Care for High Risk Pregnancy

Reported by: Windelyn Gamaro o o Nutrition: Assess nutrition status Nutritional needs: o Caloric need: 2100-2500 Kcal o Protein: 74-76 g/day o Carbohydrates: sufficient intake; avoid empty calorie such as softdrinks o Fiber o Fats: for better absorption of Vit. ADEK; avoid too much Essential Minerals and Vitamins: Iron Calcium Sodium Folic Acid Vitamins C, B group, A, D, E, K Bath o o o o Daily bath if desired Avoid soap on nipple: with drying effect Towel dry breast; increases integrity/toughness of nipples Tub bath: usually contraindicated except when there is care in getting into and out of a bathtub; nonskid rubber mat on bathtub floor to prevent falls o Douching: not needed to manage vaginal discharge (leucorrhea is estrogen induced); daily bath will suffice Clothing Loose comfortable clothes No constrictions around breasts, abdomen, legs, no round garter Flat-heeled shoes for comfort and balance Support panty hose for varicosities Supportive cotton-lined brassier Maternity girdle Sleep and Rest 8 hours of sleep 1-2 hours of afternoon nap Exercising Cleansing breathing Pelvic Rock Squatting/Tailor sitting Abdominal Breathing Kegel Panting

1. 2. 3. 4. 5.

 Nursing Considerations: Regular exercise needed Avoid fatigue Exercise in standing position Avoid excess strenuous activity Marital Relations/Coitus First trimester: less interest in sex Second trimester: increase interest in sex Third trimester: less interest in sex Sexual intercourse does not usually cause harm; avoid fatigue; may need counsel regarding comfortable position. Suggested position:

Side lying Woman on top position SAD Habits

Smoking o May increase: o Risk for SGA o Prematurity o Infant mortality o Spontaneous abortion o Placenta previa/abruptio placenta o Premature rapture of membrane Alcohol o May cause: o Fetal alcohol syndrome Caffeine o Reduce intake of coffee, tea etc to 300 mg per day or no more than 2-3 servings per day Drugs o NO MEDICATIONS IS TAKEN DURING PREGNANCY UNLESS ABSOLUTELY NECESSARY AND PRESCRIBED! 1. 2. 3. Risk factors Demographic Factor Age Weight Height

Socioeconomic Status 1. Inadequate finances 2. Overcrowding

3. Nutritional deprivation 4. Severe social problems 5. Unplanned and unprepared pregnancy especially among adolescents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Obstetric History Hx of infertility or multiple gestation Grandmultiparity Previous abortion/ ectopic pregnancy Previous loses: fetal death, still birth, neonatal or perinatal death Previous operative OB: CS, forceps delivery Previous uterine/cervix abnormality Previous abnormal labor Previous high risk infant Previous H-mole Medical condition affecting pregnancy Cardiac or Pulmonary disease Metabolic Disease: diabetes and thyroid disease Endocrine Disorders: pituitary or adrenal Chronic Renal Disease: Repeated UTI, Bacteriurea Chronic Hypertention Infection Congenital abnormalities of Reproductive tract Hemoglobinopaties Seizure Disorder Malignancy Major emotional disorder, mental retardation Complications of pregnancy Pregnancy induced hypertension 3 Major symptoms: H- Hypertension E- Edema P- Protenuria Types: Preeclampsia (mild: 140/90 and severe:160/110) Eclampsia with seizure episode 1. 2. 3. 4. Nursing Care Maintain bed rest in left lateral recumbent Provide high protein diet with moderate sodium Frequent monitoring Administer Drug: Magnesium Sulfate

Incompetent Cervix

Signs and symptoms: o Painless contraction o History of abortion o Findings of relaxed cervical os upon IE. Treatment: o Cerclage Nursing Care o Provide psychological support o Provide post cerclage procedure care o Advise limitation of activities within 2 weeks after treatment o Monitoring: Mother and child growth o Instruct to report signs of labor o Assess: signs of labor, infection or PROM Placenta Previa

Signs: o Painless vaginal bleeding o Soft uterus o Slight/profuse bleeding after cointus, activity or IE Nursing Care o Maintain bed rest o DO NOT PERFORM IE o Assess: v/s, bleeding, onset and progress of labor, FHT o Institute shock measures as necessary o Provide psychological and physical comfort Abruptio Placenta

Assessment: o Painful vaginal bleeding in 3rd trimester o Rigid, board like and painful abdomen o Enlarged uterus due to concealed bleeding o May have tetanic contraction during labor Nursing Care o Maintain bed rest o Monitor: v/s, FHT, labor onset and progress, I&O, uterine pain and bleeding o Give IV, plasma or blood as per order o Provide psychological support: prepare pt. for dx tests, explain what is happening, answer questions of patient. o Assess for complications