MSU 405

​Nursing Management of Pregnancy at Risk

By Sarah Sauder, CNM, FNE A/P

Open Ended

What questions do you have about chapters 19 and 20 so far?

Open Ended

Pregnancies can start off low risk and develop into high-risk situations, or they may start off as high-risk pregnancies to begin with.

What are some pre-existing conditions that would mean the pregnant person has a high-risk pregnancy?

​Why might this pregnancy be considered high risk?
How do you think the couple may react on learning this information?

​Consider the following scenario: A couple has finally become pregnant after numerous attempts over the last 4 years. The woman is now 37 years old, and her partner is 40. The couple is informed that the pregnancy, for various reasons, is considered high risk.

Pregnancy Complications

(Spontaneous abortion, Ectopic pregnancy, and Gestational trophoblastic disease were covered in Previous Class)

• Cervical Insufficiency

• Bleeding during pregnancy

• Hyperemesis gravidarum

• Gestational hypertension

• HELLP syndrome

• Gestational diabetes

• Blood incompatibility

• Amniotic fluid imbalances

• Multiple gestation

• Premature rupture of membranes

Multiple Choice

A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, "I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device." The nurse should suspect which of the following?

• Missed abortion

• Ectopic pregnancy

• Severe pre-eclampsia

• Hydatidiform mole

Cervical Insufficiency

Premature dilatation of cervix

• Cause unknown; possibly due to cervical damage

• Therapeutic management:

  • Bed rest, pelvic rest, avoidance of heavy lifting

  • Cervical cerclage

• Nursing assessment

  • Risk factors

  • Pink-tinged vaginal discharge or pelvic pressure

  • Cervical shortening via transvaginal ultrasound

• Nursing management

  • Continuing surveillance; close monitoring for preterm labor

  • Emotional support

  • Education

Hemorrhagic Disorders

OB Emergency

-> Leading cause of maternal death

-> Can occur during pregnancy, during labor, and/or after delivery antepartum, intrapartum, postpartum

when the placenta is inserted wholly or partly into the lower uterine segment of the uterus, partially or completely covering the internal cervical opening

Placenta Previa

​the early separation of a normally implanted placenta after the 20th week of gestation, prior to birth

Placental Abruption

​placenta abnormally adherent to the myometrium; penetration of the myometrium; invasion of the myometrium to the peritoneal covering

​​Placenta Accreta, Increta, and Percreta

Categorize

Options (12)

Onset: quiet &
sneaky

Onset: sudden/stormy

Bleeding: external, bright red in color

Bleeding: concealed or overt, dark or port wine in color

Could lead to
anemia or shock
from bleeding too
much

May lead to
anemia or shock
from bleeding too
much

Pain: not unless in
labor

Pain: severe & steady

Uterus: nontender, soft, normal contour

Uterus: tender, firm/boardlike abdomen, abnormal contour

FHT usually present

FHT present or absent

Comparison of Placenta Previa and Placental Abruption

Placenta Previa

Placental Abruption

Multiple Choice

A nurse is caring for a client who is at 32 weeks of gestation and has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following medications should the nurse expect the provider will prescribe?

• Betamethasone (Celestone)

• Indomethacin (Indocin)

• Nifedipine (Procardia)

• Methylergonovine (Methergine)

Multiple Select

A nurse is providing care for a client wo has a marginal abruptio placentae. Which of the following findings are risk factors for developing the condition? Select all that apply.

• Fetal Position

• Blunt abdominal trauma

• Cocaine use

• Maternal age

• Cigarette smoking

Multiple Select

A nurse in an antepartum clinic is assessing a client who as a TORCH infection. Which of the following findings should the nurse expect? Select all that apply.

• Joint pain

• Malaise

• Rash

• Urinary frequency

• Tender lymph nodes

Categorize

Options (4)

Maternal age older than 40 years

Chronic renal disease

Maternal age older than 25 years

Previous birth of an infant that was large or stillborn

A nurse is discussing with a newly licensed nurse two conditions, gestational diabetes mellitus and gestational hypertension. Sort the following risk factors the nurse should include in teaching for each condition: Gestational Diabetes Mellitus or Gestational Hypertension

Gestational Diabetes Mellitus

Gestational Hypertension

Multiple Select

A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for this client? Select all that apply

• Diabetes

• Multifetal pregnancy

• Maternal age greater than 40

• Gestational trophoblastic disease

• Oligohydramnios