21378090 Maternal Child Nursing Care

8/3/2019 21378090 Maternal Child Nursing Care

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Maternal & Child Nursing CareSecond Edition

Marcia L. London Patricia W. Ladewig Jane W. Ball Ruth C. Bindler

Lecture Notes

Chapter 15Pregnancy at Risk: Gestational OnsetMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Causes of Bleeding During the First and Second Trimester Abortion: Expulsion of the fetus before 20 weeks gestation

Expulsion of fetus less than 500g Spontaneous: Occur naturally Induced: Caused by medical or surgical means

Medical therapy: Bed rest and abstinence from sex

Persistent bleeding: Hospitalization IV therapy or blood transfusions Dilatationand curettage (D&C) or suction evacuation 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler


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Miscarriage Related to chromosomal abnormalities Classification

Threatened abortion Imminent abortion Complete abortion Incomplete abortion Missed abortion Recurrent abortion Septic abortion


2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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AFIGURE 151 Types of spontaneous abortion. A, Threatened. The cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs. B, Imminent. The placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased. C, Incomplete. The embryoor fetus has passed out of the uterus, but the placenta remains.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by

Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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BFIGURE 151 (continued) Types of spontaneous abortion. A, Threatened. The cervix is not dilated, and the placenta is still attached to the uterine wall, but somebleeding occurs. B, Imminent. The placenta has separated from the uterine wall,the cervix has dilated, and the amount of bleeding has increased. C, Incomplete.The embryo or fetus has passed out of the uterus, but the placenta remains.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by



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CFIGURE 151 (continued) Types of spontaneous abortion. A, Threatened. The cervix is not dilated, and the placenta is still attached to the uterine wall, but somebleeding occurs. B, Imminent. The placenta has separated from the uterine wall,the cervix has dilated, and the amount of bleeding has increased. C, Incomplete.The embryo or fetus has passed out of the uterus, but the placenta remains.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by



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Spontaneous Abortion: Treatment Bed rest Abstinence from coitus D&C or suction evacuation Rh immune globulin




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Spontaneous Abortion: Nursing Care Assess the amount and appearance of any vaginal bleeding Monitor the womans vitalsigns and degree of discomfort Assess need for Rh immune globulin Assess fetalheart rate Assess the responses and coping of the woman and her familyMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Ectopic Pregnancy: Risk Factors Tubal damage Previous pelvic or tubal surgery Endometriosis Previous ectopic pregnancy Presence of an IUD High levels of progesterone


2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Je

rsey 07458


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Ectopic Pregnancy: Risk Factors (contd) Congenital anomalies of the tube Use of ovulation-inducing drugs Primary infertility Smoking Advanced maternal age


2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Je

rsey 07458


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Causes of Bleeding During First Half of Pregnancy Ectopic pregnancy

Implantation of fertilized ovum in site other than uterus Mortality rates declin

ed almost 90% Initially symptoms of pregnancy Positive hCG present in blood andurine Chorionic villi grow into tube wall or implantation site Rupture and bleeding into the abdominal cavity occurs 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458



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Causes of Bleeding During First Half of Pregnancy (contd) Ectopic pregnancy

Result is sharp unilateral pain and syncope Referred shoulder pain Lower abdominal pain Vaginal bleeding

Medical therapy: Intramuscular methotrexate if future pregnancy desired Surgicaltherapy: Salpingostomy or salpingectomyMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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PATHOPHYSIOLOGY ILLUSTRATED: ECTOPIC PREGNANCY Various implantation sites in ectopic pregnancy. The most common site is within the fallopian tube, hence the name tubal pregnancy.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Ectopic Pregnancy: Nursing Care Assess the appearance and amount of vaginal bleeding Monitor vital signs Assessthe womans emotional status and coping abilities Evaluate the couples informational needs Provide post-operative careMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Gestational trophoblastic disease Gestational trophoblastic disease

Pathologic proliferation of trophoblastic cells Includes:

hydatidiform mole Invasive mole (chorioadenoma destruens) Choriocarcinoma, a form of cancer

Initially, clinical picture similar to pregnancy Classic signs: Uterine enlargement greater than gestational age, vaginal bleeding 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458



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Gestational Trophoblastic Disease: Symptoms Vaginal bleeding Anemia Passing of hydropic vesicles Uterine enlargement greaterthan expected for gestational age Absence of fetal heart sounds Elevated hCGMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Gestational Trophoblastic Disease: Symptoms Low levels of MSAFP Hyperemesis gravidarum Preeclampsia




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Causes of Bleeding During First Half of Pregnancy (contd) Therapy: Suction evacuation of the mole

Uterine curettage for removal of placental fragments Hysterectomy for excessivebleeding




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FIGURE 152 Hydatidiform mole. A common sign is vaginal bleeding, often brownish (the characteristic prune juice appearance) but sometimes bright red. In this figure, some of the hydropic vessels are being passed. This occurrence is diagnosticfor hydatidiform mole.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Incompetent Cervix Associated with repeated second trimester abortions Possible causes

Cervical trauma Infection Congenital cervical or uterine anomalies Increased uterine volume (as with a multiple gestation)

Diagnosis: Positive history of repeated second trimester abortionsMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Treatment: Surgical Procedures Shirodkar procedure (cerclage) Modification of it by McDonald Reinforces the weakened cervix Purse-string suture is placed in cervix Done in first trimester orearly in second trimester Cesarean birth may be planned Suture may be cut at term and vaginal birth permittedMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 074

58


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FIGURE 153 A cerclage or purse-string suture is inserted in the cervix to preventpreterm cervical dilatation and pregnancy loss. After placement the string is tightened and secured anteriorly.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Nursing Interventions Monitor women for premature labor Monitor for premature rupture of membranes Teach client

Signs of premature labor Signs of premature rupture of membranes

Tell client to contact healthcare provider if membranes rupture or labor beginsMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Hyperemesis Gravidarum Exact cause of hyperemesis is unclear Increased levels of hCG may play a role Severe cases: Causes dehydration

Fluid-electrolyte imbalance Alkalosis Metabolic acidosis Decreased urinary output




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Aim of Treatment Control vomiting: Antiemetics Correct fluid and electrolyte imbalance potassiumchloride Correct dehydration: Intravenous (IV) fluids Improve nutritional statatus

Vitamin supplements Total parenteral nutrition




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Nursing Care Supportive Directed at maintaining a relaxed environment Maintaining oral hygiene Monitoring weight Monitoring for signs of complications Once oral feedings resume, food needs to be attractively servedMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Premature Rupture of Membranes Spontaneous rupture of membranes before labor Preterm PROM (PPROM): Rupture of membranes before term Maternal risk of infection increases Risk of abruptio placentae Fetal-newborn: Risk of respiratory distress syndrome Fetal sepsis, malpresentation and prolapse of umbilical cord Increased perinatal morbidity and mortalityMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 by



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Premature Rupture of Membranes (contd) Prevention of infection

Use sterile speculum to detect amniotic fluid Limit digital vaginal examinations

If maternal signs of infection evident, antibiotic therapy started immediately U

pon admission to nursery: Infant assessed for sepsis, placed on antibioticMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Premature Rupture of Membranes (contd) Absence of infection and gestation age less than 37

Hospitalization and bed rest Complete blood cell count (CBC) C-reactive proteinand urinalysis Continuous or intermittent fetal monitoring Regular nonstress tests (NSTs) or biophysical profiles Maternal vital signs assessed every 4 hours Re

gular laboratory evaluations 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458



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Premature Rupture of Membranes (contd) Absence of infection /gestation age less than 37weeks

Fetal lung maturity studies Maternal corticosteroid administration Bed rest withbathroom privileges Monitor temperature and pulse every 4 hours Keep fetal movement chart and have weekly NST Call healthcare provider for signs of complicatio

ns 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

If sent home: Discharge instructions



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Preterm Labor Labor that occurs between 20 and 37 weeks gestation Documented uterine contractions (4 in 20 minutes or 8 in 1 hour) Documented cervical change Cervical dilatation of greater than 1 cm Cervical effacement of 80% or more Chart page 347Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007 byPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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TABLE 151Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler

Risk Factors for Spontaneous Preterm Labor. 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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TABLE 152

Self-Care Measures to Prevent Preterm Labor. 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458



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Preterm Labor (contd) Management

Assessment of cervicovaginal fibronectin Assessment of cervical length via ultrasound Obtaining history of previous preterm birth Assess for the presence of infections Educating clients about preterm labor Assessing for early signs and symp

toms Maternal laboratory studies 2007 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458



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Preterm Labor (contd) Management

IV infusion: Promotes maternal hydration Tocolysis: Medications used to stop labor -adrenergic agonists and magnesium sulfate Prostaglandin synthetase inhi

itors Calcium channel

lockers

2007

y Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458

Tocolytics



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Preterm La

or (contd) Nursing management

Identify woman at risk Assess the progress of la

or Administration of medications Teach how to recognize onset of la

or Provide information a

out community resources

Assess impact of la

or on mother and fetus


2007



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Signs and Symptoms of Preterm La

or Uterine contractions occurring every 10 minutes or less Mild menstrual-like cramps felt low in the ad

omen Constant or intermittent feeling of pelvic pressure Rupture of mem

ranes Low, dull

ackache, which may

e constant or intermittentMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007

yPearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Jersey 07458


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Signs and Symptoms of Preterm La

or (contd) A change in vaginal discharge A

dominal cramping with or without diarrhea


2007



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Classification and Pathophysiology Classification

Gestational (or transient) hypertension Preeclampsia-eclampsia Chronic hypertension Chronic hypertension with superimposed preeclampsia or eclampsia


2007



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Preeclampsia-eclampsia Definition

Blood pressure of 140/90 or higher on two occasions at least 6 hours apart accom

panied

y proteinuria Signs of impending eclampsia include:

Scotomata,

lurred vision, epigastric pain, vomiting, persistent or severe headache, neurologic hyperactivity, pulmonary edema, or cyanosis 2007




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Characteristics of Preeclampsia Maternal vasospasm Decreased perfusion to virtually all organs Decrease in plasma volume Activation of the coagulation cascade Alterations in glomerular capillary endothelium EdemaMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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PATHOPHYSIOLOGY ILLUSTRATED: PRECLAMPSIA A, In a normal pregnancy, the passive quality of the spiral arteries permits increased

lood flow to the placenta. B, In preclampsia vasoconstriction of the myometrial se

ment of the spiral arteriesoccurs.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Maternal Risks Hyperreflexia and headache Seizures, renal failure and a

ruptio placentae Disseminated intravascular coagulation (DIC) Ruptured liver and pulmonary em

olism HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count)Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Fetal-Neonatal Risks Small for gestational age (SGA) Premature Hypermagnesemia (Magnesium sulfate administration to mother) Increased mor

idity and mortality


2007

y Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, New Je

rsey 07458


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Clinical Manifestations and Diagnosis Mild preeclampsia

BP 140/90 mm Hg or higher 1+ proteinuria may occur Liver enzymes may

e elevatedminimally Edema may

e present BP 160/110 mm Hg or higher measurements, 6 hoursapart

2007


Severe preeclampsia



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Clinical Manifestations and Diagnosis Severe preeclampsia

Proteinuria 5 g in a 24-hour urine collection Dipstick urine protein 31 to 41 on2 random samples Samples must

e o

tained at least 4 hours apart Visual or cere

ral distur

ances Grand mal convulsion May occur antepartum, intrapartum, or pos

tpartum

Eclampsia


2007



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Management Home care of mild preeclampsia

Client monitors her

lood pressure Measures weight and tests urine protein dailyRemote NSTs performed daily or

i-weekly Advised to report signs of worsening preeclampsia Bed rest and moderate to high protein diet Fetal evaluation

2007


Hospital care of mild preeclampsia



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Management (contd) Severe preeclampsia

Bed rest Diet: High-protein, moderate-sodium Anticonvulsants: Magnesium sulfateFluid and electrolyte replacement Corticosteroids and antihypertensive drugs


2007



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Management (contd) Eclampsia

Anticonvulsants: Bolus of magnesium sulfate Sedation and other anticonvulsants:Dilantin Diuretics to treat pulmonary edema Furosemide (Lasix) Digitalis: For circulatory failure Strict monitoring of intake and output


2007



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Management (contd) Nursing care

Monitor vital signs and auscultate lungs Evaluate fetal heart rate patterns Moni

tor urinary output and urine protein hourly Check specific gravity of the urinehourly Weigh the woman daily at the same time Assess deep tendon reflexes and clonus 2007




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Deep Tendon Reflex Rating Scale 2007



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FIGURE 154 To elicit clonus, with the knee flexed and the leg supported, sharplydorsiflex the foot, hold it momentarily, and then release it. Normally the footreturns to its usual position of plantar flexion. Clonus is present if the foot jerks or taps against the examiners hand. If so, the num

er of taps or

eats of clonus is recorded.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007


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HELLP Hemolysis, elevated liver enzymes, and low platelet


2007



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Chronic Hypertensive Disease Chronic hypertension exists when the

lood pressure is 140/90mm Hg or higher

efore pregnancy or

efore the 20th week of gestation, or when hypertension persists 42 days following child

irth. Gestational hypertenison- occurs midpregnancy without proteinuria


2007



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DIC Definition Disseminated intravascular coagulation (DIC) is a systemic process producing

oth throm

osis an hemorrhage. It involves

Exposure of

lood to procoagulants Formation of fi

rin in the circulation Fi

rinolysis Depletion of clotting factors End-organ damage

2007




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Rh Alloimmunization: Causes Rh-negative woman carries an Rh-positive fetus Fetal red

lood cells cross intomaternal circulation Response: Production of Rh anti

odies Transfer of RBCs usually occurs at

irth The first child is not affected Su

sequent pregnancy

Rh anti

odies enter the fetal circulation Result: Hemolysis of fetal red

lood c

ells and fetal anemia 2007




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AFIGURE 155 Rh alloimmunization sequence. A, Rh-positive father and Rh-negative mother. B, Pregnancy with Rh-positive fetus. Some Rh-positive

lood enters the mothers

loodstream. C, As the placenta separates, the mother is further exposed tothe Rh-positive

lood. D, Anti-Rh-positive anti

odies (triangles) are formed. E,In su

sequent pregnancies with an Rh-positive fetus, Rh-positive red

lood cells are attacked

y the anti-Rh-positive maternal anti

odies, causing hemolysis of

the red

lood cells in the fetus.Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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BFIGURE 155 (continued) Rh alloimmunization sequence. A, Rh-positive father and Rhnegative mother. B, Pregnancy with Rh-positive fetus. Some Rh-positive


loodstream. C, As the placenta separates, the mother is furtherexposed to the Rhpositive


odies (triangles) areformed. E, In su



y the anti-Rhpositive maternal anti

odies, causing hem

olysis of the red




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CFIGURE 155 (continued) Rh alloimmunization sequence. A, Rh-positive father and Rhnegative mother. B, Pregnancy with Rh-positive fetus. Some Rh-positive








odies, causing hem

olysis of the red




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DFIGURE 155 (continued) Rh alloimmunization sequence. A, Rh-positive father and Rhnegative mother. B, Pregnancy with Rh-positive fetus. Some Rh-positive








odies, causing hem

olysis of the red




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EFIGURE 155 (continued) Rh alloimmunization sequence. A, Rh-positive father and Rhnegative mother. B, Pregnancy with Rh-positive fetus. Some Rh-positive








odies, causing hem

olysis of the red




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Rh Alloimmunization: Fetal and Neonatal Risks Anemia Hemolytic syndrome Erythro

lastosis fetalis

Marked fetal edema, called hydrops fetalis Congestive heart failure Marked jaundice


2007



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Rh Alloimmunization: Prevention Screen for Rh incompati

ility and sensitization

Take a history Identify Rh-negative woman Anti

ody screen (indirect Coom

s test)Identifies if woman is sensitized Give injection of 300 mcg Rh immune glo

ulin


2007



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Rh Alloimmunization: Prevention (contd) Give Rh immune glo

ulin in the following cases

Pregnant Rh-women who have no anti

ody titer At 28 weeks gestational age Mother whose

a

ys father is Rh positive or unknown After each a

ortion and within 72 hours postpartum Amniocentesis and placenta previa Invasive procedures that may cau

se

leeding


2007



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Rh Alloimmunization 2007



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ABO Incompati

ility Cause: Mother has type O

lood and infant has A, B, or AB

Anti-A and anti-B anti

odies occur naturally During pregnancy maternal anti

odie

s cross placenta Cause hemolysis of the fetal red

lood cells Unlike Rh incompati

ility, first infant is often involved, no evidence of repeated sensitization,no antepartal treatment 2007




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ABO Incompati

ility (contd) Creates hyper

iliru

inemia in the infant Hyper

iliru

inemia is treated with phototherapy Assess for potential for ABO incompati

ility - type O mother and type Aor B father Following

irth

New

orn assessed carefully Asses for development of hyper

iliru

inemia

Unlike Rh incompati

ility, it cannot

e preventedMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Effects of Surgical Procedures First trimester surgery: Increase incidence of a

ortion Increased incidence of fetal mortality Low-

irth-weight (less than 2500 g) infants Increased incidence of preterm la

or Increased incidence of intrauterine growth restriction Ina

ilityto perform some diagnostic procedures (x-ray) - may hinder diagnosis of diseaseduring pregnancyMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007

y



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Special Considerations Surgery during early second trimester decreases risk of complication During surgery, wedge placed under mothers hip prevents uterine compression of major

lood vessels Insertion of nasogastric tu

e to decrease vomiting An indwelling catheter

Prevents

ladder distension Facilitates monitoring of output

2007




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Special Considerations (contd) Fetal heart rate must

e monitored electronically during and after surgery Postoperatively

Encourage to turn,

reathe deeply, and cough Encourage use of ventilation therapy Early am

ulation to prevent complications

Discharge teaching is very importantMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Impact of Trauma During Pregnancy Types of trauma

Blunt trauma Penetrating injuries Gunshot wounds Falls Direct assaults Maternalshock Premature la

or or spontaneous a

ortion 2007


rsey 07458

Causes: Motor vehicle accident - most common

Impact



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Impact of Trauma During Pregnancy (contd) Maternal mortality: From head trauma or hemorrhage

Uterine rupture is rare Placental a

ruption High rate of fetal mortality Premature

irth

Traumatic separation of the placenta

Early rupture of mem

ranesMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Treatment Major injuries

Life-saving measures for woman Esta

lishing an airway Control external

leeding

Administer IV fluid to alleviate shock Kept on her left side to prevent furtherhypotension Oxygen is administered at 100% Exploratory surgery may

e necessary 2007




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Treatment (contd) Fetus near term and uterus damaged: Cesarean section Fetus immature

Uterus can

e repaired Pregnancy continue to term

Evaluation of fetal heart rate and movement Minor injuries

Fetal monitoring for minimum of 4 hours Signs of o

stetric complications such asuterine

leeding Monitoring for 24 hours is recommended 2007




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Physical A

use During Pregnancy Incidence: 4% to 8% May result in loss of pregnancy Preterm la

or, low-

irth-weight infants, and fetal death A

used women have higher rates of complications

Anemia, infection, and low weight gain First- and second-trimester

leeding 2007


rsey 07458

Be alert for non-specific signsMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler


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Physical A

use During Pregnancy (contd) Management: Early detection Ask a

out a

use at several prenatal visits Client may only disclose a

use after knowing her caregivers Assess old scars on parts ofthe

ody Be alert for signs of

ruising: Target areas of violence during pregnancy

Clients

reasts A

domen or genitalia 2007




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Treatment Create an accepting, nonjudgmental environment Allow client to express her concerns She needs to

e aware of community resources

Emergency shelters Police, legal, and social services Counseling

Client has to make decision to seek assistanceMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Prenatal Infections Toxoplasmosis: Protozoan toxoplasma gondii Transmission

Eating raw or undercooked meat Contact with the feces of infected cats


2007



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Prenatal Infections (contd) Fetal-neonatal risks

Fetal infection Severe fetal disease or death

Severe neonatal disorders Treatment

Sulfadiazine and pyrimethamine Given after the first trimester


2007



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Prenatal Infections (contd) Ru

ella: Virus Transmission: Across placenta to fetus

Fetal neonatal infection Infant should

e isolated Ru

ella syndrome Vaccinationof all children Vaccination of women of reproductive age 2007


rsey 07458

Treatment: Prevention



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Prenatal Infections (contd) Cytomegalovirus: Virus Transmission

Across placenta to fetus Cervical route during

irth

Fetal infection Fetal death Neonatal disorders Treatment: Currently none exist

Maternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Prenatal Infections (contd) Herpes simplex virus: HSV-1 or HSV-2 Transmission: Ascending infection during

irth

After mem

ranes rupture Transplacental: Rare

Neonatal infection Treatment: Antiviral therapy (acyclovir) Active herpes lesion: Cesarean section No evidence of genital infection exists, vaginal

irth is preferredMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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Prenatal Infections (contd) Group B streptococcal infection (GBS) -

acterial infection Transmission: Vertical from mother during

irth

From colonized nursing personnel From colonized infants

Neonatal infection treated with anti

iotics Prevention

Early identification Anti

iotic prophylaxis 2007




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Prenatal Infections (contd) Other Infections

Urinary tract infections Vaginal infections Sexually transmitted infections

Maternal infections may cause spontaneous a

ortions. Some evidence links infecti

on and prematurity Risk of maternal and fetal mor

idity and mortality Early diagnosis and treatment is necessaryMaternal & Child Nursing Care, 2/e By London / Ladewig / Ball / Bindler 2007



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21378090 Maternal Child Nursing Care

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