FETAL DISTRESS

-Compromise of the fetus during the antepartum period (before labor) or intrapartum period (birth process) -commonly used to describe fetal hypoxia (low oxygen levels in the fetus)
-Fetal distress can be detected due to abnormal slowing of labor, the presence of meconium (dark green fecal material from the fetus) or other abnormal substances in the amniotic fluid, or via fetal monitoring with an electronic device showing a fetal scalp pH of less than 7.2.

Etiology/Risk factors:

Maternal -poor placental perfusion -hypovolemia -hypotension -myometrial hypotonus: prolonged labor, excess oxytocin -with cardiac problems -<35 y/o and 16 below

Fetal -cord compression: oligohydramnios, enlargement, prolapsed -infection -nuchal cord -pre-existing hypoxia

Signs & symptoms:

FHT above 160/min or 100/min O2 sat Maternal fever, abnormal HR, Difficulty of breathing, irritable Persistent severe variable deceleration Fetal bradycardia

Nursing Management:

Alteration of maternal position (left-side lying) hydration, O2 admin by mask, discontinue oxytocin, bed rest Teach how to properly bear down Immediate delivery of the baby is required; if unsuccessful emergency CS Frequent FHT monitoring & fetal movement

PREGNANT CLIENT WITH CARDIAC PROBLEMS

PRE ECLAMPSIA
-

High BP (greater than 140/90) developing during pregnancy, after 20wks AOG in a woman whose BP was previously normal-accompanied by excessive fluid retention

Risk factors:

First pregnancy Overweight women under 20 or over 35y/o mother or sister suffered from pre-eclampsia multiple pregnancy

Signs & symptoms:

High BP 140/90 or higher with proteinuria with or w/o edema (especially in the hands, feet and face)

ECLAMPSIA: BP= 160/110, edema, proteinuria + SEIZURE

Epigastric pain may experience before seizure

Nursing Management:
-

promote bed rest

seizure precaution to prevent complication administer meds to prevent eclampsia; Magnesium sulfate (muscle relaxant); before giving check the deep tendon reflex with the use of percussion hammer inform patient that it causes hotness/hot flushes check UO and VS support a nutritious diet; fat & Na intake

Submitted by: Ma. Ruffa Louraine M. Cruz BSN IV-A; group A2-A

A Woman's Diet Prior To Pregnancy Affects The Health Of Her Future Offspring
Main Category: Nutrition / Diet Also Included In: Women's Health / Gynecology; Pregnancy / Obstetrics; Pediatrics / Children's Health Article Date: 04 Jul 2011 - 0:00 PDT Poor maternal diet before conception can result in offspring with reduced birth weights and increased risk of developing type II diabetesand obesity. This work, which is being presented at the Society for Experimental Biology Annual Conference in Glasgow on Saturday the 2nd of July, used an animal model to illustrate the importance of maternal diet even before pregnancy begins. During the study mice that were fed a low protein diet for ten weeks before conception (but had a normal diet during pregnancy) gave birth to offspring that had lower birth weights, showed catch-up growth after weaning and increased insulin sensitivity. These effects combined can lead to problems later in life. MSc researcher, Ms Anete Dudele, from the University of Aarhus, explains: "Low birth weight and catch-up growth is associated with enhanced insulin-sensitivity in young adults, this then deteriorates into insulin resistance and type II diabetes with increased age. There is also evidence that male offspring are more

likely to develop obesity." Humans and mice respond in the same way to poor diet during pregnancy; their offspring show low birth weights and increased risk of obesity, type II diabetes and cardiovascular disease. "If humans respond in the same way as mice to pre-conception diet as well then women should not only consider what they eat during pregnancy but also before pregnancy if they want to reduce the risk of their future children acquiring lifestyle diseases," says Ms. Dudele. Cardiovascular disease is often associated with obesity and type II diabetes and future research by the team will determine whether offspring born to mothers who had poor preconception diets are predisposed to these types of problems as well. Source: Daisy Brickhill Society for Experimental Biology

Inducing Labor Is Not Associated With Higher Rates Of Cesarean Sections

Main Category: Pregnancy / Obstetrics Also Included In: Women's Health / Gynecology Article Date: 20 Jun 2011 - 9:00 PDT A new study published in the international Nordic journalActa Obstetricia et Gynecologica Scandinavica(AOGS) reveals that inducing labor in the weeks around term, or from week 39 to week 41, is not connected with higher rates of cesarean section compared with waiting for a later spontaneous or induced labor. There has been much debate about this in recent years with a concern that induction as opposed to expectant management might lead to a higher risk for the woman to end up with emergency cesarean section, rather than to deliver normally. Ole Bredahl Rasmussen, MD, of Herning Hospital in Denmark and Steen Rasmussen from the Danish Medical Birth Registry, have analyzed data from the Danish Birth Registry, one of the largest such registries in the world, and made comparisons among both women who were having their first birth as well as women who had previously had a child. To obtain a good basis for the study they used a large cohort of women with securely dated pregnancies and delivering in any type of hospital, from smaller regional to large university hospitals. Data from a total of 230,528 women delivering between 2004 and 2009 were used. This is a considerably larger population-based material than used up to now in comparable studies. Overall induction rates were 15.0% and section rates were higher among the induced compared to spontaneous labors, but after adjustment for confounding factors such as age, parity, smoking and use of epidural analgesia and adjusting for each gestational week, the results showed that in induced

women, induction of labor did not convey an increased risk of cesarean section when comparing outcomes in gestational weeks 39, 40 or 41 with those women who waited longer for a spontaneous or later induced labor. The study further confirmed that there is a higher cesarean rate among the more obese women (higher BMI) and with older age in both nulliparous and parous women. "The rate of cesarean section differs in different gestational weeks," Rasmussen notes. "Our study thus shows that it is necessary to take gestational length into account when induction of labor and expectant management are being compared." But the decision to induce labor around term seems not to be dependent on timing for success at term and during the week before or after this, when the end-point of emergency cesarean section is considered. The risk for that is either not or at best only marginally increased. Induction of labor is therefore an acceptable tool when a woman is either going past term or is presenting with a problem during her pregnancy, even if it is not a severe medical illness. Full citation: Rasmussen et al. Cesarean section after induction of labor compared with expectant management: no added risk from gestational week 39. Acta Obstetricia et Gynecologica Scandinavica. DOI: 10.1111/j.1600-0412.2011.01160.x. Source: Wiley-Blackwell