BSN II- SECTION 6
Pregnancy At Risk: Pregestational Problems
1. SUBSTANCE ABUSE
Just the facts
• 1 out of 6 women smoke during
pregnancy.
• Nearly 10% of women admit to
drinking while pregnant.
• More than 5% of women report use of
illicit drugs during pregnancy
COCAINE/ CRACK
- Blocks the reuptake of dopamine
MATERNAL EFFECTS:
 Tachycardia, Hypertension, Seizures
FETAL EFFCTS:
 Prematurity, Behavioral problems,
Irritability
MARIJUANA
- Most commonly abused illicit drug
- No evidence of teratogenic effects on
fetus
- May cause withdrawal symptoms after
delivery.
CRYSTAL METH
- Synthetic stimulant
- Increases dopamine in the brain
MATERNAL EFFECTS:
 Tachycardia, vasoconstriction,
hypertension.
 Spontaneous abortion placental
separation
FETAL EFFCTS:
 Premature birth , low birth weight
 Cleft palate, abnormal brain
development
HEROIN/ METHADONE
- Opioid similar to cocaine
- Produces euphoria
NCM 109- PRELIMS
MATERNAL EFFECTS:
 Poor Nutrition, anemia, pre
eclampsia
 Higher incidence of STDs
FETAL EFFCTS:
 Low birth weight, small head
circumference, prematurity
 Restlessness, inconsolable crying,
seizures
 Methadone is used as therapy for
opioid addiction
PRESCRIPTION DRUGS:
COMMONLY ABUSED
 Opiates (Oxytocin, Demerol, Codeine)
 CNS depressants (Xanax, Valium)
 Stimulants (Ritalin)
MATERNAL/FETAL EFFECTS:
 Remember pregnancy categories
 Decreased placenta perfusion
 Birth defects
 Stillbirth, Miscarriage
2. DIABETES MELLITUS
Carbohydrate metabholism
 Too little glucose is produced
 Cells become glucose resistant
During pregnancy:
 Early Pregnancy- Increased levels of
estrogen, progesterone, and other
hormones stimulate increased insulin
production
 Second Half of Pregnancy- Placental
secretion of human placental
lactogen and prolactin cause an
increase resistance to insulin and
decreased glucose tolerance.
THE POLYS- CLINICAL MANIFESTATIONS
• Screening at 24-28 weeks gestation for
average risk individuals
• Test: 1-hour GTT (glucose tolerance
test)
• 3 hour oral GTT
BSN II- SECTION 6 NCM 109- PRELIMS

• Positive diagnosis of GDM is made CLINICAL THERAPY

when two or more values are met or
• Screening
exceeded
• Antiretroviral therapy
TREATMENT: • Evaluation and treatment for other
conditions
• Good prenatal care
• Monitor disease progression and
• Diet control
complications
• Glucose monitoring
• High risk pregnancy requires close
• Insulin Therapy
monitoring
• Evaluation of fetal status
• Intrapartum management
• AFP, NST, Ultrasounds
• Education
• Elective delivery
• C-section ASSOCIATED RISKS
• Decreased insulin needs during labor
MATERNAL:
• Glucose checks every 2 hours
 Antiretroviral therapy
• Decreased insulin needs after birth
 Opportunistic infection

FETAL:
Maternal And Fetal Risks Maternal:
 ART
 Hydramnios  Neonatal Transmission
 Preeclampsia
NURSING CONSIDERATIONS:
 Urinary tract infections
 Education/prevention
Fetal:
 Screening
 Macrosomia  Medication management
 Birth trauma  Psychological implications
 Hypoglycemia
IF IT'S WET AND NOT YOURS PLEASE USE PPE!!!!
 Death
4. CARDIOVASCULAR DISEASE
INTRAPARTUM/ POSTPARTUM MANAGEMENT
• Approximately 1% of pregnant women
- Decreased insulin needs during labor
of childbearing age have preexisting
- Glucose checks every 2 hours
heart disease
- Decreased insulin needs after birth
• Leading cause of non-obstetric
3. HIV INFECTION maternal mortality
- Human immunodeficiency virus • Rheumatic fever is the leading cause
- Transmitted through blood, blood of cardiac complications
products or other body fluids
- Decreases the body’s immune • Other types include mitral valve
disease and congenital causes
response
• Peripartum cardiomyopathy
RISKS
• Many changes that put strain on the
 IV drug use
heart:
 History of multiple sex partners
 History of sexually transmitted  increased intravascular volume
infections  decreased systemic vascular
 Bisexually/ Homosexual partner resistance
 cardiac output changes during
labor and birth
BSN II- SECTION 6 NCM 109- PRELIMS

 major intravascular changes after  Glycosides

delivery o Digitalis
CLASSIFICATION BY DEGREE OF DISABILITY

-Class I - PHASES OF CARE

-Class II ANTEPARTUM

-Class III - Focused on minimizing the stress on

-Class IV the heart
- Peak hemodynamic changes occur
between 28- 32 weeks
- Treat diagnosis that are causing stress
- Teach patient and family s/s of
problems
- Provide nutritional counselling with
family present
- Increase fiber intake

INTRAPARTUM

- Routine labour assessments

- Atrial Blood gasses
- A Swan – Ganz catheter
- ECG monitoring
- Continuous blood pressure and pulse
oximetry
- Continuous fetal monitoring
- Minimize anxiety
- Keep head and shoulders elevated/
sidelying
CARE and MANAGEMENT - Medications for pain relief
Multidisciplinary Approach POSTPARTUM
 Offer support and teaching based on
- First 24-48 hours is the most unstable
learning needs
time
 Interview
- Vital signs
o Personal/familial medical history
- Pulse Oximetry
o ROS
- Lung and Heart auscultation
o Medications presently taking
- Edema
o Social questioning
- Bleeding assessment
 Physical Exam
- Uterine tone
 Laboratory and Diagnostic Testing
- Urinary output
DRUG THERAPY - Dietary intake
- Mother-infant bonding
 Vitamins and Iron
- Emotional state
 Anticoagulant
- Activity-rest pattern
o Heparin
 Diuretic
o Lasix for congestive heart failure