead to emergency CS
Non Stress Test (NST)
A prenatal non-stress assesses fetal heart rate and movement
It provides useful information about the oxygen supply to the fetus
The noninvasive procedure has no risk for the pregnant person or child
It takes 20 to 30 minutes, but can take up to an hour
A nonreactive non-stress test indicates the fetus needs more monitoring and
testing
A prenatal non-stress test (NST) is a common test done before birth (prenatal). It
is used to ensure the health of the fetus before labor. The test assesses fetal heart
rate and movement at around 26 to 28 weeks of gestation, but can also be done
later in the pregnancy as needed.
"Non-stress" means that there is no stress put on the fetus (for example, an
attempt to get the heart rate up) during the test. This type of test is usually done
when the fetus is considered high-risk.
Non-Stress Test Purpose
There are many reasons a non-stress test is performed when a person is

pregnant. Overall, the test helps to evaluate the health of the fetus, providing
useful information about the oxygen supply to the fetus, which is linked with
fetal movement.
Later in pregnancy, the fetal heart rate typically increases with the fetus's
physical activity. If fetal hypoxia (or other conditions) is present, the
response can be disrupted because there is a lack of adequate oxygen.
A non-stress test is noninvasive and does not pose any type of risk to the
pregnant person or the fetus. If the test is failed, it usually indicates that more tests,
further monitoring, or special care orders will be needed.
A provider might do a non-stress test if:
The fetus is at risk (secondary to lack of adequate oxygenation)
Newborn complications have occurred (usually in high-risk pregnancies)
The pregnant person has had stillbirths in the past
Contraction Stress Test
A contraction stress test measures the fetal heart rate after the uterus is
stimulated to contract. This is done to make sure that during labor the fetus can
handle contractions and get the oxygen needed from the placenta
CST or oxytocin challenge test, is more costly and presents more of a risk to the
fetus, but identifies fetal reserve during contractions. The test measures late
decelerations during contractions induced by either nipple stimulation or oxytocin
infusion. The test is negative if no late decelerations are observed.
A negative CST indicates that the fetus is not suffering from hypoxia and does
not need immediate delivery. When there are late deceleration after some, but not
all of the uterine contractions makes the physician suspect a fetal hypoxia and
he/she may perform cesarean delivery.
Invasive Diagnostic Test:
Chorionic Villus Sampling (CVS)

is a prenatal test in which a sample of chorionic villi is removed from the placenta
for testing. The sample can be taken through the cervix (transcervical) or the
abdominal wall (transabdominal).
During pregnancy, the placenta provides oxygen and nutrients to the growing
baby and removes waste products from the baby's blood.
The chorionic villi are wispy projections of placental tissue that share the baby's
genetic makeup.
The test can be done as early as 10 weeks of pregnancy
Chorionic villus sampling can reveal whether a baby has a chromosomal

condition, such as Down syndrome, as well as other genetic conditions, such as
cystic fibrosis.
Although chorionic villus sampling can provide valuable information about your
baby's health, it's important to understand the risks — and be prepared for the
results.
Chorionic villus sampling can provide information about your baby's genetic
makeup. Generally, chorionic villus sampling is offered when the test results might
have a significant impact on the management of the pregnancy or your desire to
continue the pregnancy.
Chorionic villus sampling is usually done between weeks 11 and 14 of pregnancy

— earlier than other prenatal diagnostic tests, such as amniocentesis.
You might consider chorionic villus sampling if:
You had positive results from a prenatal screening test. If the results of a
screening test — such as the first trimester screen or prenatal cell-free DNA
screening — are positive or worrisome, you might opt for chorionic villus
sampling to confirm or rule out a diagnosis.
You had a chromosomal condition in a previous pregnancy. If a previous

pregnancy was affected by Down syndrome or another chromosomal
condition, this pregnancy may be at a slightly higher risk, too.
You're 35 or older. Babies born to women 35 and older have a higher risk of
chromosomal conditions, such as Down syndrome.
You have a family history of a specific genetic condition, or you or your

partner is a known carrier of a genetic condition. In addition to identifying
Down syndrome, chorionic villus sampling can be used to diagnose many
other genetic conditions — including single gene disorders such as Tay-
Sachs and cystic fibrosis.
Tay-Sachs disease is a rare, inherited disorder that is characterized by

neurological problems caused by the death of nerve cells (neurons ) ...
Cystic fibrosis (CF) is an inherited disease in which the body makes very thick,
sticky mucus. The mucus causes problems in the lungs, pancreas, and other
organs. People with cystic fibrosis (SIS-tik fye-BROH-sis) get lung infections often.
Over time, they have more trouble breathing
Chorionic villus sampling can't detect certain birth defects, such as neural tube
defects. If neural tube defects are a concern, an ultrasound or genetic
amniocentesis might be recommended instead.
Your health care provider might caution against transcervical chorionic villus
sampling — which is done through the vagina — if you have:
An active cervical or vaginal infection, such as herpes
Vaginal bleeding or spotting in the previous two weeks
An inaccessible placenta, due to a tilted uterus or noncancerous growths in

your cervix or the lower part of your uterus
Amniocentesis
A prenatal diagnostic test in which a small amount of amniotic fluid is removed to
determine any genetic abnormality.
Embryoscopy
Embryoscopy is performed in the first trimester
In this technique, a rigid endoscope is inserted via the cervix in the space
between the amnion and the chorion, under sterile conditions and ultrasound
guidance, to visualize the embryo for the diagnosis of structural malformations.
Fetoscopy
Fetoscopy is an endoscopic procedure during pregnancy to allow surgical
access to the fetus, the amitotic cavity, the umbilical cord, and the fetal side of
the placenta. A small (3–4 mm) incision is made in the abdomen , and an
endoscope is inserted through the abdominal wall and uterus into the amniotic
cavity.
Percutaneous Umbilical Blood Sampling (PUBS)

At 16th week post-LMP, rapid diagnosis in 2-3 days
Puncture of the umbilical cord with ultrasound guidance
Applications
Diagnosis of structural anomalies
Diagnosis of hematologic or immunologic disorders
Rapid detection of true misaicism
Misaicism occurs when a person has two or more genetically different

sets of cells in his or her body.
If those abnormal cells begin to out number the normal cells, it can lead
to disease that can be traced from the cellular level to affected tissue,
like skin, the brain, or other organs
kapag nag cs pati uterus tinatahi di lang abdom
bakit sini sc?
sa cervix ay walang pagbabago or di pa din nag cocontract
or kapag si baby ay distress, to know if the baby is distress, sa fetal heart

tone malalaman using stet.
kapag nag cacarry ng twins/multiple or nasa abnormal position ang baby
ang abnormality sa placenta ay usually common.
os - opening
abruptio - abdominal pain
placenta previa - painless but has vaginal bleeding, it can be seen through scan
prolapsed umbillical cord - nauuna yung cord lumabas kesa baby, best thing to
do is cs
genital herpes - itchy and parang may lalabas na tubig sa ilalim doon sa balat na
may nana
may naka harang or may pelciv fracture, if there is a malaking damage sa birth
canal
CSF - cerebrospinal fluid, clear/colorless fluid
hydrocephalous - extra fluid. may parrang tube na mag dedrain through brain
para maalis yung fluid
may fluid pa din sa brain pero hindi dapat sumobra. hindi tama na walang
csf, coz if there is head accident walang mag prprotect. parang kapag yung
swimming pool walang tubig tapos nag swimming ka masakit. yung sa brain
ganon din, kasi masakit kapag nag dikit dikit yung buto also sa mga tuhod
meron din.
kapag nag buntis ulit after 1 year possible na ma cs. once u deliver through cs,
possible din na ma cs ka sa susunod na pagbubuntis
high risk pregnancy
possible reason for cs
health concern
mechanical obstruction
previous c-section
screening procedures
assess muna bago i confirm ang cs
screening procedures
maam kelan po malalaman kung iccs po yung nanay? possible po bang habang
nanganganak bigla pong mapag desisyunan ng obygenie na ics po? kase hindi kaya
ni nanay ilabas?
there is always vaginal bleeding after manganak, bawal ibalik sa kwarto kapag
hindi pa ninilinis.
assessment :
screeening
ante = before
antenatal
teaching - kapag may mga students
non teaching - infirmary, no medical students doing their clinical exposure
screening is to check if there is abnormalities
geographical - kasi yung ibang disease ay pwedeng mahawa o mapasa through

genes
3 interventions
dependent - doctors order (wound changing, medication, )
independent - kahit walang may order (pagpapalit ng bedsheet)

collaborative - need other department to help u do procedure. (xray, lab exam)
social burden - ask if nakakakain ba ng ayos, inaalagaan ba yung sarili. the

environment.
7 principles ethics
1. confidentiality - data provacy dontneed to discus to others
screening is done also for those healthy mother. less accurate kasi baka
nagsisinungaling yung patient.
diagnostic test - there are indication na may nakukuhang sakit mismo or abnormality
to a single patient. more accurate kasi may mga exam na by the help of some other
machine.
non invasive - dont involve tools that breaks skin (theres no bleeding like xray, MIR,
ECG, etc... basta hindi masusugatan, hindi makakapag open ng skin)
invasive - requires to use tools that can break skin (biopsy, etc...) insertion of
anything in the skin is considered as invasive.
pag may mabilis ang FHR kulang sa oxygen or fetal distress - administer oxygen
inhalatio for the baby
stillbirth - pinanganak na patay baby

there are ways to help the uterus contract - like addition of medication above IV fluid
like oxytocin to stimulate contraction, then after contraction check the FHR just to
check if there is fetal distress. pag may fetal distress administer oxygen doon sa
mother para sa bata.
hindi pwedeng tawagin na swero - intravenous fluid dapat
deceleration - yung contraction ay bumabalik na sa normal.

chromosomal condition - genetically transmitted
tay sach disease - rare , yung mga batang malaki na pero sometimes di pa din
tumatayo
any foreign object that is inserted to the human body can cause infection. anything
that will be inserted to the body should be sterile
when u do CSV walang vaginal bleeding or spotting within 2 weeks before exam
kung ano yung nandon sa loob ng katawan na hindi naman dapat nandon i consider
na agad na foreign object
amniocentesis - kukuha lang ng small amount of amniotic fluid to determine if there
is genetic disease.
sa screening malalaman kung kailangan pa ng mga procedure na ito
diagnostic test is not for normal pregnancy, it is only for some pregnant woman who
has abnormality.
Chapter 2 - Pre Gestational Condition

Definition
Rheumatic Heart Disease
is a chronic condition resulting from rheumatic fever that is characterized by
scarring and deformity of the heart valves.
rheumatic heart condition - kapag may streptococcus at hndi uminom ng

antibiotic delikado or kpag may scarlet fever and also kapag may poor
hygiene
Heart valve damage that arises as a complication of rheumatic fever years after
the illness has resolved.
It develops as a result of chronic inflammation and scarring of the heart valves

triggered by rheumatic fever - an inflammatory autoimmune disease that can
develop as a result of strep throat or scarlet fever.
common sign of infection is fever
If not treated, rheumatic heart disease can progress to heart failure.
Streptococcus infection
Scarlet fever is an infection caused by group A streptococcus (group A strep),
the same bacteria responsible for strep throat.
Also known as Scarlatina, it's characterized by a rash and a red tongue. It's most
likely to strike children between ages 5 and 15 and rarely, if ever, affects adults.
Although once a dangerous disease of childhood, scarlet fever is now highly

treatable and uncommon in most of the world
Cause:
Group A strep bacteria travel via droplets of infected fluid that become airborne
when an infected person coughs or sneezes. Touching something that the bacteria
have landed on and then touching your mouth, eyes, or nose can cause you to
become infected.
The disease spreads more in crowded conditions. Hand washing and covering
coughs and sneezes can help prevent spread. A child is still infectious until two
days of antibiotics.
Causes of RHF
1. Genetics may play a role in rheumatic heart disease
As they appears to be a genetic link that makes some people more

susceptible to rheumatic heart disease. But little is known about the genetic
factors that increase or decrease the risk of developing RHD.
2. Lifestyle Risk Factors
The primary risk factor for rheumatic fever is failing to take steps to prevent
infection from strep bacteria (as well as other infectious microbes). This
means infrequent hand washing, especially after sneezing or coughing or
before eating.
When the heart is involved, inflammation can develop on the surface called
pericarditis
Swelling and irritation of the thin, saclike tissue surrounding the heart
(pericardium). Pericarditis often causes sharp chest pain. The chest pain occurs
when the irritated layers of the pericardium rub against each other. Pericarditis is
usually mild and goes away without treatment.
pericarditis - nagkikiskis yung muscles and sumasakit or most common sign

ay may chest pain (sa surrounding ng heart ang infected)
Chest pain is the most common symptom of pericarditis. Other signs and
symptoms of pericarditis may include:
Cough
Fatigue or general feeling of weakness or being sick
Leg swelling
Low-grade fever
Pounding or racing heartbeat (heart palpitations)
Shortness of breath when lying down
Swelling of the belly (abdomen)
Within the valves - endocarditis
It is a life-threatening inflammation of the inner lining of your heart's

chambers and valves (endocardium). Endocarditis is usually caused by an
infection.
endo - inflammation is a kind of foreign body (chamber at lung ang

infected)
In the heart muscle itself - myocarditis
A rare condition in which the heart muscle becomes thick and inflamed and
may also become weak.
myocarditis - ang infected ay heart muscle
hndi pwedeng mag sabay sabay ang peri,endo, at myo
Myocarditis is usually caused by a viral infection, but it may also be caused

by bacterial, parasitic, or fungal infections; autoimmune disorders; or being
exposed to radiation or certain chemicals or drugs
For pregnant women with rheumatic heart disease, increased pressure on the
damaged heart valve leads to increased maternal and fetal risks. These
complications might include:
1. Death of mother and baby
2. Increased risk of preterm delivery which may affect baby and mother's
health
3. Increased risk of other complications of pregnancy
4. In some cases, serious complication is associated with a greater risk of heart

failure shortly before, during, or after delivery.
Rheumatic heart disease (RHD) is the most common acquired

heart disease in pregnancy. (the real coz of RHF is streptococcus
infection virus or fungi)
For women with rheumatic heart disease, this increased pressure presents
increased maternal and/or fetal risks.
Pregnancy can lead to the appearance or worsening of symptoms including

shortness of breath with a simple activity, and waking at night out of breath.
Women with more severe RHD, it could lead to the development of much
more serious symptoms such as pulmonary edema, atrial fibrillation of
clotting. These changes begin in the first trimester but peak at 28-30 weeks
and are sustained until term.
pre term delivery - below 37 weeks
Causes of RHF:
1. Genetics may play a role in rheumatic heart disease, as there appears to be a
genetic
link that makes some people more susceptible to rheumatic heart disease. But
little is known about the genetic factors that increase or decrease the risk of
developing RHD.
2. Lifestyle Risk Factors The primary risk factor for rheumatic fever is failing to take
steps to prevent infection from strep bacteria (as well as other infectious
microbes). This means infrequent hand washing, especially after sneezing or
coughing or before eating.
Atrial Fibrillation
Often called AFib or AF, is the most common type of treated heart arrhythmia.
Arrhythmia is when the heart beats too slowly, too fast, or in an irregular way
Management of rheumatic heart disease in pregnancy:

1. Women with moderate or severe rheumatic heart disease require close
supervision, normally at a tertiary referral center with cardiology and intensive
care facilities.
2. Where a heart valve has been replaced, or for atrial fibrillation, anticoagulants
(anticoagulants - pang pa buo ng dugo) including Warfarin or low-molecular
weight heparin (LMWH) are mostly taken
3. Any prescribed antibiotics secondary prophylaxis (usually LA bacillin injections

every 21-28 days) is safe during pregnancy. It is vital that women does not miss
any injections to avoid a recurrence of rheumatic fever and worsening of the
rheumatic heart disease.
4. Require no special management during pregnancy but should have careful

assessment preconception, or early in pregnancy, by a cardiologist and
obstetrician to establish the safest birth pathway.
Management of RHD in high risk pregnancy:
The treatment plans arranged by multidisciplinary team involved
1. The prescribing of certain medications to stimulate lung functions in order to

prevent serious complications in case that preterm delivery might be urgently
required.
2 Baby's heart system and general development were closely monitored every 2
weeks.
2. Possible complications were closely observed under the supervision of

multidisciplinary care provider by cardiac specialist, obstetrician-gynecologist
and pediatrician
Taking good care of pregnant women with rheumatic heart

fever:
1. If suspected signs and symptoms manifest, immediate medical attention must be
provided as soon as possible in order to get the condition diagnosed accurately,
leading to a timely and appropriate treatment plan.
2. If a rheumatic heart disease is diagnosed during pregnancy, comprehensive

treatments must be given by a multidisciplinary team including a cardiologist,
obstetrician-gynecologist, and pediatrician.
Pulmonary Edema
condition caused by excess fluid in the lungs. This fluid collects in the numerous
air sacs in the lungs, making it difficult to breathe
Atrial Fibrillation
often called AFib or AF, is the most common type of treated heart arrhythmia.
Arrhythmia is when the heart beats too slowly, too fast, or in an irregular way.
Diabetes Mellitus
Is a group of diseases marked by high blood sugar, and gestational diabetes is
one type of diabetes that develops during pregnancy due to hormonal changes.
diabetes mellitus - sobra ang sugar sa dugo
Particularly, women who develop gestational diabetes did not have the disease
prior to pregnancy
Signs and symptoms associated with gestational diabetes

include:
sign - is yung nakikita ng nurse or physician or nung nag aassess sa patient -
objective
symptoms - yung sinasabi ng patient - subjective
1. Increased, frequent urination
a. may increase ng urination ay normal pero kapag increased frequent or di na

macontrol pwedeng sign siya ng gestational diabetes
2. Increased thirst
3. Fatigue
4. Nausea and vomiting
5. Weight loss even with increased appetite
6. Blurred vision
7. Yeast infection
Similar to type 2 diabetes, gestational diabetes develops when the baby is no

longer able to respond effectively to insulin - a condition called insulin resistance.
Causes of gestational diabetes:
When the body's cells don't properly absorb glucose, the simple sugar builds
up in the bloodstream, resulting in elevated levels of glucose on blood tests.
Insulin resistance in pregnant women is due mainly to hormonal

changes
Gestational diabetes is caused by the effects of placental

hormones. These hormones include:
1. Growth hormones
2. Cortisol (a stress hormones)
a. kapag nakakaya mo yung stress because of your cortisol
3. Estrogen and progesterone
a. estrogen - helps or make the women develop organs like pelvis and hips, or
na cucurve pa lalo then the breast to grow
b. progesterone - helps to thicken the uterus to prepare for fertilizing the egg,
then helps to have a regular menstration
4. Human placental lactogen (a hormone produced in the placenta that helps break
down fat from the mother to provide energy for the fetus)
5. Placental insulinase (another hormone from the placenta that inactives insulin)
6. Eating more, exercising less, and having larger fat deposits.
a. These changes allow the growing fetus access to more nutrients. The
woman's body compensates by producing more insulin, but sometimes even
this extra insulin isn't enough to keep glucose levels normal, resulting in
diabetes
Numerous factors raise a pregnant woman's risk of developing

gestational diabetes, including:
1. Prediabetes (blood sugar that's elevated, but not high enough to be called
diabetes)
2. HPN
3. A personal or family history of gestational diabetes
4. A family hx of DM type 2
5. Hormone disorders, such as polycystic ovary syndrome (PCOS)
6. Being overweight, or gaining too much weight during pregnancy
7. Being older than 25
8. Being of African, American Indian, Asian, Hispanic, or Pacific Islander descent
9. Previously giving birth to a baby that weighed at least 9 pounds or had a birth
defect
10. Previously having an unexplained stillbirth or miscarriage
Screening tests for gestational diabetes include:
1. Glucose Challenge Test
Involves drinking a syrupy glucose solution, and then undergoing blood test
to measure your blood sugar level one hour later.
Generally, a blood sugar level is considered normal if it is below 140

milligrams per deciliter (mg/dL) or 7.8 millimoles per liter (mmol/L). A blood
sugar level of 190 mg/dL or 10.6 mg/dL indicates gestational diabetes
2. Follow-up glucose testing
If your blood sugar level was higher than normal during the initial glucose
challenge test, you'll need to complete another one to determine if you have
gestational diabetes. This test will be similar to the first screening except the
glucose solution will be sweeter and your blood will be checked hourly for
three hours. If two of these blood tests comes back high, you will receive a
gestational diabetes diagnosis
Treatment and Medication Options for Gestational Diabetes:

1. Monitor your blood sugar.
2. Maintain a healthy diet
3. Get exercise.
4. Use medication.
Complications of Gestational Diabetes:

1. An Extra-Large Baby
2. High Blood Pressure (Preeclampsia)
3. Low Blood Sugar (Hypoglycemia)
Chapter 3 - Substance Abuse in

Pregnancy
Substance abuse defined as long-term, pathological use of alcohol or drugs,
characterized by daily intoxication, inability to reduce consumption, and impairment
in social or occupational functioning; broadly, alcohol or drug addiction.
Prenatal substance use is a critical public health concern that is linked with
several harmful maternal and fetal consequences.
Drugs taken by a pregnant woman reach the fetus primarily by crossing the
placenta, the same route taken by oxygen and nutrients, which are needed for the
fetus's growth and development. However, drugs that do not cross the placenta
may still harm the fetus by affecting the uterus or the placenta.
Drugs that a pregnant women takes during

pregnancy can affect the fetus in several ways:
They can act directly on the fetus, causing damage, abnormal development
(leading to birth defects), or death.
They can alter the function of the placenta, usually by causing blood vessels to
narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus
from the mother. Sometimes the result is a baby that is underweight and
underdeveloped.
They can cause the muscles of the uterus to contract forcefully, indirectly injuring
the fetus by reducing its blood supply or triggering preterm labor and delivery.
How Drugs Cross the Placenta
How a Drugs Affects a Fetus Depends on:
The fetus's stage of development
The strength and dose of the drug
The permeability of the placenta (how easily substances pass through it)
The genetic make-up of the mother, which affects how much of the drug is active
and available
pag sobra or abuse using substance or drugs may consequences
Because of this problem, the FDA eliminated the five

risk categories. Instead, the FDA now requires that
the drug label include more information about the
risk of taking every drug during pregnancy. This
information includes the following:
The risks of taking the drug during pregnancy and breastfeeding
The evidence that has identified these risks
Information to help health care practitioners decide whether the drug should be
used during pregnancy and to help them explain the risks and benefits of using the
drug to the woman
Typically, health care practitioners follow a general

rule:
They consider giving a pregnant woman a drug to treat a disorder only when the
potential benefit outweighs known risks.
Vaccines During Pregnancy

Immunization is as effective in women who are pregnant as in those who are not.
Vaccines made with a live virus (such as the rubella vaccine and varicella
vaccine) are not given to women who are or might be pregnant.
Other vaccines (such as those for cholera, hepatitis A, hepatitis B, plague,

rabies, and typhoid) are given to pregnant women only if they are at substantial risk
of developing that particular infection and if the risk of side effects from the vaccine
is low.
However, all pregnant women who are in the 2nd or 3rd trimester during the
influenza (flu) season should be given the influenza vaccine.
All pregnant women should be given the tetanus-diphtheria-pertussis (Tdap)

vaccine between 27 and 36 weeks of each pregnancy. This vaccine protects
against pertussis (whooping cough).
Drugs used to treat heart and blood vessel disorder

during pregnancy:
Drugs to lower high blood pressure (antihypertensives) may be needed by
pregnant women who have had high blood pressure before pregnancy or who
develop it during pregnancy. Either type of high blood pressure increases the risk
of problems for the woman (such as preeclampsia) and for the fetus (see page
High Blood Pressure During Pregnancy).
Antidepressants During Pregnancy:

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such
as paroxetine, are commonly used during pregnancy. Use is common because
about 7 to 23% of pregnant women have depression. For pregnant women, the
benefits of treating depression usually outweigh the risks.
Antiviral Drugs During Pregnancy

Some antiviral drugs (such as zidovudine and ritonavir for HIV infection) have
been safely used during pregnancy for many years. However, some antiviral drugs
may cause problems in the fetus.
Social Drugs During Pregnancy

Cigarette (tobacco) smoking during pregnancy
The most consistent effect of smoking on the fetus during pregnancy is
A reduction in birth weight (growth restriction) The more a woman smokes

during pregnancy, the less the baby is likely to weigh. The average birth
weight of babies born to women who smoke during pregnancy is 6 ounces
less than that of babies born to women who do not smoke.
Birth defects of the heart, brain, and face are more common among babies
of smokers than among those of nonsmokers. Also, the risk of the following
may be increased:
Alcohol during pregnancy
Drinking alcohol during pregnancy is the leading known cause of birth

defects. Because the amount of alcohol required to cause fetal alcohol
syndrome is unknown, pregnant women are advised to abstain from drinking
any alcohol regularly or on binges. Avoiding alcohol altogether is even safer.
The risk of miscarriage almost doubles for women who drink alcohol in any
form during pregnancy, especially if they drink heavily.
Fetal alcohol syndrome is one of the most serious consequences of

drinking during pregnancy. Binge drinking as few as three drinks a day can
cause this syndrome. It occurs in about 2 of 1,000 live births. This syndrome
includes the following:
• Inadequate growth before birth or after birth
• Birth defects of the face
• A small head (microcephaly), probably caused by inadequate growth of the
brain
• Intellectual disability
• Abnormal behavioral development
• Less commonly, joint abnormalities and heart defects
Caffeine during pregnancy
Whether consuming caffeine during pregnancy harms the fetus is unclear.

Evidence seems to suggest that consuming caffeine in small amounts (for
example, one cup of coffee a day) during pregnancy poses little or no risk to
the fetus.
Caffeine, which is contained in coffee, tea, some sodas, chocolate, and

some drugs, is a stimulant that readily crosses the placenta to the fetus.
Some evidence suggests that drinking more than seven cups of coffee a day
may increase the risk of having a stillbirth, premature birth, low-birth-weight
baby, or miscarriage.
Aspartame during pregnancy
Aspartame, an artificial sweetener, appears to be safe during pregnancy

when it is consumed in small amounts, such as in amounts used in normal
portions of artificially sweetened foods and beverages. For example,
pregnant women should consume no more than 1 liter of diet soda a day.
Pregnant women with phenylketonuria, an unusual disorder, should not

consume any aspartame.
Illicit Drugs During Pregnancy
Use of illicit drugs (particularly opioids) during pregnancy can cause

complications during pregnancy and serious problems in the developing
fetus and the newborn. For pregnant women, injecting illicit drugs increases
the risk of infections that can affect or be transmitted to the fetus. These
infections include hepatitis and HIV infection (including AIDS). Also, when
pregnant women take illicit drugs, growth of the fetus is more likely to be
inadequate, and premature births are more common.
Amphetamines during pregnancy
Use of amphetamines during pregnancy may result in birth defects,

especially of the heart, and possibly inadequate growth before birth.
Bath salts during pregnancy
Bath salts refers to a group of designer drugs made from various

substances that resemble amphetamine. More and more pregnant
women are using these drugs. The drugs may cause the blood vessels
in the fetus to narrow, reducing the amount oxygen the fetus gets. Also,
these drugs increase the risk of the following:
• Stillbirth
• Premature detachment of the placenta (abruptio placentae)
• Possibly birth defects
Cocaine during pregnancy
Cocaine taken during pregnancy may cause the blood vessels that carry
blood to the uterus and placenta to narrow (constrict). Then, less oxygen
and fewer nutrients reach the fetus. If pregnant women use cocaine
regularly, risk of the following is increased:
• Miscarriage
• Inadequate growth of the fetus
• Premature detachment of the placenta (placental abruption, or abruptio
placentae)
• Premature birth
• Stillbirth
• Birth defects (including brain and spinal cord, urinary tract, and bone
defects)
Hallucinogens during pregnancy
Hallucinogens may, depending on the drug, increase the risk of the

following:
• Miscarriage
• Premature labor and delivery
• Withdrawal syndrome in the fetus or newborn
Hallucinogens include methylenedioxymethamphetamine

(MDMA, or Ecstasy), rohypnol, ketamine,
methamphetamine, and LSD (lysergic acid diethylamide).
Marijuana during pregnancy
Whether use of marijuana during pregnancy can harm the fetus is

unclear. The main component of marijuana, tetrahydrocannabinol, can
cross the placenta and thus may affect the fetus. However, use of a
small amount of marijuana does not appear to increase the risk of birth
defects or to slow the growth of the fetus.
Marijuana does not cause behavioral problems in the newborn unless it

is used heavily during pregnancy.
Opioids during pregnancy
Opioids are used to relieve pain, but they also cause an exaggerated
sense of well-being, and if used too much, they can cause dependence
and addiction.
Opioids, such as heroin, methadone, and morphine, readily cross the

placenta. Consequently, the fetus may become addicted to them and
may have withdrawal symptoms 6 hours to 8 days after birth. However,
use of opioids rarely results in birth defects.
Use of opioids during pregnancy increases the risk of complications

during pregnancy, such as
• Miscarriage
• Abnormal presentation of the baby
• Preterm delivery
Babies of heroin users are more likely to be small.
Drugs Used During Labor and Delivery

Drugs used to relieve pain during pregnancy (such as local anesthetics and
opioids) usually cross the placenta and can affect the newborn. For example, they
can weaken the newborn's urge to breathe. Therefore, if these drugs are needed
during labor, they are given in the smallest effective doses.
PREVALENCE:
Approximately 5% of pregnant women use illicit substances
Larger portion use cigarettes and alcohol
Many use more than one substance
Among women age 15 to 17 who were pregnant had a higher rate of use than
those who were not pregnant
RISK FACTORS:
Late initiation of prenatal care
Multiple missed prenatal visits
Impaired school or work performance
Plus OB history of: miscarriage, growth restriction, prematurity, placental

abruption, stillbirth, precipitous delivery
Offspring with neuro developmental or behavioral pblms
Offspring not living with mother or involved with CPS
H/o drug or alcohol related problems (e.g. pancreatitis, skin abscesses. SBE)
Family history of substance use (genetic and environmental factors)
Frequent encounters with law enforcement agencies
Having a partner who abuses substances (particularly important for women who
may have been introduced to and supplied with drugs from partner)
NEONATAL LABORATORY TESTING:

Usually urinalysis
May detect only recent maternal use
May test meconium (begins to form at 12 weeks gestation and the presence and
concentration of drug in meconium is thought to be related to the amount, timing
and duration of drug exposure during intrauterine life). Can test meconium up to
three days after delivery
Neonatal hair can be tested for narcotics, marijuana and cocaine use
MANAGEMENT:
Factual and non-judgmental information
Discussion about maternal and fetal risk
Testing (UDS)
Assessing motivations
Discussing factors that may influence treatment
TREATMENT:
AA and NA (self help)
Residential treatment
Substance dependence treatment programs (outpatient, PHP, IOP)
Smoking cessation programs
Medication (e.g. methadone, bupropion, nicotine patch)
Treating underlying disorder
Social support (social services)
Collaborative care (ob/gyn, psychiatrist, case management / social services,

etc.)
Chapter 3 - Substance Abuse in
Pregnancy
What are the priority nursing interventions for
substance abuse?
Nursing interventions for a client with substance abuse include:
Providing health teaching for client and family. Clients and family members
need facts about the substance, its effects, and recovery.
Addressing family issues.
Promoting coping skills.
COCAINE ABUSE DURING PREGNANCY

Decreased uterine blood flow leading to poor fetal oxygenation and increased
fetal blood pressure and heart rate.
Cocaine use during early gestation is associated with an increased risk of

spontaneous abortion, whereas later use is associated with premature labor and
delivery, placental abruption, low birth weight, SIDS, intrauterine growth
retardation, low Apgar scores, meconium staining, fetal death, microcephaly,
neurodevelopmental delay, and structural/congenital anomalies, especially
involving the gastrointestinal and renal systems.
The increased risk for meconium staining and non reassuring fetal heart tracings
associated with maternal cocaine use may be due to the fact that the normal
catecholamine surge in
the newborn that occurs during labor may overwhelm the myocardium in the
cocaine-exposed infant.
Studies on cocaine abuse indicate that maternal cocaine use during pregnancy
is associated with an increased incidence of high maternal gravidity, poor prenatal
care, and preterm birth.
Marijuana
is a commonly abused substance, with greater than 25% of women in their
reproductive years admitting to past or current marijuana use.
Marijuana use during pregnancy has been associated with few short-term or
long-term effects on the exposed neonate, its risks are dose-dependent, with an
increased incidence of intrauterine growth retardation and SIDS seen in the infants
born to heavy users.
The use of marijuana may be most beneficial as an indicator of poly-substance

abuse and lower socioeconomic status that may influence both prenatal care and
the home environment.
SEDATIVE/HYPNOTIC USE DURING PREGNANCY

Maternal use of sedatives/hypnotics leads to physical dependency in the fetus
characterized by the neonatal abstinence/withdrawal syndrome. Drugs that are
associated with neonatal withdrawal include heroin/methadone, caffeine, cocaine,
ethanol, marijuana, and nicotine.
Includes behavioral and autonomic nervous system dysfunction plus

gastrointestinal, respiratory, and central nervous system abnormalities.
Women using sedatives/hypnotics during pregnancy may need to be

hospitalized during detoxification because the risk for seizures and other central
nervous system effects is relatively high.
SCREENING FOR MATERNAL DRUG USE DURING

PREGNANCY:
Maternal hair analysis, although a good screening test for detecting maternal
drug use during the previous 3 months with drug metabolites persisting for up to 3
months in the infant’s hair after birth, is falsely positive in those women exposed
passively to second-hand smoke from crack cocaine and marijuana. Although
theoretically useful, hair analysis is unavailable to most clinicians on a routine basis
Meconium analysis, which is easily performed, gives a picture of the drug use
pattern during the latter half of pregnancy and may be the ideal screening test for
maternal drug use. Because meconium can be attained only at delivery, it is not
useful for antepartum screening
Urine toxicology assay- can detect maternal drug use within the past 48 to 72
hours, they may miss the infrequent users and cannot quantify the frequency or
amount of drug used.
Abstinence should be the ultimate goal of the management and treatment of

substance abuse during pregnancy.
Other treatment options include:
formal counseling programs,
self-help groups,
women’s shelters, and
halfway houses
Chapter 4 - HIV in Pregnancy

HIV or Human Immunodeficiency Virus is a virus that causes AIDS or Acquired
Immunodeficiency Virus
A person may be “HIV positive” but not have AIDS. A HIV infected person may
not develop AIDS for 10 years or longer
An AIDS infected person cannot fight off diseases as they would normally and
are more susceptible to infections, certain cancers and other health problems that
can be life-threatening or fatal.
Human immunodeficiency virus (HIV) is a type of virus that preferentially targets

white blood cells called CD4 T-cells. By killing more and more of these cells, the
body's immune defenses are weakened and eventually compromised. If an
untreated HIV infection progresses, there is ongoing damage to immune defense
cells. As this happens, the body becomes increasingly less able to fight off
infections. When this happens, a person is said to have Acquired Immune
Deficiency Syndrome (AIDS).
HIV is a virus that can be transmitted from someone with HIV to someone
without through body fluids like semen, blood, vaginal secretions, and breast milk.
HIV is most commonly passed during unprotected sex, primarily anal and vaginal
sex, but is also effectively transmitted through shared needles.
HIV can also be passed from mother to child via the placenta during pregnancy
or during childbirth, due to exposure to blood or vaginal fluid, or while breastfeeding
There are two types of HIV
HIV-1
HIV-2
Destroy specific blood cells that help the body to fight diseases.
AIDS is not a disease, its a syndrome
When the immune system become weakened by HIV, the illness progresses to
AIDS.
What are the causes of HIV in pregnancy?
HIV spreads through infected body fluids, like blood, semen and breast milk.
It spreads mainly through unprotected sex or sharing drug needles.
You can pass HIV to your baby during pregnancy, labor, birth or breastfeeding.
Treatment can help protect your baby from getting infected.
During pregnancy, HIV can pass through the placenta and infect the fetus.
During labor and delivery, the baby may be exposed to the virus from a woman's
blood and other fluids.
When a woman goes into labor, the amniotic sac breaks (her water breaks).
Once this occurs, the risk of transmitting HIV to the baby increase
HIV/AIDS in Pregnancy
Fetus may contract HIV transplacentally, at birth or through breastmilk.
Absolutely no breastfeeding for these mothers.
Current maternal treatment is oral zidovudine (AZT) during pregnancy and IV

AZT during labor. Newborn also treated with AZT.
Although maternal antibodies may be present at birth in some babies, the

antibody tests will usually convert to negative before 18 months of age.
Effect of HIV on Pregnancy
Pregnancy-related complications for women with HIV include:
Increased risk of spontaneous abortions
Double the rate of pre-term deliveries
Increased risk of having LBW infant
Increased risk of stillbirths
Increased risk of bacterial pneumonia, urinary tract and other postnatal

infections
HIV Symptoms During Pregnancy:

Fever and chills
Rash
Fatigue
Joint pain or muscle aches
Swollen lymph nodes
Ulcers in the mouth
Sore throat
Yeast Infections
The HIV test will be done at the same time as other

routine antenatal blood tests:
Blood group and Rhesus factor
Full blood count
Hepatitis B
Rubella and syphilis
One sample of blood can be used for all the tests
What types of HIV tests are available during

pregnancy?
Antigen/antibody tests
This blood test can detect HIV just 18 to 45 days Trusted Source after initial
exposure. It looks for both the HIV antibodies and antigens present in the blood.
Both standard and rapid antigen/antibody tests are available. The rapid test uses
a finger prick and may not detect the virus for up to 90 daysTrusted Source after
exposure.
Antibody tests
This blood or saliva test can detect HIV in 23 to 90 days Trusted Source after
initial exposure. Many rapid tests are antibody tests, including the at-home self-
test. Antibody tests that are performed using blood from a vein detect HIV
sooner than those done by finger prick or with saliva.
Nucleic acid tests (NATs)

This blood test can detect HIV in just 10 to 33 daysTrusted Source after initial
exposure. It looks for the virus in the blood versus just the antibodies. NATs are
expensive and are not usually the first test given unless there is a confirmed
exposure to HIV or there are symptoms.
The specific test given may depend on:
the location where testing is performed
the conditions of exposure (confirmed versus suspected exposure)
whether an individual is symptomatic
how long ago exposed to the virus may have occurred
What is the treatment?

Pregnant women with HIV will usually be offered a combination of treatment and
interventions including:
medicines during pregnancy and birth to help women stay healthy for longer,
and to prevent them from passing the virus on to the baby
advice about safe delivery methods
medicines for the baby which will be offered for a few weeks after birth.
Current international evidence suggests that the drug treatment before and
after birth causes no harm in babies
advice about the safest feeding methods for the baby.
Prevention
Preventive measures are best attempts to control the global problems of
HIV/AIDS
Four basis approaches to control HIV/AIDS include:
Prevention by health education to make lifesaving choices and avoiding blood-

borne HIV infections
ARVs treatment with combination therapy or postexposure prophylaxis
Specific prophylaxis for HIV manifestations, e.g. isoniazid for TB.
PHC approaches with integrated care in mother and child and health education.
Nursing Roles in Prevention for Patients

Assess
Identify risks for HIV infection
Intervene
Counsel on the benefits of HIV testing
Educate on HIV transmission and risk reduction
Refer those testing HIV-positive to care and support
Educate those testing HIV-negative about prevention
Nursing Care
Educate the HIV-positive woman on methods to reduce the risk of transmission
to her developing fetus/infant
Pregnant women with HIV/AIDS are more susceptible to infection
Breastfeeding is absolutely contraindicated for mothers who are HIV-positive
What is the most important nursing consideration

when taking care of HIV positive patients?
Compassion and empathy are essential in the daily nursing care of a person with
HIV/AIDS. Thus, nurses must take time to talk to their patients and their families
about how they are coping with the disease, as this may help the patients identify
specific problems and allow them to externalize them
Prevention:
Until an effective vaccine is developed, nurses need to prevent HIV infection by
teaching patients how to eliminate or reduce risky behaviors.
Safe sex. Other than abstinence, consistent and correct use of condoms is
the only effective method to decrease the risk of sexual transmission of HIV
infection.
Sex partners. Avoid sexual contact with multiple partners or people who are
known to be HIV positive or IV/injection drug users.
Blood and blood components. People who are HIV positive or who use
injection drugs should be instructed not to donate blood or share drug
equipment with others.
Nursing Care Plan (NCP)

Assessment
Nursing assessment includes identification of potential risk factors, including

a history of risky sexual practices or IV/injection drug use.
Nutritional status. Nutritional status is assessed by obtaining a diet

history and identifying factors that may affect the oral intake.
Skin integrity. The skin and mucous membranes are inspected daily for
evidence of breakdown, ulceration, or infection.
Respiratory status. Respiratory status is assessed by monitoring the

patient for cough, sputum production, shortness of breath, orthopnea,
tachypnea, and chest pain.
Neurologic status. Neurologic status is determined by assessing the

level of consciousness; orientation to person, pace, and time; and
memory lapses.
Fluid and electrolyte balance. F&E status is assessed by examining

the skin and mucous membranes for turgor and dryness.
Knowledge level. The patient’s level of knowledge about the disease
and the modes of disease transmission is evaluated.
Diagnosis
Impaired skin integrity related to cutaneous manifestations of HIV infection,

excoriation, and diarrhea
Diarrhea related to enteric pathogens of HIV infection.
Risk for infection related to immunodeficiency.
Activity intolerance related weakness, fatigue, malnutrition, impaired F&E

balance, and hypoxia associated with pulmonary infections.
Disturbed thought processes related to shortened attention span, impaired

memory, confusion, and disorientation associated with HIV encephalopathy.
Ineffective airway clearance related to PCP, increased bronchial secretions,

and decreased ability to cough related to weakness and fatigue.
Pain related to impaired perianal skin integrity secondary to diarrhea, KS,

and peripheral neuropathy.
Imbalanced nutrition, less than body requirements related to decreased oral

intake
Planning
Achievement and maintenance of skin integrity.
Resumption of usual bowel pattern.
Absence of infection.
Improve activity intolerance.
Improve thought processes.
Improve airway clearance.
Increase comfort.
Improve nutritional status
Implementation
Promote skin integrity. Patients are encouraged to avoid scratching; to use

nonabrasive, nondrying soaps and apply nonperfumed moisturizers; to
perform regular oral care; and to clean the perianal area after each bowel
movement with nonabrasive soap and water.
Promote usual bowel patterns. The nurse should monitor for frequency
and consistency of stools and the patient’s reports of abdominal pain or
cramping.
Prevent infection. The patient and the caregivers should monitor for signs
of infection and laboratory test results that indicate infection.
Improve activity intolerance. Assist the patient in planning daily routines

that maintain a balance between activity and rest.
Maintain thought processes. Family and support network members are

instructed to speak to the patient in simple, clear language and give the
patient sufficient time to respond to questions.
Improve airway clearance. Coughing, deep breathing, postural drainage,

percussion and vibration is provided for as often as every 2 hours to prevent
stasis of secretions and to promote airway clearance.
Relieve pain and discomfort. Use of soft cushions and foam pads may
increase comfort as well as administration of NSAIDS and opioids.
Improve nutritional status. The patient is encouraged to eat foods that are
easy to swallow and to avoid rough, spicy, and sticky food items.
Evaluation
Expected patient outcomes may include:
Achieved and maintained of skin integrity.
Resumption of usual bowel pattern.
Absence of infection.
Improved activity intolerance.
Improved thought processes.
Improved airway clearance.
Increased comfort.
Improved nutritional status.
Increased socialization.
Absence of complications.
HIV
is a virus
transmitted through anal ang vagina or shared needles (using drugs)
transmitted into the baby by placenta (where the nutrition comes from)
they are not able to donate blood
AIDS
kapag ung person ay may HIV, magiging AIDS
Causes of HIV to the pregnancy
infected through semen ang breastmilk (transmitted through breastfeeding) -

bottle fed
treatments are given or ordered by the doctor/dependent
spontaneous pregnancy - hndi maka buo ng baby, nag popositive sa pregnancy test
but below 20 weeks nawawala yung fetus
dont ask questions na nagsasagot lang sa yes or no
promotion - wala pang sakit
prevention - meron nang sakit ilelessen lang ung paglala
Chapter 5 - Anemia in Pregnancy
Pathophysiology:
The hemoglobin level for nonpregnant women is usually 3.5 g/dL. However, the
hemoglobin level during the second trimester of pregnancy averages 11.6 g/dL as
a result of the dilution of the mother’s blood from increased plasma volume. This is
called physiologic anemia and is normal during pregnancy.
Iron cannot be adequately supplied in the daily diet during pregnancy.

Substances in the diet, such as milk, tea, and coffee, decrease absorption of iron.
During pregnancy, additional iron is required for the increase in maternal RBCs and
for transfer to the fetus for storage and production of RBCs. The fetus must store
enough iron to last 4 to 6 months after birth.
During the third trimester, if the woman’s intake of iron is not sufficient, her
hemoglobin will not rise to a value of 12.5 g/dL and nutritional anemia may occur.
This will result in decreased transfer of iron to the fetus.
Hemoglobinopathies, such as thalassemia, sickle cell disease, and G-6-PD, lead

to anemia by causing hemolysis or increased destruction of RBCs.
The hemoglobinopathies are a group of disorders passed down through families

(inherited) in which there is abnormal production or structure of the hemoglobin
molecule.
Sickle cell disease (SCD) is one such blood disorder caused by the abnormal
hemoglobin that damages and deforms red blood cells.
Thalassemia inherited (i.e., passed from parents to children through genes)

blood disorder caused when the body doesn't make enough of a protein called
hemoglobin, an important part of red blood cells.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a condition in

which red blood cells break down when the body is exposed to certain drugs or the
stress of infection. It is hereditary, which means it is passed down in families
When you're pregnant, you may develop anemia.
If there’s anemia, the blood doesn't have enough healthy red blood cells to carry
oxygen to the tissues and the baby.
During pregnancy, the body produces more blood to support the growth of your
baby.
If you're not getting enough iron or certain other nutrients, your body might not
be able to produce the amount of red blood cells it needs to make this additional
blood.
Several types of anemia can develop during pregnancy. These

include:
1. Iron-deficiency anemia
This type of anemia occurs when the body doesn't have enough iron to
produce adequate amounts of hemoglobin. That's a protein in red blood cells. It
carries oxygen from the lungs to the rest of the body.
In iron-deficiency anemia, the blood cannot carry enough oxygen to tissues

throughout the body.
Iron deficiency is the most common cause of anemia in pregnancy.
2. Folate-deficiency anemia
Folate is the vitamin found naturally in certain foods like green leafy
vegetables A type of B vitamin, the body needs folate to produce new cells,
including healthy red blood cells.
During pregnancy, women need extra folate. But sometimes they don't get
enough from their diet. When that happens, the body can't make enough
normal red blood cells to transport oxygen to tissues throughout the body. Man
made supplements of folate are called folic acid.
Folate deficiency can directly contribute to certain types of birth defects,

such as neural tube abnormalities (spina bifida) and low birth weight.
3. Vitamin B12 deficiency
The body needs vitamin B12 to form healthy red blood cells.
When a pregnant woman doesn't get enough vitamin B12 from their diet,
their body can't produce enough healthy red blood cells.
Women who don't eat meat, poultry, dairy products, and eggs have a greater
risk of developing vitamin B12 deficiency, which may contribute to birth defects,
such as neural tube abnormalities, and could lead to preterm labor.
Lethargy- lack enough healthy red blood cells to carry adequate oxygen to your
body's tissues
SOB-With anemia, the lungs overcompensate in order to bring in more oxygen,
causing breathing difficulties. Low levels of hemoglobin prevent adequate oxygen
from reaching the brain. Blood vessels swell, blood pressure drops, and it can result
in headaches, neurological issues, and vertigo.
Palpitations-Heart palpitations in pregnancy are very common. During pregnancy,

the amount of blood in your body increases significantly. Your heart works harder to
pump the extra blood throughout your body and to your baby. This extra work can
result in heart palpitations.
Chest Pain- When there's a low level of oxygen in the blood, the heart works extra
hard to compensate. This puts a lot of pressure on the heart, which can cause it to
beat faster, irregularly, and experience pain.
Headache- brain gets less oxygen than usual
Dizziness and fainting (syncope)- are often caused by a drop in blood pressure.
This is from the hormones released during pregnancy that relax the body's blood
vessels. Too little blood is then pumped up to the brain. When this happens, you lose
consciousness (faint).
Pallor-paleness is anemia, a condition in which your body doesn't have enough red
blood cells
to transport and circulate oxygen. You are particularly susceptible during pregnancy
since your blood flow has increased and you need extra iron and folate to produce
enough healthy red blood cells.
Tachycardia - sthe heart tends to compensate for the lack of red blood cells
reaching the body's tissues by pumping faster
Systolic murmurs
are common during pregnancy. Most often these are ejection murmurs caused
by increased flow through the right and left ventricular outflow tracts.
Risks of Anemia in Pregnancy:

1. A preterm or low-birth-weight baby
2. A blood transfusion (if you lose a significant amount of blood during delivery)
3. Postpartum depression
4. A baby with anemia
5. A child with developmental delays
Untreated folate deficiency can increase your risk of having a:

1. Preterm or low-birth-weight baby
2. Baby with a serious birth defect of the spine or brain (neural tube defects)
3. Untreated vitamin B12 deficiency can also raise your risk of having a baby with
neural tube defects.
Tests for Anemia:

Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein
in red blood cells that carries oxygen from the lungs to tissues in the body.
Hematocrit test. It measures the percentage of red blood cells in a sample of

blood.
Treatment for Anemia:

iron supplement and/or folic acid supplement in addition to your prenatal
vitamins
vitamin B12 supplement.
animal foods in your diet, such as:
meat
eggs
dairy products
Nursing Management:
1. Provide client and family teaching. Discuss using iron supplements and
increasing dietary sources of iron as indicated.
2. Prepare for blood-typing and crossmatching, and for administering packed PBCs
during labor if the client has severe anemia.
3. Provide support and management for clients with hemoglobinopathies.
a. In a client who has thalassemia or who carries the trait, provide support,
especially if the woman has just learned that she is a carrier. Also assess for
signs of infection throughout the pregnancy.
b. In a pregnant client with sickle cell disease, assess iron and folate stores,
and reticulocyte counts; complete screening for hemolysis; provide dietary
counseling and folic acid supplements; and observe for signs of infection.
c. In a pregnant client with G-6-PD, provide iron and folic acid supplementation
and nutrition counseling, and explain the need to avoid oxidizing drugs.
Chapter 5 - Anemia in Pregnancy

According to WHO (World Health Organization), Anemia is a condition in which
the number of red blood cells or the hemoglobin concentration within them is lower
than normal. Hemoglobin is needed to carry oxygen and if you have too few or
abnormal red blood cells, or not enough hemoglobin, there will be a decreased
capacity of the blood to carry oxygen to the body’s tissues.
Statistics: Anemia is a serious global public health problem that particularly

affects young children and pregnant women. WHO estimates that 42% of children
less than 5 years of age and 40% of pregnant women worldwide are anemic.
Symptoms of Anemia?
Anemia can cause a range of symptoms including fatigue, weakness, dizziness and
drowsiness. Children and pregnant women are especially vulnerable, with an
increased risk of maternal and child mortality.
What causes anemia?
The most common cause of anemia is low levels of iron in the body. This type of
anemia is called iron-deficiency anemia.
Anemia is caused by loss of blood in your body through:
Blood loss, which may be due to:
Heavy periods
Peptic ulcers
Regular use of some over-the-counter non-steroidal anti-inflammatory drugs

(NSAIDs)
What are risk factors for Anemia?

For women, women lose blood due to monthly period.
For infants, Premature infants and infants who do not get adequate iron supply
from breast milk carry a greater risk of developing anemia.
Vegetarians, Vegetarians are more likely to have inadequate levels of iron if they
do not get enough iron from food sources other than meat.
How does anemia affect the body?

Anemia can have other affects on your body in addition to feeling tired or cold.
Other signs that you might be lacking in iron include having brittle or spoon-
shaped nails and possible hair loss.
How does anemia affect pregnancy?

Iron deficiency anemia during pregnancy increases the chance of complications,
such as premature birth.
After the birth, studies have indicated that babies born to women with low iron
levels have a higher risk of low birth weight and problems with their own iron levels.
Treatment:
It is important to have a balanced diet that is rich in vitamins and minerals to
avoid suffering from any deficiency.
When it comes to iron-deficiency anemia, look for foods that are rich in iron,
vitamin C, and vitamin B12 and folate.
Food Sources of iron include:
Watercress
Kale
Raisins
Apricots
Prunes
Meat
Chicken
Iron-fortified cereals and breads
Chapter 6 - Rh Incompatibility in
Pregnancy
Anaphy Review
ABO Blood Group
Blood types are based on the presence or absence of two antigens

▪Type A
▪Type B
Presence of:
• A & B antigen — AB
• A antigen — A
• B antigen — B
Lack of both
A & B antigen — O
Antibodies
• protects body from “invaders”
• are the “recognizers” of foreign objects
• our body’s tiny soldiers
Rh Incompatibility
A condition which develops when there is a difference in Rh between the
pregnant(-) mother and the baby(+)
Mother’s immune system creates antibodies against baby’s Rh+ blood
The effects of Rh incompatibility can range from mild to severe. Mildest forms
of Rh Incompatibility:
hemolytic anemia
jaundice
Severe forms of Rh Incompatibility:
hydrops fetalis — abnormal amounts of fluid build up in two or more body areas
of a fetus or newborn
total body swelling
respiratory distress
circulatory distress
Kernicterus — brain damage that can result from high levels of bilirubin in a
baby's blood.
fetal death
Treatment of Rh Incompatibility
Antenatal
Intravascular transfusion blood transfused into fetal umbilical vein
Postnatal Phototherapy
is a method of using artificial light to treat conditions like eczema, psoriasis,

cancer, seasonal depression, and jaundice.
Detection of Rh Incompatibility
1. There are no pyhsical symptoms present in Rh incompatibility
2. If a woman is pregnant, she should undergo a blood type test.
3. This test will determine her Rh factor
Prevention of Rh Incompatibility
RhoGam
injection used to treat Rh incompatibility during pregnancy.
the shot contains antibodies (collected from plasma donors) that stop your
immune system from reacting to your baby’s Rh positive blood cells.
given if the mother is Rh negative

• IM
• At 28 weeks and—
• within 72 hours after delivery (if the baby is indeed Rh+)
• given with each pregnancy
💡 The “Rh factor” is a red blood cell surface antigen that was named after
the monkeys in which it was first discovered.
Chapter 7 - Placenta
PLACENTA develops in your uterus during pregnancy
Provides oxygen and nutrients to your growing baby and removes waste
products from your
baby's blood.
Placenta attaches to the wall of your uterus and baby's umbilical cord 500g-
weight 15-20 cm- diameter 1.5 to 3.0 cm thick
This is a fetomaternal organ
It has two components:
Fetal part - develops from the chorionic sac (chorion frondosum)
Maternal part - derived from the endometrium (functional layer - decidua

basalis)
The placenta and the umbilical cord are a transport system for substances
between the mother and the fetus. (vessel in umbilical cord)
Function of the Placenta

Protection
Nutrition
Respiration
Excretion
Hormone production
Respiration
The placenta is the only source of oxygen for the fetus. Fetal hemoglobin has a
higher affinity for oxygen than adult hemoglobin. The fetal hemoglobin is more
attractive to oxygen molecules than the maternal hemoglobin. As a result, when
maternal blood and fetal blood are nearby in the placenta, oxygen is drawn off the
maternal hemoglobin, across the placental membrane, onto the fetal hemoglobin.
Carbon dioxide, hydrogen ions, bicarbonate and lactic acid are also exchanged in
the placenta, allowing the fetus to maintain a healthy acid-base balance.
Nutrition
All of the nutrition for the fetus comes from the mother. This nutrition is mostly in
the form of glucose, which is used for energy and growth. The placenta can also
transfer vitamins and minerals to the fetus, as well as potentially harmful
substances if the mother is consuming medications, alcohol, caffeine or cigarette
smoke.
Endocrine Function:
Human Chorionic Gonadotrophin
The syncytiotrophoblast produces hCG.
hCG levels increase in early pregnancy, plateau at around ten weeks gestation,
then start to fall.
HCG helps to maintain the corpus luteum until them placenta can take over the
production of estrogen and progesterone.
HCG can cause symptoms of nausea and vomiting in early pregnancy.
Higher levels of hCG occur with multiple pregnancy (e.g. twins) and molar
pregnancy. Pregnancy tests look for hCG as a marker of pregnancy.
Estrogen
The placenta produces estrogen, which helps to soften tissues and make
them more flexible. Estrogen allows the muscles and ligaments of the uterus
and pelvis to expand, and the cervix to become soft and ready for birth.
It also enlarges and prepares the breasts and nipples for breastfeeding.
Progesterone
The placenta mostly takes over the production of progesterone by five
weeks gestation.
The role of progesterone is to maintain the pregnancy.
It causes relaxation of the uterine muscles (preventing contraction and

labour) and maintains the endometrium.
It causes side effects by relaxing other muscles, such as the lower

oesophageal sphincter (causing heartburn), the bowel (causing constipation)
and the blood vessels (causing hypotension, headaches and skin flushing). It
also raises the body temperature between 0.5 and 1 degree Celsius.
During pregnancy, possible placental problems

include placental abruption, placenta previa and
placenta accreta.
PLACENTAL ABRUPTION
Separation of placenta from the uterine wall
Incidence:
1% of all pregnancies
20% of all third-trimester bleeders
Recurrence risk
10% in first pregnancy
25% in second pregnancy
Signs and symptoms of placental abruption include:

Vaginal bleeding, although there might not be any.
Abdominal pain.
Back pain.
Uterine tenderness or rigidity.
Uterine contractions, often coming one right after another.
Diagnosing Placental Abruptio

When a woman has placental abruptio, the most common signs are:
Vaginal bleeding
Abdominal tenderness or back pain
Contractions; and
Abnormalities in the baby’s heartbeat
Placental Abruptio
Also called abruptio placentae, refers to bleeding at the decidual - placental
interface that cause partial or total placental detachment prior to delivery of the
fetus. The diagnosis is typically reserved for pregnancies over 20 weeks of
gestation. The major clinical findings are vaginal bleeding and abdominal pain,
often accompanied by hypertonic uterine contractions, uterine tenderness, and
a nonreassuring fetal heart rate (FHR) pattern
Types of Abruption
Whether the blood remains inside a woman’s uterus or flows out through her
vagina. A woman with placental abruption always bleeds, but sometimes the
blood stays within her uterus and can be seen only through an ultrasound. An
abruption of this sort is called a concealed abruption. About 20% of abruptions
are concealed.
Nursing Diagnosis for a Client with Abruptio Placenta
Pain related to bleeding between uterine wall and placenta secondary to
premature separation of placenta
Fluid volume deficit
Risk for fetal injury (mother)
Grieving related to actual or threatened loss of infant
Powerlessness related to maternal condition
Nursing Management of Abruptio Placenta

Assess amount and charcater of bleeding
Assess abdominal/uterine tenderness, contractions and resting
Monitor VS for shock
Assess FHT and activity
Measure fundal height since concealed bleeding may be present
Provide emotional support
Prepare for possible C-Section
O2 therapy
Monitor FHR tracing
Monitor fundal height
Bed rest - left lateral recumbent/position
Monitor for DIC
Emotional support
Placenta Previa
The placenta is implanted partially or completely over the lower uterine
degment (over or adjacent to the internal os) it is called Placenta Preavia
Placenta which has implanted partially or wholly in the lower uterine

segment. The incidence of placenta previa is 0.5% - -1%
Seventy percent of patients with placenta previa present with painless

vaginal bleeding in the third trimester, 20% have contractions associated with
bleeding, and 10% have the diagnosis made incidentally by ultrasonography or
at term.
Clinical Features (Symptoms)

Vaginal Bleeding:
Sudden in onset, painless
Revealed bleeding (fresh blood)
Bright red or dark colored
Unrelated to activity
Risk Factors
Previous placenta previa
Multiple pregnancies - due to the placenta occupying a large surface area
Cigarette smoking
Increased maternal age
Uterine scar (previous caesarean section)
Endometritis
Diagnosis
Abdominal examination: abnormal fetal presentation (transverse lie, breech
presentation), the presenting part is high above the inlet and deviated
anteriorly or laterally
FHR - normal
If cervical os dilated - cautious inspection
Digital examination is never permitted unless at term pregnancy, in an
operating room with all the preparations for immediate cesarean section; the
examination can cause life-threatening hemorrhage.
Mnemonic: Previa
P - Painless bright red bleeding
R - Replace blood loss
E - Evident in lower segment
I - Inspect FHR
A - Avoid vaginal exam
Placenta accreta
is a serious pregnancy condition that occurs when the placenta grows too
deeply into the uterine wall.
Typically, the placenta detaches from the uterine wall after childbirth.
With placenta accreta, part or all of the placenta remains attached.
This can cause severe blood loss after delivery.
Types of placenta accreta:

Placenta accreta: The placenta firmly attaches to the wall of the uterus. It does
not pass through the wall of the uterus or impact the muscles of the uterus. Most
common type of the condition.
Placenta increta: This type of the condition sees the placenta more deeply
imbedded in the wall of the uterus. It still does not pass through the wall, but is
firmly attached to the muscle of the uterus.
Placenta percreta: The most severe of the types, placenta percreta happens
when the placenta passes through the wall of the uterus. The placenta might
grow through the uterus and impact other organs, such as the bladder or
intestines.
Risks for the mother and baby from placenta accreta:

1. Premature delivery
2. Damage to the uterus and surrounding organs
3. Loss of fertility due to the need for a
4. hysterectomy (removal of uterus)
5. Excessive bleeding that requires a blood transfusion
6. Death
CAUSES:
1. Multiple cesarean sections (c sections): Women who have had multiple
cesarean sections have a higher risk of developing placenta accreta.
This results from scarring of the uterus from the procedures. The more
cesarean sections a woman has over time, the higher her risk of placenta
accreta.
2. Placenta previa: This condition occurs when the placenta is located at the
bottom of the uterus, blocking the opening of the cervix.
The lower part of the uterus is less suited for the placenta to implant. In
patients with placenta previa and a history of prior cesarean section(s), the
risk for placenta accreta increases with the number of cesarean sections
the patient has had.
3. History of fibroid removal: If the woman has had a fibroid (a not cancerous
growth or tumor of the uterine muscle) removed, the scarring could lead to
placenta accreta.
How is placenta accreta diagnosed?

Ultrasound
Magnetic resonance imaging (MRI)
Nursing Management:
1. Identify placenta accreta in the client. Be aware of the client’s risk status.
2. Assist with rapid treatment and intervention.
3. Be prepared for a D&C or hysterectomy.
4. Provide physical and emotional support.
5. Provide client and family education.

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Care of Mother and Child at

Risk or with Problems - Acute

💡 Ma’am Araos I [email protected]/ 0916-682-3813

💡 2 hours per week

Intended Learning Outcomes

2. demonstrate leadership and management skills in promoting safe and quality

4. ensure a well-organized recording and reporting system; and

Identifying prenatal clients at risk

Nursing care of mothers with Pre-gestational conditions

Nursing care of mothers with Gestational conditions

Nursing care management of the client with high-risk labor& delivery

Nursing care management of the high-risk post-partal client

Care of couple with problems of infertility

Nursing care of high-risk newborns

Nursing care of common health problems that develop toddler stage

Nursing care of common health problems that develop during school-age

Nursing care of common health problems that develop during adolescence

Chapter 1 - Care of Mother, Child at Risk or

a. Identifying Clients at Risk

1. Assessment of Risk factors

1. Rheumatic heart disease

A dictionary definition of the word “risk” is hazard, danger, exposure to mischance or

What is high risk prenatal client?

A family history of genetic conditions

Being pregnant with multiple babies

Having a history of complicated pregnancies, such as preterm labor, C-section,

What are the four types of genetic disorders (inherited)?

Multifactorial inheritance - also called complex or polygenic inheritance.

Chromosome abnormalities - Chromosomal abnormalities typically occur due

Mitochondrial inheritance - caused by mutations in the non-nuclear (

high blood pressure

Alzheimer's disease - progressive mental deterioration that can occur in middle

Arthritis - painful inflammation and stiffness of the joints.

Diabetes - disease in which the body’s ability to produce or respond to the

Cancer - a disease caused by an uncontrolled division of abnormal cells in a

Obesity - the condition of being grossly fat or overweight.

The period of viability varies in different countries from 20 to 28 weeks

Preterm labour is considered to be established if regular uterine contractions can

kapag nag cs pati uterus tinatahi di lang abdomen

Why it's done?

Your baby or babies are in an abnormal position. A C-section might be the

You're carrying multiples. A C-section might be needed if you're carrying twins

3rd Trimester Bleeding

Abruptio Placenta - premature separation of placenta from uterine wall

Vaginal bleeding, abdominal pain, uterine tenderness,

US may miss early abruption

Placenta Previa - implantation of placenta over cervical OS

Large amount of BR vaginal bleeding, painless

Health concern - A C-section might be recommended if you have a severe

Genital herpes outbreaks usually look like a cluster of itchy or painful

What is the Cerebrospinal Fluid?

Screening Procedures of High Risk Prenatal Client

Screening of High Risk Cases:

This examination may be performed in a big institution (teaching or non-

Screening for High Risk Pregnancy

Geographical, genetical and economical variation

Risk factor or univerdal approach

Individual or group antenatal care

History and physical examination, EDD