RISK

CONDITIONS
RELATED TO
PREGNANCY
ABORTION
A pregnancy that ends before 20 weeks gestation, spontaneously or electively
Types:
1. SPONTANEOUS - Pregnancy that ends because of natural causes
2. INDUCED - Therapeutic or elective reasons for terminating the pregnancy
3. TREATHENED - Developing spontaneous abortion
4. INEVITABLE - Threatened loss that cannot prevented
5. INCOMPLETE - Loss of some products of conception and retention of
others
6. COMPLETE - Loss of all products of conception
7. MISSED - Retention of products of conception in utero after fetal death
8. HABITUAL - Spontaneous abortion in three or more successive pregnancy
ASSESSMENT
Spontaneous vaginal bleeding occurs
Passage of clots or tissue through the vagina occurs
Low uterine cramping or contractions occur
Hemorrhage and shock can occur
ABORTION
ABORTION
INTERVENTIONS
Maintain bed rest
Monitor vital signs
Monitor cramping & bleeding
Count perineal pads to evaluate blood loss & save expelled tissues & clots
Maintain intravenous fluids as prescribed; monitor for signs of shock
Prepare client for dilatation & curettage as prescribed for incomplete
abortion
Rh immune globulin is given to appropriate Rho(D) negative woman
ABORTION
Causes:
1
st
trimester abnormal development (50%)
2
nd
trimester maternal infection
chronic disease
endocrine defects
incompetent cervix
uterine defects
environmental toxins
ABORTION
Causes

THREATENED ABORTION
Vaginal bleeding/spotting efore 20 weeks
Cervix closed, may or may not have cramping


Bleeding stops
Continued pregnancy
MISSED ABORTION
Death of the conceptus
Without expulsion
IMMINENT/INEVITABLE ABORTION
Obvious rupture of membrane,
Cervical dilation,
Cramping, bleeding
INCOMPLETE ABORTION
Retention of some tissue usually the placenta
Bleeding and cramping continue
Requires dilation and curretage
COMPLETE ABORTION
Expulsion of the complete products of conception
Bleeding and cramping stops
ABORTION
NURSING DIAGNOSIS
ANXIETY related to possible pregnancy loss
RISK FOR DEFICIENT FLUID VOLUME related to
excessive losses: vaginal bleeding during pregnancy
RISK FOR INFECTION related to internal site for
organism invasion secondary to vaginal bleeding during
pregnancy
ANTICIPATORY GRIEVING related to threatened
abortion; potential for infant with congenital anomalies
INFECTION
May affect the fetus by crossing the placenta or
ascending the vagina.
During the 1rst trimester, may result in spontaneous
abortion or fetal developmental defects.
Late part of pregnancy, may cause preterm birth, CNS
defects, or neonatal infection and sepsis
Prevention of infection is the primary goal.
Prenatal screening and identification of risk factors,
along with client teaching & can lead to early
identification and prompt treatment
INFECTION
MEDICAL CARE
Rubella vaccination prior to pregnancy
Screening for TORCH infections, Group B
streptococcus, and possibly hepatitis and HIV
Medications: prophylactic antibiotics, antiviral:
zidovudine (AZI), and infectives, immune globulins, and
so forth
Fetal screening/ultrasounds to determine effects of
infections
INFECTION
NURSING DIAGNOSIS
Anxiety related to effects of prenatal infection on
developing fetus
Anticipatory grieving related to potential loss of fetus,
or developmental defects
Risk for infection related to (specify the conditions that
cause risk)
Social Isolation related to fear of rejection

MATERNAL INFECTION
FETAL-NEONATAL EXPOSURE

Ascending chorioamnionitis
Across Placenta Vagina
BACTERIA
Group B Streptococcus
Bacterial Vaginosis
VIRUSES
Rubella , Herpes, HIV

PROTOZOA
Toxoplasmosis

SPIROCHETE
BACTERIA
Group B Streptococcus
Gonorrhea, Chlamydia
Trichomoniasis

VIRUSES
Herpes, Hepatitis B, HIV
Fetal-Neonatal Effect

Preterm SROM
Preterm Birth
Congenital Infection
(HIV, syphilis, herpes)
Congenital Malformations
Spontaneous Abortion
Stillbirth
NEONATAL SEPSIS
ACQUIRED IMMUNODEFICIENCY SYNDROME
Causative Factor: Human Immunodeficiency Virus (HIV)

Symptoms: May demonstrate at the time of pregnancy or
possibly develop life threatening infections because normal
pregnancy involves some suppression of the maternal immune
system

Treatment: ZIDOVUDINE (AZT) is recommended for the
prevention of maternal fetal HIV transmission & is administered
orally beginning after 14 weeks gestation, intravenously during
labor & in the form of syrup to the neonate after birth for 6 weeks
ACQUIRED IMMUNODEFICIENCY SYNDROME
Transmission
Sexual exposure to genital secretions of infected person
Parenteral exposure to infected blood & tissue
Perinatal exposure of an infant to infected maternal
secretions through birth or breast feeding

Risk to the Mother: The mother with HIV is managed as
high risk because she is vulnerable to infections
ACQUIRED IMMUNODEFICIENCY SYNDROME
Diagnostic Care
1. Tests used to determine the presence of antibodies to HIV
include enzyme-linked immunosorbent assay (ELISA), Western
blot & immunofluorescent assay (IFA)
2. A single reactive ELISA test by itself cannot be used to diagnose
HIV & should be repeated in duplicate with the same blood
sample; if the result is repeatedly reactive, follow-up test using
Western Blot or IFA should be done
3. A (+) Western blot or IFA is considered confirmatory for HIV
4. A (+) ELISA that fails to be confirmed by Western blot or IFA
should not be considered negative & repeat testing should take
place ion 3-6 months
ACQUIRED IMMUNODEFICIENCY SYNDROME
Assessment
Stage 1
1. Fever
2. Myalgia
3. Lymphadenopathy
4. Headache

Stage 2
1. Infection is active but asymptomatic & may remain so for
years
2. Person may experience an outbreak of herpes zoster
(shingles)
3. Person may experience a transient thrombocytopenia
ACQUIRED IMMUNODEFICIENCY SYNDROME
Assessment
Stage 3
1. Person is asymptomatic
2. Immune dysfunction is evident
3. All body system can show signs of immune dysfunction
4. Integumentary & gynecological problems are common

Stage 4
1. Advanced HIV infection
2. Person is vulnerable to common bacterial
3. Infections
4. Development of opportunistic infections occurs
5. Serious immune compromise occurs
ACQUIRED IMMUNODEFICIENCY SYNDROME
Interventions
Prenatal period
Prevent opportunistic infection
Avoid procedures that increase the risk of perinatal
transmission such as amniocenthesis & fetal scalp
sampling
Intrapartum Period
If the fetus has not been exposed to HIV in utero, the
highest risk exists during delivery through the birth canal
Avoid the use of scalp electrodes
Avoid episiotomy to decease the amount of maternal
blood in & around the birth canal
ACQUIRED IMMUNODEFICIENCY SYNDROME
Interventions
Intrapartum Period
Avoid the administration of Oxytocin because contractions induced can be
strong causing vaginal tears or necessitating an episiotomy
Place heavy absorbent pads under the mothers hips to absorb amniotic
fluid and maternal blood
Minimize the neonates exposure to maternal blood & blood fluids; promptly
remove the neonate from the mothers blood following delivery
Suction fluids from the neonate promptly
Prepared to administer zidovudine intravenously as prescribed to the
mother during labor & delivery
ACQUIRED IMMUNODEFICIENCY SYNDROME
Interventions
Post partum period
1. Monitor for signs of infection
2. Place the mother in protective isolation if the mother is
immunosuppressed
3. Restrict breast-feeding
4. Instruct the mother to monitor for signs of infection &
report any signs if they occur
SEXUALLY TRANSMI TTED DI SEASES
CHLAMYDI A
A sexually transmitted pathogen associated with an increased risk for
premature births, stillbirths, neonatal conjunctivitis & NB chlamydial
pneumonia
In non-pregnant state, can cause salphingitis, pelvic abscesses, chronic pelvic
pain & infertility
Diagnostic test is a culture for Chlamydia Trachomatis

Assessment
1. Usually asymptomatic
2. Bleeding between periods or after coitus
3. Mucoid or purulent cervical discharge
4. Dysuria
5. In the NB, conjunctivitis & pneumonia
STD CHLAMYDIA
Interventions
1. Screen the client to determine whether the client is high
risk; instruct the client in the importance of re-screening
because re-infection can occur as the client nears term
2. Instruct the client about the prescribed medication for
treatment
3. Instruct the client about medication for the neonate if
prescribed
4. Administer appropriate eye prophylaxis to the neonate
5. Monitor neonate for signs & symptoms of pneumonia, if
at risk
6. Ensure that the sexual partner is treated
STD
SYPHILIS
A chronic infectious disease caused by the organism
Treponema pallidum
Transmission is by physical contact with syphilitic lesion,
which usually are found on the skin, the mucous
membranes of the mouth or on the genitals
May cause abortion or premature labor & is passed to the
fetus after the 4
th
month of pregnancy as congenital syphilis
STD SYPHILIS
Assessment
Primary Stage (most infectious stage)
1. Appearance of ulcerative, painless lesions produced by spirochetes at the
point of entry into the body
Secondary Stage (Highly infectious stage)
1. Appearance of lesions about 3 weeks after the primary stage anywhere on
the skin & mucous membranes
2. Generalized lympadenopathy
Tertiary Stage
1. Entrance of spirochetes into the internal organs, causing permanent
damage; symptoms occurring 10-30 years following the untreated primary
lesion
2. Invasion of the central nervous system, causing meningitis, ataxia, general
paresis & progressive mental deterioration
3. Deterious effects on the aortic valve & aorta
STD SYPHILIS
Interventions
1. Obtain serum test for syphilis on the first prenatal
visit; prepare to repeat the test at 36 weeks of
gestation because the disease may be acquired after
the initial visit
2. If the test result is (+), treatment is necessary with an
antibiotic, such as penicillin
3. Instruct the client that treatment of her partner is
necessary, if infection is present
STD
GONORRHEA
Infection caused by Neisseria Gonorrhoeae, causes
inflammation of the mucous membranes of the genital &
urinary tracts
Transmission of the organism is by sexual intercourse
Infection my be transmitted to the NBs eyes during
delivery causing blindness (ophtalmia neonatorum)
Assessment
1.Female usually asymptomatic; vaginal discharge, urinary
frequency & pain possible
2.Male Fever, painful urination, pelvic pain, epididymis
with pain, tenderness & swelling
STD GONORRHEA
Interventions
1. Obtain culture for gonorrhea on the first prenatal visit;
prepare to repeat culture because infection may occur
during pregnancy
2. Administer antibiotics prophylactically to the eyes of
the NB infant
3. Instruct the client that treatment of her partner is
necessary if infection is present
STD
CONDYLOMATA ACUMI NATA (VENEREAL WARTS)
Caused by human papilla mavirus; infection affects the cervix,
urethra, anus, penis & scrotum
Transmitted through sexual contact

Assessment
1. Infection produces small to large wart like growths on genitals
2. Cervical cell changes may be noted because human papillonavirus
is associated with cervical malignancies

Interventions
1. Lesions are removed by the use of cytotoxic agents, cryotheraphy,
electrocautery & laser
2. Encourage yearly Pap Smear
3. Avoid sexual contact until the lesions are healed