Maternal child health nursing

Module 4

Objectives

• Discuss infection in pregnancy, Rh and ABO incompatibilities, multiples pregnancies, preterm, true and false labors

• discuss substance abuse in pregnancy• Discuss FDA drug categories

Pregnancy: Infections

• TORCH group– Toxoplasmosis– Other – Rubella – Cytomegalovirus– Herpes genitalis

(Herpes Simplex Virus Type 2)

– FON p 903 box 28-5

Congenital Rubella Syndrome with rash

HIV/AIDs

• Review: – Human immunodeficiency virus emerged as one of

most significant diseases of 20th century– Acquired immune deficiency syndrome results from

HIV -> profound depression of immune system– s/s may present differently in women than in men

• Common presentation of chronic vaginitis, candidiasis

• Transmission precautions: mother, infant, care providers

A word about standard precautions

• Standard precautions in healthcare were developed to their present form in response to increasing awareness of blood- and body-fluid-borne illnesses

HIV/AIDs

• Human immunodeficiency virus• Causative organism responsible for AIDs• Severely depressed immune system• Transmitted through body fluids• Chronic vaginitis and candidiasis are common

presenting problems in women• Difficult to determine obstetric risk

HIV/AIDs• Prevent transmission from mother to child during

birth and postpartum– Avoid breaking skin barriers – Delivery within 4 hours of ROM– Breastfeeding not recommended where clean formula

available• HIV can cause microcephaly and facial deformities

in fetus, as well as infecting fetus with virus• Later signs of infant infection may include failure to

thrive, recurrent infection, interstitial pneumonia, neurological problems

Other infections

• STDs• Vaginal • Urinary tract

Nursing care: infections• Anti-infective: is Mom responding well? Is she

having side effects?• Hydration: is mom drinking enough fluids?• Elimination: constipated? Diarrhea? • Urination: is Mom’s urine dark, concentrated?• Nutrition: is Mom getting the right nutrition to

help her get well?• Immune function: is she resting? Anxious?

Showing signs of other infection? Exercising?

Rh incompatibility • Rh negative mom, Rh positive fetus• First vs subsequent pregnancies– Antibodies, antigens from first pregnancy– Attack second pregnancy: erythroblastosis fetalis

• Hyperbilirubinemia– Can cause RBCs to break down too quickly in

newborn– Kernicterus is buildup of bilirubin in CNS

Rh incompatibility

Rh incompatibility• Coomb’s test– Direct: tests infant’s blood for antibody-coated

RBCs – Indirect: tests mother’s blood for number of

antibodies • RhoGAM– IM injection of anti-Rh gamma globulin– Given to Mom at 28 weeks and at 72 hours

postpartum to prevent antibody development– Also given if Rh-negative mom has abortion,

ectopic pregnancy or amniocentesis

Rh incompatibility• Phototherapies– Fluorescent lights make bilirubin easier to excrete– May be in form of blanket (Wallaby fiberoptic)

• teaching– How disease works– RhoGAM: how it works, when to have it, who

should have it, keep records with Mom– Phototherapies: eye protection under lamps, skin

exposure

Fluorescent light therapy

ABO incompatibility

• Most often: Type O mother leaks antibodies to type A, B or AB baby

• Rare• Can happen with first pregnancy• May also cause erythroblastosis fetalis• Treatment similar as for Rh incompatibility

Multiples pregnancies

multiples• Twins (33.1 per 1,000 live births)– Monozygotic: fertilized egg splits at embryonic

stage -> identical twins– Dizygotic: two eggs fertilized -> fraternal twins

• Triplets or higher order births (137.6: 100,000 live births)

• Quadruplets or greater number usually result from fertility drugs

• Prematurity a risk for multiple births

multiples• Risks: abortion, maternal anemia, PIH,

placenta previa, abruptio placentae, hydramnios

• Resources: parents of multiples groups, financial resources, resources for baby supplies, may need referrals to lactation consultant

• Education: self-care, time management, needs unique to pre-term babies

multiples• Increase with certain fertility treatments• Fertility treatments may be given to older

mother – Stressed resources, energy, health– May have had more complicated pregnancy due to

advanced maternal age– Lessened support: older grandparents, peers

raising older children– Parents may have more education and earning

power

Substance abuse in pregnancy

Substance abuse in pregnancy

• Substance abuse includes both legal (nicotine, alcohol) and illegal (cocaine, marijuana) drugs

• Prescription drugs and other medications can also cross the placental barrier and affect the fetus

• Alcohol, tobacco and marijuana most commonly used during pregnancy

Substance abuse in pregnancy• Cocaine: constricts blood vessels– Detached placenta– Intracranial bleeding

• Tobacco– Low birth weight– Increased risk of SIDS

• Narcotics– Withdrawal symptoms– Preterm labor, spontaneous abortion

Substance abuse in pregnancy

• Alcohol– No safe amount for pregnancy has been

determined– Results: abortion, fetal demise, IUGR, fetal alcohol

syndrome, fetal alcohol effects– FAS: facial/cranial abnormalities, delayed

development, mental retardation, short attention span

Substance abuse in pregnancy• Sedatives (barbiturates, tranquilizers)– Delayed lung maturity– Neonatal abstinence syndrome

• Amphetamines (speed, crystal, ice)– Placental abruption– Cleft palate

• Marijuana– Often used with other drugs– IUGR

Substance abuse in pregnancy• Caffeine: stimulates fetus

Nursing care: substance abuse• Safe withdrawal• Nonjudgmental attitude• Prevention of injury– Prevent shaken baby syndrome

• Assessment (mother and baby): vital signs, changes in baseline, s/s withdrawal

• Education of infant needs and provide social support

Neonatal abstinence syndrome• Fetus exposed to addictive drugs in utero and

born dependent on them• When baby is born, supply is abruptly cut off• May cause long-term developmental and

neurological problems• S/S: tremors, hyperirritability, wakefulness,

diarrhea, poor feeding, sneezing, yawning• Treatment: IV fluids, small amounts of similar

substances to control symptoms• Nursing: minimize stimuli, swaddling, seizure

precautions

FDA drug categories

• Assigns A, B, C, D or X designation to drugs to differentiate risk

• Proposal has been made to update drug information to more accurately reflect risk

• Note that drug categories do not necessarily reflect ascending risk

FDA drug categories

Preterm labor

Preterm labor• Preterm: 0-37 weeks• Late preterm: 34-37 weeks• May be prompted by known or unknown

cause– Maternal infection or dehydration, fetal disease– Terbutaline SQ, magnesium sulfate IV titration

• Non-Braxton Hicks contractions, cervical dilation, s/s true labor

preterm labor• Terbutaline/Brethine– SQ, PO– Acts on smooth muscle and inhibits uterine

muscle activity– FDA warns against using injected terbutaline

longer than 48-72 to stop preterm labor• Maternal heart problems

Nursing care: preterm labor• Encourage hydration• Monitor FHR, status• Note time, color, amount, odor of any

amniotic fluid• Monitor maternal v/s• Treat underlying cause

True and false labor

• Contractions– Regular pattern v irregular – Increase in intensity, duration, frequency over

period of hours or days (not weeks) v stop with ambulation or position change

– Start in lower back, travel to lower abdomen v fundus or back

– Do not stop after interventions v decrease with interventions

True and false labor

• Cervical softening, effacement, dilation v possible softening without effacement or dilation

• Fetal descent into pelvis v no significant change in fetal position

• Educate regarding physiological benefit to fetus when pregnancy allowed to continue to 40 weeks