Exam (elaborations)
ABNORMAL PREGNANCY
- Module
- Institution
Exam of 38 pages for the course Maternal at Maternal (ABNORMAL PREGNANCY)
[Show more]
Seller
Follow
Content preview
lOMoAR cPSD| 47061011ABNORMAL PREGNANCY
1. RISK FACTORS IN PREGNANCY
Hyperemesis Gravidarum
This is a condition where vomiting is severe and continuous throughout the day. The
woman vomits everything she has eaten. This usually leads to severe dehydration and
ketoacidosis. She becomes malnourished. If treatment is not started quickly, liver and
kidney damage may result. Anaemia may develop as a result of lack of vitamin B, folic
acid and iron.
Can you think of three conditions that are associated with hyperemesis gravidarum?
Did you think of these?
Hyperemesis gravidarum occurs in very few women. It is usually associated with multiple
pregnancies, hydatidiform mole and/or a history of habitual abortions.
Management of Hyperemesis Gravidarum
If in a health centre or dispensary, the patient should be referred to a hospital as soon
as the diagnosis is made. In the hospital, the following should be done:
• Intravenous infusion of five percent dextrose alternating with normal saline will be
given to correct the dehydration.
• Anti emetics like promethazine hydrochloride (phenergan) or metoclopromide
hydrochloride (plasil) are given usually parenterally to control the vomiting.
• Multivitamin supplements are given.
• The patient is reassured and her visitors restricted.
• Routine nursing care and observations of vital signs are maintained twice daily or
as necessary.
The patient should be discharged at least two to three days after vomiting has ceased.
The case should be followed up in the antenatal clinic.
Polyhydramnios
This is a condition in which the quantity of amniotic fluid exceeds 1500mls. It may not
become apparent until it reaches 3000mls. It is a fairly rare condition.
, lOMoAR cPSD| 47061011
Polyhydramnios is associated with the following conditions:
• Oesophageal atresia
• Open neural tube defect
• Multiple pregnancy, especially in monozygotic twins
• Maternal diabetes mellitus
• Rarely in rhesus isoimmunisation
• Severe foetal abnormalities
There are two types of polyhydramnios: chronic and acute.
Chronic Polyhydramnios
This occurs gradually, usually from about the 30th week of pregnancy.
It is the most common type.
Acute Polyhydramnios
This is a rare type, which occurs at about 20 weeks and comes on very suddenly. The
uterus reaches the xiphisternum in about three to four days. It is associated with
monozygotic twins or severe foetal abnormality. Polyhydramnios can be recognised in the
following ways:
• The mother may complain of
breathlessness and discomfort.
• If the condition is acute in onset, she may complain of severe abdominal pain.
• The condition may aggravate other symptoms associated with pregnancy such as
indigestion, heartburn, constipation, oedema, varicose veins of the vulva and lower
limbs.
• On abdominal inspection, the uterus is larger than expected for the period of
gestation and is globular in shape. The abdominal skin appears stretched and tight
with marked striae gravidurum and marked superficial blood vessels.
• On palpation, the uterus is tense and it is difficult to feel foetal parts.
• The abdominal girth is much more than expected for the period of gestation.
• Auscultation of the foetal heart is difficult because of the free movement of the
foetus.
• Where possible an ultrasonic scan should be done to confirm the diagnosis. It may
also reveal multiple pregnancy or foetal abnormality if these are present
Management of Polyhydramnios
The mother is admitted to hospital and, where possible, the cause of the condition is
determined. The subsequent care will be determined by the condition of the mother, the
cause and the period of gestation.
If there is foetal abnormality, the method and timing of delivery will depend on the
severity. If there is gross abnormality, induction should be started. The nursing care
should include rest in bed in sitting position to relieve dyspnoea. Assist the patient with
personal hygiene and routine prenatal observations.
, lOMoAR cPSD| 47061011
If abdominal discomfort is severe, abdominal amniocentesis may be considered. If it is
done, infection prevention measures must be observed and only 500ml should be
withdrawn at a time. Labour may be induced in the case of late pregnancy. Before the
membranes are ruptured, the lie must be determined and the membranes ruptured
cautiously allowing the fluid to flow slowly. This is to avoid cord prolapse, alteration of
the lie and abruptio placenta which may occur after sudden reduction of uterine size.
Complications of Polyhydramnios
There are several complications associated with polyhydramnios. These include:
• Increased foetal mobility leading to
unstable lie and malpresentation
• Cord presentation and cord prolapse
• Premature rupture of the membranes
• Placenta abruptio when the membranes rupture
• Premature labour
• Postpartum haemorrhage
Oligohydramnios
In this condition there is an abnormally small amount of amniotic fluid. It may be 300 to
500ml at term but amounts vary and it may be much less. It is associated with absence
of kidneys or Potter's syndrome in which the foetus has pulmonary hypoplasia. The lack
of amniotic fluid reduces intrauterine space and causes deformities of the foetus due to
compression. The baby's skin is dry and leathery in appearance and the nose may be flat.
It may have talipes and a squashed-looking face.
The following characteristics will help you recognise the presence of oligohydramnios:
• The uterus is smaller than expected for the period of gestation
• The mother notices reduced foetal movements if she has had a previous normal
pregnancy
• On palpation the foetal parts are easily felt and the uterus is small and compact
Management
The woman should be admitted for investigations, usually in the form of an ultrasound
scan. If there are no foetal abnormalities, the pregnancy will be allowed to continue.
Labour may be induced early to avoid placental insufficiency.
Analgesics are given during labour because the contractions are usually very painful.
However, be aware that impaired circulation may cause foetal hypoxia. After delivery the
baby is examined carefully for abnormalities.
, lOMoAR cPSD| 47061011
Bleeding in Late Pregnancy (Antepartum Haemorrhage
Bleeding in late pregnancy refers to any bleeding from the genital tract from the 28th
week of gestation and before the birth of the baby. It is usually known as antepartum
haemorrhage.
Remember:
Never perform a vaginal examination on a woman with antepartum haemorrhage.
This may lead to severe bleeding which can be fatal.
The two most important causes of bleeding in late pregnancy are placenta praevia and
abruptio placentae. You will now look at each of these separately.
Placenta Praevia
This is bleeding from a partially separated placenta, which is wholly or partially situated
in the lower uterine segment. It might be covering either part or the entire internal os. It
is more likely to occur with increasing maternal age. It is more common in women aged
35 and above. It is also associated with increasing parity, and is twice as common in
multigravida as in primigravida.
Placenta praevia is divided into four types or degrees.
Type 1
The placenta lies in the upper segment and only the lower margin dips into the lower
uterine segment.
Type II
The placenta is partially situated in the lower uterine segment with the lower margin of
the placenta reaching the edge of the internal os but does not cover it. It is known as
marginal placenta praevia.
Type III
The placenta covers the internal os when closed up to three to four centimetres dilatation.
This is known as partial or incomplete placenta praevia.
Type IV
The placenta lies centrally over the internal os and covers the os even when the cervix is
fully dilated.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Quizgecko. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
71143 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy revision notes and other study material for 15 years now