1. May arrives at the health care clinic and tells the nurse that her last D.

D. Weigh and bathe the infant before feeding.

menstrual period was 9 weeks ago. She also tells the nurse that a 14.Nurse Hazel is teaching a mother who plans to discontinue breast
home pregnancy test was positive but she began to have mild cramps feeding after 5 months. The nurse should advise her to include which
and is now having moderate vaginal bleeding. During the physical foods in her infant’s diet?
examination of the client, the nurse notes that May has a dilated cervix. A. Skim milk and baby food.
The nurse determines that May is experiencing which type of abortion? B. Whole milk and baby food.
A. Inevitable C. Iron-rich formula only.
B. Incomplete D. Iron-rich formula and baby food.
C. Threatened 15.Mommy Linda is playing with her infant, who is sitting securely
D. Septic alone on the floor of the clinic. The mother hides a toy behind her back
2. Nurse Reese is reviewing the record of a pregnant client for her first and the infant looks for it. The nurse is aware that estimated age of the
prenatal visit. Which of the following data, if noted on the client’s infant would be:
record, would alert the nurse that the client is at risk for a spontaneous A. 6 months
abortion? B. 4 months
A. Age 36 years C. 8 months
B. History of syphilis D. 10 months
C. History of genital herpes 16.Which of the following is the most prominent feature of public health
D. History of diabetes mellitus nursing?
3. Nurse Hazel is preparing to care for a client who is newly admitted A. It involves providing home care to sick people who are
to the hospital with a possible diagnosis of ectopic pregnancy. Nurse not confined in the hospital.
Hazel develops a plan of care for the client and determines that which B. Services are provided free of charge to people within
of the following nursing actions is the priority? the catchments area.
A. Monitoring weight C. The public health nurse functions as part of a team
B. Assessing for edema providing a public health nursing services.
C. Monitoring apical pulse D. Public health nursing focuses on preventive, not
D. Monitoring temperature curative, services.
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition 17.When the nurse determines whether resources were maximized in
and insulin needs during pregnancy. The nurse determines that the implementing Ligtas Tigdas, she is evaluating
client understands dietary and insulin needs if the client states that the A. Effectiveness
second half of pregnancy require: B. Efficiency
A. Decreased caloric intake C. Adequacy
B. Increased caloric intake D. Appropriateness
C. Decreased Insulin 18.Vangie is a new B.S.N. graduate. She wants to become a Public
D. Increase Insulin Health Nurse. Where should she apply?
5. Nurse Michelle is assessing a 24 year old client with a diagnosis of A. Department of Health
hydatidiform mole. She is aware that one of the following is B. Provincial Health Office
unassociated with this condition? C. Regional Health Office
A. Excessive fetal activity. D. Rural Health Unit
B. Larger than normal uterus for gestational age. 19.Tony is aware the Chairman of the Municipal Health Board is:
C. Vaginal bleeding A. Mayor
D. Elevated levels of human chorionic gonadotropin. B. Municipal Health Officer
6. A pregnant client is receiving magnesium sulfate for severe C. Public Health Nurse
pregnancy induced hypertension (PIH). The clinical findings that would D. Any qualified physician
warrant use of the antidote , calcium gluconate is: 20.Myra is the public health nurse in a municipality with a total
A. Urinary output 90 cc in 2 hours. population of about 20,000. There are 3 rural health midwives among
B. Absent patellar reflexes. the RHU personnel. How many more midwife items will the RHU
C. Rapid respiratory rate above 40/min. need?
D. Rapid rise in blood pressure. A. 1
7. During vaginal examination of Janah who is in labor, the presenting B. 2
part is at station plus two. Nurse, correctly interprets it as: C. 3
A. Presenting part is 2 cm above the plane of the ischial D. The RHU does not need any more midwife item.
spines. 21.According to Freeman and Heinrich, community health nursing is a
B. Biparietal diameter is at the level of the ischial spines. developmental service. Which of the following best illustrates this
C. Presenting part in 2 cm below the plane of the ischial statement?
spines. A. The community health nurse continuously develops
D. Biparietal diameter is 2 cm above the ischial spines. himself personally and professionally.
8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. B. Health education and community organizing are
A condition that warrant the nurse in-charge to discontinue I.V. infusion necessary in providing community health services.
of Pitocin is: C. Community health nursing is intended primarily for
A. Contractions every 1 ½ minutes lasting 70-80 health promotion and prevention and treatment of
seconds. disease.
B. Maternal temperature 101.2 D. The goal of community health nursing is to provide
C. Early decelerations in the fetal heart rate. nursing services to people in their own places of
D. Fetal heart rate baseline 140-160 bpm. residence.
9. Calcium gluconate is being administered to a client with pregnancy 22.Nurse Tina is aware that the disease declared through Presidential
induced hypertension (PIH). A nursing action that must be initiated as Proclamation No. 4 as a target for eradication in the Philippines is?
the plan of care throughout injection of the drug is: A. Poliomyelitis
A. Ventilator assistance B. Measles
B. CVP readings C. Rabies
C. EKG tracings D. Neonatal tetanus
D. Continuous CPR 23.May knows that the step in community organizing that involves
10. A trial for vaginal delivery after an earlier caesareans, would likely training of potential leaders in the community is:
to be given to a gravida, who had: A. Integration
A. First low transverse cesarean was for active herpes B. Community organization
type 2 infections; vaginal culture at 39 weeks C. Community study
pregnancy was positive. D. Core group formation
B. First and second caesareans were for cephalopelvic 24.Beth a public health nurse takes an active role in community
disproportion. participation. What is the primary goal of community organizing?
C. First caesarean through a classic incision as a result A. To educate the people regarding community health
of severe fetal distress. problems
D. First low transverse caesarean was for breech B. To mobilize the people to resolve community health
position. Fetus in this pregnancy is in a vertex problems
presentation. C. To maximize the community’s resources in dealing
11.Nurse Ryan is aware that the best initial approach when trying to with health problems.
take a crying toddler’s temperature is: D. To maximize the community’s resources in dealing
A. Talk to the mother first and then to the toddler. with health problems.
B. Bring extra help so it can be done quickly. 25.Tertiary prevention is needed in which stage of the natural history of
C. Encourage the mother to hold the child. disease?
D. Ignore the crying and screaming. A. Pre-pathogenesis
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. B. Pathogenesis
What should the nurse do to prevent trauma to operative site? C. Prodromal
A. Avoid touching the suture line, even when cleaning. D. Terminal
B. Place the baby in prone position. 26.The nurse is caring for a primigravid client in the labor and delivery
C. Give the baby a pacifier. area. Which condition would place the client at risk for
D. Place the infant’s arms in soft elbow restraints. disseminated intravascular coagulation (DIC)?
13. Which action should nurse Marian include in the care plan for a 2 A. Intrauterine fetal death.
month old with heart failure? B. Placenta accreta.
A. Feed the infant when he cries. C. Dysfunctional labor.
B. Allow the infant to rest before feeding. D. Premature rupture of the membranes.
C. Bathe the infant and administer medications before 27.A fullterm client is in labor. Nurse Betty is aware that the fetal heart
feeding. rate would be:
 A. 80 to 100 beats/minute A. Loud, machinery-like murmur.
B. 100 to 120 beats/minute B. Bluish color to the lips.
C. 120 to 160 beats/minute C. Decreased BP reading in the upper extremities
D. 160 to 180 beats/minute D. Increased BP reading in the upper extremities.
28.The skin in the diaper area of a 7 month old infant is excoriated and 42.The reason nurse May keeps the neonate in a neutral thermal
red. Nurse Hazel should instruct the mother to: environment is that when a newborn becomes too cool, the neonate
A. Change the diaper more often. requires:
B. Apply talc powder with diaper changes. A. Less oxygen, and the newborn’s metabolic rate
C. Wash the area vigorously with each diaper change. increases.
D. Decrease the infant’s fluid intake to decrease B. More oxygen, and the newborn’s metabolic rate
saturating diapers. decreases.
29.Nurse Carla knows that the common cardiac anomalies in children C. More oxygen, and the newborn’s metabolic rate
with Down Syndrome (tri-somy 21) is: increases.
A. Atrial septal defect D. Less oxygen, and the newborn’s metabolic rate
B. Pulmonic stenosis decreases.
C. Ventricular septal defect 43.Before adding potassium to an infant’s I.V. line, Nurse Ron must be
D. Endocardial cushion defect sure to assess whether this infant has:
30.Malou was diagnosed with severe preeclampsia is now receiving A. Stable blood pressure
I.V. magnesium sulfate. The adverse effects associated with B. Patant fontanelles
magnesium sulfate is: C. Moro’s reflex
A. Anemia D. Voided
B. Decreased urine output 44.Nurse Carla should know that the most common causative factor of
C. Hyperreflexia dermatitis in infants and younger children is:
D. Increased respiratory rate A. Baby oil
31.A 23 year old client is having her menstrual period every 2 weeks B. Baby lotion
that last for 1 week. This type of menstrual pattern is best defined by: C. Laundry detergent
A. Menorrhagia D. Powder with cornstarch
B. Metrorrhagia 45.During tube feeding, how far above an infant’s stomach should the
C. Dyspareunia nurse hold the syringe with formula?
D. Amenorrhea A. 6 inches
32. Jannah is admitted to the labor and delivery unit. The critical B. 12 inches
laboratory result for this client would be: C. 18 inches
A. Oxygen saturation D. 24 inches
B. Iron binding capacity 46. In a mothers’ class, Nurse Lhynnete discussed childhood diseases
C. Blood typing such as chicken pox. Which of the following statements about chicken
D. Serum Calcium pox is correct?
33.Nurse Gina is aware that the most common condition found during A. The older one gets, the more susceptible he becomes
the second-trimester of pregnancy is: to the complications of chicken pox.
A. Metabolic alkalosis B. A single attack of chicken pox will prevent future
B. Respiratory acidosis episodes, including conditions such as shingles.
C. Mastitis C. To prevent an outbreak in the community, quarantine
D. Physiologic anemia may be imposed by health authorities.
34.Nurse Lynette is working in the triage area of an emergency D. Chicken pox vaccine is best given when there is an
department. She sees that several pediatric clients arrive impending outbreak in the community.
simultaneously. The client who needs to be treated first is: 47.Barangay Pinoy had an outbreak of German measles. To prevent
A. A crying 5 year old child with a laceration on his scalp. congenital rubella, what is the BEST advice that you can give to
B. A 4 year old child with a barking coughs and flushed women in the first trimester of pregnancy in the barangay Pinoy?
appearance. A. Advice them on the signs of German measles.
C. A 3 year old child with Down syndrome who is pale B. Avoid crowded places, such as markets and movie
and asleep in his mother’s arms. houses.
D. A 2 year old infant with stridorous breath sounds, C. Consult at the health center where rubella vaccine
sitting up in his mother’s arms and drooling. may be given.
35.Maureen in her third trimester arrives at the emergency room with D. Consult a physician who may give them rubella
painless vaginal bleeding. Which of the following conditions is immunoglobulin.
suspected? 48.Myrna a public health nurse knows that to determine possible
A. Placenta previa sources of sexually transmitted infections, the BEST method that may
B. Abruptio placentae be undertaken is:
C. Premature labor A. Contact tracing
D. Sexually transmitted disease B. Community survey
36.A young child named Richard is suspected of having pinworms. The C. Mass screening tests
community nurse collects a stool specimen to confirm the diagnosis. D. Interview of suspects
The nurse should schedule the collection of this specimen for: 49.A 33-year old female client came for consultation at the health
A. Just before bedtime center with the chief complaint of fever for a week. Accompanying
B. After the child has been bathe symptoms were muscle pains and body malaise. A week after the start
C. Any time during the day of fever, the client noted yellowish discoloration of his sclera. History
D. Early in the morning showed that he waded in flood waters about 2 weeks before the onset
37.In doing a child’s admission assessment, Nurse Betty should be of symptoms. Based on her history, which disease condition will you
alert to note which signs or symptoms of chronic lead poisoning? suspect?
A. Irritability and seizures A. Hepatitis A
B. Dehydration and diarrhea B. Hepatitis B
C. Bradycardia and hypotension C. Tetanus
D. Petechiae and hematuria D. Leptospirosis
38.To evaluate a woman’s understanding about the use of diaphragm 50.Mickey a 3-year old client was brought to the health center with the
for family planning, Nurse Trish asks her to explain how she will use chief complaint of severe diarrhea and the passage of “rice water”
the appliance. Which response indicates a need for further health stools. The client is most probably suffering from which condition?
teaching? A. Giardiasis
A. “I should check the diaphragm carefully for holes B. Cholera
every time I use it” C. Amebiasis
B. “I may need a different size of diaphragm if I gain or D. Dysentery
lose weight more than 20 pounds” 51.The most prevalent form of meningitis among children aged 2
C. “The diaphragm must be left in place for atleast 6 months to 3 years is caused by which microorganism?
hours after intercourse” A. Hemophilus influenzae
D. “I really need to use the diaphragm and jelly most B. Morbillivirus
during the middle of my menstrual cycle”. C. Steptococcus pneumoniae
39.Hypoxia is a common complication of laryngotracheobronchitis. D. Neisseria meningitidis
Nurse Oliver should frequently assess a child with 52.The student nurse is aware that the pathognomonic sign of measles
laryngotracheobronchitis for: is Koplik’s spot and you may see Koplik’s spot by inspecting the:
A. Drooling A. Nasal mucosa
B. Muffled voice B. Buccal mucosa
C. Restlessness C. Skin on the abdomen
D. Low-grade fever D. Skin on neck
40.How should Nurse Michelle guide a child who is blind to walk to the 53.Angel was diagnosed as having Dengue fever. You will say that
playroom? there is slow capillary refill when the color of the nailbed that you
A. Without touching the child, talk continuously as the pressed does not return within how many seconds?
child walks down the hall. A. 3 seconds
B. Walk one step ahead, with the child’s hand on the B. 6 seconds
nurse’s elbow. C. 9 seconds
C. Walk slightly behind, gently guiding the child forward. D. 10 seconds
D. Walk next to the child, holding the child’s hand. 54.In Integrated Management of Childhood Illness, the nurse is aware
41.When assessing a newborn diagnosed with ductus arteriosus, that the severe conditions generally require urgent referral to a
Nurse Olivia should expect that the child most likely would have an:
hospital. Which of the following severe conditions DOES NOT always D. At the end of the day
require urgent referral to a hospital? 68.The nurse explains to a breastfeeding mother that breast milk is
A. Mastoiditis sufficient for all of the baby’s nutrient needs only up to:
B. Severe dehydration A. 5 months
C. Severe pneumonia B. 6 months
D. Severe febrile disease C. 1 year
55.Myrna a public health nurse will conduct outreach immunization in a D. 2 years
barangay Masay with a population of about 1500. The estimated 69.Nurse Ron is aware that the gestational age of a conceptus that is
number of infants in the barangay would be: considered viable (able to live outside the womb) is:
A. 45 infants A. 8 weeks
B. 50 infants B. 12 weeks
C. 55 infants C. 24 weeks
D. 65 infants D. 32 weeks
56.The community nurse is aware that the biological used in Expanded 70.When teaching parents of a neonate the proper position for the
Program on Immunization (EPI) should NOT be stored in the freezer? neonate’s sleep, the nurse Patricia stresses the importance of placing
A. DPT the neonate on his back to reduce the risk of which of the following?
B. Oral polio vaccine A. Aspiration
C. Measles vaccine B. Sudden infant death syndrome (SIDS)
D. MMR C. Suffocation
57.It is the most effective way of controlling schistosomiasis in an D. Gastroesophageal reflux (GER)
endemic area? 71.Which finding might be seen in baby James a neonate suspected of
A. Use of molluscicides having an infection?
B. Building of foot bridges A. Flushed cheeks
C. Proper use of sanitary toilets B. Increased temperature
D. Use of protective footwear, such as rubber boots C. Decreased temperature
58.Several clients is newly admitted and diagnosed with leprosy. D. Increased activity level
Which of the following clients should be classified as a case of 72.Baby Jenny who is small-for-gestation is at increased risk during
multibacillary leprosy? the transitional period for which complication?
A. 3 skin lesions, negative slit skin smear A. Anemia probably due to chronic fetal hyposia
B. 3 skin lesions, positive slit skin smear B. Hyperthermia due to decreased glycogen stores
C. 5 skin lesions, negative slit skin smear C. Hyperglycemia due to decreased glycogen stores
D. 5 skin lesions, positive slit skin smear D. Polycythemia probably due to chronic fetal hypoxia
59.Nurses are aware that diagnosis of leprosy is highly dependent on 73.Marjorie has just given birth at 42 weeks’ gestation. When the nurse
recognition of symptoms. Which of the following is an early sign assessing the neonate, which physical finding is expected?
of leprosy? A. A sleepy, lethargic baby
A. Macular lesions B. Lanugo covering the body
B. Inability to close eyelids C. Desquamation of the epidermis
C. Thickened painful nerves D. Vernix caseosa covering the body
D. Sinking of the nosebridge 74.After reviewing the Myrna’s maternal history of magnesium sulfate
60.Marie brought her 10 month old infant for consultation because of during labor, which condition would nurse Richard anticipate as a
fever, started 4 days prior to consultation. In determining malaria risk, potential problem in the neonate?
what will you do? A. Hypoglycemia
A. Perform a tourniquet test. B. Jitteriness
B. Ask where the family resides. C. Respiratory depression
C. Get a specimen for blood smear. D. Tachycardia
D. Ask if the fever is present everyday. 75.Which symptom would indicate the Baby Alexandra was adapting
61.Susie brought her 4 years old daughter to the RHU because of appropriately to extra-uterine life without difficulty?
cough and colds. Following the IMCI assessment guide, which of the A. Nasal flaring
following is a danger sign that indicates the need for urgent referral to B. Light audible grunting
a hospital? C. Respiratory rate 40 to 60 breaths/minute
A. Inability to drink D. Respiratory rate 60 to 80 breaths/minute
B. High grade fever 76. When teaching umbilical cord care for Jennifer a new mother, the
C. Signs of severe dehydration nurse Jenny would include which information?
D. Cough for more than 30 days A. Apply peroxide to the cord with each diaper change
62.Jimmy a 2-year old child revealed “baggy pants”. As a nurse, using B. Cover the cord with petroleum jelly after bathing
the IMCI guidelines, how will you manage Jimmy? C. Keep the cord dry and open to air
A. Refer the child urgently to a hospital for confinement. D. Wash the cord with soap and water each day during a
B. Coordinate with the social worker to enroll the child in tub bath.
a feeding program. 77.Nurse John is performing an assessment on a neonate. Which of
C. Make a teaching plan for the mother, focusing on the following findings is considered common in the healthy neonate?
menu planning for her child. A. Simian crease
D. Assess and treat the child for health problems like B. Conjunctival hemorrhage
infections and intestinal parasitism. C. Cystic hygroma
63.Gina is using Oresol in the management of diarrhea of her 3-year D. Bulging fontanelle
old child. She asked you what to do if her child vomits. As a nurse you 78.Dr. Esteves decides to artificially rupture the membranes of a
will tell her to: mother who is on labor. Following this procedure, the nurse Hazel
A. Bring the child to the nearest hospital for further checks the fetal heart tones for which the following reasons?
assessment. A. To determine fetal well-being.
B. Bring the child to the health center for intravenous B. To assess for prolapsed cord
fluid therapy. C. To assess fetal position
C. Bring the child to the health center for assessment by D. To prepare for an imminent delivery.
the physician. 79.Which of the following would be least likely to indicate anticipated
D. Let the child rest for 10 minutes then continue giving bonding behaviors by new parents?
Oresol more slowly. A. The parents’ willingness to touch and hold the new
64.Nikki a 5-month old infant was brought by his mother to the health born.
center because of diarrhea for 4 to 5 times a day. Her skin goes back B. The parent’s expression of interest about the size of
slowly after a skin pinch and her eyes are sunken. Using the IMCI the new born.
guidelines, you will classify this infant in which category? C. The parents’ indication that they want to see the
A. No signs of dehydration newborn.
B. Some dehydration D. The parents’ interactions with each other.
C. Severe dehydration 80.Following a precipitous delivery, examination of the client’s vagina
D. The data is insufficient. reveals
65.Chris a 4-month old infant was brought by her mother to the health a fourth-degree laceration. Which of the following would be
center because of cough. His respiratory rate is 42/minute. Using the contraindicated when caring for this client?
Integrated Management of Child Illness (IMCI) guidelines of A. Applying cold to limit edema during the first 12 to 24
assessment, his breathing is considered as: hours.
A. Fast B. Instructing the client to use two or more peripads to
B. Slow cushion the area.
C. Normal C. Instructing the client on the use of sitz baths if
D. Insignificant ordered.
66.Maylene had just received her 4th dose of tetanus toxoid. She is D. Instructing the client about the importance of perineal
aware that her baby will have protection against tetanus for (kegel) exercises.
A. 1 year 81. A pregnant woman accompanied by her husband, seeks admission
B. 3 years to the labor and delivery area. She states that she’s in labor and says
C. 5 years she attended the facility clinic for prenatal care. Which question should
D. Lifetime the nurse Oliver ask her first?
67.Nurse Ron is aware that unused BCG should be discarded after A. “Do you have any chronic illnesses?”
how many hours of reconstitution? B. “Do you have any allergies?”
A. 2 hours C. “What is your expected due date?”
B. 4 hours D. “Who will be with you during labor?”
C. 8 hours
82.A neonate begins to gag and turns a dusky color. What should the 96. Rh isoimmunization in a pregnant client develops during which of
nurse do first? the following conditions?
A. Calm the neonate. A. Rh-positive maternal blood crosses into fetal blood,
B. Notify the physician. stimulating fetal antibodies.
C. Provide oxygen via face mask as ordered B. Rh-positive fetal blood crosses into maternal blood,
D. Aspirate the neonate’s nose and mouth with a bulb stimulating maternal antibodies.
syringe. C. Rh-negative fetal blood crosses into maternal blood,
83. When a client states that her “water broke,” which of the following stimulating maternal antibodies.
actions would be inappropriate for the nurse to do? D. Rh-negative maternal blood crosses into fetal blood,
A. Observing the pooling of straw-colored fluid. stimulating fetal antibodies.
B. Checking vaginal discharge with nitrazine paper. 97. To promote comfort during labor, the nurse John advises a client to
C. Conducting a bedside ultrasound for an amniotic fluid assume certain positions and avoid others. Which position may cause
index. maternal hypotension and fetal hypoxia?
D. Observing for flakes of vernix in the vaginal discharge. A. Lateral position
84. A baby girl is born 8 weeks premature. At birth, she has no B. Squatting position
spontaneous respirations but is successfully resuscitated. Within C. Supine position
several hours she develops respiratory grunting, cyanosis, tachypnea, D. Standing position
nasal flaring, and retractions. She’s diagnosed with respiratory distress 98. Celeste who used heroin during her pregnancy delivers a neonate.
syndrome, intubated, and placed on a ventilator. Which nursing action When assessing the neonate, the nurse Lhynnette expects to find:
should be included in the baby’s plan of care to prevent retinopathy of A. Lethargy 2 days after birth.
prematurity? B. Irritability and poor sucking.
A. Cover his eyes while receiving oxygen. C. A flattened nose, small eyes, and thin lips.
B. Keep her body temperature low. D. Congenital defects such as limb anomalies.
C. Monitor partial pressure of oxygen (Pao2) levels. 99. The uterus returns to the pelvic cavity in which of the following time
D. Humidify the oxygen. frames?
85. Which of the following is normal newborn calorie intake? A. 7th to 9th day postpartum.
A. 110 to 130 calories per kg. B. 2 weeks postpartum.
B. 30 to 40 calories per lb of body weight. C. End of 6th week postpartum.
C. At least 2 ml per feeding D. When the lochia changes to alba.
D. 90 to 100 calories per kg 100. Maureen, a primigravida client, age 20, has just completed a
86. Nurse John is knowledgeable that usually individual twins will grow difficult, forceps-assisted delivery of twins. Her labor was unusually
appropriately and at the same rate as singletons until how many long and required oxytocin (Pitocin) augmentation. The nurse who’s
weeks? caring for her should stay alert for:
A. 16 to 18 weeks A. Uterine inversion
B. 18 to 22 weeks B. Uterine atony
C. 30 to 32 weeks C. Uterine involution
D. 38 to 40 weeks D. Uterine discomfort
87. Which of the following classifications applies to monozygotic twins
for whom the cleavage of the fertilized ovum occurs more than 13 days
after fertilization? A woman with hyperemesis gravidarum asks the nurse about
A. conjoined twins suggestions to minimize nausea and vomiting. Which suggestion
B. diamniotic dichorionic twins would be most appropriate for the nurse to make?
C. diamniotic monochorionic twin A.
D. monoamniotic monochorionic twins "Make sure that anything around your waist is quite snug."
88. Tyra experienced painless vaginal bleeding has just been B.
diagnosed as having a placenta previa. Which of the following "Try to eat three large meals a day with less snacking."
procedures is usually performed to diagnose placenta previa? C.
A. Amniocentesis "Lie down for about an hour after you eat."
B. Digital or speculum examination D.
C. External fetal monitoring "Drink fluids in between meals rather than with meals."
D. Ultrasound D.
89. Nurse Arnold knows that the following changes in respiratory "Drink fluids in between meals rather than with meals."
functioning during pregnancy is considered normal:
A. Increased tidal volume A client with hyperemesis gravidarum is admitted to the facility after
B. Increased expiratory volume being cared for at home without success. What would the nurse expect
C. Decreased inspiratory capacity to include in the client's plan of care?
D. Decreased oxygen consumption A.
90. Emily has gestational diabetes and it is usually managed by which total parenteral nutrition
of the following therapy? B.
A. Diet nothing by mouth
B. Long-acting insulin C.
C. Oral hypoglycemic administration of labetalol
D. Oral hypoglycemic drug and insulin D.
91. Magnesium sulfate is given to Jemma with preeclampsia to prevent clear liquid diet
which of the following condition? B.
A. Hemorrhage nothing by mouth
B. Hypertension
C. Hypomagnesemia A client is diagnosed with gestational hypertension and is receiving
D. Seizure magnesium sulfate. Which finding would the nurse interpret as
92. Cammile with sickle cell anemia has an increased risk for having a indicating a therapeutic level of medication?
sickle cell crisis during pregnancy. Aggressive management of a sickle A.
cell crisis includes which of the following measures? respiratory rate of 10 breaths/minute
A. Antihypertensive agents B.
B. Diuretic agents difficulty in arousing
C. I.V. fluids C.
D. Acetaminophen (Tylenol) for pain urinary output of 20 mL per hour
93. Which of the following drugs is the antidote for magnesium toxicity? D.
A. Calcium gluconate (Kalcinate) deep tendons reflexes 2+
B. Hydralazine (Apresoline) D.
C. Naloxone (Narcan) deep tendons reflexes 2+
D. Rho (D) immune globulin (RhoGAM)
94. Marlyn is screened for tuberculosis during her first prenatal visit. An A woman is receiving magnesium sulfate as part of her treatment for
intradermal injection of purified protein derivative (PPD) of the severe preeclampsia. The nurse is monitoring the woman's serum
tuberculin bacilli is given. She is considered to have a positive test for magnesium levels. Which level would the nurse identify as
which of the following results? therapeutic?
A. An indurated wheal under 10 mm in diameter appears A.
in 6 to 12 hours. 10.8 mEq/L
B. An indurated wheal over 10 mm in diameter appears B.
in 48 to 72 hours. 3.3 mEq/L
C. A flat circumcised area under 10 mm in diameter C.
appears in 6 to 12 hours. 6.1 mEq/L
D. A flat circumcised area over 10 mm in diameter D.
appears in 48 to 72 hours. 8.4 mEq/L
95. Dianne, 24 year-old is 27 weeks’ pregnant arrives at her C.
physician’s office with complaints of fever, nausea, vomiting, malaise, 6.1 mEq/L
unilateral flank pain, and costovertebral angle tenderness. Which of the
following diagnoses is most likely? After reviewing a client's history, which factor would the nurse identify
A. Asymptomatic bacteriuria as placing her at risk for gestational hypertension?
B. Bacterial vaginosis A.
C. Pyelonephritis Mother had gestational hypertension during pregnancy.
D. Urinary tract infection (UTI) B.
This is the client's second pregnancy. After teaching a woman who has had an evacuation for gestational
C. trophoblastic disease (hydatidiform mole or molar pregnancy) about
Sister-in-law had gestational hypertension. her condition, which statement indicates that the nurse's teaching was
D. successful?
Client has a twin sister. A.
A. "My blood pressure will continue to be increased for about 6 more
Mother had gestational hypertension during pregnancy. months."
B.
A nurse is reviewing an article about preterm premature rupture of "I will be sure to avoid getting pregnant for at least 1 year."
membranes. Which factors would the nurse expect to find placing a C.
woman at high risk for this condition? Select all that apply. "I won't use my birth control pills for at least a year or two."
A. D.
high body mass index "My intake of iron will have to be closely monitored for 6 months."
B. B.
single gestations "I will be sure to avoid getting pregnant for at least 1 year."
C.
low socioeconomic status The nurse is developing a plan of care for a woman who is pregnant
D. with twins. The nurse includes interventions focusing on which area
urinary tract infection because of the woman's increased risk?
E. A.
smoking chorioamnionitis
C. B.
low socioeconomic status oligohydramnios
D. C.
urinary tract infection preeclampsia
E. D.
smoking post-term labor
C.
The nurse is reviewing the laboratory test results of a pregnant client. preeclampsia
Which finding would alert the nurse to the development of HELLP
syndrome? While assessing a pregnant woman, the nurse suspects that the client
A. may be at risk for hydramnios based on which of the following? (Select
elevated platelet count all that apply.)
B.
hyperglycemia A) History of diabetes
C. B) Complaints of shortness of breath
elevated liver enzymes C) Identifiable fetal parts on abdominal palpation
D. D) Difficulty obtaining fetal heart rate
leukocytosis E) Fundal height below that for expected gestational age
C. A) History of diabetes
elevated liver enzymes B) Complaints of shortness of breath
D) Difficulty obtaining fetal heart rate
A woman with gestational hypertension experiences a seizure. Which
intervention would the nurse identify as the priority? Which compound would the nurse have readily available for a client
A. who is receiving magnesium sulfate to treat severe preeclampsia?
control of hypertension A.
B. calcium carbonate
fluid replacement B.
C. calcium gluconate
oxygenation C.
D. potassium chloride
delivery of the fetus D.
C. ferrous sulfate
oxygenation B.
calcium gluconate
A woman with placenta previa is being treated with expectant
management. The woman and fetus are stable. The nurse is assessing Which finding would the nurse interpret as suggesting a diagnosis of
the woman for possible discharge home. Which statement by the gestational trophoblastic disease?
woman would suggest to the nurse that home care might be A.
inappropriate? vaginal bleeding, absence of FHR, decreased hPL levels
A. B.
"My mother lives next door and can drive me here if necessary." gestational hypertension, hyperemesis gravidarum, absence of FHR
B. C.
"I have a toddler and preschooler at home who need my attention." visible fetal skeleton on ultrasound, absence of quickening, enlarged
C. abdomen
"I realize the importance of following the instructions for my care." D.
D. elevated hCG levels, enlarged abdomen, quickening
"I know to call my health care provider right away if I start to bleed B.
again." gestational hypertension, hyperemesis gravidarum, absence of FHR
B.
"I have a toddler and preschooler at home who need my attention." Which information on a client's health history would the nurse identify
as contributing to the client's risk for an ectopic pregnancy?
The health care provider orders PGE2 for a woman to help evacuate A.
the uterus following a spontaneous abortion. Which action would be use of oral contraceptives for 5 years
most important for the nurse to do? B.
A. recurrent pelvic infections
Use clean technique to administer the drug. C.
B. ovarian cyst 2 years ago
Administer intramuscularly into the deltoid area. D.
C. heavy, irregular menses
Keep the gel cool until ready to use. B.
D. recurrent pelvic infections
Maintain the client supine for 1/2 hour after administration.
D. Upon entering the room of a client who has had a spontaneous
Maintain the client supine for 1/2 hour after administration. abortion, the nurse observes the client crying. Which response by the
nurse would be most appropriate?
A woman at 10 weeks gestation comes to the clinic for an evaluation. A.
Which finding might lead the nurse to suspect gestational trophoblastic "A baby still wasn't formed in your uterus."
disease? B.
A. "Will a pill help your pain?"
blood pressure of 120/84 mm Hg C.
B. "I'm sorry you lost your baby."
history of bright red spotting 6 weeks ago D.
C. "Why are you crying?"
fundal height measurement of 18 cm C.
D. "I'm sorry you lost your baby."
report of frequent mild nausea
C. It is determined that a client's blood Rh is negative and her partner's is
fundal height measurement of 18 cm positive. To help prevent Rh isoimmunization, the nurse would expect
to administer Rho(D) immune globulin at which time?
A.
at 28 weeks' gestation and again within 72 hours after delivery
B.
24 hours before delivery and 24 hours after delivery
C.
in the first trimester and within 2 hours of delivery
D.
at 32 weeks' gestation and immediately before discharge
A.
at 28 weeks' gestation and again within 72 hours after delivery

A client is suspected of having a ruptured ectopic pregnancy. Which

assessment would the nurse identify as the priority?
A.
jaundice
B.
infection
C.
edema
D.
hemorrhage
D.
hemorrhage

A nurse is teaching a woman with mild preeclampsia about important

areas that she needs to monitor. The nurse determines that the
teaching was successful based on which statement by the woman?
Select all that apply.

A.
"I will weigh myself once a week."
B.
"I should complete a fetal kick count each day."
C.
"I should check my blood pressure twice a day."
D.
"I will check my urine for protein four times a day."
E.
"I'll call my health care provider if I have burning when I urinate."
 Pathophysiology:
 Inadequate production of testosterone due to
testicular or pituitary dysfunction.
MALE REPRODUCTIVE DISORDERS  Causes include aging, testicular injury, chemotherapy,
1. INFERTILITY or genetic conditions (Klinefelter syndrome).
Pathophysiology: S&S:
 Infertility occurs due to impaired sperm production,  Fatigue, depression
function, or delivery.  Reduced muscle mass and strength
 Causes include hormonal imbalances (low  Low libido and erectile dysfunction
testosterone, FSH, LH), genetic conditions (Klinefelter Hallmark Feature:
syndrome), infections (orchitis, prostatitis), varicocele,  Low serum testosterone levels
and lifestyle factors (smoking, alcohol, obesity). Treatment & Management:
S&S:  Testosterone replacement therapy (TRT)
 Inability to conceive after 1 year of unprotected  Weight loss and exercise
intercourse Nursing Interventions:
 Erectile dysfunction  Monitor testosterone replacement therapy (TRT) for
 Low libido side effects such as polycythemia, prostate
 Testicular pain/swelling (if infection-related) enlargement, and cardiovascular risks.
 Educate the patient on the correct administration of
Hallmark Feature: testosterone (gel, injection, patches).
 Low sperm count or abnormal sperm morphology in  Promote weight loss and exercise to naturally boost
semen analysis testosterone.
 Monitor mood and energy levels for signs of
Treatment & Management:
improvement or worsening depression.
 Hormonal therapy (testosterone replacement,
gonadotropins)
4. VARICOCELE
 Surgery (for varicocele or blockages)
Pathophysiology:
 Assisted reproductive techniques (IVF, ICSI)
 Enlargement of testicular veins causing increased
 Lifestyle modifications (healthy diet, avoid scrotal temperature and impaired sperm production.
smoking/alcohol)
S&S:
Nursing Interventions:
 Dull, aching scrotal pain
 Educate the patient on lifestyle modifications (diet,
 Visible or palpable enlarged veins (“bag of worms”
exercise, smoking cessation, stress reduction).
appearance)
 Assist in semen collection for analysis.
Hallmark Feature:
 Provide emotional support and counseling for couples  Dilated veins in the scrotum, worsened by standing
struggling with infertility.
Treatment & Management:
 Educate on assisted reproductive technologies (IVF,  Surgical ligation or embolization
ICSI).
 Scrotal support and pain management
 Encourage adherence to prescribed hormonal therapy
Nursing Interventions:
or medications
 Educate on post-surgical care
 Provide scrotal support
2. ERECTILE DYSFUNCTION (ED)  Educate the patient on scrotal support and the use of
Pathophysiology: tight-fitting underwear to reduce discomfort.
 Dysfunction in blood flow, nerve supply, or hormonal  Advise on avoiding prolonged standing or strenuous
regulation leading to an inability to achieve or activities.
 Provide pain management (NSAIDs).
maintain an erection.  Monitor post-surgical patients for complications like
 Causes include vascular diseases (hypertension, infection or recurrence.
diabetes), neurological conditions (Parkinson’s, spinal
cord injury), medications (antidepressants, beta- 5. TESTICULAR DISORDERS (CRYPTORCHIDISM,
blockers), and psychological factors (stress, anxiety). ORCHITIS, TORSION, CANCER)
S&S: A. CRYPTORCHIDISM (Undescended Testis)
 Difficulty achieving or maintaining an erection Pathophysiology:
 Reduced sexual desire  Failure of one or both testes to descend into the
Hallmark Feature: scrotum from the abdomen during fetal development.
 Persistent erectile difficulty for more than 3 months  Associated with hormonal imbalances, genetic
Treatment & Management: factors, or anatomical defects.
 Phosphodiesterase-5 inhibitors (e.g., Sildenafil, S&S:
Tadalafil)  Absence of one or both testes in the scrotum.
 Testosterone replacement (if low testosterone)  Asymmetrical or underdeveloped scrotum.
 Vacuum erection devices Hallmark Feature:
 Penile implants for severe cases  Non-palpable testis in the scrotum at birth or infancy.
Nursing Interventions: Treatment & Management:
 Encourage lifestyle changes (exercise, smoking  Observation: Some cases resolve naturally by 6
cessation) months.
 Provide emotional support  Hormonal Therapy: hCG injections may stimulate
 Educate on the use of phosphodiesterase-5 inhibitors descent.
(Sildenafil, Tadalafil), including possible side effects.  Surgical Intervention (Orchiopexy): Done before age 1
 Educate on alternative treatment options (vacuum to prevent infertility and cancer risk.
devices, penile implants). Nursing Interventions:
 Monitor for adverse effects of testosterone  Educate parents on the importance of early surgical
replacement therapy if prescribed. correction.
 Monitor for complications like infertility and testicular
3. HYPOGONADISM (LOW TESTOSTERONE) cancer.
  Provide post-operative care (pain management,  Chemotherapy or Radiation Therapy (for advanced
wound care). cases).
 Surveillance (monitor tumor markers: AFP, hCG,
B. ORCHITIS (Testicular Inflammation) LDH).
Pathophysiology: Nursing Interventions:
 Inflammation of one or both testes, commonly due to  Educate on testicular self-examination (TSE) for early
viral (mumps) or bacterial infections (STIs, UTIs). detection.
 Can lead to infertility if untreated.  Provide emotional support—many young patients
S&S: experience anxiety.
 Sudden onset of scrotal pain and swelling.  Monitor for chemotherapy/radiation side effects
 Fever, chills, nausea. (nausea, fatigue, hair loss).
 Tender, red, and warm testicle.  Discuss fertility preservation options (sperm banking
Hallmark Feature: before treatment).
 Painful, swollen testis with systemic infection signs.
Treatment & Management: E. HYDROCELE
 Viral Orchitis (Mumps): Supportive care (rest, pain Pathophysiology:
relief).  Fluid accumulation in the tunica vaginalis surrounding
 Bacterial Orchitis: Antibiotics, anti-inflammatory the testicle.
medications.  Can be congenital (infants) or acquired (trauma,
 Scrotal Support & Ice Packs to reduce swelling. infection, cancer).
Nursing Interventions: S&S:
 Administer prescribed antibiotics or antivirals.  Painless scrotal swelling.
 Provide comfort measures (scrotal elevation, ice  Transillumination test positive (light passes through
packs). fluid-filled sac).
 Educate about vaccination (MMR vaccine to prevent Hallmark Feature:
mumps orchitis).  Soft, fluid-filled mass in the scrotum with
transillumination.
C. TESTICULAR TORSION (Surgical Emergency) Treatment & Management:
Pathophysiology:  Observation (in infants, most resolve spontaneously).
 Twisting of the spermatic cord, cutting off blood  Surgical drainage or hydrocelectomy if large or
supply to the testis. symptomatic.
 Can lead to ischemia and necrosis if untreated within Nursing Interventions:
6 hours.  Educate parents about natural resolution in infants.
S&S:  Provide scrotal support and monitor for discomfort.
 Sudden, severe scrotal pain.  Post-op care: monitor for infection and scrotal
 Swelling and redness of the scrotum. swelling.
 Absent cremasteric reflex (no testicular retraction
when inner thigh is stroked). F. EPIDIDYMITIS
 Nausea and vomiting. Pathophysiology:
Hallmark Feature:  Inflammation of the epididymis due to bacterial
 Acute onset of scrotal pain with an absent cremasteric infections (STIs like chlamydia, gonorrhea, or UTIs).
reflex. S&S:
Treatment & Management:  Gradual onset of scrotal pain.
 Emergency Surgery (Orchiopexy) within 6 hours.  Swelling, redness, warmth.
 Manual Detorsion (if surgery is delayed).  Positive Prehn’s sign (pain relief when scrotum is
 If testis is necrotic, orchiectomy (removal) is lifted).
necessary. Hallmark Feature:
Nursing Interventions:  Gradual testicular pain with a positive Prehn’s sign.
 Recognize and respond quickly—testicular torsion is Treatment & Management:
a medical emergency.  Antibiotics (based on cause).
 Prepare the patient for emergency surgery.  Pain management (NSAIDs, scrotal elevation).
 Provide pain management and emotional support. Nursing Interventions:
 Educate on the importance of early intervention to  Educate on safe sex practices (if STI-related).
prevent testicular loss.  Encourage hydration and rest.
 Monitor for complications like abscess formation.
D. TESTICULAR CANCER
Pathophysiology: Summary of Nursing Interventions for Testicular Disorders:
 Uncontrolled growth of testicular cells, usually 1. Cryptorchidism → Educate on early surgical
affecting younger males (15-35 years). correction (before age 1).
 Most cases are germ cell tumors (seminomas or non- 2. Orchitis → Administer antibiotics, provide scrotal
seminomas). support, encourage MMR vaccination.
 Risk factors: Cryptorchidism, family history, HIV 3. Testicular Torsion → Emergency response, prepare
infection. for surgery, pain management.
S&S: 4. Testicular Cancer → Educate on TSE, provide
 Painless testicular lump or swelling. emotional support, monitor treatment side effects.
 Heaviness in the scrotum. 5. Hydrocele → Educate on natural resolution, post-op
 Dull ache in the lower abdomen or groin. care for surgical drainage.
Hallmark Feature: 6. Varicocele → Advise on scrotal support, surgical
 Painless, firm, non-tender testicular mass. repair if needed.
Treatment & Management: 7. Epididymitis → Administer antibiotics, scrotal
 Orchiectomy (surgical removal of the affected testis). elevation, educate on STI prevention.
  Encourage loose-fitting underwear to reduce irritation.
6. PROSTATE DISORDERS (PROSTATITIS, BPH, CANCER)
 Pathophysiology: Inflammation, enlargement, or 9. PHIMOSIS (Inability to retract foreskin)
malignancy affecting urine flow. Pathophysiology:
 S&S: Urinary retention, painful urination, lower back  Caused by recurrent infections, scarring, or congenital
pain. tightness of the foreskin.
 Hallmark: Digital rectal exam findings, PSA elevation. S&S:
 Treatment: Antibiotics (for infection), alpha-blockers  Difficulty pulling back the foreskin, pain, ballooning of
(for BPH), surgery (for cancer). the foreskin during urination
Nursing Interventions: Hallmark Feature:
 Encourage hydration  Non-retractable foreskin in older children/adults
 Monitor urinary retention and infection signs Treatment & Management:
Benign Prostatic Hyperplasia (BPH)  Topical corticosteroids
 Educate on medication use (alpha-blockers, 5-  Circumcision in severe cases
alpha reductase inhibitors). Nursing Interventions:
 Encourage double voiding techniques to improve  Educate on hygiene
urine flow.  Monitor for infections and urinary difficulties
 Monitor for urinary retention (may require  Educate on gentle foreskin retraction during bathing.
catheterization).  Apply prescribed topical corticosteroids to reduce
 Prepare patients for surgical procedures like inflammation.
 Encourage good hygiene to prevent infections.
TURP if indicated.  Prepare the patient for circumcision if severe or
Prostatitis recurrent infections occur.
 Encourage fluid intake to flush bacteria.
 Administer prescribed antibiotics and pain relievers. 10. PARAPHIMOSIS (Trapped retracted foreskin causing
 Educate on avoiding caffeine, alcohol, and spicy swelling)
foods, which can irritate the bladder. Pathophysiology:
Prostate Cancer  Occurs when the foreskin is pulled back and cannot
 Provide pre- and post-operative care for return to its normal position, leading to restricted
prostatectomy patients. blood flow.
 Educate on PSA screening and early detection. S&S:
 Monitor for urinary incontinence and erectile  Painful, swollen glans penis, difficulty urinating
dysfunction post-treatment. Hallmark Feature:
 Constricting band of tissue behind the glans
7. BALANITIS (Inflammation of the glans penis) Treatment & Management:
Pathophysiology:  Manual reduction with lubrication
 Caused by poor hygiene, infections (bacterial, fungal),  Emergency circumcision if severe
irritants (soaps, latex), or diabetes. Nursing Interventions:
S&S:  Educate on avoiding forceful retraction
 Redness, swelling, pain, discharge from the penis  Assist in manual reduction and monitor for necrosis
Hallmark Feature:  Assist in manual reduction using lubrication and cold
 Inflamed, irritated glans with or without discharge compresses.
Treatment & Management:  Monitor for signs of ischemia or necrosis (may require
 Antifungal (if Candida), antibiotics (if bacterial) emergency circumcision).
 Proper hygiene, topical corticosteroids for  Provide post-procedure wound care and pain
inflammation management.
Nursing Interventions:
 Educate on proper genital hygiene FEMALE DISORDERS
 Encourage proper glucose control in diabetics
 Administer prescribed antifungal, antibacterial, or 1. MENORRHAGIA
corticosteroid creams. Definition:
 Advise on avoiding irritants like harsh soaps or latex  Heavy or prolonged menstrual bleeding lasting
condoms. more than 7 days or exceeding 80 mL of blood loss
 Encourage diabetes control if the patient is diabetic. per cycle.
 Common causes: Hormonal imbalances, fibroids,
8. BALANOPOSTHITIS (Inflammation of the glans and polyps, endometriosis, clotting disorders, or IUD use.
foreskin) Pathophysiology:
Pathophysiology:  Hormonal imbalance (estrogen dominance,
 Similar to balanitis but includes foreskin inflammation, progesterone deficiency): Leads to excessive
commonly seen in uncircumcised males. endometrial proliferation.
S&S:  Endometrial dysfunction: Poor clotting control leads
 Pain, redness, swelling of glans and foreskin, foul- to excessive bleeding.
smelling discharge  Structural abnormalities (fibroids, polyps):
Hallmark Feature: Increase vascularization, causing heavy bleeding.
 Inflamed foreskin with difficulty retracting Signs & Symptoms:
Treatment & Management:  Excessive bleeding (soaking through pads/tampons
 Same as balanitis (antifungal, antibiotics, hygiene) every 1-2 hours).
Nursing Interventions:  Passing large blood clots.
 Educate on foreskin hygiene  Fatigue or anemia (due to blood loss).
 Monitor for recurrent infections (possible need for  Pelvic pain or cramping.
circumcision) Hallmark Feature:
 Administer prescribed antifungal or antibiotic creams.
  Heavy menstrual bleeding lasting longer than 7 days Menorrhagia (Heavy Metrorrhagia (Irregular
Condition
with clot passage. Periods) Bleeding)
Treatment & Management: Type of Excessive menstrual Bleeding between
 Medications: Bleeding bleeding periods
o NSAIDs (Ibuprofen) to reduce blood flow. Occurs during Occurs outside the
o Hormonal therapy (oral contraceptives, Timing
menstruation menstrual cycle
progesterone, IUD with levonorgestrel). Hormonal imbalance,
o Tranexamic acid (to prevent excessive blood Causes Infections, polyps, cancer
fibroids, IUDs
loss). Hallmark Heavy bleeding > 7 Spotting or irregular
 Surgical Interventions: Feature days bleeding
o Endometrial ablation (for severe cases).
Main NSAIDs, hormonal Hormonal therapy,
o Myomectomy (if fibroids are the cause).
Treatment therapy, surgery treating underlying cause
o Hysterectomy (last resort).
Nursing Interventions:
 Monitor vital signs (for hypovolemia, anemia).
 Assess bleeding patterns (frequency, amount, NURSING CARE ON SUDDEN PREGNANCY
presence of clots). COMPLICATIONS
 Encourage iron-rich foods or iron supplements (to Causes of Bleeding and Spotting During Pregnancy
prevent anemia). 1. First Trimester:
 Educate on medication adherence (e.g., hormonal o Implantation bleeding
therapy). o Miscarriage
 Provide psychological support (if heavy bleeding o Ectopic pregnancy
impacts quality of life).
o Molar pregnancy
2. Second and Third Trimester:
2. METRORRHAGIA
o Placenta previa
Definition:
o Placental abruption
 Irregular, intermenstrual bleeding (bleeding
o Uterine rupture
between periods).
 Common causes: Hormonal imbalance, endometrial o Preterm labor
hyperplasia, polyps, infections, cervical cancer, Nursing Assessment
pregnancy complications.  Patient History:
Pathophysiology: o Gestational age
 Hormonal disruption: Leads to uncoordinated o Onset, duration, and characteristics of
shedding of the endometrium. bleeding (color, amount, associated pain)
 Endometrial abnormalities (polyps, hyperplasia): o History of previous pregnancy complications
Cause spontaneous bleeding. o Presence of additional symptoms (cramping,
 Infections (PID, cervicitis): Lead to inflammation dizziness, fever)
and spotting.  Physical Examination:
Signs & Symptoms: o Vital signs (BP, pulse, temperature)
 Unscheduled vaginal bleeding between periods. o Abdominal assessment for tenderness,
 Spotting or light bleeding after intercourse. uterine tone, and fetal movements
 Pelvic discomfort or cramping. o Inspection for vaginal bleeding and
 Possible anemia (if frequent bleeding occurs). assessment of cervical dilation (if necessary)
Hallmark Feature:  Diagnostic Tests:
 Unpredictable vaginal bleeding between menstrual o Ultrasound to assess fetal viability and
cycles.
placental position
Treatment & Management:
o Blood tests (CBC, blood type, Rh factor,
 Medications:
hCG levels)
o Hormonal therapy (birth control,
o Coagulation profile if heavy bleeding is
progesterone).
present
o Antibiotics (if infection-related).
Nursing Interventions
 Surgical Interventions:
1. Monitor and Stabilize the Patient:
o Dilation & Curettage (D&C) for diagnostic o Assess and document bleeding amount and
evaluation. vital signs regularly.
o Hysteroscopy to remove polyps or abnormal o Monitor fetal heart rate and uterine activity.
tissues.
o Administer IV fluids or blood transfusion if
Nursing Interventions:
needed.
 Assess bleeding frequency, duration, and
2. Provide Emotional Support:
associated symptoms.
o Offer reassurance and clear communication
 Monitor hemoglobin levels to check for anemia.
about the condition.
 Educate on the importance of regular
o Involve family members in patient care and
gynecological exams (to rule out malignancies).
decision-making.
 Encourage adherence to prescribed hormonal
3. Administer Medications as Prescribed:
treatments.
o Tocolytics for preterm labor prevention.
 Provide emotional support (irregular bleeding may
cause anxiety).
o Rho(D) immune globulin if the mother is Rh-
negative.
o Pain management if cramping or
Key Differences:
contractions are present.
4. Prepare for Emergency Situations:
 o Have equipment ready for possible 1. Serum β-hCG
emergency delivery or surgery. o Inappropriately rising levels (should double
o Ensure the availability of blood products for every 48 hours in normal pregnancy)
transfusion. 2. Transvaginal Ultrasound (TVUS)
5. Educate the Patient: o No intrauterine pregnancy detected
o Advise on warning signs (heavy bleeding, o Presence of an adnexal mass
severe pain, dizziness, fever). 3. Progesterone levels (low in ectopic pregnancy)
o Educate on the importance of follow-up care 4. Culdocentesis (rarely used)
and bed rest if recommended. o Checks for blood in the peritoneal cavity
o Provide information on lifestyle
modifications, including activity restrictions Treatment & Management
and nutrition. Medical Management (For unruptured ectopic pregnancy)
🔹 Methotrexate (IM injection)
 Stops cell growth and dissolves ectopic tissue
Ectopic Pregnancy  Indicated for stable patients with a small ectopic
Definition pregnancy and no rupture
Ectopic pregnancy occurs when a fertilized egg implants Surgical Management
outside the uterine cavity, most commonly in the fallopian 1. Salpingostomy (removes the ectopic pregnancy but
tubes (tubal pregnancy). Other locations include the cervix, preserves the tube)
ovaries, abdomen, or cesarean scar. 2. Salpingectomy (removal of the fallopian tube if
ruptured or severely damaged)
Causes 3. Laparotomy ( explore lap) /Laparoscopy (for
1. Tubal damage or scarring (e.g., from infections, emergency cases with rupture and internal bleeding)
surgery, or inflammation) Supportive Treatment
2. Pelvic Inflammatory Disease (PID)  IV fluids, blood transfusion (if hemorrhage occurs)
3. Endometriosis  Pain management
4. Previous ectopic pregnancy  Rhogam if the mother is Rh-negative
5. Use of assisted reproductive technologies (e.g.,
IVF) Nursing Interventions
6. Tubal sterilization or previous tubal surgery ✅ Monitor Vital Signs – Assess for shock (hypotension,
7. Intrauterine device (IUD) use (though rare, can tachycardia)
increase risk if pregnancy occurs) ✅ Assess for Signs of Rupture – Severe abdominal pain,
8. Smoking (affects tubal motility)
dizziness, shoulder pain
9. Hormonal imbalances affecting tubal transport
✅ Monitor hCG Levels & Ultrasound Reports – Track
treatment progress
Pathophysiology ✅ Administer Medications – Methotrexate if indicated
 Normally, the fertilized ovum travels to the uterus for ✅ Educate on Signs of Rupture – Instruct the patient to seek
implantation. emergency care if symptoms worsen
 In ectopic pregnancy, tubal damage, altered tubal ✅ Provide Emotional Support – Ectopic pregnancy can be
motility, or obstruction prevents the ovum from emotionally distressing
reaching the uterus. ✅ Prepare for Surgery if Needed – Ensure informed consent
 The embryo implants in an extrauterine site and preoperative care
(commonly the fallopian tube). ✅ Assess Bleeding – Monitor for increased vaginal bleeding
 Growth of the embryo leads to stretching and possible ✅ Monitor for Infection – Check for fever, chills, and
rupture of the tube, causing hemorrhage. increased pain
 If undiagnosed, this can lead to life-threatening
internal bleeding.

Abdominal Pregnancy
Signs & Symptoms (S&S) Definition:
🔹 Classic Triad (though not always present) Abdominal pregnancy is a rare and life-threatening type of
1. Abdominal pain (often unilateral, sharp, stabbing) ectopic pregnancy where the fertilized ovum implants and
2. Amenorrhea (missed period) develops in the peritoneal cavity outside the uterus, usually on
3. Vaginal bleeding (light spotting to heavy bleeding) organs like the liver, intestines, or omentum.
🔹 Other Symptoms
 Dizziness, fainting (signs of hypovolemia due to Causes & Risk Factors
internal bleeding)
🔹 Primary Abdominal Pregnancy – The fertilized ovum
 Shoulder pain (due to diaphragmatic irritation from implants directly in the abdominal cavity.
blood in the abdominal cavity)
🔹 Secondary Abdominal Pregnancy – More common; occurs
 Nausea and vomiting when a tubal ectopic pregnancy ruptures or is expelled into the
abdomen and re-implants.
Risk Factors:
 Previous ectopic pregnancy
 Tubal damage from infections or surgery
Hallmark Sign  Endometriosis
 Unilateral lower abdominal pain with vaginal  Use of assisted reproductive technology (IVF)
bleeding in a woman of reproductive age with a  History of multiple pregnancies
positive pregnancy test  Intrauterine device (IUD) use
 Cullen’s sign (periumbilical ecchymosis) in severe
cases with rupture
Pathophysiology
 The fertilized egg implants on an abdominal organ.
Diagnosis
  The placenta attaches to highly vascularized areas benign and malignant conditions, with varying degrees of
(e.g., intestines, liver, peritoneum). invasiveness.
 Growth of the fetus causes compression of abdominal
structures. Types of GTD
 Risk of severe internal bleeding due to placental 1. Hydatidiform Mole (Molar Pregnancy) – Benign
invasion of vital organs.  Complete Mole – No fetal tissue, only abnormal
placental growth
Signs & Symptoms (S&S)  Partial Mole – Abnormal placenta with some fetal
✅ Abdominal pain (persistent, severe, localized or diffuse) tissue
✅ Amenorrhea (missed period) 2. Persistent Gestational Trophoblastic Neoplasia (GTN) –
✅ Irregular vaginal bleeding (dark brown or scant bleeding) Malignant
✅ Fetal movement felt abnormally high in the abdomen  Invasive Mole – Invades the uterine wall; can cause
✅ Displacement of uterus (not palpable in expected position) hemorrhage
✅ Maternal gastrointestinal symptoms (nausea, vomiting,  Choriocarcinoma – Highly malignant, spreads to
bloating) lungs, liver, and brain
✅ Severe hemorrhage (if rupture occurs)  Placental-Site Trophoblastic Tumor (PSTT) – Rare,
slow-growing, invades the uterus
Hallmark Signs
🔹 Palpable fetus outside the uterus Causes & Risk Factors
🔹 Failure of uterine enlargement despite advancing 🔹 Maternal Age – More common in women <20 or >40 years
gestation 🔹 Previous Molar Pregnancy
🔹 Fetal movements perceived in unusual locations 🔹 Nutritional Deficiencies – Low folate or protein intake
🔹 Genetic Factors – Chromosomal abnormalities during
Diagnosis fertilization
1. Serum β-hCG Levels (confirms pregnancy but does
not indicate location) Pathophysiology
2. Ultrasound (Abdominal & Transvaginal) – No  GTD arises from abnormal trophoblastic proliferation.
intrauterine pregnancy, fetus in abdominal cavity  In complete molar pregnancy, fertilization of an
3. MRI or CT Scan (used in complex cases for precise empty ovum leads to an overgrowth of paternal
location) chromosomes, forming only trophoblastic tissue.
4. Physical Examination  In partial moles, two sperm fertilize a normal ovum,
o Soft, non-pregnant uterus leading to triploidy (69 chromosomes) and abnormal
o Unusual fetal position fetal development.
 If untreated, some cases progress to malignant GTN,
invading the uterus and spreading systemically.
Treatment & Management
Surgical Management (Definitive Treatment)
🔹 Laparotomy/Laparoscopy – Removal of the fetus and Signs & Symptoms (S&S)
placenta (if safely possible) ✅ Excessive nausea & vomiting (Hyperemesis Gravidarum)
🔹 Placenta Consideration ✅ Painless vaginal bleeding (dark brown or grape-like
 If attached to vital organs, it may be left in place to vesicles)
prevent massive bleeding ✅ Uterus larger than expected for gestational age
 Methotrexate may be used to help placenta resorption ✅ No fetal heartbeat on ultrasound
Supportive Care ✅ Very high β-hCG levels
🔹 Blood transfusion & IV fluid resuscitation (for ✅ Early-onset preeclampsia (<20 weeks gestation)
hemorrhage) 🔴 For Choriocarcinoma:
🔹 Monitoring for organ damage (due to placental invasion)  Hemoptysis, dyspnea (lung metastasis)
🔹 Postoperative care – Assess for infection, bleeding, and  Severe pelvic pain & bleeding
sepsis  Neurological symptoms if brain metastasis occurs
🔹 Emotional & Psychological Support
Diagnosis
Nursing Interventions 1. Serum β-hCG – Extremely high levels
✅ Monitor Vital Signs – Watch for hypovolemic shock 2. Transvaginal Ultrasound
(tachycardia, hypotension) o "Snowstorm" or "grape-like clusters" pattern
✅ Assess for Severe Pain or Hemorrhage – Prepare for (molar pregnancy)
emergency surgery if needed o No fetal heartbeat (complete mole)
✅ Monitor hCG & Ultrasound Reports – Track progression 3. Histopathology – Confirms diagnosis after uterine
✅ Educate the Patient on Warning Signs – Pain, heavy evacuation
bleeding, dizziness 4. Chest X-ray / CT Scan – Check for metastasis in
✅ Provide Emotional Support – High-risk pregnancy with GTN cases
potential loss
✅ Postoperative Care – Pain management, infection Treatment & Management
prevention, and monitoring for complications 1. Molar Pregnancy Treatment
🔹 Suction Curettage or Dilation & Evacuation (D&E) – First-
line treatment
Gestational Trophoblastic Disease (GTD) 🔹 Rhogam if Rh-negative
Definition: 🔹 Serial β-hCG Monitoring – Weekly until undetectable, then
Gestational Trophoblastic Disease (GTD) is a group of rare monthly for 6-12 months
conditions that arise from abnormal growth of trophoblastic 🔹 Contraception (at least 1 year) – Avoid pregnancy until β-
cells, which form the placenta during pregnancy. GTD includes hCG normalizes
2. GTN (Invasive Mole, Choriocarcinoma) Treatment
🔹 Methotrexate or Actinomycin-D (Chemotherapy) – First- 1. Cervical Cerclage (Surgical Stitching of the Cervix)
line for malignant cases 🔹 Indicated for:
🔹 Hysterectomy (if childbearing is not a concern or if  Cervical length <25mm before 24 weeks
cancer is advanced)  History of recurrent second-trimester losses
🔹 Multimodal Therapy (Surgery, Chemotherapy, Radiation) 🔹 Types of Cerclage:
for Metastatic Disease  Prophylactic (before symptoms start, 12-14 weeks
gestation)
Nursing Interventions  Emergency (rescue cerclage, when dilation has
✅ Monitor for Bleeding & Shock – Assess for signs of begun, up to 24 weeks)
hemorrhage 🚫 Contraindications:
✅ Educate on β-hCG Follow-up – Regular monitoring  Active infection, preterm labor, ruptured membranes
prevents complications 2. Progesterone Therapy
✅ Emotional Support & Counseling – GTD can be  Vaginal or intramuscular progesterone to prevent
distressing due to pregnancy loss preterm birth
✅ Encourage Contraception Compliance – Prevent 3. Bed Rest & Activity Modification
recurrence while monitoring hCG  Avoid heavy lifting and strenuous activity
✅ Monitor for Metastatic Symptoms – Assess for lung, liver, 4. Monitoring & Surveillance
or brain involvement  Serial Ultrasounds – To track cervical length
 Fetal Well-being Checks
5. Tocolytics (if needed for uterine irritability)
Cervical Insufficiency (Incompetent Cervix)  Used to prevent premature contractions
Definition
Cervical insufficiency (incompetent cervix) is a painless, Nursing Interventions
premature dilation of the cervix during the second trimester of ✅ Monitor for Signs of Preterm Labor – Cramps,
pregnancy, leading to pregnancy loss or preterm birth. It contractions, bleeding
occurs without contractions or labor-like symptoms. ✅ Educate on Activity Restrictions – Avoid prolonged
standing, heavy lifting
Causes & Risk Factors ✅ Provide Emotional Support – Anxiety is common due to
🔹 Congenital Factors: pregnancy loss risk
 Uterine abnormalities (e.g., bicornuate uterus) ✅ Monitor for Infection Post-Cerclage – Fever, foul-smelling
 Genetic collagen disorders (e.g., Ehlers-Danlos discharge
syndrome) ✅ Teach Patient About Warning Signs – Sudden increase in
🔹 Acquired Factors: discharge, pressure, or pain
 Previous cervical trauma (e.g., cervical surgery,
dilation & curettage)
 Prior second-trimester pregnancy losses Placenta Previa
 Multiple pregnancies (overstretching of the cervix) Definition
 Infections or inflammation Placenta previa is a condition in which the placenta partially or
completely covers the cervix (internal os), leading to a risk of
Pathophysiology bleeding during pregnancy and delivery. It occurs in
 The cervix normally remains closed and firm during approximately 1 in 200 pregnancies and is a major cause of
pregnancy. painless vaginal bleeding in the second and third trimesters.
 In cervical insufficiency, structural weakness leads to
premature dilation without contractions. Types of Placenta Previa
 The fetal membranes may bulge into the cervix, 1. Complete (Total) Placenta Previa – The placenta
increasing the risk of rupture and preterm labor. entirely covers the cervical opening.
2. Partial Placenta Previa – The placenta partially
covers the cervix.
Signs & Symptoms (S&S)
3. Marginal Placenta Previa – The placenta extends to
✅ Painless cervical dilation
the edge of the cervix but does not cover it.
✅ Pelvic pressure or heaviness
4. Low-lying Placenta – The placenta is implanted in
✅ Increased vaginal discharge (watery or mucus-like)
the lower uterus but does not reach the cervix. (May
✅ Mild spotting or bleeding
resolve as pregnancy progresses.)
✅ Bulging fetal membranes (detected via ultrasound)
🚨 Severe Cases:
 Sudden rupture of membranes Causes & Risk Factors
🔹 Previous uterine surgery (e.g., C-section, D&C,
 Preterm labor or second-trimester miscarriage
myomectomy)
🔹 Previous placenta previa
Diagnosis
🔹 Multiparity (having multiple pregnancies)
1. History of Recurrent Pregnancy Losses – Typically
🔹 Advanced maternal age (>35 years)
in the second trimester without pain
🔹 Multiple gestation (twins, triplets, etc.)
2. Transvaginal Ultrasound (TVUS)
🔹 Smoking & cocaine use (affect placental attachment)
o Shortened cervix (<25mm before 24 weeks)
🔹 Uterine abnormalities (fibroids, scarring)
o Funnel-shaped dilation of the internal
cervical os
Pathophysiology
3. Pelvic Examination
 Normally, the placenta implants in the upper uterus.
o Painless cervical dilation
 In placenta previa, the placenta implants in the lower
o Protrusion of fetal membranes in late-stage
segment, covering or approaching the cervix.
cases
 As the cervix thins and dilates in later pregnancy, the
placenta may detach, causing painless, bright red
Treatment & Management vaginal bleeding.
 violence
Signs & Symptoms (S&S) 🔹 Cocaine or Smoking – Causes vasoconstriction, leading to
✅ Painless, bright red vaginal bleeding (usually after 20 placental detachment
weeks) 🔹 Previous Placental Abruption
✅ Episodes of bleeding increase in frequency & intensity 🔹 Premature Rupture of Membranes (PROM) – Loss of
✅ Soft, non-tender uterus amniotic fluid weakens placental attachment
✅ Fetal heart rate usually normal (unless severe 🔹 Polyhydramnios or Multiple Pregnancies – Overstretching
hemorrhage occurs) of the uterus
🚨 Severe Cases (Complications) 🔹 Maternal Age >35 or <20
 Massive hemorrhage (maternal and fetal distress)
 Preterm labor Pathophysiology
 Placenta accreta (abnormally attached placenta) 1. Disruption of blood vessels in the placenta leads to
 Fetal growth restriction (due to placental bleeding between the placenta and uterus.
insufficiency) 2. Hematoma formation further separates the placenta
from the uterine wall.
Diagnosis 3. Reduced oxygen and nutrient supply to the fetus
1. Transabdominal & Transvaginal Ultrasound – leads to fetal hypoxia and distress.
Gold standard for identifying placental location 4. If severe, maternal hemorrhage can cause shock,
2. MRI (if needed) – Determines placental invasion in disseminated intravascular coagulation (DIC), and
severe cases (e.g., placenta accreta) organ failure.
3. No Vaginal Examination! – Digital exams can cause
severe hemorrhage Signs & Symptoms (S&S)
✅ Sudden, severe abdominal pain (hallmark sign)
Treatment & Management ✅ Dark red vaginal bleeding (may be absent in concealed
1. Expectant Management (For Stable Cases, No Heavy abruptions)
Bleeding) ✅ Rigid, board-like uterus (due to uterine hypertonicity)
✅ Pelvic Rest – No vaginal exams, intercourse, or douching ✅ Fetal distress (late decelerations, bradycardia, or absent
✅ Bed Rest & Hospitalization (if bleeding occurs) heart tones)
✅ Monitor Fetal Growth – Serial ultrasounds ✅ Hypovolemic shock (tachycardia, hypotension, pallor,
✅ Tocolytics (if preterm labor occurs) cold clammy skin, dizziness)
✅ Corticosteroids – Given at 24-34 weeks to mature fetal 🚨 Severe Complications:
lungs if early delivery is likely  Disseminated Intravascular Coagulation (DIC) –
2. Delivery Planning Uncontrolled bleeding
 C-section at 36-37 weeks (preferred for  Renal failure due to hypovolemia
complete/partial previa)  Maternal and fetal death
 Emergency C-section if heavy bleeding or fetal
distress occurs Diagnosis
1. Clinical Assessment – Based on symptoms (pain,
Nursing Interventions bleeding, rigid uterus)
🚫 Avoid vaginal exams 2. Ultrasound – May show retroplacental clot, but not
✅ Monitor vaginal bleeding & vital signs (assess for always definitive
hypovolemia) 3. Fetal Monitoring – Signs of fetal distress (late
✅ Assess fetal heart rate & movement decelerations, bradycardia)
✅ Administer IV fluids & blood transfusion (if needed) 4. CBC & Coagulation Panel – Check for anemia,
✅ Educate on pelvic rest & bleeding precautions thrombocytopenia, DIC markers
✅ Prepare for possible early C-section 5. Kleihauer-Betke Test – Detects fetal blood in
maternal circulation (for Rh-negative mothers)

Treatment & Management

Placental Abruption (Abruptio Placentae)
1. Emergency Management (For Severe Cases)
Definition
🚨 Immediate C-section if fetal distress or severe bleeding
Placental abruption is the premature separation of the
placenta from the uterine wall before delivery, leading to ✅ IV Fluids & Blood Transfusion – Maintain maternal
maternal hemorrhage and potential fetal distress. It is a life- hemodynamics
threatening obstetric emergency. ✅ Oxygen Therapy – Improve fetal oxygenation
✅ Continuous Fetal Monitoring – Assess for distress
2. Expectant Management (For Mild Cases, Preterm
Types of Placental Abruption
Pregnancies)
1. Partial Abruption – Only part of the placenta
✅ Hospitalization & Close Monitoring
detaches; mild to moderate bleeding.
✅ Bed Rest & Tocolytics (if no severe bleeding & stable
2. Complete Abruption – The entire placenta
fetus)
separates; severe hemorrhage and fetal distress.
✅ Corticosteroids for Fetal Lung Maturity (if <34 weeks)
3. Concealed Abruption – Blood is trapped behind the
placenta, with minimal external bleeding but internal
hemorrhage. Nursing Interventions
4. Revealed Abruption – Visible vaginal bleeding, as ✅ Monitor for Signs of Shock (BP, HR, LOC, urine output)
blood escapes through the cervix. ✅ Assess for Increasing Bleeding & Uterine Tone
✅ Administer Oxygen & IV Fluids
Causes & Risk Factors ✅ Prepare for Emergency C-section
🔹 Maternal Hypertension (Most Common Cause) – Chronic ✅ Provide Emotional Support to the Mother & Family
HTN or preeclampsia
🔹 Abdominal Trauma – Car accidents, falls, or domestic
Disseminated Intravascular Coagulation (DIC)
Definition o 🔻 Low Platelet Count (<100,000)
Disseminated Intravascular Coagulation (DIC) is a life- (Consumed in microclots)
threatening condition characterized by widespread activation 2. Complete Blood Count (CBC):
of the clotting cascade, leading to simultaneous blood clot o Thrombocytopenia (Low Platelets)
formation and excessive bleeding due to the depletion of 3. Blood Smear:
clotting factors and platelets. o Schistocytes (Fragmented RBCs) – Due to
DIC is always a secondary condition caused by an destruction in microclots
underlying disorder, such as placental abruption, sepsis, or 4. Organ Function Tests:
trauma. o Increased Creatinine (Kidney Damage)
o Elevated Liver Enzymes (Liver
Dysfunction)
Causes & Risk Factors
Obstetric Causes:
Treatment & Management
🔹 Placental Abruption – Releases thromboplastin, triggering
1. Treat the Underlying Cause!
clotting
✅ Deliver the Baby (If Obstetric DIC) – Emergency C-section
🔹 Amniotic Fluid Embolism – Activates clotting cascade
for placental abruption, eclampsia, etc.
🔹 Severe Preeclampsia or HELLP Syndrome – Endothelial
✅ Antibiotics for Sepsis
damage leads to coagulation activation
✅ Manage Trauma or Cancer-Related Causes
🔹 Retained Dead Fetus Syndrome – Prolonged fetal demise
2. Control Bleeding & Restore Coagulation
releases thromboplastin
✅ Fresh Frozen Plasma (FFP) – Replaces clotting factors
🔹 Postpartum Hemorrhage (PPH) – Severe bleeding
✅ Cryoprecipitate – Replenishes fibrinogen
depletes clotting factors
✅ Platelet Transfusion – If <50,000 and active bleeding
🔹 Sepsis (Chorioamnionitis) – Infection-induced inflammation
✅ Packed RBCs – If severe hemorrhage
triggers clotting
✅ Heparin (Controversial in Chronic DIC Only) – Prevents
Non-Obstetric Causes:
further clotting in slow-progressing cases
🔹 Sepsis (Gram-negative infections)
3. Supportive Care
🔹 Severe Trauma or Burns
✅ IV Fluids & Blood Transfusion for Shock
🔹 Cancer (Leukemia, Solid Tumors)
✅ Oxygen Therapy & Mechanical Ventilation (if ARDS
🔹 Liver Disease (Impaired Clotting Factor Production)
develops)
🔹 Severe Blood Transfusion Reactions
✅ Monitor Urine Output (for Kidney Function) – Maintain
>30 mL/hr
Pathophysiology
1. Triggering Event – Release of procoagulant
Nursing Interventions
substances (e.g., thromboplastin from placenta in
✅ Monitor for Bleeding – Assess gums, IV sites, urine, stool,
abruption or amniotic fluid embolism).
uterus
2. Widespread Clot Formation – Small blood clots
✅ Avoid IM Injections & Unnecessary IV Sticks – Prevent
form in vessels, leading to ischemia and organ
bleeding
damage (especially kidneys, liver, brain, and lungs).
✅ Frequent Vital Signs & Shock Assessment – Hypotension,
3. Depletion of Clotting Factors & Platelets – Leads
tachycardia, decreased urine output
to severe bleeding (gums, IV sites, uterus).
✅ Strict I&O Monitoring – Kidney function is at risk
4. Fibrinolysis Activation – The body attempts to
✅ Prepare for Emergency Blood Transfusion & Delivery (If
break down clots, producing fibrin degradation
Obstetric Cause)
products (FDPs), which further impair clotting and
✅ Provide Emotional Support to Patient & Family
worsen bleeding.
Preterm Labor (PTL)
Definition
Signs & Symptoms (S&S)
Preterm labor is the onset of regular uterine contractions
✅ Bleeding from multiple sites – IV lines, gums, nose,
leading to cervical changes (dilation and effacement) before 37
surgical wounds, uterus (postpartum hemorrhage)
weeks of gestation. It is a major cause of neonatal morbidity
✅ Petechiae, Ecchymosis, and Purpura – Due to capillary
and mortality.
leakage
✅ Hematuria (blood in urine) & GI bleeding
Risk Factors & Causes
✅ Tachycardia & Hypotension (Shock Signs) – Due to blood
🔹 Previous Preterm Birth
loss
🔹 Multiple Gestation (Twins, Triplets, etc.)
✅ Respiratory Distress (Pulmonary Microemboli or ARDS)
🔹 Infections (UTIs, bacterial vaginosis, chorioamnionitis)
✅ Oliguria/Anuria (Kidney Failure) – Due to microvascular
🔹 Premature Rupture of Membranes (PROM)
clotting
🔹 Uterine or Cervical Abnormalities (e.g., cervical insufficiency,
✅ Altered Mental Status (Brain Ischemia) – Confusion,
fibroids)
restlessness, coma
🔹 Placental Issues (placenta previa, placental abruption)
🚨 Severe Complications:
🔹 Polyhydramnios or Oligohydramnios
 Multi-Organ Failure (Kidneys, Liver, Brain, Lungs)
🔹 Smoking, Drug Use (Cocaine, Nicotine)
 Hypovolemic Shock
🔹 Short Interpregnancy Interval (<6 months)
 Death if untreated
🔹 Maternal Age (<17 or >35 years)
🔹 Excessive Uterine Distension (e.g., large fetus,
Diagnosis
polyhydramnios)
1. Coagulation Studies:
o 🔺 Prolonged PT & aPTT (Depleted clotting
Pathophysiology
factors)
1. Uterine Overdistension (e.g., multiple pregnancy,
o 🔺 Low Fibrinogen (<150 mg/dL)
polyhydramnios) → Stimulates contractions.
(Consumed in clotting)
2. Inflammation/Infection → Cytokines trigger labor-like
o 🔺 Elevated D-dimer & Fibrin Degradation
changes.
Products (FDPs) (Indicates fibrinolysis)
 3. Hormonal Imbalance → Excess corticotropin- ✅ Monitor Cervical Changes via ultrasound
releasing hormone (CRH) leads to contractions. ✅ Emotional & Psychological Support – Anxiety is common
4. Cervical Insufficiency or Structural Defects → Weak
cervix leads to early dilation. Nursing Interventions
✅ Monitor Contractions & Cervical Changes
Signs & Symptoms (S&S) ✅ Administer Tocolytics & Corticosteroids as Prescribed
✅ Regular Uterine Contractions (Every 10 minutes or more) ✅ Educate on Warning Signs (Pelvic pressure, back pain,
✅ Cervical Changes (Dilation & Effacement) bleeding)
✅ Pelvic Pressure, Cramping, or Lower Back Pain ✅ Encourage Hydration & Rest (Dehydration can trigger
✅ Increased Vaginal Discharge (Watery, Mucous, or Bloody contractions)
Show) ✅ Prepare for Possible Preterm Delivery & Neonatal ICU
✅ Premature Rupture of Membranes (PROM) – Sudden gush (NICU) Care
or leakage of fluid
🚨 Severe Complications:
 Preterm Birth → Risk of neonatal respiratory distress Premature Rupture of Membranes (PROM) & Preterm
syndrome (RDS), necrotizing enterocolitis (NEC), and Premature Rupture of Membranes (PPROM)
intraventricular hemorrhage (IVH). Definition
 Chorioamnionitis → Infection-related PTL.  PROM (Premature Rupture of Membranes):
 Neonatal Morbidity & Mortality → Low birth weight, Rupture of amniotic sac before the onset of labor at
developmental delays. ≥37 weeks gestation.
 PPROM (Preterm Premature Rupture of
Diagnosis Membranes): Rupture of membranes before 37
1. Transvaginal Ultrasound (TVUS) – Measures cervical weeks and before labor begins. It increases the risk
length (<25mm = high risk). of preterm birth and neonatal complications.
2. Fetal Fibronectin (fFN) Test – A negative test
suggests low risk of PTL in the next 7 days. Causes & Risk Factors
3. CBC, CRP, & Urinalysis – Check for infection (UTI, 🔹 Infections (UTIs, Bacterial Vaginosis, Chorioamnionitis)
chorioamnionitis). 🔹 Previous PROM or Preterm Birth
4. Amniotic Fluid Analysis – To rule out intra-amniotic 🔹 Multiple Gestation (Twins, Triplets, etc.)
infection. 🔹 Polyhydramnios (Excess Amniotic Fluid)
🔹 Smoking, Drug Use (Cocaine, Nicotine)
🔹 Short Cervical Length or Cervical Insufficiency
Management & Treatment (MTIN) 🔹 Trauma (Accidents, Domestic Violence, Amniocentesis,
1. Tocolytics (To Stop Uterine Contractions) Sexual Intercourse)
Tocolytics delay labor for 48 hours to allow for
corticosteroid administration and fetal lung maturation. Pathophysiology
Tocolytic Mechanism Side Effects 1. Membrane Weakening – Caused by inflammation,
Respiratory depression, mechanical stretching, or infection.
Magnesium Relaxes uterine
loss of reflexes, flushing, 2. Rupture of Amniotic Sac – Loss of protective barrier
Sulfate smooth muscle
hypotension increases risk of infection.
Nifedipine Blocks calcium entry Hypotension, dizziness, 3. Preterm Labor Risk (PPROM) – Pro-inflammatory
(CCB) into muscle cells headache cytokines and prostaglandins may trigger
Relaxes uterine Tachycardia, contractions.
Terbutaline
muscle via β2 palpitations,
(Beta-agonist)
receptors hyperglycemia Signs & Symptoms (S&S)
Inhibits Risk of premature ✅ Sudden Gush or Leakage of Clear Fluid from the Vagina
Indomethacin prostaglandins ductus arteriosus (Hallmark Sign)
(NSAID) (which stimulate closure in fetus (limit use ✅ Continuous Vaginal Wetness (May be mistaken for urine or
contractions) to <32 weeks) discharge)
✅ Absence of Contractions (Initially)
🚨 Contraindications for Tocolytics: ✅ Risk of Infection – Fever, foul-smelling discharge, maternal
 Severe Preeclampsia or Eclampsia tachycardia, uterine tenderness (suggestive of
 Placental Abruption chorioamnionitis)
 Intrauterine Infection (Chorioamnionitis) 🚨 Complications:
 Fetal Distress or Intrauterine Death  Preterm Labor & Birth (PPROM)
2. Corticosteroids (Fetal Lung Maturity)  Chorioamnionitis (Intra-amniotic Infection)
✅ Betamethasone 12 mg IM q24h x 2 doses OR  Umbilical Cord Prolapse (If Baby is Not Engaged
Dexamethasone 6 mg IM q12h x 4 doses in the Pelvis)
✅ Given between 24-34 weeks (may be considered up to 36+6  Neonatal Respiratory Distress Syndrome (RDS) &
weeks) Sepsis
✅ Reduces risk of neonatal RDS, NEC, and IVH
3. Antibiotics (If PROM or Infection) Diagnosis
✅ Ampicillin + Azithromycin (For chorioamnionitis) 1. Sterile Speculum Exam (No Digital Exam)
✅ Penicillin (If GBS Positive) o Pooling of Fluid in the Vaginal Vault
4. Neuroprotection for Preterm Infant o Nitrazine Test (pH >7.1 = Amniotic Fluid)
✅ Magnesium Sulfate (If <32 Weeks GA) – Prevents cerebral o Ferning Test (Microscopic Amniotic Fluid
palsy & neurodevelopmental impairment. Crystals)
5. Supportive Care & Monitoring 2. Ultrasound (USG) – Checks for Oligohydramnios
✅ Hydration & Bed Rest (if stable) (Decreased Amniotic Fluid Volume).
✅ Continuous Fetal Monitoring – Check for distress
 3. Amnisure or Actim PROM Test – Detects placental Signs &
Type Description Management
proteins in vaginal fluid. Symptoms
4. Fetal Monitoring – Assesses for distress, products in
tachycardia, or decelerations. fetal tissue Misoprostol
uterus
Monitor for
Management & Treatment Complete All fetal tissue Bleeding stops, infection, no
1. Term PROM (≥37 Weeks) Abortion expelled uterus contracts intervention
✅ Induce Labor (Oxytocin or Misoprostol) if No needed
Spontaneous Labor in 12-24 Hours Fetus dies but No fetal heart
✅ Monitor for Chorioamnionitis (Fever, Uterine Missed Misoprostol or
is retained in tone, no
Tenderness, Foul-Smelling Fluid) Abortion D&C
the uterus bleeding
✅ IV Antibiotics if Infection Present
Fever, foul-
2. Preterm PROM (PPROM) (<37 Weeks) IV antibiotics,
Septic Infection after smelling
Gestational evacuation of
Management Abortion abortion discharge,
Age uterus
pelvic pain
Expectant Management (Monitor, Delay
<34 Weeks
Delivery)
2. Induced Abortion
Delivery Recommended (Reduce Infection Termination of pregnancy by medical or surgical methods.
34-36+6 Weeks
Risk) Medical Abortion (≤10 weeks)
>37 Weeks Immediate Induction or Delivery ✅ Mifepristone (Anti-progesterone) + Misoprostol (Uterine
3. Medications for PPROM Management Contractions)
✅ Corticosteroids (Betamethasone or Dexamethasone) ✅ Used up to 10 weeks gestation
 Given if <34 weeks to enhance fetal lung maturity. ✅ Side Effects: Heavy bleeding, cramping, nausea
✅ Antibiotics (Latency Therapy) Surgical Abortion
 Ampicillin + Azithromycin or Erythromycin – ✅ Manual Vacuum Aspiration (MVA) (≤12 weeks)
Prevents infection & prolongs pregnancy. ✅ Dilation & Curettage (D&C) (1st Trimester)
✅ Tocolytics (If No Infection & No Fetal Distress) ✅ Dilation & Evacuation (D&E) (2nd Trimester)
 Nifedipine, Indomethacin, or Magnesium Sulfate – 🚨 Complications:
Delays labor to allow steroids to work.  Hemorrhage
✅ Magnesium Sulfate (Neuroprotection)  Infection (Endometritis, Septicemia)
 Given if <32 weeks to reduce the risk of cerebral  Uterine Perforation
palsy.  Asherman’s Syndrome (Uterine Scarring)
4. Infection Management
🚨 Immediate Delivery If Chorioamnionitis is Present! Nursing Interventions
✅ IV Broad-Spectrum Antibiotics (Ampicillin + Gentamicin) ✅ Monitor Vital Signs (BP, HR, Temp for Shock/Infection)
✅ Monitor for Sepsis & Neonatal Infection ✅ Assess Vaginal Bleeding & Pain
✅ Provide Emotional Support & Counseling
Nursing Interventions ✅ Administer Rhogam if Rh-negative
✅ Monitor for Signs of Infection (Fever, Uterine Tenderness, ✅ Educate on Warning Signs (Heavy Bleeding, Fever,
Tachycardia) Severe Pain)
✅ Assess Amniotic Fluid (Color, Odor, Amount) ✅ Advise on Contraceptive Use & Family Planning
✅ Encourage Left Lateral Position (Improve Fetal Perfusion)
✅ Avoid Vaginal Exams (Prevent Infection)
✅ Educate on Signs of Preterm Labor (Contractions, Pelvic Uterine Boggy (Uterine Atony)
Pressure, Back Pain) Definition
✅ Emotional Support & NICU Preparation (If Preterm Birth is A boggy uterus refers to a soft, flaccid uterus that fails to
Likely) contract effectively after delivery, leading to postpartum
hemorrhage (PPH). It is most commonly due to uterine
Abortion atony, the inability of the uterus to contract properly after
Definition childbirth.
Abortion is the termination of pregnancy before the fetus
reaches viability (<20 weeks of gestation or fetal weight Causes of a Boggy Uterus (Uterine Atony)
<500g). It can be spontaneous (miscarriage) or induced 🔹 Prolonged or Precipitous Labor (Overworked uterus)
(medical or surgical). 🔹 Overdistension of the Uterus (Twins, polyhydramnios,
macrosomia)
Types of Abortion 🔹 Retained Placental Fragments (Prevents full contraction)
1. Spontaneous Abortion (Miscarriage) 🔹 Use of Tocolytics (e.g., Magnesium Sulfate, Terbutaline)
Occurs naturally without medical intervention. 🔹 Chorioamnionitis (Uterine Infection)
Signs & 🔹 High Parity (Multiple Previous Pregnancies)
Type Description Management
Symptoms 🔹 General Anesthesia (Muscle Relaxation)
Vaginal
Cervix closed, Bed rest,
Threatened bleeding, mild Signs & Symptoms
fetus still hydration, avoid
Abortion cramping, no ✅ Soft, Boggy Uterus on Palpation
viable intercourse
tissue passage ✅ Heavy Vaginal Bleeding (PPH)
Cervix open, Heavy bleeding, Expectant ✅ Increased Uterine Size (Fundus Above Expected Level)
Inevitable pregnancy strong cramps, management or ✅ Tachycardia, Hypotension (Signs of Hypovolemic
Abortion cannot be rupture of medical Shock)
saved membranes evacuation ✅ Pallor, Dizziness, Weakness
Incomplete Partial Heavy bleeding, D&C (Dilation & 🚨 Severe Complications:
Abortion expulsion of pain, retained Curettage),
  Postpartum Hemorrhage (PPH) – Leading Cause 🔹 Age <20 or >40 years
of Maternal Death 🔹 African American ethnicity
 Hypovolemic Shock 🔹 Family history of hypertension
 DIC (Disseminated Intravascular Coagulation)
Signs & Symptoms
Management & Treatment ✅ BP ≥140/90 mmHg on 2 occasions at least 4 hours apart
1. Immediate Nursing Interventions ✅ No proteinuria (Unlike preeclampsia)
✅ Fundal Massage (First-line treatment to stimulate ✅ No signs of organ damage (No headache, visual changes,
contractions) or liver dysfunction)
✅ Monitor Vital Signs & Bleeding (Watch for signs of ✅ No edema (Although swelling can occur in normal
hemorrhagic shock) pregnancy)
✅ Assess for Bladder Distention (Full bladder prevents
uterine contraction; catheterization may be needed) Diagnosis
2. Medications (Uterotonics – Stimulate Uterine 📌 BP Measurement – Elevated BP ≥140/90 mmHg after 20
Contraction) weeks gestation
Contraindication 📌 Urinalysis – No proteinuria (to rule out preeclampsia)
Medication Mechanism
s 📌 Liver Function Tests (LFTs), Kidney Function Tests –
Oxytocin (Pitocin) – Stimulates uterine Normal in GH, abnormal in preeclampsia
None in PPH
1st Line contractions 📌 Platelet Count – Normal in GH, low in severe preeclampsia
Methylergonovine Causes sustained HTN,
(Methergine) uterine contraction Preeclampsia Management & Treatment
Carboprost 1. Monitoring & Lifestyle Changes (Mild GH: BP 140-
Induces powerful
(Hemabate, Asthma 159/90-109 mmHg)
contractions
Prostaglandin F2α) ✅ Frequent BP Checks (Twice Weekly if Stable)
Prostaglandin ✅ Home BP Monitoring & Kick Counts (Monitor Fetal
Misoprostol (Cytotec) analog, promotes Rare Movements)
contractions ✅ Healthy Diet (Low-Sodium, High-Protein, Hydration)
3. Surgical Interventions (If Medical Management Fails) ✅ Exercise (Walking, Prenatal Yoga)
🚨 If bleeding continues despite medications: ✅ Rest & Avoid Stress (Reduce Workload, No Heavy
✅ Manual Removal of Retained Placental Fragments Lifting)
✅ Uterine Tamponade (Bakri Balloon, Packing)
✅ B-Lynch Suture (Compression Sutures for Atony) 2. Medications (If BP ≥160/110 mmHg or Severe GH)
✅ Uterine Artery Ligation or Embolization 🚨 First-Line Antihypertensives:
✅ Hysterectomy (Last Resort in Uncontrollable PPH) ✅ Labetalol (Preferred, Beta-Blocker, Avoid in Asthma)
✅ Methyldopa (Safe for Pregnancy, Centrally Acting)
Nursing Interventions ✅ Nifedipine (Calcium Channel Blocker, Used in
✅ Perform Fundal Massage (Firm, circular motion until uterus Hypertensive Crisis)
firms up) ❌ Avoid:
✅ Monitor for Hypovolemic Shock (BP, HR, LOC) 🔴 ACE Inhibitors (-prils) & ARBs (-sartans) → Cause fetal
✅ Administer Uterotonic Medications as Ordered kidney damage
✅ Monitor Urine Output (≥30mL/hr – Indicates Perfusion) 🔴 Diuretics → May decrease placental perfusion
✅ Educate on Importance of Early Breastfeeding
(Stimulates natural Oxytocin release) 3. Fetal Monitoring
✅ Ultrasound for Fetal Growth – Every 2-4 weeks (Check for
IUGR)
Gestational Hypertension (GH) ✅ Non-Stress Test (NST) – Weekly or Biweekly (Check for
Definition Fetal Distress)
Gestational hypertension (GH) is new-onset high blood ✅ Amniotic Fluid Index (AFI) – Monitor for oligohydramnios
pressure (≥140/90 mmHg) after 20 weeks of pregnancy
without proteinuria or organ damage. It differs from Complications
preeclampsia, which involves proteinuria or signs of end- 🚨 Maternal Complications
organ dysfunction. GH typically resolves within 12 weeks 🔴 Progression to Preeclampsia (Common in 50% of GH
postpartum but may increase the risk of preeclampsia and Cases)
chronic hypertension. 🔴 Placental Abruption (Premature Separation of Placenta,
Leading to Fetal Distress & Bleeding)
Pathophysiology 🔴 HELLP Syndrome (Hemolysis, Elevated Liver Enzymes,
1. Increased Vascular Resistance – Due to abnormal Low Platelets – Severe Form of Preeclampsia)
placental development, leading to vasoconstriction 🔴 Stroke or Eclampsia (Seizures Due to Uncontrolled
and high blood pressure. Hypertension)
2. Endothelial Dysfunction – Reduced nitric oxide 🚨 Fetal Complications
production affects blood vessel relaxation. 🔴 Intrauterine Growth Restriction (IUGR – Poor Blood Flow
3. Placental Ischemia (In Severe Cases) – If to Fetus)
worsened, it may progress to preeclampsia with 🔴 Preterm Birth (If Severe Hypertension Requires Early
systemic organ involvement. Delivery)
🔴 Stillbirth (If Hypertension Causes Placental
Risk Factors Insufficiency)
🔹 First pregnancy (Primigravida)
🔹 History of Hypertension or Preeclampsia Delivery Plan
🔹 Obesity, Diabetes, Chronic Kidney Disease (CKD) 📌 If BP Is Controlled & No Complications:
🔹 Multiple Pregnancy (Twins, Triplets, etc.) ✅ Expectant Management Until 37-39 Weeks (If Stable)
✅ Induction of Labor at Term (To Prevent Preeclampsia 🔴 Oliguria (<500 mL/24h)
Progression) 🔴 Severe Headache or Visual Changes
📌 If Severe Hypertension or Worsening Symptoms
(≥160/110 mmHg, Preeclampsia Signs): Complications
🚨 Immediate Delivery (≥34 Weeks or Earlier If 🚨 Eclampsia (Seizures – Life-Threatening!)
Maternal/Fetal Distress) 🚨 HELLP Syndrome (Hemolysis, Elevated Liver Enzymes,
📌 Postpartum Monitoring: Low Platelets)
✅ BP Should Normalize Within 12 Weeks Postpartum 🚨 Placental Abruption (Severe Bleeding, Fetal Distress)
✅ Monitor for Postpartum Preeclampsia (Sudden BP Rise 🚨 Disseminated Intravascular Coagulation (DIC –
& Seizures After Birth) Uncontrolled Bleeding)
🚨 Fetal Growth Restriction (IUGR), Preterm Birth, Stillbirth
Nursing Interventions
✅ Monitor BP Frequently & Report Any Severe Elevations Diagnosis
✅ Educate on Danger Signs (Severe Headache, Blurred 1. Blood Pressure Monitoring (BP ≥140/90 mmHg
Vision, RUQ Pain – May Indicate Preeclampsia) after 20 weeks)
✅ Encourage Bed Rest & Left-Side Lying Position (To 2. Proteinuria Tests (24-hour urine collection, dipstick,
Improve Blood Flow to Placenta) protein/creatinine ratio)
✅ Administer Antihypertensive Medications as Ordered 3. Liver Function Tests (LFTs) – AST, ALT, LDH for
✅ Prepare for Possible Induction of Labor (If BP Worsens liver damage
or Preeclampsia Develops) 4. Renal Function Tests – Creatinine, BUN for kidney
involvement
5. Coagulation Profile – Platelets, PT/PTT for clotting
Preeclampsia abnormalities
Definition 6. Fetal Monitoring – Ultrasound, Doppler studies for
Preeclampsia is a pregnancy-specific hypertensive fetal well-being
disorder characterized by new-onset hypertension (BP
≥140/90 mmHg) and proteinuria (≥300 mg in 24-hour urine) Treatment & Management
after 20 weeks of gestation. It can progress to severe 1. Mild Preeclampsia (BP <160/110, No Severe Symptoms)
preeclampsia, eclampsia (seizures), or HELLP syndrome if ✅Monitor BP, Urine Protein, Fetal Growth
not managed properly. ✅ Encourage Rest (Left Lateral Position to Improve Blood
Flow)
Pathophysiology ✅ Regular Prenatal Checkups (NST, BPP, Doppler Studies)
1. Abnormal Placental Development → Poor ✅ Antihypertensive Medications (If BP ≥140/90 Persistent)
trophoblast invasion leads to defective spiral artery  Labetalol (First-line)
remodeling.  Methyldopa (Safe in Pregnancy)
2. Placental Ischemia & Endothelial Dysfunction →  Nifedipine (CCB)
Release of anti-angiogenic factors and oxidative
stress. 2. Severe Preeclampsia (BP ≥160/110 or End-Organ
3. Vasoconstriction & Increased Vascular Damage)
Permeability → Hypertension, proteinuria, and multi- 🚨 Requires Hospitalization & Immediate Management!
organ damage. ✅ Magnesium Sulfate (Seizure Prophylaxis)
4. End-Organ Damage → Affects brain (seizures), liver  Loading Dose: 4-6 g IV over 15-30 min
(HELLP syndrome), kidneys (proteinuria), and lungs
 Maintenance: 1-2 g/hr IV
(pulmonary edema).
 Monitor for Magnesium Toxicity: Absent reflexes,
respiratory depression, oliguria
Risk Factors  Antidote: Calcium Gluconate
🔹 First Pregnancy or New Paternity ✅ Antihypertensives (To Lower BP Rapidly, Avoid Stroke)
🔹 History of Preeclampsia or Family History  Labetalol IV (First-line, Avoid in Asthma)
🔹 Multiple Gestation (Twins, Triplets, etc.)  Hydralazine IV
🔹 Chronic Hypertension, Diabetes, Obesity  Nifedipine PO
🔹 Autoimmune Disorders (Lupus, Antiphospholipid ✅ Delivery of the Baby (Definitive Cure)
Syndrome)  If ≥37 weeks → Immediate Delivery (Induction or
🔹 Age <20 or >35 Years C-Section if Indicated)
🔹 Preexisting Kidney Disease  If <34 weeks & Stable → Steroids
(Betamethasone) for Fetal Lung Maturity
Signs & Symptoms (S&S)
✅ Hypertension (≥140/90 mmHg on 2 occasions, 4 hours Nursing Interventions
apart) ✅ Monitor BP Every 15-30 Minutes (Severe Cases)
✅ Proteinuria (≥300 mg/24h or Protein/Creatinine Ratio ✅ Assess for Signs of Worsening Preeclampsia (Seizures,
≥0.3) Visual Changes, RUQ Pain)
✅ Edema (Face, Hands, Legs due to fluid retention) ✅ Monitor Reflexes & Respirations (Magnesium Sulfate
✅ Severe Headaches (Indicates Cerebral Involvement) Toxicity Prevention)
✅ Visual Disturbances (Blurred Vision, Scotoma, Diplopia) ✅ Ensure Seizure Precautions (Padded Bedrails, Oxygen,
✅ RUQ/Epigastric Pain (Liver Involvement) Suction at Bedside)
✅ Oliguria (<500mL/24h – Kidney Dysfunction) ✅ Strict I&Os (Oliguria <30mL/hr = Renal Dysfunction!)
✅ Pulmonary Edema (Dyspnea, Crackles, Chest Pain) ✅ Encourage Left Lateral Position (Enhances Uteroplacental
🚨 Severe Preeclampsia Features: Perfusion)
🔴 BP ≥160/110 mmHg ✅ Emotional Support & Education on Early Warning Signs
🔴 Thrombocytopenia (Platelets <100,000)
🔴 Elevated Liver Enzymes (AST/ALT >2× Normal)
Eclampsia 🚨 First-Line Treatment 🚨
Definition ✅ Loading Dose: 4-6 g IV over 15-20 min
Eclampsia is a severe complication of preeclampsia, ✅ Maintenance Dose: 2 g/hr IV infusion
characterized by the onset of seizures in a pregnant woman ✅ Monitor: Deep Tendon Reflexes (DTRs), Respiratory Rate,
with hypertension and organ dysfunction. It is a life- Urine Output
threatening emergency that requires immediate medical ❌ Magnesium Toxicity Signs:
intervention to prevent maternal and fetal death.  Loss of Reflexes
 Respiratory Depression (<12 breaths/min)
Pathophysiology  Decreased Urine Output (<30 mL/hr)
1. Severe Hypertension & Endothelial Dysfunction →  Antidote: Calcium Gluconate (1 g IV over 5-10
Increased vascular permeability, brain swelling, and min)
decreased cerebral perfusion.
2. Cerebral Vasospasm & Ischemia → Leads to 2. Blood Pressure Control
headaches, visual disturbances, and seizures. 🚨 Target BP: <160/110 mmHg (Prevent Stroke)
3. Widespread Organ Dysfunction → Affects kidneys ✅ First-Line Medications:
(renal failure), liver (HELLP syndrome), and placenta  Labetalol (IV) – Beta-Blocker
(fetal distress, IUGR, stillbirth).  Hydralazine (IV) – Vasodilator
 Nifedipine (PO) – Calcium Channel Blocker
Risk Factors ❌ Avoid: ACE Inhibitors (-prils) & ARBs (-sartans) →
🔹 Severe Preeclampsia (BP ≥160/110 mmHg, Proteinuria, Cause fetal kidney damage
Organ Dysfunction)
🔹 First Pregnancy (Primigravida) 3. Fetal Monitoring & Delivery Decision
🔹 Chronic Hypertension or Gestational Hypertension 📌 Fetal Well-Being Check:
🔹 Multiple Pregnancy (Twins, Triplets, etc.) ✅ Continuous Fetal Heart Rate (FHR) Monitoring – Detects
🔹 Obesity, Diabetes, Kidney Disease Fetal Distress
🔹 Teenage Pregnancy or Advanced Maternal Age (>35 ✅ Ultrasound (Assess Placental Function & Growth
years) Restriction)
🔹 History of Preeclampsia or Eclampsia in a Previous 📌 Delivery Timing:
Pregnancy 🚨 Immediate Delivery (Regardless of Gestational Age) If:
 Seizures are uncontrollable despite MgSO₄
Signs & Symptoms  Signs of severe maternal or fetal compromise (e.g.,
🚨 Prodromal Symptoms (Before Seizures) stroke, organ failure, fetal distress)
✅ Severe Persistent Headache ✅ If Stable After Seizure:
✅ Blurred Vision, Seeing Spots or Flashing Lights  ≥34 Weeks: Induce Labor or C-Section
✅ Epigastric or Right Upper Quadrant Pain (Liver  <34 Weeks & Stable: Delay Delivery for
Involvement) Corticosteroids (Fetal Lung Maturity)
✅ Nausea & Vomiting
✅ Severe Hypertension (≥160/110 mmHg)
Complications
🚨 Eclamptic Seizure Symptoms 🚨 Maternal Risks
✅ Generalized Tonic-Clonic Seizures (Convulsions, Loss of 🔴 Stroke (Intracranial Hemorrhage, Coma, Death)
Consciousness, Foaming at the Mouth)
🔴 Disseminated Intravascular Coagulation (DIC) – Life-
✅ Cyanosis & Respiratory Distress (Due to Airway
Threatening Bleeding Disorder
Obstruction)
🔴 Pulmonary Edema (Fluid Accumulation in Lungs,
✅ Post-Seizure Confusion or Coma
Leading to Respiratory Failure)
🚨 Other Severe Features 🔴 Renal Failure (Due to Severe Vasospasm & Decreased
✅ Pulmonary Edema (Shortness of Breath, Crackles in Kidney Perfusion)
Lungs) 🔴 HELLP Syndrome (Hemolysis, Liver Damage, Low
✅ Oliguria (<500 mL Urine Output in 24 Hours, Due to Platelets)
Kidney Dysfunction) 🚨 Fetal Risks
✅ HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, 🔴 Intrauterine Growth Restriction (IUGR)
Low Platelets) 🔴 Preterm Birth (High Risk of Respiratory Distress
✅ Placental Abruption (Vaginal Bleeding, Uterine Pain,
Syndrome)
Fetal Distress) 🔴 Stillbirth (Due to Placental Insufficiency, Hypoxia)

Diagnosis
Nursing Interventions
📌 BP Measurement – Severe Hypertension (≥160/110
✅ Monitor BP Every 15-30 Minutes in Severe Cases
mmHg)
✅ Administer & Monitor Magnesium Sulfate Therapy
📌 Urinalysis – Proteinuria (≥300 mg/24hr or Dipstick ≥1+
(Assess Reflexes & Respiratory Rate!)
Protein)
✅ Ensure Airway & Oxygenation During Seizure (Turn
📌 Liver Function Tests (LFTs) – Elevated AST/ALT (HELLP
Patient to Left Side, Oxygen 10 L/min via Mask)
Syndrome)
✅ Administer Antihypertensive Medications as Ordered
📌 Platelet Count – Low Platelets (HELLP Syndrome, DIC
✅ Monitor Fetal Heart Rate & Prepare for Possible Urgent
Risk)
Delivery
📌 Kidney Function Tests – Increased Creatinine & BUN
✅ Provide Emotional Support to Family & Patient
(Kidney Dysfunction)
📌 Head CT/MRI (If Needed) – To Rule Out Stroke or Brain
Hemorrhage
HELLP Syndrome
Definition
Emergency Management
HELLP syndrome is a life-threatening complication of
1. Seizure Control – Magnesium Sulfate (MgSO₄) preeclampsia that involves:
  Hemolysis (H) → Breakdown of red blood cells
 Elevated Liver enzymes (EL) → Liver damage Treatment & Management
 Low Platelets (LP) → Increased bleeding risk 1. Immediate Stabilization
It is considered a severe form of preeclampsia and can lead ✅ Hospitalization in ICU or Labor & Delivery Unit
to maternal and fetal complications if not treated promptly. ✅ IV Fluids (To Maintain BP & Organ Perfusion, Avoid
Overload)
Pathophysiology ✅ Seizure Prevention (Magnesium Sulfate – MgSO₄)
1. Vasospasm & Endothelial Dysfunction → Blood ✅ Blood Pressure Control (Labetalol, Hydralazine,
vessel damage Nifedipine)
2. Hemolysis (RBC Breakdown) → Fragmented RBCs
due to narrowed vessels 2. Delivery of the Baby (Definitive Treatment)
3. Liver Damage & Necrosis → Causes elevated liver 🚨 Immediate Delivery (Regardless of Gestational Age) If:
enzymes & RUQ pain ✅ Gestational Age ≥34 Weeks
4. Low Platelets (Thrombocytopenia) → Increased ✅ Severe Maternal Complications (DIC, Liver Failure,
risk of bleeding & DIC Stroke, Fetal Distress)
✅ Unstable Maternal or Fetal Condition
Risk Factors 📌 If <34 Weeks & Stable:
🔹 Severe Preeclampsia or Eclampsia ✅ Corticosteroids (Betamethasone) for Fetal Lung Maturity
🔹 Gestational Hypertension ✅ Monitor Closely, Prepare for Delivery
🔹 Multiple Pregnancy (Twins, Triplets, etc.)
🔹 Maternal Age <20 or >40 3. Blood & Platelet Transfusion (If Severe
🔹 History of HELLP Syndrome in Previous Pregnancy Thrombocytopenia)
🔹 Obesity, Diabetes, Chronic Hypertension ✅ Platelets (If <20,000/mm³ or Active Bleeding)
✅ Packed RBCs (If Severe Anemia)
Signs & Symptoms ✅ Fresh Frozen Plasma (If DIC Develops)
🚨 Classic Symptoms (HELLP Triad)
✅ H – Hemolysis → Fatigue, jaundice, pallor Nursing Interventions
✅ EL – Elevated Liver Enzymes → Right upper quadrant ✅ Monitor BP, Platelets, Liver Enzymes, and Kidney
(RUQ) pain, nausea, vomiting Function
✅ LP – Low Platelets → Easy bruising, bleeding gums, ✅ Assess for Bleeding (Gums, IV Sites, Petechiae,
petechiae Hematuria)
🚨 Other Symptoms ✅ Monitor for Signs of DIC (Oozing from IV Sites, Bruising,
✅ Severe Hypertension (≥160/110 mmHg) Shock)
✅ Headache, Blurred Vision (Cerebral Edema) ✅ Administer Medications as Ordered (MgSO₄, Labetalol,
✅ Proteinuria (Sign of Preeclampsia) Hydralazine, Steroids)
✅ Epigastric or RUQ Pain (Liver Involvement) ✅ Prepare for Emergency C-Section if Needed
✅ Nausea, Vomiting, Fatigue (Liver Dysfunction) ✅ Provide Emotional Support to Family

Diagnosis
📌 Hemolysis Multiple Pregnancy
✅ Peripheral Blood Smear: Schistocytes (Fragmented RBCs) Definition
✅ LDH (>600 IU/L): Increased due to RBC breakdown A multiple pregnancy occurs when a woman carries two or
✅ Low Haptoglobin: Indicates hemolysis more fetuses in the same pregnancy. The most common type
📌 Liver Involvement is twin pregnancy, but it can include triplets, quadruplets, or
✅ AST/ALT (>70 IU/L): Elevated due to liver damage more.
✅ Bilirubin (>1.2 mg/dL): Indicates RBC breakdown
📌 Low Platelets Types of Multiple Pregnancy
✅ Platelet Count (<100,000/mm³): Thrombocytopenia 1. Dizygotic (Fraternal) Twins
📌 Other Tests  Two eggs fertilized by two sperm → Two
✅ Coagulation Profile (PT, aPTT, INR): Check for DIC genetically unique siblings
✅ Kidney Function Tests (Creatinine, BUN): Assess renal  Two placentas (Dichorionic), Two amniotic sacs
involvement (Diamniotic)
✅ Ultrasound (Liver & Placenta): Check for hepatic  More common in older mothers, fertility treatments,
hematoma or placental abruption family history
2. Monozygotic (Identical) Twins
Complications  One egg fertilized, then splits into two embryos
🚨 Maternal Risks  Genetically identical, same sex
🔴 Disseminated Intravascular Coagulation (DIC) →  Types depend on when the embryo splits:
Widespread bleeding & clotting Chorion Amnion Timing of
Type
🔴 Liver Rupture or Hematoma → Can cause massive internal (Placenta) (Sac) Split
bleeding Dichorionic-Diamniotic
🔴 Stroke (Cerebral Hemorrhage) → Due to severe 2 2 Days 1-3
(Di-Di)
hypertension
Monochorionic-
🔴 Acute Kidney Injury (AKI) → Due to poor blood perfusion 1 2 Days 4-8
Diamniotic (Mo-Di)
🔴 Placental Abruption → Premature detachment of placenta
Monochorionic-
🚨 Fetal Risks 1 1 Days 9-12
Monoamniotic (Mo-Mo)
🔴 Preterm Birth → Due to emergency delivery
After Day
🔴 Intrauterine Growth Restriction (IUGR) → Poor placental Conjoined Twins 1 1
13
function
🔴 Stillbirth → If placental insufficiency occurs 🚨 Mo-Mo and Conjoined Twins have the highest risks!
Risk Factors Polyhydramnios is a condition characterized by excess
🔹 Advanced maternal age (≥35 years) amniotic fluid volume (>1,500-2,000 mL or an amniotic
🔹 Assisted reproductive technologies (IVF, Ovulation fluid index [AFI] >25 cm on ultrasound). It occurs in about
Induction) 1% of pregnancies and can lead to maternal and fetal
🔹 Family history of fraternal twins complications if severe.
🔹 Previous multiple pregnancies
🔹 Obesity or tall maternal stature Types of Polyhydramnios
1. Mild (AFI: 25–30 cm) – Usually asymptomatic,
Signs & Symptoms requires monitoring.
✅ Excessive Weight Gain & Uterine Size Larger than 2. Moderate (AFI: 30–35 cm) – May cause discomfort
Gestational Age and increased risks.
✅ Increased Nausea & Vomiting (Hyperemesis 3. Severe (AFI: >35 cm) – Increased risk of
Gravidarum) complications, may require intervention.
✅ More Fetal Movements than Normal
✅ Elevated hCG & Alpha-Fetoprotein (AFP) Levels Causes & Risk Factors
✅ Ultrasound Confirmation of Multiple Gestation Maternal Causes:
🔹 Gestational Diabetes (Fetal polyuria due to hyperglycemia)
Complications of Multiple Pregnancy 🔹 Rh Incompatibility (Hemolytic disease leads to fetal
🚨 Maternal Risks hydrops)
 Preterm Labor & Preterm Birth 🔹 Maternal Infections (TORCH – Toxoplasmosis, Rubella,
 Gestational Hypertension & Preeclampsia CMV, Herpes)
 Gestational Diabetes Fetal Causes:
 Postpartum Hemorrhage (PPH) due to Uterine 🔹 Congenital Anomalies (GI or CNS defects)
Overdistension  Esophageal Atresia, Duodenal Atresia → Fetus
 Anemia & Nutritional Deficiencies unable to swallow amniotic fluid
🚨 Fetal Risks  Anencephaly → Lack of brain structures affecting
 Twin-to-Twin Transfusion Syndrome (TTTS) (Mo- swallowing
Di Twins Only) 🔹 Multiple Pregnancy (Twin-to-Twin Transfusion
 Intrauterine Growth Restriction (IUGR) Syndrome - TTTS)
 Cord Accidents (Especially in Mo-Mo Twins: Cord 🔹 Fetal Hydrops (Severe fetal anemia or heart
Entanglement) failure)
 Congenital Anomalies 🔹 Chromosomal Abnormalities (Trisomy 21, 18, 13)
 Stillbirth
Signs & Symptoms
Management & Treatment ✅ Rapidly Enlarging Abdomen & Excessive Fundal Height
1. Prenatal Care ✅ Difficulty Breathing (Dyspnea due to uterine pressure on
✅ Frequent Ultrasounds (Every 2-4 Weeks to Monitor diaphragm)
Growth & Amniotic Fluid Levels) ✅ Lower Extremity Edema & Varicose Veins (Increased
✅ Monitor BP, Glucose (Risk for Preeclampsia & venous pressure)
Gestational Diabetes) ✅ Preterm Labor Symptoms (Uterine Overdistension)
✅ High-Calorie, High-Protein Diet (Increased Nutritional ✅ Fetal Malpresentation (Breech, Transverse Lie due to
Needs) excess fluid)
✅ Iron & Folic Acid Supplements (Prevent Anemia & Neural
Tube Defects) Complications
✅ Early Detection of TTTS (Serial Ultrasounds for Mo-Di 🚨 Maternal Risks
Twins)  Preterm Labor & Preterm Birth
 Premature Rupture of Membranes (PROM) →
2. Delivery Planning Increased risk of cord prolapse
✅ Di-Di Twins: Vaginal Birth Possible if both are cephalic  Placental Abruption (Sudden loss of fluid can cause
(head-down) placental detachment)
✅ Mo-Di Twins: C-Section Preferred due to increased  Postpartum Hemorrhage (PPH) (Overdistended
complications uterus fails to contract)
✅ Mo-Mo Twins: Planned C-Section at 32-34 weeks to  Increased Risk of C-Section (Fetal Malposition)
prevent cord entanglement 🚨 Fetal Risks
✅ Triplets or Higher: C-Section is the safest option  Cord Prolapse (After PROM, leading to fetal distress)
 Stillbirth or Intrauterine Growth Restriction (IUGR)
in Severe Cases
Nursing Interventions
 Neonatal Respiratory Distress (Due to Preterm
✅ Monitor for Preterm Labor (Contractions, Cervical
Birth or Congenital Anomalies)
Changes, PROM)
✅ Assess for Hypertension & Proteinuria (Early Detection
of Preeclampsia) Diagnosis
✅ Provide Nutritional Counseling (Increased Caloric & 1. Ultrasound (AFI Measurement) – Gold Standard
Protein Intake) o Mild: 25–30 cm
✅ Encourage Frequent Rest & Left Lateral Positioning o Moderate: 30–35 cm
(Improves Uteroplacental Perfusion) o Severe: >35 cm
✅ Monitor Fetal Heart Tones Separately for Each Baby 2. Glucose Screening for Gestational Diabetes
✅ Prepare for Possible NICU Admission (Prematurity Risk) 3. Fetal Anomaly Scan (Detect GI/CNS Defects)
4. Karyotyping (If Chromosomal Abnormalities
Polyhydramnios normal: 500-1000 ml Suspected)
Definition
Management & Treatment 🔹 Twin-to-Twin Transfusion Syndrome (TTTS – Donor
1. Mild Polyhydramnios (AFI <30 cm) Twin) → One twin has reduced blood flow
✅ Monitor AFI Every 1–2 Weeks 4. Amniotic Fluid Loss
✅ Treat Underlying Conditions (Diabetes, Infection, Rh 🔹 Premature Rupture of Membranes (PROM) → Leakage of
Isoimmunization) amniotic fluid
✅ Encourage Rest & Left Lateral Positioning 🔹 Chronic Amniotic Fluid Leak

2. Moderate to Severe Polyhydramnios (AFI >30 cm) Signs & Symptoms

🚨 Requires More Aggressive Monitoring & Possible ✅ Fundal Height Smaller than Gestational Age
Intervention ✅ Decreased Fetal Movements (Due to Less Cushioning
✅ Amnioreduction (Amniocentesis to Remove Excess Fluid)
Fluid) – Temporary relief but risk of preterm labor ✅ Oligohydramnios on Ultrasound (AFI <5 cm or SDP <2
✅ Indomethacin (NSAID to Reduce Fetal Urine Output, cm)
Used Before 32 Weeks) ✅ Meconium-Stained Amniotic Fluid (If Prolonged
✅ Steroids (Betamethasone) If Preterm Birth is Expected Oligohydramnios)
✅ Monitor Closely for Preterm Labor & PROM
Complications
Delivery Considerations 🚨 Maternal Risks
✅ Planned Delivery at 37–39 Weeks (If Stable)  Increased Risk of Induction & C-Section (Due to
✅ Early Induction or C-Section for Severe Cases (Risk of Fetal Distress)
Cord Prolapse, Malpresentation)  Prolonged Labor (Poor Cervical Dilation & Fetal
✅ NICU Team Should Be Present (High Risk of Neonatal Malposition)
Complications) 🚨 Fetal Risks
 Cord Compression → Variable Decelerations
Nursing Interventions (Fetal Distress on CTG)
✅ Monitor Fundal Height & AFI Regularly  Pulmonary Hypoplasia (If Oligohydramnios Occurs
✅ Assess for Signs of Preterm Labor (Contractions, Before 24 Weeks)
Cervical Changes)  Growth Restriction (IUGR Due to Placental
✅ Monitor for Dyspnea & Maternal Discomfort Insufficiency)
✅ Prepare for Possible Amnioreduction (Educate on Risks  Limb Deformities (Due to Compression in Low
& Benefits) Fluid Environment)
✅ Ensure Fetal Well-Being (NST, BPP, Doppler Studies)
✅ Educate on Signs of PROM (Sudden Gush of Fluid, Cord Diagnosis
Prolapse Risk) 1. Ultrasound (Gold Standard)
o AFI <5 cm or SDP <2 cm confirms
oligohydramnios.
Oligohydramnios 2. Doppler Ultrasound (Assess Placental Blood Flow &
Definition Fetal Well-Being)
Oligohydramnios is a condition characterized by low amniotic 3. Non-Stress Test (NST) or Biophysical Profile
fluid levels, defined as: (BPP)
 Amniotic Fluid Index (AFI) <5 cm on ultrasound o Detects fetal distress due to cord
 Single Deepest Pocket (SDP) <2 cm compression.
 Amniotic fluid volume <200–500 mL (depending on 4. Maternal Lab Tests
gestational age) o Kidney Function Tests (For Maternal
It can lead to fetal complications, growth restriction, and Dehydration)
birth complications if left untreated. o Glucose Testing (For Gestational
Diabetes)
Causes & Risk Factors
1. Maternal Causes Management & Treatment
🔹 Hypertension & Preeclampsia (Vasoconstriction reduces 1. Mild Oligohydramnios (AFI 5–8 cm)
placental perfusion) ✅ Encourage Maternal Hydration (Drink More Fluids!)
🔹 Dehydration or Hypovolemia (Affects amniotic fluid ✅ Monitor with Weekly Ultrasounds
production) ✅ Rest & Avoid Heavy Physical Activity
🔹 Diabetes (Can cause placental insufficiency)
🔹 Uteroplacental Insufficiency (Leads to reduced fetal urine 2. Moderate to Severe Oligohydramnios (AFI <5 cm)
production) 🚨 Requires More Aggressive Management
2. Fetal Causes ✅ Amnioinfusion (Injecting Fluid via Amniocentesis or
🔹 Renal Anomalies (Fetal Urinary Tract Issues) During Labor)
 Renal Agenesis (Potter Syndrome) → No kidneys, ✅ IV Hydration (May Increase AFI in Some Cases)
no urine ✅ Steroids (Betamethasone) If Preterm Delivery is Likely
 Obstructive Uropathy (Posterior Urethral Valves) ✅ Early Delivery if Fetal Distress, IUGR, or Severe
→ Urine retention in fetus Oligohydramnios is Present
🔹 Intrauterine Growth Restriction (IUGR) (Due to
chronic placental insufficiency)
Delivery Considerations
🔹 Chromosomal Abnormalities (Trisomy 18, 21,
✅ If ≥37 Weeks: Induction of Labor (Avoid Fetal Distress)
etc.)
✅ If <34–36 Weeks: Expectant Management + Fetal
3. Placental Causes
Monitoring
🔹 Post-Term Pregnancy (>41 Weeks) → Aging placenta
✅ If Severe Oligohydramnios & Fetal Distress: Emergency
reduces amniotic fluid
C-Section
🔹 Placental Abruption (Loss of fluid due to detachment)
Nursing Interventions 1. Maternal Testing
✅ Monitor Fundal Height & AFI Regularly 🩸 Blood Type & Rh Screening (Early Pregnancy) –
✅ Assess for Fetal Movements & Signs of Fetal Distress Determines Rh status.
(NST, CTG) 🩸 Indirect Coombs Test (At 28 weeks & if suspected
✅ Encourage Maternal Hydration (Oral & IV as Needed) sensitization) – Detects maternal Rh antibodies in the blood.
✅ Prepare for Possible Amnioinfusion or Induction 2. Fetal Monitoring
✅ Monitor for Signs of PROM (Fluid Leakage, Cord 🩸 Amniocentesis (If High-Risk) – Measures bilirubin levels in
Prolapse Risk) amniotic fluid.
🩸 Middle Cerebral Artery (MCA) Doppler Ultrasound –
Detects fetal anemia non-invasively.
Rh Incompatibility 🩸 Direct Coombs Test (After Birth) – Detects antibodies
Definition attached to fetal RBCs.
Rh incompatibility occurs when an Rh-negative mother
carries an Rh-positive fetus, leading to an immune reaction Prevention & Management
against fetal red blood cells. This condition can cause 1. Prevention with Rh Immunoglobulin (RhoGAM)
hemolytic disease of the newborn (HDN) or ✅ RhoGAM is given to Rh-negative mothers to prevent
erythroblastosis fetalis, leading to fetal anemia, jaundice, antibody formation.
hydrops fetalis, or stillbirth if untreated. ✅ Administered at:
 28 weeks gestation (Routine dose)
Pathophysiology  Within 72 hours of delivery (If baby is Rh-positive)
1. First Pregnancy (Sensitization Phase)  After any event with fetal-maternal bleeding
o During pregnancy or delivery, fetal Rh- (Miscarriage, Amniocentesis, Trauma, Ectopic
positive RBCs enter the mother’s Pregnancy, CVS, etc.)
bloodstream through placental microtears, ✅ RhoGAM coats fetal Rh-positive cells,
trauma, or procedures (amniocentesis, preventing the mother’s immune system from
abortion, ectopic pregnancy). reacting.
o The maternal immune system recognizes
Rh-positive cells as foreign and produces 2. Management of Affected Pregnancies
IgM antibodies. 🚨 If Fetal Anemia is Detected:
o IgM cannot cross the placenta, so the first ✅ Intrauterine Blood Transfusion (IUT) via the umbilical
baby is usually unaffected. vein
2. Subsequent Pregnancies (Immune Response ✅ Early Delivery (If Severe Anemia is Present) – Usually
Phase) before 37 weeks
o In later pregnancies with an Rh-positive 🚨 Postnatal Management (For Neonates with Hemolytic
fetus, the mother’s immune system quickly Disease of the Newborn - HDN):
produces IgG antibodies, which cross the ✅ Phototherapy (To reduce jaundice & prevent kernicterus)
placenta. ✅ Exchange Transfusion (If severe
o These antibodies attack fetal RBCs, anemia/hyperbilirubinemia)
causing hemolysis, anemia, jaundice, ✅ IV Immunoglobulin (IVIG) to reduce hemolysis
hepatosplenomegaly, and hydrops fetalis
(severe fetal edema). Nursing Interventions
o Severe cases can lead to fetal death due to ✅ Ensure Rh Screening & Indirect Coombs Test for All
heart failure (hydrops fetalis). Pregnant Women
✅ Administer RhoGAM at 28 Weeks & Postpartum If Baby
Risk Factors is Rh-Positive
🔹 Rh-negative mother carrying an Rh-positive fetus ✅ Monitor Fetal Growth & Hydrops Fetalis via Ultrasound
🔹 Previous pregnancy, miscarriage, abortion, ectopic ✅ Prepare for Intrauterine Transfusion (If Severe Anemia)
pregnancy ✅ Monitor Newborn for Jaundice & Anemia After Birth
🔹 Amniocentesis, chorionic villus sampling (CVS), or ✅ Educate Parents on Phototherapy & Exchange
trauma during pregnancy Transfusion if Needed
🔹 Blood transfusion with Rh-incompatible blood
🔹 External cephalic version (ECV) for breech presentation
Fetal Death (Intrauterine Fetal Demise - IUFD)
Signs & Symptoms of Fetal Effects Definition
🚨 Mild Cases: Fetal death, also known as intrauterine fetal demise (IUFD),
✅ Mild anemia & jaundice at birth is the death of a fetus at or after 20 weeks of gestation but
✅ Slight hepatosplenomegaly before birth. If the death occurs before 20 weeks, it is
🚨 Severe Cases (Hemolytic Disease of the Newborn - classified as a miscarriage (spontaneous abortion).
HDN):
✅ Severe Fetal Anemia → Increased cardiac output → Heart Causes & Risk Factors
failure 1. Maternal Factors
✅ Hydrops Fetalis → Severe edema, ascites, pleural & 🔹 Hypertensive Disorders (Preeclampsia, Eclampsia,
pericardial effusion Chronic Hypertension)
✅ Neonatal Jaundice (Hyperbilirubinemia) → Can lead to 🔹 Gestational Diabetes (Uncontrolled, Leading to Fetal
Kernicterus (brain damage from excess bilirubin) Growth Restriction or Macrosomia)
✅ Hepatosplenomegaly → Liver & spleen enlargement due to 🔹 Infections (TORCH – Toxoplasmosis, Rubella, CMV,
overworked RBC production Herpes, Syphilis, Listeriosis)
✅ Stillbirth in severe untreated cases 🔹 Autoimmune Disorders (Lupus, Antiphospholipid
Syndrome - APS)
Diagnosis 🔹 Substance Abuse (Smoking, Alcohol, Drugs – Cocaine,
Methamphetamine, etc.)
🔹 Obesity (Increased Risk of Hypertension, Diabetes, and 2. Delivery Options (Depends on Gestational Age &
Stillbirth) Maternal Condition)
2. Fetal Causes 📌 If <20 Weeks:
🔹 Chromosomal Abnormalities (Trisomy 13, 18, 21, Turner ✅ Expectant Management (Allow Natural Expulsion)
Syndrome) ✅ Medical Management (Misoprostol to Induce Uterine
🔹 Congenital Anomalies (Neural Tube Defects, Heart Contractions)
Defects, Renal Agenesis) ✅ Dilation & Evacuation (D&E) If Needed
🔹 Fetal Infections (Cytomegalovirus, Parvovirus B19, 📌 If >20 Weeks:
Syphilis, Zika Virus) ✅ Induction of Labor (Preferred Over C-Section, Unless
🔹 Twin-to-Twin Transfusion Syndrome (TTTS in Medically Indicated)
Monochorionic Twins) ✅ Prostaglandins (Misoprostol) or Oxytocin to Induce
3. Placental & Umbilical Cord Causes Labor
🔹 Placental Abruption (Premature Separation of the ✅ C-Section (Only If Medically Necessary – E.g., Placenta
Placenta, Cutting Off Oxygen Supply) Previa, Prior Uterine Surgery)
🔹 Placenta Previa (Placenta Covering the Cervix, Leading
to Fetal Hypoxia) 3. Post-Delivery Care
🔹 Placental Insufficiency (Poor Blood Flow, Leading to ✅ Monitor for Maternal Complications (Postpartum
Growth Restriction & Hypoxia) Hemorrhage, Infection, DIC)
🔹 Umbilical Cord Accidents (Cord Prolapse, True Knot, ✅ Emotional & Psychological Support (Grief counseling,
Cord Torsion, Nuchal Cord) Memory Box, Funeral Options)
4. Other Causes ✅ Autopsy & Placental Examination (If Parents Consent,
🔹 Prolonged Pregnancy (>42 Weeks – Increased Risk of To Determine Cause)
Placental Aging & Fetal Distress)
🔹 Polyhydramnios or Oligohydramnios (Excess or Low
Complications
Amniotic Fluid, Causing Fetal Complications)
🚨 Maternal Risks
🔹 Maternal Trauma (Car Accident, Domestic Violence,
 Disseminated Intravascular Coagulation (DIC) (If
Falls, Abdominal Trauma)
IUFD Is Prolonged)
 Infection (Chorioamnionitis, Sepsis)
Signs & Symptoms  Postpartum Hemorrhage (PPH Due to Uterine
🚨 Maternal Symptoms: Atony)
✅ Absence of Fetal Movements (Most Common Complaint) 🚨 Psychological Effects
✅ Loss of Pregnancy Symptoms (Breast Tenderness,  Depression, Anxiety, PTSD, Emotional Trauma
Nausea, etc.)  Future Pregnancy Anxiety & Fear
✅ No Uterine Growth (Fundal Height Stagnation or
Reduction)
Nursing Interventions
✅ Dark Red Vaginal Bleeding (If Associated with Placental
✅ Provide a Compassionate & Supportive Environment
Abruption)
✅ Encourage Parental Bonding (Holding the Baby,
✅ Foul-Smelling Vaginal Discharge (If Infection is Present)
Footprints, Photographs If Desired)
🚨 Clinical Findings:
✅ Prepare for Induction & Monitor for Labor Complications
✅ Absence of Fetal Heartbeat on Doppler or Ultrasound
✅ Offer Genetic Counseling & Support for Future
(Confirms Diagnosis)
Pregnancies
✅ No Cardiac Activity on Ultrasound (Gold Standard
✅ Discuss RhoGAM Administration (If Mother Is Rh-
Diagnosis)
Negative & Fetus Is Rh-Positive)
✅ Decreased Amniotic Fluid (Oligohydramnios May Be
✅ Provide Follow-Up Care & Mental Health Referrals
Present in IUFD Cases)

Prevention Strategies
Diagnosis
🚨 For High-Risk Pregnancies:
1. Ultrasound (Gold Standard)
✅ Control Hypertension & Diabetes During Pregnancy
o Confirms absence of fetal heartbeat &
✅ Frequent Ultrasounds & Fetal Monitoring If IUGR or
movement.
Placental Insufficiency Is Suspected
2. Doppler Ultrasound
✅ Kick Count Monitoring (Report Decreased Fetal
o Detects lack of fetal blood flow.
Movements Immediately!)
3. Non-Stress Test (NST) ✅ Prompt Management of Infections & High-Risk
o No fetal heart rate activity on monitoring. Conditions (Preeclampsia, Rh Incompatibility, etc.)
4. Amniotic Fluid Assessment ✅ Early Delivery If IUFD Risk Is High (E.g., Severe
o Decreased or absent amniotic fluid may Preeclampsia, Fetal Growth Restriction, Severe
indicate IUFD. Oligohydramnios)
5. Maternal Blood Tests (To Identify Cause)
o CBC, Coagulation Profile (DIC Screening),
TORCH Screening, Antiphospholipid Chronic Heart Failure (CHF)
Antibodies, Glucose Levels, Thyroid Definition
Tests Chronic Heart Failure (CHF) is a progressive condition
where the heart is unable to pump enough blood to meet the
Management & Treatment body's needs. It results from structural or functional cardiac
1. Confirmation & Parental Counseling disorders that impair ventricular filling (diastolic
✅ Provide Emotional Support & Explain the Diagnosis dysfunction) or ejection of blood (systolic dysfunction).
Compassionately
✅ Discuss the Cause (If Identified) & Options for Delivery Pathophysiology
✅ Psychological Support & Grief Counseling 1. Cardiac Dysfunction (↓ Pumping Ability) → ↓
Cardiac Output (CO)
 2. Neurohormonal Activation (RAAS & SNS) → 2. Lifestyle Modifications
Vasoconstriction, Fluid Retention, & ↑ Afterload ✅ Sodium Restriction (<2g/day)
3. Ventricular Remodeling (Hypertrophy/Dilation) → ✅ Fluid Restriction (<1.5-2L/day If Severe CHF)
Worsens Cardiac Function ✅ Daily Weight Monitoring (Report >2kg Gain in 2 Days)
4. End-Stage CHF → Multi-Organ Failure Due to ✅ Exercise (Moderate, As Tolerated)
Hypoperfusion ✅ Smoking & Alcohol Cessation
Types of Heart Failure
🔹 Left-Sided Heart Failure (LHF) → Affects lungs 3. Advanced Therapies (If Severe HF)
(pulmonary congestion) ✅ Implantable Cardioverter-Defibrillator (ICD) – If EF <35%
🔹 Right-Sided Heart Failure (RHF) → Affects systemic ✅ Cardiac Resynchronization Therapy (CRT) – If
circulation (edema, JVD, ascites) Conduction Abnormalities
🔹 Systolic HF (HFrEF, EF <40%) → Impaired contractility ✅ Heart Transplant (If End-Stage, Refractory to
🔹 Diastolic HF (HFpEF, EF ≥50%) → Impaired Medications)
relaxation/filling

Nursing Interventions
Causes & Risk Factors ✅ Monitor Respiratory Status (Oxygenation, Crackles,
✅ Hypertension (HTN) Dyspnea)
✅ Coronary Artery Disease (CAD) / Myocardial Infarction ✅ Assess Fluid Balance (Daily Weights, I&O, Edema, JVD)
(MI) ✅ Educate on Medication Adherence & Lifestyle Changes
✅ Diabetes Mellitus ✅ Monitor for Signs of Decompensation (Sudden Dyspnea,
✅ Valvular Heart Disease Fatigue, Weight Gain)
✅ Arrhythmias (e.g., Atrial Fibrillation) ✅ Elevate Head of Bed (Eases Breathing)
✅ Cardiomyopathy (Dilated, Hypertrophic, Restrictive) ✅ Administer Diuretics & Monitor for Hypokalemia (With
✅ Chronic Kidney Disease (CKD) Furosemide)
✅ Obesity & Smoking
✅ Excessive Alcohol/Drug Use
Mitral Valve Prolapse (MVP)
Definition
Signs & Symptoms Mitral Valve Prolapse (MVP) is a condition where the mitral
Left-Sided Heart Failure (Pulmonary Symptoms) valve leaflets bulge (prolapse) into the left atrium during
🚨 Hallmark: Pulmonary Congestion & Dyspnea systole. It is a common valvular disorder and is often
✅ Dyspnea (Shortness of Breath) – Worse When Lying benign, but in some cases, it can lead to mitral regurgitation
Down (Orthopnea) (MR), arrhythmias, or complications like infective endocarditis.
✅ Paroxysmal Nocturnal Dyspnea (PND) – Waking Up
Gasping for Air Pathophysiology
✅ Crackles/Rales (Fluid in Lungs) 1. Structural Abnormality → The mitral valve leaflets
✅ Pink, Frothy Sputum (Severe Cases – Pulmonary Edema) are redundant, thickened, or elongated, causing
✅ Fatigue, Weakness (↓ Cardiac Output) improper closure.
2. Valve Prolapse → The leaflets billow into the left
atrium during systole, leading to turbulence.
Right-Sided Heart Failure (Systemic Symptoms) 3. Mitral Regurgitation (MR) (If Severe) → Blood leaks
🚨 Hallmark: Peripheral Edema & Venous Congestion back into the left atrium, leading to volume overload
✅ Jugular Venous Distension (JVD) and possible heart failure.
✅ Peripheral Edema (Legs, Ankles, Ascites)
✅ Hepatomegaly & RUQ Pain (Liver Congestion)
Causes & Risk Factors
✅ Weight Gain (Fluid Retention) ✅ Primary (Idiopathic) MVP → Often due to myxomatous
degeneration of the valve.
Diagnosis ✅ Connective Tissue Disorders
📌 Echocardiogram (Gold Standard) → Measures Ejection  Marfan Syndrome
Fraction (EF)  Ehlers-Danlos Syndrome
📌 BNP (>100 pg/mL Suggests HF) → Released Due to  Osteogenesis Imperfecta
Ventricular Stretch ✅ Genetic Predisposition → Runs in families
📌 Chest X-ray (Pulmonary Edema, Cardiomegaly) ✅ Autonomic Dysfunction (May be Associated
📌 ECG (Check for Arrhythmias, Ischemia) with Anxiety, Panic Attacks, or Dysautonomia)
📌 Cardiac MRI (If Cardiomyopathy Suspected) ✅ Rheumatic Heart Disease (Rare Cause in
Developed Countries)
Treatment & Management
1. Medications Signs & Symptoms
✅ ACE Inhibitors / ARBs (Lisinopril, Losartan) → ↓ 🔹 Often Asymptomatic – Many people with MVP do not
Afterload, Prevent Remodeling experience symptoms.
✅ Beta-Blockers (Metoprolol, Carvedilol) → ↓ HR, ↓ If Symptomatic:
Myocardial Oxygen Demand ✅ Atypical Chest Pain (Not Related to Exertion)
✅ Diuretics (Furosemide, Spironolactone) → ↓ Fluid ✅ Palpitations (Due to Arrhythmias, Usually PVCs or PACs)
Overload, ↓ Edema ✅ Fatigue, Dizziness, or Syncope (Autonomic Dysfunction)
✅ ARNIs (Sacubitril/Valsartan) → Blocks RAAS, Enhances ✅ Dyspnea (If Mitral Regurgitation Develops)
Natriuresis ✅ Anxiety or Panic Attacks (Common in MVP Syndrome)
✅ SGLT2 Inhibitors (Dapagliflozin, Empagliflozin) → Newer 🚨 Severe MVP (With Significant MR) Can Lead To:
HF Therapy, Reduces Hospitalizations 🔴 Heart Failure Symptoms (Dyspnea, Fatigue, Orthopnea)
✅ Digoxin (If Severe, AFib Present) → Increases Contractility 🔴 Atrial Fibrillation (AFib) → Due to Left Atrial Enlargement
🚨 Avoid NSAIDs & CCBs (Can Worsen CHF) 🔴 Infective Endocarditis Risk (If Damaged Valve)
Hallmark Clinical Finding 🔹 Symptoms: Chest pain (angina), shortness of breath, heart
🔍 Mid-Systolic Click Followed by a Late Systolic Murmur attack (myocardial infarction, MI)
(Best Heard at Apex with Stethoscope in Mitral Area) 🔹 Complications: Heart failure, arrhythmias, sudden cardiac
 The click is due to sudden tensing of the prolapsing death
mitral leaflets. 🔹 Treatment: Lifestyle changes, statins, beta-blockers,
 The murmur indicates mitral regurgitation (if nitrates, angioplasty/stents, CABG
present).
 Standing or Valsalva Maneuver → Click Occurs 2. Hypertension (HTN)
Earlier (Due to ↓ Venous Return). 🔹 Cause: High blood pressure (≥140/90 mmHg) due to
genetics, obesity, high salt intake, stress, or kidney
Diagnosis disease
📌 Echocardiogram (Gold Standard) → Confirms MVP & 🔹 Symptoms: Often asymptomatic, may cause headaches,
Assesses Severity of MR dizziness, or nosebleeds
📌 Auscultation Findings (Mid-Systolic Click ± Late Systolic 🔹 Complications: Stroke, heart failure, kidney disease,
Murmur) aneurysm
📌 ECG → Usually Normal but May Show Arrhythmias 🔹 Treatment: Lifestyle modifications, ACE inhibitors, ARBs,
📌 Holter Monitor (If Palpitations/Arrhythmias Suspected) beta-blockers, diuretics

Treatment & Management 3. Heart Failure (HF)

1. Lifestyle Modifications 🔹 Cause: The heart’s inability to pump blood effectively due to
✅ Regular Exercise (Avoid Extreme Endurance Activities If CAD, hypertension, valve disease, or cardiomyopathy
Severe MR) 🔹 Types:
✅ Hydration & Adequate Salt Intake (If Prone to  Left-sided HF (Pulmonary congestion → Dyspnea,
Hypotension/Autonomic Dysfunction) crackles, orthopnea)
✅ Reduce Caffeine, Alcohol, & Stimulants (Can Trigger  Right-sided HF (Systemic congestion → Edema,
Palpitations) JVD, ascites)
✅ Manage Anxiety (Cognitive Behavioral Therapy, 🔹 Complications: Pulmonary edema, arrhythmias,
Relaxation Techniques) multi-organ failure
🔹 Treatment: ACE inhibitors, beta-blockers,
2. Medications (If Symptomatic or Arrhythmias Present) diuretics, SGLT2 inhibitors, heart transplant (if
✅ Beta-Blockers (e.g., Metoprolol, Atenolol) → Reduce severe)
Palpitations, Anxiety, & Autonomic Dysfunction
✅ Antiarrhythmics (If Severe Palpitations/Afib) 4. Arrhythmias (Irregular Heartbeats)
✅ Antibiotics for Infective Endocarditis Prophylaxis (Only If 🔹 Cause: Electrical conduction abnormalities due to ischemia,
Prior Endocarditis or Valve Surgery) electrolyte imbalance, or structural defects
🔹 Types:
3. Surgical Intervention (If Severe Mitral Regurgitation or  Bradycardia (Slow HR, <60 bpm) → Sinus
HF Symptoms) bradycardia, heart block
✅ Mitral Valve Repair (Preferred Over Replacement)  Tachycardia (Fast HR, >100 bpm) → Atrial
✅ Mitral Valve Replacement (If Repair Not Feasible) fibrillation (AFib), ventricular tachycardia
🚨 Surgery Indicated If:  Ventricular Fibrillation (VFib) → Medical emergency
🔴 Severe MR With Left Ventricular Dysfunction → Sudden cardiac arrest
🔴 Symptoms of Heart Failure (Dyspnea, Fatigue, 🔹 Symptoms: Palpitations, dizziness, syncope, chest
Pulmonary Edema) pain
🔴 Atrial Fibrillation or Pulmonary Hypertension Due to MR 🔹 Treatment: Antiarrhythmics, beta-blockers,
pacemaker, defibrillator (ICD)

Nursing Interventions
✅ Monitor for Symptoms of Worsening MR (Dyspnea, 5. Valvular Heart Disease (VHD)
Edema, Fatigue) 🔹 Cause: Stenosis (narrowing) or regurgitation (leakage) of
✅ Educate on Lifestyle Changes (Exercise, Hydration, heart valves due to rheumatic fever, aging, or infections
Anxiety Management) 🔹 Common Types:
✅ Assess for Palpitations or Arrhythmias (May Need Holter  Aortic Stenosis (AS) → Narrowed aortic valve →
Monitor) Chest pain, dyspnea, syncope
✅ Reassure Patients (MVP is Often Benign & Does Not  Mitral Valve Prolapse (MVP) → Mitral valve bulging
Always Require Treatment) → Palpitations, fatigue
 Mitral Regurgitation (MR) → Leaking valve → Heart
failure symptoms
🔹 Treatment: Valve repair/replacement,
Cardiovascular Diseases (CVDs)
anticoagulants (if AFib present)
Definition
Cardiovascular diseases (CVDs) refer to a group of disorders
that affect the heart and blood vessels. They are the leading 6. Peripheral Artery Disease (PAD)
cause of death worldwide and include conditions such as 🔹 Cause: Atherosclerosis in legs/arms, reducing blood supply
coronary artery disease (CAD), heart failure, hypertension, 🔹 Symptoms: Leg pain with walking (claudication), cold feet,
arrhythmias, and valvular diseases. non-healing wounds
🔹 Complications: Limb amputation, critical limb ischemia
Types of Cardiovascular Diseases 🔹 Treatment: Antiplatelets (Aspirin, Clopidogrel), statins,
1. Coronary Artery Disease (CAD) / Ischemic Heart Disease lifestyle changes, angioplasty
(IHD)
🔹 Cause: Narrowing or blockage of coronary arteries due to 7. Stroke (Cerebrovascular Disease)
atherosclerosis → ↓ Blood flow to heart muscle
🔹 Cause: Blockage (ischemic stroke) or rupture 3. Surgical & Interventional Treatments
(hemorrhagic stroke) of brain blood vessels ✅ Angioplasty & Stents (For CAD & PAD)
🔹 Symptoms: FAST (Face drooping, Arm weakness, Speech ✅ Coronary Artery Bypass Grafting (CABG) (For Severe
difficulty, Time to call 911) CAD)
🔹 Complications: Paralysis, cognitive impairment, death ✅ Pacemaker/Implantable Cardioverter Defibrillator (ICD)
🔹 Treatment: Clot-busting drugs (tPA), anticoagulants, carotid (For Arrhythmias)
surgery, rehabilitation ✅ Valve Repair/Replacement (For Valvular Heart Disease)

8. Aortic Aneurysm & Dissection Nursing Interventions

🔹 Cause: Weakening of the aorta, leading to dilation ✅ Monitor BP, HR, ECG, and Oxygen Saturation
(aneurysm) or tearing (dissection) ✅ Educate on Medication Adherence & Lifestyle Changes
🔹 Symptoms: Severe chest/back pain, hypotension, sudden ✅ Encourage Smoking Cessation & Regular Exercise
collapse ✅ Monitor for Signs of Worsening CVD (Chest Pain,
🔹 Complications: Internal bleeding, death Dyspnea, Edema, Syncope)
🔹 Treatment: Blood pressure control, surgery (if large or ✅ Encourage Regular Check-ups & Preventive Care
ruptured)

Risk Factors for CVD Anemia

Modifiable (Can Be Changed) Definition
✅ Hypertension Anemia is a condition in which the red blood cell (RBC) count
✅ High Cholesterol (Dyslipidemia) or hemoglobin (Hb) level is lower than normal, leading to
✅ Smoking reduced oxygen delivery to tissues. It can result from blood
✅ Diabetes Mellitus loss, decreased RBC production, or increased RBC
✅ Obesity & Poor Diet (High Fat, High Salt) destruction.
✅ Lack of Physical Activity
✅ Alcohol & Drug Abuse Normal Hemoglobin (Hb) Levels
✅ Chronic Stress 📌 Men: 13.5 - 17.5 g/dL
Non-Modifiable (Cannot Be Changed) 📌 Women: 12.0 - 15.5 g/dL
❌ Age (>45 in men, >55 in women) 📌 Children: 11.0 - 16.0 g/dL
❌ Family History of CVD 🔹 Anemia is diagnosed when Hb falls below these normal
❌ Genetic Disorders (e.g., Marfan Syndrome, values.
Hypercholesterolemia)
❌ Male Gender (Higher Risk Before Menopause) Anemia in Pregnancy
Definition
Diagnosis of CVD Anemia in pregnancy is a condition where the hemoglobin
📌 Electrocardiogram (ECG/EKG) → Detects arrhythmias, (Hb) level falls below the normal range due to increased
ischemia, heart attack blood volume, iron deficiency, or underlying conditions. It is
📌 Echocardiogram (ECHO) → Assesses heart function & common due to the increased iron and folic acid demands
valve disease during pregnancy.
📌 Cardiac Enzymes (Troponin, CK-MB) → Detects heart 🔴 WHO Definition of Anemia in Pregnancy:
attack  Mild Anemia: Hb 10–10.9 g/dL
📌 Stress Test (Exercise or Pharmacologic) → Evaluates  Moderate Anemia: Hb 7–9.9 g/dL
CAD  Severe Anemia: Hb <7 g/dL
📌 Coronary Angiography (Cardiac Cath) → Identifies
blocked arteries Causes of Anemia in Pregnancy
📌 Doppler Ultrasound → Checks for PAD 1. Iron Deficiency Anemia (Most Common, 75-80%)
🔹 Cause: Insufficient dietary iron intake, increased fetal
Treatment & Management demand, blood loss
1. Lifestyle Modifications (First-Line for Prevention & 🔹 Lab Findings: Low ferritin, low serum iron, high TIBC
Management) 🔹 Symptoms: Fatigue, pallor, dizziness, brittle nails, pica
✅ Heart-Healthy Diet (Low Salt, Low Fat, High Fiber, (craving non-food items like ice)
Omega-3s) 2. Folate Deficiency Anemia
✅ Regular Exercise (30-45 min, 5x per week) 🔹 Cause: Poor diet, increased folate requirement (for fetal
✅ Quit Smoking & Limit Alcohol neural development)
✅ Manage Stress (Meditation, Yoga, Therapy) 🔹 Lab Findings: Macrocytic RBCs, low folate levels
✅ Weight Control (BMI <25) 🔹 Symptoms: Fatigue, pallor, glossitis (inflamed tongue), no
neurological symptoms
3. Vitamin B12 Deficiency Anemia
2. Medications
🔹 Cause: Vegetarian diet, pernicious anemia (intrinsic
✅ Antihypertensives (ACEi, ARBs, Beta-Blockers, CCBs,
factor deficiency), malabsorption
Diuretics) → Lower BP
🔹 Lab Findings: Macrocytic RBCs, low B12,
✅ Statins (Atorvastatin, Rosuvastatin) → Lower Cholesterol
hypersegmented neutrophils
✅ Antiplatelets (Aspirin, Clopidogrel) → Prevent Clots in
🔹 Symptoms: Neurological signs (numbness, tingling,
CAD/PAD
memory loss)
✅ Anticoagulants (Warfarin, NOACs) → For Stroke
4. Hemolytic Anemia
Prevention in AFib
🔹 Cause: Autoimmune diseases, sickle cell disease, G6PD
✅ Diuretics (Furosemide, Spironolactone) → Reduce Fluid
deficiency
Overload in HF
🔹 Lab Findings: High reticulocytes, high bilirubin, low
✅ Antiarrhythmics (Amiodarone, Digoxin) → Treat
haptoglobin
Arrhythmias
🔹 Symptoms: Jaundice, dark urine, splenomegaly
5. Anemia of Chronic Disease
🔹 Cause: Chronic infections, renal disease, inflammatory 💊 Intravenous (IV) Iron if oral iron is not tolerated or Hb <8
conditions g/dL
🔹 Lab Findings: Low iron, normal/high ferritin, low TIBC 💊 Iron Therapy Duration: Continue for 3 months after Hb
🔹 Symptoms: Mild fatigue, pallor normalization
🔴 Side Effects of Iron Supplements:
Risk Factors for Anemia in Pregnancy ✔ Constipation
✅ Poor Diet (Low Iron, Folate, or B12) ✔ Black stools
✅ Multiple Pregnancies (Increased Nutrient Demand) ✔ Nausea
✅ Frequent Pregnancies (<2 Years Apart)
✅ Heavy Menstrual Bleeding Before Pregnancy 3. Folate & B12 Supplementation
✅ Malabsorption Disorders (Celiac, Crohn’s Disease) 💊 Folic Acid 400-600 mcg/day (Prevention of neural tube
✅ Parasitic Infections (Hookworm, Malaria) defects)
💊 Vitamin B12 Injections for Deficiency
Signs & Symptoms of Anemia in Pregnancy
🔴 Mild to Moderate Anemia: 4. Blood Transfusion (If Severe Anemia, Hb <7 g/dL with
✅ Fatigue, weakness Symptoms)
✅ Pale skin, mucous membranes 🚨 Indicated in cases of severe anemia or acute bleeding
✅ Dizziness, lightheadedness 🚨 Used if Hb <6 g/dL in late pregnancy or postpartum
✅ Shortness of breath hemorrhage risk
✅ Brittle nails, hair loss
🚨 Severe Anemia: Nursing Interventions
✅ Tachycardia (Increased Heart Rate) ✅ Monitor Hemoglobin Levels Regularly (1st, 2nd, 3rd
✅ Palpitations, Chest Pain Trimesters)
✅ Fainting or Extreme Weakness ✅ Assess Dietary Intake & Educate on Iron/Folate-Rich
✅ Difficulty Breathing Foods
✅ Monitor for Side Effects of Iron Therapy (GI Upset,
Complications of Anemia in Pregnancy Constipation)
For Mother: ✅ Encourage Compliance with Supplements & Follow-Up
⚠️Preterm Labor Appointments
⚠️Preeclampsia (High Blood Pressure & Proteinuria) ✅ Provide Emotional Support & Address Pregnancy-
⚠️Heart Failure (In Severe Anemia) Related Concerns
⚠️Postpartum Hemorrhage (PPH)
⚠️Delayed Wound Healing & Increased Infection Risk Prevention of Anemia in Pregnancy
For Baby: 📌 Routine Iron & Folic Acid Supplementation (IFA):
⚠️Low Birth Weight (<2.5 kg)  WHO Recommends: 30-60 mg Iron + 400 mcg
⚠️Preterm Birth Folic Acid Daily
⚠️Fetal Growth Restriction (IUGR)  Start Preconceptionally & Continue Until 6 Months
⚠️Neural Tube Defects (If Folate Deficient) Postpartum
⚠️Stillbirth or Neonatal Death (Severe Cases) 📌 Regular Prenatal Check-ups:
 Monitor for early signs of anemia
Diagnosis of Anemia in Pregnancy  Screen for risk factors like poor diet & chronic
📌 Complete Blood Count (CBC): Checks Hb, hematocrit, illnesses
RBC size 📌 Spacing of Pregnancies:
📌 Iron Studies (Ferritin, Serum Iron, TIBC): Evaluates iron  At least 2 years between pregnancies to replenish
status nutrient stores
📌 Vitamin B12 & Folate Levels: Checks for megaloblastic
anemia
📌 Peripheral Blood Smear: Identifies RBC abnormalities Sickle Cell Anemia (Genetic Disorder)
(e.g., sickle cells) 🔹 Cause: Inherited mutation in the hemoglobin S gene
(affects oxygen transport)
Treatment & Management 🔹 Lab Findings: Sickle-shaped RBCs, low Hb, high
1. Dietary Modifications reticulocytes
✅ Iron-Rich Foods: 🔹 Symptoms: Pain crises, organ damage, jaundice,
 Heme Iron (Better Absorbed): Red meat, poultry, recurrent infections
liver 🔹 Treatment: Hydroxyurea (to reduce sickling), pain
 Non-Heme Iron: Green leafy vegetables, legumes, management, blood transfusions, bone marrow transplant
nuts, fortified cereals (curative in some cases)
✅ Folate Sources: Leafy greens, oranges, beans, fortified
grains Definition
✅ Vitamin B12 Sources: Dairy, eggs, fish, fortified cereals (for Sickle Cell Anemia (SCA) is a genetic disorder characterized
vegetarians) by abnormal hemoglobin S (HbS), causing red blood cells to
🚨 Enhance Iron Absorption: become sickle-shaped. These rigid, crescent-shaped cells
✔ Take Iron with Vitamin C (Citrus fruits, tomatoes, bell clump together, leading to blocked blood flow, pain crises,
peppers) and organ damage.
✖ Avoid Tea, Coffee, Calcium-Rich Foods with Iron
(Reduce Absorption) Causes & Pathophysiology
🔹 Cause: Autosomal recessive disorder (must inherit two
2. Iron Supplementation (For Iron Deficiency Anemia) copies of the mutated gene – one from each parent)
💊 Ferrous Sulfate 300-600 mg/day (Best taken on an empty 🔹 Mutation: A single amino acid substitution (valine replaces
stomach) glutamic acid) in the beta-globin chain of hemoglobin
🔹 Effects: ✔ Acute chest syndrome
✅ Sickled RBCs are fragile → Hemolysis → Chronic ✔ Preoperative management
Anemia 🔴 Complications: Iron overload (treated with iron chelation
✅ Rigid RBCs block small blood vessels → Painful vaso- therapy)
occlusive crises 4. Bone Marrow Transplant (Only Cure!)
✅ Organ ischemia → Damage to organs (kidneys, liver, ✔ Potential cure in children with severe disease
brain, heart, spleen) ✔ Limited availability due to donor matching requirements
5. Infection Prevention (Key in Children)
Types of Sickle Cell Disease (SCD) ✅ Daily Penicillin (Until Age 5): Prevents pneumococcal
🔹 Sickle Cell Anemia (HbSS) – Most severe form (2 HbS infections
genes) ✅ Vaccinations: Pneumococcal, meningococcal, influenza
🔹 Sickle Cell Trait (HbAS) – Carrier state, usually 6. Oxygen Therapy (For Acute Hypoxia)
asymptomatic ✔ Helps prevent further sickling of RBCs
🔹 HbSC Disease & HbS Beta-Thalassemia – Milder forms 7. Folic Acid Supplementation
✔ Supports RBC production (due to chronic hemolysis)
Signs & Symptoms
🔴 Chronic Symptoms (Due to Anemia & Organ Damage): Nursing Interventions
✅ Fatigue, weakness ✅ Monitor for signs of vaso-occlusive crises & acute chest
✅ Pallor, jaundice (from hemolysis) syndrome
✅ Growth delay in children ✅ Administer oxygen if hypoxia occurs
✅ Enlarged spleen (splenomegaly) ✅ Encourage hydration (IV or oral fluids)
🚨 Acute Complications (Sickle Cell Crises): ✅ Provide pain relief (opioids for severe pain)
1. Vaso-Occlusive Crisis (Pain Crisis) – Most Common ✅ Educate patients on triggers (avoid cold, dehydration,
🔹 Cause: Sickled cells block blood flow stress, infections)
🔹 Symptoms: Severe bone/joint pain, swelling, fever ✅ Ensure vaccination compliance & infection prevention
🔹 Triggers: Cold weather, dehydration, infection, stress ✅ Monitor for complications (stroke, priapism, splenic
2. Acute Chest Syndrome (Life-Threatening!) sequestration)
🔹 Cause: Sickled cells block blood vessels in lungs
🔹 Symptoms: Chest pain, cough, fever, shortness of breath Pregnancy Considerations
🔹 Management: Oxygen, IV fluids, blood transfusion 🤰 Pregnancy in sickle cell patients is high-risk due to
3. Splenic Sequestration Crisis (Common in Children) increased risk of preeclampsia, fetal growth restriction,
🔹 Cause: Spleen traps sickled RBCs → Sudden hypovolemic and preterm birth.
shock 📌 Management:
🔹 Symptoms: Severe anemia, enlarged spleen, rapid heart ✔ Close monitoring by a high-risk obstetrician
rate, low BP ✔ Continue hydroxyurea (benefits vs. risks)
🔹 Treatment: Emergency blood transfusion, splenectomy ✔ Regular blood transfusions if severe anemia
(if recurrent) ✔ Prevent dehydration & infections
4. Stroke (Silent or Overt Stroke)
🔹 Cause: Sickled cells block brain arteries
🔹 Symptoms: Weakness, slurred speech, vision loss, seizures Folic Acid Deficiency
🔹 Prevention: Transfusions, hydroxyurea Definition
5. Aplastic Crisis (Life-Threatening) Folic acid deficiency is a condition where there is an
🔹 Cause: Parvovirus B19 infection → Stops RBC production insufficient amount of folate (Vitamin B9) in the body, leading
🔹 Symptoms: Sudden severe anemia, pallor, fatigue to impaired DNA synthesis, abnormal red blood cell
🔹 Treatment: Blood transfusions production (megaloblastic anemia), and increased risk of
6. Priapism (Painful Prolonged Erection) neural tube defects (NTDs) in pregnancy.
🔹 Cause: Blocked blood flow in penile vessels
🔹 Management: IV fluids, pain relief, aspiration of blood Causes of Folic Acid Deficiency
from penis if severe 1. Inadequate Dietary Intake
🔹 Most Common Cause
Diagnosis 🔹 Poor consumption of folate-rich foods (leafy greens, citrus
📌 Complete Blood Count (CBC): Low Hb, high reticulocytes fruits, legumes)
(due to RBC destruction) 🔹 Common in malnourished individuals, alcoholics, and
📌 Peripheral Blood Smear: Sickle-shaped RBCs elderly patients
📌 Hemoglobin Electrophoresis: Confirms presence of HbS 2. Increased Folate Requirement
📌 Newborn Screening: Done at birth in many countries ✅ Pregnancy & Lactation (Due to fetal growth & placental
transfer)
Treatment & Management ✅ Infancy & Adolescence (Due to rapid growth)
1. Pain Management (For Crises) ✅ Chronic Hemolytic Anemia (e.g., Sickle Cell Disease,
💊 Mild Pain: Acetaminophen, NSAIDs (ibuprofen) Thalassemia)
💊 Severe Pain: Opioids (morphine, hydromorphone) 3. Malabsorption Disorders
💊 IV Fluids: Prevent dehydration, reduce sickling ❌ Celiac Disease
2. Hydroxyurea (First-Line Disease-Modifying Drug) ❌ Crohn’s Disease
✅ Increases fetal hemoglobin (HbF) → Reduces sickling ❌ Gastric Bypass Surgery
✅ Decreases pain crises & acute chest syndrome ❌ Tropical Sprue
✅ Given daily to reduce complications 4. Drug-Induced Folate Deficiency
3. Blood Transfusions 💊 Methotrexate (Folate antagonist)
🚨 Indications: 💊 Sulfa Drugs (Sulfasalazine, Trimethoprim-
✔ Severe anemia (Hb <6 g/dL) Sulfamethoxazole)
✔ Stroke prevention in children 💊 Phenytoin, Phenobarbital, Valproic Acid
(Anticonvulsants) ✔ Treat malabsorption syndromes (Celiac, Crohn’s)
💊 Metformin (Diabetes medication) ✔ Increase folate in pregnant women, lactating mothers,
5. Chronic Alcoholism dialysis patients
🍺 Alcohol blocks folate absorption and increases
excretion Prevention of Folic Acid Deficiency
6. Chronic Hemodialysis ✔ Daily Folic Acid Supplement (400 mcg) for All Women of
💉 Folate is lost in dialysis fluid Childbearing Age
✔ Eat a Folate-Rich Diet
Pathophysiology ✔ Limit Alcohol & Stop Smoking
🔹 Folate is essential for DNA & RNA synthesis, particularly in ✔ Prenatal Care & Screening in Pregnancy
rapidly dividing cells (e.g., RBCs).
🔹 Deficiency leads to impaired RBC maturation, causing Nursing Interventions
megaloblastic anemia (large, immature RBCs). ✅ Monitor CBC & Serum Folate Levels
🔹 In pregnancy, folate deficiency can cause neural tube ✅ Educate Patients on Folate-Rich Diet & Supplementation
defects (spina bifida, anencephaly) in the fetus. ✅ Assess for Neurological Symptoms & Oral Ulcers
✅ Advise Pregnant Women on Neural Tube Defect
Signs & Symptoms Prevention
General Symptoms (Due to Anemia) ✅ Encourage Prenatal Vitamins (Folic Acid 400-800 mcg)
✅ Fatigue & Weakness
✅ Pale Skin (Pallor)
✅ Shortness of Breath Down Syndrome (Trisomy 21)
✅ Dizziness & Lightheadedness Definition
Neurological Symptoms Down Syndrome is a genetic disorder caused by an extra
✅ Irritability & Mood Changes copy of chromosome 21 (Trisomy 21). It leads to intellectual
✅ Depression & Cognitive Decline disability, characteristic facial features, and various
✅ Forgetfulness & Difficulty Concentrating congenital abnormalities affecting multiple organ systems.
🚨 Unlike Vitamin B12 Deficiency, Folate Deficiency Does
NOT Cause Peripheral Neuropathy (Tingling/Numbness in Causes & Types of Down Syndrome
Hands & Feet). 🔹 95% - Trisomy 21 (Most Common) → Nondisjunction
Oral & GI Symptoms during meiosis leads to an extra chromosome 21 in all cells.
✅ Glossitis (Smooth, Red, Inflamed Tongue) 🔹 4% - Translocation Down Syndrome → Extra chromosome
✅ Mouth Ulcers (Stomatitis, Cheilitis) 21 is attached to another chromosome (often 14 or 21).
✅ Loss of Appetite & Weight Loss 🔹 1% - Mosaic Down Syndrome → Some cells have an extra
Pregnancy-Related Risks chromosome 21, while others are normal.
🚨 Neural Tube Defects (NTDs) → Spina Bifida,
Anencephaly
Risk Factors
🚨 Preterm Birth, Low Birth Weight, Placental Abruption
✅ Advanced Maternal Age (>35 years)
✅ Previous Child with Down Syndrome
Diagnosis ✅ Balanced Translocation Carrier Parent
📌 Complete Blood Count (CBC):
 Low Hemoglobin (Hb) → Anemia
Pathophysiology
 Increased Mean Corpuscular Volume (MCV >100
📌 Extra Chromosome 21 leads to overexpression of genes,
fL) → Megaloblastic Anemia
disrupting normal development.
 Hypersegmented Neutrophils
📌 Affects neurological, cardiovascular, musculoskeletal,
📌 Serum Folate Level: Low (Normal: >3 ng/mL)
endocrine, and immune systems.
📌 RBC Folate Level: More accurate long-term indicator
📌 Homocysteine Level: Elevated (Folate is needed to
Signs & Symptoms
metabolize homocysteine)
1. Physical Features
📌 Methylmalonic Acid (MMA) Level: Normal (Differentiates
✔ Flat facial profile & nasal bridge
from B12 deficiency, where MMA is elevated)
✔ Upward slanting palpebral fissures (almond-shaped
eyes)
Treatment & Management
✔ Epicanthal folds (extra skin fold on the inner corner of
1. Folic Acid Supplementation
the eye)
💊 For Deficiency: 1–5 mg/day orally for 1–4 months
✔ Small head & ears, short neck
💊 For Pregnancy Prevention: 400–800 mcg/day (4 mg/day
✔ Protruding tongue & small mouth
if previous NTDs)
✔ Single palmar crease (Simian crease)
💊 For Chronic Hemolytic Anemia & Dialysis Patients: 1
✔ Short fingers & hypotonia (low muscle tone)
mg/day lifelong
2. Cognitive & Developmental Delay
2. Dietary Modifications (Folate-Rich Foods)
✔ Mild to moderate intellectual disability
🥦 Green Leafy Vegetables (Spinach, Kale, Broccoli,
✔ Delayed speech & motor development
Asparagus)
✔ Learning difficulties
🍊 Citrus Fruits (Oranges, Grapefruit, Lemons)
✔ Behavioral challenges
🍚 Fortified Grains (Bread, Cereal, Pasta, Rice)
3. Congenital Anomalies & Medical Conditions
🥜 Legumes (Lentils, Chickpeas, Beans, Peas)
🚨 Heart Defects (50%) – Atrioventricular Septal Defect
🥚 Eggs, Nuts, Liver
(AVSD), Ventricular Septal Defect (VSD)
3. Stop Folate-Depleting Drugs
🚨 Gastrointestinal Issues – Duodenal Atresia,
❌ Reduce alcohol, methotrexate, sulfa drugs, phenytoin (if
Hirschsprung’s Disease
possible)
🚨 Endocrine Disorders – Hypothyroidism, Diabetes
4. Manage Underlying Conditions
🚨 Immune System Weakness – Higher risk of infections,
leukemia
🚨 Hearing & Vision Problems – Recurrent ear infections, ✅ Group B Streptococcus (GBS) – Risk of neonatal
cataracts infection
🚨 Atlantoaxial Instability – Risk of spinal cord Risk Factors in Pregnancy
compression 🤰 Hormonal Changes (Increased progesterone) → Causes
relaxation of ureters & bladder, leading to urine stasis
Diagnosis 🤰 Uterine Enlargement → Compresses bladder & ureters,
Prenatal Screening (Non-Definitive Tests) causing urinary retention
🟢 First-Trimester Screening (10-14 weeks): 🤰 Glycosuria & Aminoaciduria → Promotes bacterial growth
✔ Nuchal Translucency Ultrasound (Increased fluid at the 🤰 Reduced Bladder Tone & Increased Residual Urine →
back of the neck) Increases infection risk
✔ Maternal Serum Markers (hCG, PAPP-A) 🤰 History of UTIs or Kidney Disease
🟢 Second-Trimester Screening (Quad Test, 15-20 weeks): 🤰 Sexual Activity → Increases bacterial introduction
✔ Low AFP (Alpha-fetoprotein)
✔ High hCG Types of UTI in Pregnancy
✔ Low Estriol 1. Asymptomatic Bacteriuria (ASB) (Most Common)
✔ High Inhibin-A ✔ No symptoms but bacteria present in urine culture
Definitive Diagnostic Tests ✔ If untreated, 30-40% progress to pyelonephritis
✅ Chorionic Villus Sampling (CVS) (10-13 weeks) ✔ Screening is mandatory during pregnancy
✅ Amniocentesis (15-20 weeks) 2. Cystitis (Bladder Infection – Lower UTI)
✅ Karyotyping (Postnatal Confirmation) ✔ Dysuria (Burning sensation while urinating)
✔ Urinary urgency & frequency
Treatment & Management ✔ Suprapubic pain or discomfort
📌 No Cure – Management is Supportive & Multidisciplinary ✔ Cloudy, foul-smelling urine
1. Early Intervention & Therapy ✔ Mild fever (sometimes absent)
✅ Speech Therapy – Helps with communication difficulties 3. Pyelonephritis (Kidney Infection – Upper UTI, Severe
✅ Physical Therapy – Improves muscle strength & Condition)
coordination 🚨 High fever (≥38°C or 100.4°F)
✅ Occupational Therapy – Helps with daily activities 🚨 Flank pain (CVA tenderness)
2. Medical Management 🚨 Nausea & vomiting
✅ Regular cardiac evaluations for congenital heart defects 🚨 Chills & rigors
✅ Thyroid function screening for hypothyroidism 🚨 Generalized malaise
✅ Vision & hearing tests for early detection of problems 🚨 Sepsis risk if untreated
✅ Nutritional support for feeding difficulties & obesity
prevention Diagnosis
3. Special Education & Social Support 1. Urinalysis (UA)
✅ Individualized learning programs 🔍 Positive leukocyte esterase (WBCs in urine)
✅ Support groups for families 🔍 Positive nitrites (Indicates gram-negative bacteria like E.
4. Surgery (If Needed) coli)
✔ Heart surgery for congenital defects 🔍 Pyuria (Increased WBCs in urine), Bacteriuria
✔ Gastrointestinal surgery for duodenal atresia 2. Urine Culture & Sensitivity (C&S) (Gold Standard)
✔ Confirms the bacterial organism
Nursing Interventions ✔ Positive if ≥100,000 CFU/mL bacteria
✔ Monitor growth & development milestones 3. Blood Tests (For Pyelonephritis or Sepsis Suspicion)
✔ Provide family education & emotional support ✔ Complete Blood Count (CBC) – Shows leukocytosis
✔ Encourage early therapy & special education ✔ Blood Culture – If systemic infection is suspected
✔ Promote infection prevention (vaccination, hygiene)
✔ Monitor for signs of complications (heart defects, Complications of Untreated UTI in Pregnancy
hypothyroidism) 🚨 Pyelonephritis (Kidney infection – Can cause sepsis &
✔ Ensure proper feeding techniques for hypotonic infants preterm labor)
🚨 Preterm Labor & Preterm Birth
Prognosis & Life Expectancy 🚨 Low Birth Weight Baby
📌 Life expectancy has improved significantly (50-60+ 🚨 Intrauterine Growth Restriction (IUGR)
years) with proper medical care. 🚨 Maternal Sepsis (Life-threatening infection spread to
📌 Early interventions & medical monitoring improve quality of bloodstream)
life & independence. 🚨 Neonatal Sepsis (If caused by Group B Streptococcus)

Urinary Tract Infection (UTI) in Pregnancy Treatment & Management

Definition 1. Antibiotic Therapy (Safe in Pregnancy)
A UTI in pregnancy is an infection in the urinary tract that 📌 Uncomplicated UTI (Cystitis & Asymptomatic
occurs due to bacterial invasion, most commonly caused by Bacteriuria)
Escherichia coli (E. coli). It is a serious concern in pregnant ✅ Nitrofurantoin (Macrobid) – 100 mg BID for 5-7 days
women because it can lead to complications such as (Avoid after 36 weeks)
pyelonephritis, preterm labor, and low birth weight. ✅ Cephalexin (Keflex) – 500 mg BID for 7 days
✅ Amoxicillin-Clavulanate – 500 mg BID for 7 days
Causes & Risk Factors ✅ Fosfomycin – Single dose therapy (Safe alternative)
Common Pathogens 📌 Complicated UTI / Pyelonephritis (Hospitalization may be
✅ Escherichia coli (E. coli) – Most common (80-90%) required)
✅ Klebsiella pneumoniae, Proteus mirabilis, 🚨 Ceftriaxone (IV) – 1-2g/day
Staphylococcus saprophyticus 🚨 Ampicillin + Gentamicin (IV for severe cases)
📌 Avoid these antibiotics in pregnancy: 🔹 Sudden, strong urge to urinate (Urge Incontinence
❌ Fluoroquinolones (Ciprofloxacin, Levofloxacin) – Risk of possible)
fetal cartilage damage 🔹 Incomplete emptying sensation
❌ Tetracyclines (Doxycycline) – Causes teeth discoloration 🔹 Bladder leakage with coughing, sneezing, or laughing
in fetus (Mixed Incontinence: OAB + Stress Incontinence)
🔹 Disruptions in daily activities & sleep due to urinary
2. Supportive Therapy urgency
💧 Increase fluid intake (2-3L per day) to flush out bacteria
🚽 Encourage frequent urination (Every 2-3 hours) to Diagnosis
prevent urine stasis 📌 Urinalysis & Urine Culture – Rule out UTI
🔥 Acetaminophen (Tylenol) for fever & pain (Avoid NSAIDs 📌 Bladder Diary – Tracks urination patterns & triggers
in pregnancy) 📌 Post-Void Residual (PVR) Test – Measures urine left after
🍊 Cranberry juice (May reduce bacterial adherence, but not voiding (If retention suspected)
a substitute for antibiotics) 📌 Pelvic Exam – Assesses bladder prolapse & pelvic floor
function
Prevention of UTI in Pregnancy
✅ Regular prenatal screening for ASB (Urine culture at first Management & Treatment
visit & 3rd trimester if high risk) 1. Lifestyle Modifications
✅ Encourage perineal hygiene (Wipe front to back) 💧 Fluid Management – Drink adequate water but avoid
✅ Urinate after intercourse to flush out bacteria excess before bedtime
✅ Avoid tight synthetic underwear (Cotton preferred) ⚠ Avoid Bladder Irritants – Caffeine, alcohol, spicy foods,
✅ Stay hydrated to promote urine flow & flushing of carbonated drinks
bacteria 🚽 Scheduled Voiding – Train bladder to urinate at regular
✅ Avoid using scented hygiene products (Irritates urethra) intervals
💪 Pelvic Floor Exercises (Kegels) – Strengthens muscles to
Nursing Interventions reduce incontinence
✔ Monitor for UTI symptoms (dysuria, fever, flank pain, 🧘 Bladder Training – Delaying urination gradually to extend
foul-smelling urine) bladder capacity
✔ Collect urine samples for urinalysis & culture 2. Medications (Limited Use in Pregnancy)
✔ Encourage increased fluid intake & proper hygiene ❌ Anticholinergics (Oxybutynin, Tolterodine) & Beta-3
✔ Administer prescribed antibiotics & educate about Agonists (Mirabegron) are NOT recommended in
adherence pregnancy due to fetal risks.
✔ Monitor for signs of worsening infection (fever, flank ✔ Topical Vaginal Estrogen (Postpartum, if indicated for
pain, signs of sepsis) persistent symptoms)
✔ Educate the patient on prevention strategies 3. Physical Therapy & Non-Medical Approaches
✅ Pelvic Floor Physiotherapy (Biofeedback Therapy)
✅ Acupuncture (Some evidence of benefit)
Hyperactive Bladder in Pregnancy
4. Surgical or Invasive Options (ONLY Postpartum, If
Definition
Severe)
A hyperactive bladder (overactive bladder, OAB) in
🚨 Botox Injections (Postpartum, if conservative treatment
pregnancy is characterized by frequent, urgent urination,
fails)
sometimes with incontinence, due to increased bladder
🚨 Neuromodulation (Tibial Nerve Stimulation, Sacral Nerve
sensitivity and reduced bladder capacity. This condition is
Stimulation – Last Resort)
common due to hormonal changes, uterine pressure, and
increased blood flow to the kidneys.
Nursing Interventions
✔ Assess urinary patterns & symptoms
Causes & Risk Factors
✔ Encourage bladder training techniques
Physiological Causes in Pregnancy
✅ Hormonal Changes (Progesterone & Relaxin) → Causes ✔ Teach Kegel exercises for pelvic muscle strengthening
bladder muscle relaxation, leading to urgency ✔ Provide education on lifestyle changes & bladder
✅ Increased Blood Volume & Kidney Filtration (Glomerular irritants
Filtration Rate, GFR) → More urine production ✔ Monitor for UTI signs, as frequent urination can be
✅ Uterine Enlargement & Pressure on Bladder → Reduces mistaken for infection
bladder capacity
✅ Increased Sensitivity of the Detrusor Muscle (Bladder Chronic Kidney Disease (CKD) in Pregnancy
muscle responsible for contraction) Definition
✅ Fetal Movement (Especially in the third trimester) → Can Chronic Kidney Disease (CKD) in pregnancy is a condition
stimulate the bladder where a woman has pre-existing kidney dysfunction before
Other Risk Factors conception or develops progressive kidney disease during
🚺 History of Overactive Bladder (OAB) or Urinary pregnancy (lasting >3 months). CKD increases the risk of
Incontinence hypertension, preeclampsia, preterm birth, and fetal
🚺 Obesity (Increases intra-abdominal pressure) complications.
🚺 Multiple Pregnancies (Multiparity – Increased pelvic floor
weakening) Causes & Risk Factors
🚺 Urinary Tract Infections (UTI) or Interstitial Cystitis Common Causes of CKD in Pregnancy
🚺 Neurological Disorders (Rare but possible – MS, Spinal ✅ Hypertensive Disorders (Chronic Hypertension,
cord issues) Preeclampsia, HELLP Syndrome)
✅ Diabetes Mellitus (Diabetic Nephropathy)
Signs & Symptoms ✅ Glomerulonephritis (Autoimmune or Infection-Related
🔹 Frequent urination (≥8 times/day, even at night – Kidney Damage)
nocturia) ✅ Polycystic Kidney Disease (PKD)
✅ Lupus Nephritis (Systemic Lupus Erythematosus - SLE)
✅ Urinary Tract Obstruction or Reflux Nephropathy 📌 Proteinuria (Urinalysis & 24-Hour Urine Protein Test) –
✅ History of Kidney Transplant or Dialysis Detects kidney damage
Risk Factors 📌 Electrolytes (K⁺, Na⁺, HCO₃⁻, Ca²⁺, PO₄³⁻) – Checks for
🚺 Pre-existing CKD (Before Pregnancy) imbalances
🚺 History of Kidney Stones or Recurrent UTIs 📌 Blood Pressure Monitoring – Detects worsening
🚺 Obesity & Metabolic Syndrome hypertension
🚺 Family History of Kidney Disease 📌 Fetal Ultrasound (Growth Monitoring) – Checks for IUGR
🚺 Use of Nephrotoxic Drugs (NSAIDs, ACE inhibitors, & Oligohydramnios
ARBs – should be avoided in pregnancy) 📌 Doppler Studies (Umbilical Artery Flow) – Assesses
placental function
Pathophysiology
 Normal Pregnancy Changes: Treatment & Management
o Increased Blood Volume & Glomerular 1. Blood Pressure Control (Avoiding Preeclampsia &
Filtration Rate (GFR) Progression of CKD)
o Reduced Blood Pressure (1st & 2nd 🚨 Target BP in Pregnancy: <140/90 mmHg
Trimester) ✅ Safe Antihypertensives in Pregnancy
o Higher Renal Load due to Hormonal &  Labetalol (First-line, Beta-blocker)
Cardiovascular Changes  Methyldopa (Alpha-agonist, Safe in Pregnancy)
 CKD Impact:  Nifedipine (Calcium Channel Blocker, Used in
o Reduced Kidney Function → Poor Severe Cases)
clearance of toxins → Increased Uremia & ❌ Avoid ACE inhibitors (Lisinopril, Enalapril) & ARBs
Fluid Retention (Losartan, Valsartan) → Teratogenic & Can Cause Fetal
o Proteinuria & Hypertension → Risk of Renal Damage
Preeclampsia & Preterm Birth
o Impaired Erythropoietin Production → 2. Proteinuria & Kidney Function Monitoring
Anemia ✅ Low-Protein Diet (If Severe CKD, But Balance for Fetal
o Electrolyte Imbalances (Hyperkalemia, Needs)
Acidosis) → Fetal Complications ✅ Monitor Creatinine, GFR, & Proteinuria Every 4-6 Weeks

Stages of CKD & Pregnancy Risks 3. Fluid & Electrolyte Balance

GFR ✅ Monitor & Manage Hyperkalemia (Avoid High-Potassium
CKD Stage (mL/min/1.73 Pregnancy Risk Foods if K⁺ is High)
m²) ✅ Sodium Restriction for Hypertension & Edema Control
✅ Monitor for Acidosis & Correct with Sodium Bicarbonate
Low risk (Monitor BP &
Stage 1 ≥90 (If Needed)
proteinuria)
Moderate risk (Hypertension
Stage 2 60-89 4. Anemia Management
risk)
✅ Iron Supplementation (Oral or IV If Severe Deficiency)
High risk (Preeclampsia, FGR,
Stage 3 30-59 ✅ Erythropoietin (EPO) Therapy (For Severe CKD-Related
Preterm birth)
Anemia)
Very high risk (Severe
Stage 4 15-29 complications, may require
5. Dialysis in Pregnancy (For ESRD or Severe CKD
dialysis)
Progression)
Stage 5 Extreme risk (Dialysis
<15 🚨 Indications for Dialysis in Pregnancy:
(ESRD) required, high fetal mortality)
✔ GFR <15 mL/min (End-Stage Renal Disease - ESRD)
✔ Severe Uremia (Creatinine >5 mg/dL, BUN >60 mg/dL)
Signs & Symptoms ✔ Severe Fluid Overload or Pulmonary Edema
🔹 Early CKD (Mild Cases, May Be Asymptomatic) ✔ Refractory Hyperkalemia & Metabolic Acidosis
✔ Mild fatigue & weakness 📌 Hemodialysis (HD) is preferred over Peritoneal Dialysis
✔ Mild edema (Face, hands, legs) (PD) in pregnancy.
✔ Proteinuria (Foamy Urine, Early Sign) 📌 Dialysis Frequency Increased (5-6 Times Per Week) to
🔹 Advanced CKD (Moderate-Severe Cases) Maintain Fetal Growth.
🚨 Hypertension (Common in CKD & Pregnancy, May Lead
to Preeclampsia)
Nursing Interventions
🚨 Severe Swelling (Edema – Legs, Face, Lungs –
✔ Monitor BP, Edema, & Signs of Preeclampsia
Pulmonary Edema Risk)
(Proteinuria, Headache, Vision Changes)
🚨 Decreased Urine Output (Oliguria or Fluid Retention)
✔ Encourage Adherence to Antihypertensive & Renal Diet
🚨 Nausea, Vomiting, Anemia, & Muscle Cramps (Due to
Recommendations
Uremia & Electrolyte Imbalances) ✔ Assess for Anemia & Educate on Iron & EPO Therapy
🔹 Fetal Complications
✔ Monitor Fetal Growth via Ultrasound & Doppler Studies
⚠ Fetal Growth Restriction (FGR, IUGR)
✔ Educate on Dialysis (If Needed) & Fluid Management
⚠ Low Birth Weight (LBW)
⚠ Preterm Birth & Neonatal Intensive Care (NICU)
Pneumonia in Pregnancy
Admission
Definition
⚠ Stillbirth (In Severe CKD or ESRD)
Pneumonia in pregnancy is a lower respiratory tract
infection that causes inflammation of the lungs, leading to
Diagnosis cough, fever, difficulty breathing, and hypoxia. Pregnant
📌 Serum Creatinine & Blood Urea Nitrogen (BUN) – women are at higher risk due to immune suppression,
Measures kidney function increased oxygen demand, and reduced lung capacity.
📌 Glomerular Filtration Rate (GFR) – Classifies CKD stage
Causes & Risk Factors 📌 Nasopharyngeal Swab (For Viral Causes – Influenza,
Common Causes (Pathogens) COVID-19 Testing)
🔹 Bacterial Pneumonia (Most Common):
 Streptococcus pneumoniae (Pneumococcus) – Most Treatment & Management
common 1. Antibiotic Therapy (For Bacterial Pneumonia) – SAFE IN
 Haemophilus influenzae PREGNANCY
 Mycoplasma pneumoniae (Atypical Pneumonia – ✅ First-Line Antibiotics (Mild-Moderate Cases):
"Walking Pneumonia")  Amoxicillin-Clavulanate (Augmentin)
🔹 Viral Pneumonia:  Azithromycin (For Atypical Pneumonia, Safe in
 Influenza (Flu, Severe in Pregnancy) Pregnancy)
 Respiratory Syncytial Virus (RSV) ✅ For Severe or Hospitalized Cases:
 COVID-19, SARS, MERS  Ceftriaxone (IV Cephalosporins, Safe in Pregnancy)
🔹 Fungal Pneumonia (Rare, In Immunocompromised  Vancomycin (For MRSA Pneumonia, If Indicated)
Pregnant Women): ❌ Avoid Fluoroquinolones (Ciprofloxacin, Levofloxacin –
 Pneumocystis jirovecii (In HIV+ Patients) Teratogenic in Pregnancy)

Risk Factors in Pregnancy 2. Antiviral Therapy (If Viral Pneumonia, Especially

✅ Weakened Immune System (Physiologic Influenza or COVID-19)
Immunosuppression in Pregnancy) ✅ Oseltamivir (Tamiflu) – Safe & Recommended for
✅ Pre-existing Conditions (Asthma, Diabetes, Anemia, HIV, Pregnant Women with Influenza
Heart Disease) ✅ Supportive Care (Oxygen, Hydration, Fever Control)
✅ Smoking & Secondhand Smoke Exposure
✅ Poor Prenatal Nutrition & Vitamin Deficiency (Vitamin D, 3. Supportive Management
Iron Deficiency Anemia) ✔ Oxygen Therapy (If SpO₂ < 94%) – Prevents Fetal
✅ Frequent Exposure to Sick Individuals (Healthcare Hypoxia
Workers, Teachers, etc.) ✔ IV Fluids – Prevents Dehydration & Maintains
Circulatory Volume
Pathophysiology ✔ Acetaminophen (Paracetamol) – Fever & Pain Control
1️⃣ Inhalation of Pathogen → Bacteria/Virus enters the lungs (Safe in Pregnancy)
via droplets. ✔ Nebulized Bronchodilators (Albuterol, If Wheezing
2️⃣ Inflammation of Alveoli → Fluid & pus fill alveolar sacs, Present)
reducing gas exchange. ✔ Rest & Proper Hydration (Encourage Fluids, Warm
3️⃣ Hypoxia & Respiratory Distress → Reduced oxygen Soups, Steam Inhalation)
delivery to mother & fetus.
4️⃣ Systemic Inflammatory Response → Fever, increased Complications
heart rate (tachycardia). 🚨 Maternal Complications:
5️⃣ Potential Complications → Pulmonary edema, sepsis,  Respiratory Failure (ARDS – Acute Respiratory
preterm labor. Distress Syndrome)
 Sepsis & Multi-Organ Failure
Signs & Symptoms  Pleural Effusion (Fluid Around Lungs, Needs
🚨 General Symptoms: Drainage)
✔ Fever (>38°C or 100.4°F) 🚨 Fetal Complications:
✔ Chills & Sweating  Fetal Hypoxia → Growth Restriction, Low Birth
✔ Cough (Productive or Dry, Sometimes with Mucus or Weight
Blood-Tinged Sputum)  Preterm Labor (Due to Systemic Infection &
✔ Shortness of Breath (Dyspnea, Worsening on Exertion) Maternal Distress)
✔ Chest Pain (Pleuritic – Worse with Deep Breathing or  Stillbirth (In Severe Untreated Cases)
Coughing)
✔ Fatigue & Weakness Prevention
🚨 Severe Cases (Complications): 🩺 Prenatal Vaccination (Recommended for ALL Pregnant
⚠ Cyanosis (Bluish Lips, Fingertips – Severe Hypoxia) Women)
⚠ Altered Mental Status (Confusion, Lethargy, Dizziness) ✅ Influenza Vaccine (Flu Shot, Anytime in Pregnancy,
⚠ Rapid Breathing (Tachypnea) & High Heart Rate Protects Mother & Baby)
(Tachycardia) ✅ COVID-19 Vaccine (Recommended for Pregnant Women,
⚠ Low Blood Pressure (Sepsis Risk) Prevents Severe Disease)
🔹 Fetal Risks: ✅ Pneumococcal Vaccine (For High-Risk Women – CKD,
 Preterm Labor & Preterm Birth Diabetes, Asthma, HIV+)
 Low Birth Weight (LBW) 🚫 Avoid Smoking & Secondhand Smoke Exposure
 Fetal Hypoxia → Risk of Stillbirth or Neonatal 🛌 Practice Good Hand Hygiene (Reduces Risk of
Respiratory Distress Respiratory Infections)
‍♀️Boost Immunity – Healthy Diet, Iron-Rich Foods,
Diagnosis Hydration
📌 Chest X-ray (CXR) – Safe in Pregnancy (Shield
Abdomen) → Confirms lung infection Nursing Interventions
📌 Complete Blood Count (CBC) – Leukocytosis (Increased ✔ Monitor Respiratory Status (SpO₂, RR, Lung Sounds)
WBCs, Infection Marker) ✔ Administer Oxygen & Position Patient (Semi-Fowler’s to
📌 Arterial Blood Gas (ABG) – Evaluates Oxygenation & Improve Breathing)
Acidosis in Severe Cases ✔ Encourage Coughing & Deep Breathing Exercises (To
📌 Sputum Culture & Blood Culture – Identifies Bacterial Clear Secretions)
Cause ✔ Administer Medications as Prescribed (Antibiotics,
Antivirals, Antipyretics) 📌 Chest X-ray (If Suspected Infection or Severe
✔ Monitor Fetal Well-being (Fetal Heart Rate, Kick Counts, Exacerbation, Shield Abdomen)
Ultrasound If Needed)
✔ Educate on Vaccination, Hydration, & Early Signs of Effects on Pregnancy & Fetus
Respiratory Distress 🚨 Maternal Risks:
✔ Preeclampsia & Hypertension
Asthma in Pregnancy ✔ Gestational Diabetes (Due to Steroid Use)
Definition ✔ Increased Risk of Infections (Pneumonia, Flu)
Asthma in pregnancy is a chronic inflammatory airway ✔ Cesarean Delivery (If Poorly Controlled Asthma)
disease characterized by bronchospasm, airway 🚨 Fetal Risks:
inflammation, and mucus production, leading to reversible ✔ Fetal Hypoxia → Growth Restriction (IUGR), Low Birth
airway obstruction. Poorly controlled asthma increases the Weight
risk of maternal and fetal complications, including ✔ Preterm Labor & Preterm Birth
preeclampsia, preterm birth, and low birth weight. ✔ Neonatal Hypoxia & NICU Admission
✔ Higher Risk of Asthma & Allergies in Baby
Causes & Risk Factors
Triggers (Exacerbating Factors) Treatment & Management
🔹 Allergens (Dust, pollen, mold, pet dander) 1. Controller Medications (Daily, Prevents Attacks) – SAFE
🔹 Respiratory Infections (Colds, flu, pneumonia) IN PREGNANCY
🔹 Exercise & Cold Air Exposure ✅ Inhaled Corticosteroids (ICS) – First-line Treatment
🔹 Tobacco Smoke & Air Pollution  Budesonide (Preferred in Pregnancy, Category B)
🔹 Strong Odors, Perfumes, Chemical Irritants  Beclomethasone, Fluticasone (Alternatives, Safe in
🔹 Hormonal Changes in Pregnancy (Increased estrogen & Pregnancy)
progesterone) ✅ Long-Acting Beta-Agonists (LABAs) – For Moderate-
🔹 Gastroesophageal Reflux Disease (GERD) Severe Asthma
Risk Factors for Poor Asthma Control  Salmeterol, Formoterol (Used with ICS for Better
✅ History of Severe Asthma Attacks Control)
✅ Non-Adherence to Medication ✅ Leukotriene Receptor Antagonists (LTRAs) – Alternative
✅ Obesity & Poor Nutrition for Allergy-Related Asthma
✅ Pre-existing Allergic Rhinitis or Eczema  Montelukast (Singulair) – Safe in Pregnancy
✅ Psychosocial Stress (Anxiety, Depression, Lack of
Support) 2. Reliever Medications (Rescue for Acute Symptoms)
✅ Short-Acting Beta-Agonists (SABAs) – First-Line Rescue
Pathophysiology  Albuterol (Salbutamol, Ventolin) – Safe in Pregnancy
1️⃣ Exposure to Trigger → Inflammatory response in airways  Levalbuterol – Alternative if Albuterol Causes Side
2️⃣ Bronchial Hyperresponsiveness → Smooth muscle Effects
constriction (bronchospasm) 🚨 Frequent Need for Rescue Inhaler (>2x Per Week) = Poor
3️⃣ Airway Inflammation & Swelling → Narrowed airways Control, Needs Step-Up Therapy!
4️⃣ Increased Mucus Production → Obstructs airflow
5️⃣ Decreased Oxygen Exchange → Risk of Maternal & 3. Emergency Management (Severe Asthma Attack in
Fetal Hypoxia Pregnancy)
🚑 Hospitalization if:
Signs & Symptoms ✔ Severe Dyspnea (Unable to Speak Full Sentences)
🚨 Mild to Moderate Symptoms: ✔ SpO₂ < 94% (Oxygen Required)
✔ Shortness of Breath (Dyspnea) ✔ Fetal Distress (Abnormal Fetal Heart Rate, Decreased
✔ Wheezing & Coughing (Worse at Night or Early Morning) Movements)
✔ Chest Tightness or Pressure ✅ Treatment in Emergency:
✔ Increased Mucus Production 1. Oxygen Therapy (Maintain SpO₂ > 95%)
🚨 Severe Asthma Attack (Medical Emergency! 🚑) 2. Nebulized Albuterol + Ipratropium
⚠ Severe Dyspnea (Struggling to Breathe, Speaking in (Bronchodilation)
Short Phrases) 3. IV Corticosteroids (Methylprednisolone,
⚠ Cyanosis (Bluish Lips, Fingertips – Sign of Severe Prednisone – Safe in Pregnancy)
Hypoxia) 4. Magnesium Sulfate IV (If Severe Bronchospasm,
⚠ Tachycardia (Increased Heart Rate >120 bpm) Helps Relax Airways)
⚠ Silent Chest (No Wheezing Due to Severe Airflow 5. Fetal Monitoring (Check for Distress, Decreased
Obstruction) Movements)
⚠ Decreased Fetal Movements (Fetal Distress Due to
Maternal Hypoxia) Prevention & Lifestyle Modifications
✅ Avoid Triggers (Allergens, Smoke, Strong Perfumes,
Diagnosis Cold Air)
📌 History & Physical Exam – Symptoms, triggers, past ✅ Get Flu & COVID-19 Vaccinations (Reduces Risk of
asthma attacks Respiratory Infections)
📌 Pulmonary Function Tests (PFTs) – Spirometry – ✅ Use Peak Flow Meter at Home (Detect Worsening
Measures airflow obstruction Symptoms Early)
📌 Peak Expiratory Flow Rate (PEFR) – Home Monitoring – ✅ Stay Hydrated & Maintain Good Nutrition (Iron, Vitamin
Detects worsening asthma D, Omega-3s for Lung Health)
📌 Oxygen Saturation (SpO₂) – Hypoxia Risk ✅ Manage GERD (Elevate Head While Sleeping, Avoid
📌 Arterial Blood Gas (ABG) – In Severe Cases (Checks Spicy Foods)
Oxygenation & CO₂ Retention) ✅ Regular Prenatal Checkups & Pulmonary Follow-Up
Nursing Interventions
✔ Monitor Respiratory Status (RR, SpO₂, Lung Sounds, Diagnosis
Peak Flow Readings) 📌 Clinical Assessment – Based on Symptoms & Physical
✔ Administer Oxygen if Needed (Maintain Maternal SpO₂ > Examination
95%) 📌 Rapid Influenza Test (If Flu Suspected During Flu
✔ Ensure Adherence to Medications (Educate on Season)
Controller vs. Rescue Inhalers) 📌 COVID-19 Test (If Symptoms Overlap or Close Contact
✔ Teach Proper Inhaler Technique (Use Spacer for ICS, Exposure)
Prevent Oral Thrush) 📌 Throat Swab (To Rule Out Strep Throat if Severe Sore
✔ Monitor Fetal Well-being (Fetal Heart Rate, Kick Counts) Throat Present)
✔ Educate on Trigger Avoidance & Symptom Monitoring
Treatment & Management
🔹 No Specific Cure – Symptomatic Treatment
Recommended
Acute Nasopharyngitis in Pregnancy (Common Cold) 🔹 Most Cases Resolve on Their Own in 7-10 Days
Definition 🔹 Antibiotics Are NOT Needed (Unless Secondary
Acute nasopharyngitis, commonly known as the common Bacterial Infection Develops)
cold, is a viral infection affecting the upper respiratory tract, 1. Safe Medications in Pregnancy
primarily the nose and throat. It is self-limiting but can cause ✅ Pain & Fever Relief:
discomfort in pregnancy, with potential risks if associated with  Acetaminophen (Paracetamol) – Safe for Fever &
fever or secondary infections. Body Aches
 ❌ Avoid Ibuprofen, Aspirin, & NSAIDs (Risk of
Causes & Risk Factors Pregnancy Complications)
Common Viral Causes ✅ Nasal Congestion:
🔹 Rhinoviruses (Most Common Cause – 30-50%)  Saline Nasal Spray or Steam Inhalation (Best &
🔹 Coronaviruses (Excluding COVID-19 Strains) Safest Option)
🔹 Adenoviruses  Oxymetazoline Nasal Spray (Use for MAX 3 Days to
🔹 Parainfluenza Viruses Avoid Rebound Congestion)
🔹 Respiratory Syncytial Virus (RSV)  ❌ Avoid Oral Decongestants (Pseudoephedrine &
Risk Factors Phenylephrine) in First Trimester – Risk of Birth
✅ Weakened Immune System (Normal in Pregnancy) Defects
✅ Exposure to Infected Individuals (Crowded Places, ✅ Cough Relief:
Schools, Hospitals)  Honey & Warm Lemon Water (Natural Cough
✅ Cold Weather & Seasonal Changes Soother)
✅ Poor Hand Hygiene  Dextromethorphan (DM) – Safe for Dry Cough (Avoid
✅ Pre-existing Allergies or Sinus Issues in 1st Trimester If Possible)
 ❌ Avoid Codeine-Based Cough Syrups (Risk of
Pathophysiology Respiratory Depression in Baby)
1️⃣ Viral Entry Through Nose/Mouth → Infects Nasal & ✅ Sore Throat Relief:
Throat Mucosa  Warm Saltwater Gargles (Reduces Throat Irritation &
2️⃣ Local Inflammation → Swelling, Congestion, & Mucus Inflammation)
Production  Lozenges with Honey, Lemon, or Menthol (Safe in
3️⃣ Immune Response → Fever, Body Aches, Fatigue Moderation)
4️⃣ Symptoms Peak in 2-3 Days & Resolve Within 7-10  Chamomile or Ginger Tea with Honey (Soothes
Days Irritated Throat)
✅ Hydration & Immune Support:
 Increase Fluid Intake (Water, Clear Soups, Herbal
Signs & Symptoms
Teas)
🚨 Early Symptoms (Day 1-2):
 Vitamin C-Rich Fruits (Oranges, Kiwi, Strawberries –
✔ Sore Throat & Scratchiness
Helps Shorten Cold Duration)
✔ Sneezing & Runny Nose (Rhinorrhea, Clear or White
 Zinc Lozenges (If Taken Early, May Reduce Duration
Mucus)
of Symptoms)
✔ Mild Cough
🚨 Peak Symptoms (Day 3-5):
✔ Nasal Congestion (Blocked Nose) Prevention Strategies
✔ Headache & Sinus Pressure 🛑 Avoid Contact with Sick Individuals
✔ Low-Grade Fever (Usually <38°C or 100.4°F) 🧼 Frequent Handwashing (Soap & Water for 20 Seconds)
✔ Fatigue & Body Aches 🤧 Use Tissue or Elbow When Sneezing/Coughing
✔ Watery Eyes & Mild Ear Discomfort 🏡 Disinfect Commonly Touched Surfaces (Phones,
🚨 Recovery Phase (Day 6-10): Doorknobs, Keyboards)
🍊 Boost Immunity – Eat a Balanced Diet, Take Prenatal
✔ Symptoms Gradually Improve
Vitamins
✔ Cough May Persist for 1-2 Weeks
💉 Get Flu & COVID-19 Vaccines (Reduces Risk of Severe
⚠ When to Seek Medical Help? (Complications or
Illness During Pregnancy)
Secondary Infection)
 High Fever > 38.5°C (101.3°F) – Possible Flu or
Bacterial Infection Nursing Interventions
 Severe Sinus Pain, Earache – Sinusitis or Otitis ✔ Monitor for Signs of Complications (Pneumonia,
Media Sinusitis, Dehydration)
 Green/Yellow Thick Mucus + Fever – Possible ✔ Encourage Rest & Proper Hydration (Prevents Fatigue &
Bacterial Infection Dehydration)
 Shortness of Breath or Wheezing – Possible ✔ Administer Safe Medications as Prescribed
Pneumonia or Asthma Exacerbation (Acetaminophen for Fever, Saline for Congestion)
✔ Educate on Non-Pharmacological Remedies (Steam 📌 Clinical Assessment – History of Sudden Fever, Body
Inhalation, Warm Liquids, Humidifier Use) Aches, & Respiratory Symptoms
✔ Advise on When to Seek Medical Attention (Persistent 📌 Rapid Influenza Test (Nasal or Throat Swab) – Confirms
High Fever, Severe Symptoms, Fetal Distress) Influenza A or B
📌 Chest X-ray (If Suspected Pneumonia – Abdominal
Shielding Used)
📌 Oxygen Saturation Monitoring (Assess for Hypoxia,
Influenza in Pregnancy Fetal Distress)
Definition
Influenza (flu) is a highly contagious viral respiratory Treatment & Management
infection caused by influenza A, B, or C viruses. Pregnant 1. Antiviral Therapy (Best If Given Within 48 Hours of
women are at higher risk of severe illness, complications, Symptom Onset)
and hospitalization due to physiological changes in the ✅ Oseltamivir (Tamiflu) – First-line Treatment in Pregnancy
immune, cardiovascular, and respiratory systems.  75 mg orally twice daily for 5 days
 Reduces severity & duration of illness, prevents
Causes & Risk Factors complications
Causes ✅ Alternative Antivirals (If Resistance to Oseltamivir)
🔹 Influenza A & B Viruses (Most Common Causes)  Zanamivir (Inhaled) – Safe in Pregnancy
🔹 Airborne Transmission (Droplets from  Baloxavir (Less Studied in Pregnancy – Use If
Coughing/Sneezing) Benefits Outweigh Risks)
🔹 Direct Contact (Contaminated Hands, Surfaces) 🚨 Antiviral Treatment Is Recommended for All Pregnant
Risk Factors for Severe Influenza in Pregnancy Women with Influenza (Even If Mild Symptoms!)
✅ Pregnancy Itself (Weakened Immune System)
✅ Asthma, Diabetes, or Heart Disease 2. Supportive Care (Symptom Management)
✅ Obesity (BMI > 30) ✅ Fever & Pain Relief:
✅ Smoking or Secondhand Smoke Exposure  Acetaminophen (Paracetamol) – Safe for Fever &
✅ Not Receiving the Flu Vaccine Body Aches
 ❌ Avoid NSAIDs (Ibuprofen, Aspirin – Risk of
Pathophysiology Pregnancy Complications)
1️⃣ Influenza Virus Enters Respiratory Tract → Attaches to ✅ Hydration & Nutrition:
epithelial cells  Drink Plenty of Fluids (Water, Broth, Electrolyte
2️⃣ Virus Replicates Rapidly → Spreads through airways Drinks)
3️⃣ Inflammatory Response Activated → Fever, fatigue,  Soft, Nutrient-Rich Foods (Soups, Fruits, Protein
muscle aches Sources)
4️⃣ Complications May Occur → Pneumonia, respiratory ✅ Nasal Congestion Relief:
distress, fetal distress  Saline Nasal Spray or Steam Inhalation
 Humidifier Use to Keep Airways Moist
Signs & Symptoms  ❌ Avoid Oral Decongestants in First Trimester
🚨 Mild to Moderate Symptoms: (Pseudoephedrine, Phenylephrine – Risk of Birth
✔ Sudden High Fever (> 38°C or 100.4°F) Defects)
✔ Chills & Severe Body Aches (Myalgia, Arthralgia) ✅ Cough & Sore Throat Relief:
✔ Fatigue & Weakness  Warm Saltwater Gargles (Soothes Sore Throat)
✔ Headache & Sore Throat  Honey & Lemon Tea (Natural Cough Suppressant,
✔ Dry Cough & Runny Nose (May Progress to Productive Safe in Pregnancy)
Cough)  Dextromethorphan (DM) for Cough – Safe if Used in
✔ Shortness of Breath (In Some Cases) Moderation
🚨 Severe Symptoms (Complications & Hospitalization ✅ Rest & Isolation (To Prevent Spreading the Virus to
Indicated): Others)
⚠ Persistent High Fever (> 39°C or 102°F) Despite
Treatment Prevention Strategies
⚠ Severe Shortness of Breath (Dyspnea, Wheezing, Chest 💉 Influenza Vaccination (Flu Shot) – Recommended in Any
Pain) Trimester
⚠ Bluish Lips or Face (Cyanosis – Sign of Hypoxia)  Protects Mother & Baby (Antibodies Pass to Baby for
⚠ Confusion, Dizziness, or Fainting 6 Months After Birth)
⚠ Decreased Fetal Movements or Fetal Heart Rate  Flu Vaccine Does Not Cause Flu (Inactivated Virus
Abnormalities Form is Used)
 Live Nasal Spray Vaccine (FluMist) Is NOT
Complications in Pregnancy Recommended During Pregnancy
🚨 Maternal Risks: 🛑 Avoid Close Contact with Sick Individuals
✔ Pneumonia (Viral or Secondary Bacterial Infection) 🧼 Frequent Handwashing with Soap & Water
✔ Acute Respiratory Distress Syndrome (ARDS) 😷 Wear a Mask in High-Risk Settings (Hospitals, Crowded
✔ Preterm Labor & Delivery Areas)
✔ Severe Dehydration 🏡 Disinfect Commonly Used Surfaces (Phones,
Doorknobs, Remote Controls)
🚨 Fetal Risks:
✔ Preterm Birth
✔ Low Birth Weight Nursing Interventions
✔ Miscarriage or Stillbirth (Severe Cases) ✔ Monitor Maternal & Fetal Vital Signs (Fetal Heart Rate,
✔ Neonatal Influenza Infection Maternal Oxygen Levels)
✔ Assess for Signs of Respiratory Distress (Dyspnea,
Cyanosis, Increased Work of Breathing)
Diagnosis
✔ Administer Oseltamivir (Tamiflu) as Prescribed
✔ Encourage Fluid Intake & Rest 🚨 TB Treatment Is Essential in Pregnancy! Untreated TB
✔ Provide Fever Management (Acetaminophen, Cooling Poses More Risks Than Anti-TB Drugs!
Measures) 1. First-Line Anti-TB Medications (RIPE Therapy)
✔ Educate on Flu Vaccine & Importance of Early ✅ Rifampin (RIF) – 10 mg/kg/day (Safe in Pregnancy)
Treatment ✅ Isoniazid (INH) + Pyridoxine (Vitamin B6) – Prevents
✔ Monitor for Signs of Preterm Labor or Fetal Distress Neuropathy
✅ Ethambutol (EMB) – 15 mg/kg/day
Tuberculosis (TB) in Pregnancy ✅ Pyrazinamide (PZA) – Safe but May Be Avoided in Some
Definition Cases
Tuberculosis (TB) is a chronic infectious disease caused by 📌 Standard TB Treatment Regimen in Pregnancy (Active
Mycobacterium tuberculosis, primarily affecting the lungs but TB)
capable of spreading to other organs (extrapulmonary TB). 🔹 2 Months: INH + RIF + EMB ± PZA (Intensive Phase)
Pregnant women with TB require special care, as the infection 🔹 4 Months: INH + RIF (Continuation Phase)
can lead to maternal complications, poor pregnancy 🚨 Drug-Resistant TB Requires Specialist Care (Second-
outcomes, and congenital TB in the newborn if untreated. Line Drugs Used)

Causes & Risk Factors 2. Supportive Care & Symptom Management

Causes ✅ Proper Nutrition (Protein-Rich Diet to Prevent Weight
🔹 Mycobacterium tuberculosis (Airborne Bacteria) Loss)
🔹 Transmission via Inhalation of Infectious Droplets ✅ Hydration & Rest (To Strengthen Immunity)
(Coughing, Sneezing, Talking) ✅ Cough Hygiene (Mask Wearing, Covering Mouth When
Risk Factors for TB in Pregnancy Coughing)
✅ HIV Infection (Weak Immune System) ✅ Prenatal Monitoring (Fetal Growth Monitoring for IUGR
✅ Close Contact with an Active TB Case Risk)
✅ Living in Crowded, Poorly Ventilated Areas 🚨 TB & HIV Co-Infection (More Severe Disease
✅ Malnutrition & Low Socioeconomic Status Progression!)
✅ Substance Abuse (Smoking, Alcohol, Drug Use) ✔ Antiretroviral Therapy (ART) Must Continue Alongside
✅ History of TB or Incomplete TB Treatment TB Treatment
✔ TB-HIV Drug Interactions Require Close Monitoring
Pathophysiology
1️⃣ TB Bacteria Enter Lungs → Alveolar Macrophages Engulf Prevention Strategies
Bacteria 💉 BCG Vaccine (Given at Birth in High-TB Prevalence
2️⃣ Latent TB (Dormant Bacteria) or Active TB (Disease Areas to Prevent Severe TB in Infants)
Progresses) 😷 Avoid Close Contact with TB Patients
3️⃣ Active TB Causes Lung Inflammation & Caseous 🏡 Improve Ventilation & Reduce Overcrowding
Necrosis 🔬 Screen High-Risk Pregnant Women (HIV+, Close TB
4️⃣ Spread to Bloodstream & Other Organs Contacts, Malnutrition)
(Extrapulmonary TB Possible)
Nursing Interventions
Signs & Symptoms ✔ Monitor Maternal & Fetal Well-being (Fetal Growth,
🚨 Pulmonary TB (Most Common Form) Preterm Labor Risk)
✔ Persistent Cough (≥2 Weeks, With or Without Blood) ✔ Ensure Adherence to Anti-TB Therapy (Directly
✔ Unexplained Weight Loss & Fatigue Observed Therapy [DOT] Preferred)
✔ Night Sweats & Fever ✔ Assess for Side Effects (Hepatitis from INH, Ocular
✔ Loss of Appetite Toxicity from EMB)
✔ Chest Pain & Shortness of Breath ✔ Educate on Infection Control Measures (Cough Hygiene,
🚨 Extrapulmonary TB (Spreads Beyond the Lungs) Mask Wearing, Handwashing)
✔ TB Meningitis (Headache, Stiff Neck, Confusion) ✔ Provide Emotional Support (TB Stigma Can Cause
✔ TB Lymphadenitis (Swollen Lymph Nodes, Especially in Stress & Depression)
the Neck)
✔ Bone & Joint TB (Back Pain, Joint Swelling) Chronic Obstructive Pulmonary Disease (COPD) in
✔ Genitourinary TB (Pelvic Pain, Infertility, Hematuria) Pregnancy
🚨 Congenital TB (Newborn Infection if Untreated During Definition
Pregnancy) Chronic Obstructive Pulmonary Disease (COPD) is a
✔ Low Birth Weight, Respiratory Distress, Fever progressive lung disease characterized by airflow
✔ Hepatosplenomegaly (Enlarged Liver & Spleen) obstruction, including chronic bronchitis and emphysema.
✔ Poor Feeding & Lethargy Pregnancy places additional stress on the respiratory
system, increasing the risk of maternal hypoxia and fetal
complications.
Diagnosis
📌 Tuberculin Skin Test (TST) – Safe in Pregnancy
📌 Interferon-Gamma Release Assay (IGRA) – Confirms Causes & Risk Factors
Latent TB Causes
📌 Chest X-ray with Abdominal Shielding (For Active TB 🔹 Smoking (Primary Cause)
Diagnosis) 🔹 Exposure to Air Pollution, Biomass Fuels, and
📌 Sputum Acid-Fast Bacilli (AFB) Smear & Culture – Occupational Dusts
Confirms Active TB 🔹 Genetic Factors (Alpha-1 Antitrypsin Deficiency – Rare
📌 GeneXpert MTB/RIF – Rapid Test for TB & Rifampin Cause of COPD)
Resistance 🔹 Chronic Respiratory Infections
Risk Factors in Pregnancy
✅ History of COPD or Chronic Bronchitis
Treatment & Management
✅ Smoking During Pregnancy
✅ Asthma or Respiratory Infections  Short-Acting Beta-Agonists (SABAs) – Albuterol
✅ Obesity (Can Worsen Breathing Difficulties) (Salbutamol) (Safe in Pregnancy)
✅ Pre-existing Cardiovascular Disease  Long-Acting Beta-Agonists (LABAs) – Salmeterol
(Use If Needed for Maintenance Therapy)
Pathophysiology ✅ Inhaled Corticosteroids (ICS) – For Moderate to Severe
1️⃣ Inflammation & Mucus Production → Narrowed Airways COPD
& Airflow Limitation  Budesonide (Preferred in Pregnancy)
2️⃣ Loss of Alveolar Elasticity → Air Trapping &  Fluticasone (Alternative Option)
Hyperinflation ✅ Anticholinergics (Use with Caution in Pregnancy)
3️⃣ Reduced Oxygen Exchange → Hypoxia & Increased  Ipratropium (Short-Acting, Can Be Used If
Respiratory Workload Needed)
4️⃣ Increased Carbon Dioxide Retention → Respiratory  Tiotropium (Long-Acting, Limited Pregnancy Data
Acidosis (Severe Cases) – Use Only If Benefits Outweigh Risks)
✅ Antibiotics (If Bacterial Infection Present)
Signs & Symptoms  Amoxicillin-Clavulanate, Azithromycin, or
🚨 Common Symptoms of COPD in Pregnancy Cephalosporins (Safe Choices)
✔ Chronic Cough (With or Without Mucus Production) ✅ Cough Suppressants (If Needed, With Caution)
✔ Shortness of Breath (Worsens with Pregnancy  Dextromethorphan – Use Sparingly in Pregnancy
Progression) 🚨 Avoid the Following Medications in Pregnancy:
✔ Wheezing & Chest Tightness ❌ Oral Corticosteroids (Prednisone, Prednisolone) – Only
✔ Fatigue Due to Decreased Oxygen Supply for Severe Exacerbations
✔ Cyanosis (In Severe Cases – Lips or Fingernails May ❌ Theophylline – Not Recommended Due to Toxicity Risk
Turn Blue) in Pregnancy
🚨 Severe Symptoms (Requiring Urgent Medical Attention)
⚠ Severe Shortness of Breath (Dyspnea at Rest) 3. Lifestyle & Supportive Measures
⚠ Frequent COPD Exacerbations (Worsening Symptoms, ✅ Smoking Cessation (Critical for Maternal & Fetal Health!)
Increased Mucus Production) ✅ Proper Nutrition (High-Protein Diet, Adequate Fluids to
⚠ Respiratory Failure (Confusion, Altered Consciousness, Prevent Dehydration)
Severe Cyanosis) ✅ Pulmonary Rehabilitation (Breathing Exercises, Physical
⚠ Signs of Fetal Distress (Decreased Fetal Movements, Activity Management)
Abnormal Fetal Heart Rate) ✅ Avoid Triggers (Dust, Pollutants, Cold Air, Strong Odors)
✅ Frequent Prenatal Visits (Monitor for Complications Like
Complications in Pregnancy Preterm Labor, Fetal Growth Restrictions)
🚨 Maternal Risks 🚨 Emergency Plan:
✔ Increased Risk of Respiratory Infections (Pneumonia, ✔ Seek Immediate Care If Severe Breathlessness,
Acute Bronchitis) Cyanosis, or Altered Consciousness Occur
✔ Hypoxia Leading to Respiratory Failure (Severe Cases ✔ Hospitalization May Be Needed for Oxygen Therapy &
May Require Ventilation) Intensive Monitoring
✔ Increased Risk of Preterm Labor
✔ Higher Chance of Preeclampsia Due to Oxygen Prevention Strategies
Imbalance 💉 Influenza Vaccine – Strongly Recommended in COPD
🚨 Fetal Risks Patients
✔ Intrauterine Growth Restriction (IUGR) Due to Hypoxia 💉 Pneumococcal Vaccine – Given If Needed Based on Risk
✔ Preterm Birth & Low Birth Weight Factors
✔ Neonatal Respiratory Distress Syndrome (RDS) 🏠 Avoid Environmental Pollutants (Dust, Smoke,
✔ Stillbirth (In Severe Maternal Hypoxia Cases) Chemicals, Strong Perfumes)
😷 Mask Wearing in High-Risk Areas to Reduce Infection
Exposure
Diagnosis
📌 Clinical Assessment – History of Chronic Cough,
Dyspnea, Smoking Exposure Nursing Interventions
📌 Pulmonary Function Tests (PFTs) – Usually Avoided in ✔ Monitor Maternal & Fetal Vital Signs (FHR, Oxygen
Pregnancy Unless Necessary Saturation, Respiratory Rate)
📌 Oxygen Saturation Monitoring (Ensuring Maternal ✔ Assess for Worsening COPD Symptoms & Early Signs
Oxygen > 95%) of Hypoxia
📌 Arterial Blood Gas (ABG) – If Severe COPD Suspected ✔ Administer Bronchodilators & Oxygen as Prescribed
(Detects Hypoxia & CO2 Retention) ✔ Educate on Medication Use (Proper Inhaler Technique,
📌 Chest X-ray (If Indicated, With Abdominal Shielding) Adherence to Treatment Plan)
📌 Sputum Culture (To Rule Out Infection in Case of ✔ Encourage Pulmonary Hygiene (Hydration, Effective
Exacerbation) Coughing Techniques, Chest Physiotherapy if Needed)
✔ Support Smoking Cessation & Provide Counseling
✔ Educate on Recognizing Exacerbation Symptoms &
Treatment & Management
When to Seek Help
🚨 Goal: Maintain Oxygenation & Prevent COPD
Exacerbations to Protect Mother & Baby
1. Oxygen Therapy Cystic Fibrosis (CF) in Pregnancy
✅ Oxygen Supplementation If O2 Saturation < 95% Definition
✅ Monitor ABGs to Prevent Hypercapnia (Too Much CO2 in Cystic Fibrosis (CF) is a genetic disorder affecting the
Blood) respiratory, digestive, and reproductive systems, caused
2. Medications (Safe for Pregnancy) by mutations in the CFTR (Cystic Fibrosis Transmembrane
✅ Bronchodilators (First-Line Treatment) Conductance Regulator) gene. It leads to thick, sticky
mucus production, causing chronic lung infections,
pancreatic insufficiency, and complications in pregnancy.
 Pancreatic Enzyme Needs)
Causes & Risk Factors 📌 Glucose Tolerance Test (Screening for CF-Related
Cause Diabetes)
🧬 Genetic Mutation in CFTR Gene (Autosomal Recessive 📌 Fetal Growth Ultrasounds (To Detect IUGR or Fetal
Inheritance) Distress)
Risk Factors in Pregnancy 📌 Genetic Testing & Counseling (For CF Carrier Screening
✅ Pre-existing CF Diagnosis with Severe Lung Disease of Partner & Baby)
✅ CF-Related Diabetes (CFRD)
✅ Malnutrition (Common in CF Due to Pancreatic Treatment & Management
Insufficiency) 🚨 Goal: Optimize Lung Function, Nutrition, & Oxygenation
✅ Frequent Pulmonary Exacerbations While Preventing Complications
✅ Infertility Issues (Common in CF but Not Always Present 1. Respiratory Management
in Women) ✅ Airway Clearance Therapies (Critical for Preventing
Infections)
Pathophysiology  Chest Physiotherapy (CPT)
1️⃣ Defective CFTR Protein → Impaired Chloride & Water  Positive Expiratory Pressure (PEP) Devices
Transport  Nebulized Hypertonic Saline (To Help Mucus
2️⃣ Thick Mucus Accumulation → Lung Infections, Airway Clearance)
Obstruction ✅ Bronchodilators (Albuterol for Airway
3️⃣ Pancreatic Insufficiency → Malabsorption, Nutrient Relaxation & Symptom Relief)
Deficiencies ✅ Mucolytics (Dornase Alfa – Helps Break Down
4️⃣ Reproductive Challenges → Thick Cervical Mucus Can Thick Mucus, Safe in Pregnancy)
Cause Infertility ✅ Antibiotic Therapy (For Bacterial Infections –
5️⃣ Pregnancy Adds Increased Oxygen Demand → Risk of Avoid Tetracyclines & Fluoroquinolones)
Respiratory Failure  Safe Options: Penicillins, Cephalosporins,
Azithromycin
Signs & Symptoms in Pregnancy ✅ Oxygen Therapy (If Oxygen Saturation Drops
🚨 Respiratory Symptoms Below 95%)
✔ Chronic Cough (With Thick Sputum Production)
✔ Frequent Lung Infections (Pseudomonas, 2. Nutritional & Gastrointestinal Support
Staphylococcus aureus) ✅ High-Calorie, High-Protein Diet (Essential for Fetal
✔ Shortness of Breath (Worsened in Pregnancy) Growth & Maternal Health)
✔ Clubbing of Fingers (In Advanced Disease) ✅ Pancreatic Enzyme Replacement Therapy (PERT) –
🚨 Gastrointestinal Symptoms Needed for Proper Digestion
✔ Malabsorption (Fatty Stools, Vitamin Deficiencies – A, D, ✅ Vitamin Supplementation (Fat-Soluble Vitamins A, D, E,
E, K) K)
✔ CF-Related Diabetes (CFRD – Gestational Diabetes Risk ✅ Frequent Nutritional Monitoring (To Prevent Malnutrition
Increased) & Weight Loss)
✔ Increased Nutritional Needs (High-Calorie Diet Required
for Fetal Growth) 3. CF-Related Diabetes (CFRD) Management
🚨 Reproductive & Pregnancy-Related Symptoms ✅ Insulin Therapy (Preferred Over Oral Antidiabetic Drugs)
✔ Increased Fatigue Due to Poor Oxygenation ✅ Blood Sugar Monitoring (High Risk of Gestational
✔ Higher Risk of Preterm Labor & Low Birth Weight Diabetes in CF Patients)
✔ Increased Risk of Pulmonary Hypertension & Heart ✅ Balanced Diet with Controlled Carbohydrate Intake
Failure (Severe CF Cases)
4. Infection Prevention & Immunizations
Complications in Pregnancy 💉 Influenza Vaccine (Highly Recommended in CF Pregnant
🚨 Maternal Risks Patients)
✔ Worsening Lung Function (Increased Risk of 💉 Pneumococcal Vaccine (If Not Previously Given)
Respiratory Failure) 💉 COVID-19 Vaccine (Strongly Recommended to Prevent
✔ Frequent Pulmonary Exacerbations (Hospitalization May Respiratory Infections)
Be Needed) 🏠 Avoid Exposure to Sick Individuals (To Prevent
✔ Increased Risk of CF-Related Diabetes (CFRD) & Respiratory Infections)
Gestational Diabetes
✔ Malnutrition (Can Worsen Maternal & Fetal Outcomes) Labor & Delivery Considerations
✔ Meconium Ileus or Bowel Obstruction (Rare, But 🔹 Planned Delivery in a High-Risk Obstetric Unit (With
Possible in Severe CF Cases) Pulmonary & Neonatal Support)
🚨 Fetal Risks 🔹 Vaginal Delivery Preferred (Unless Obstetric Indications
✔ Intrauterine Growth Restriction (IUGR) Due to Maternal for C-Section Exist)
Malnutrition & Hypoxia 🔹 Epidural or Regional Anesthesia (Reduces Respiratory
✔ Preterm Birth & Low Birth Weight Stress Compared to General Anesthesia)
✔ Higher Risk of Neonatal Respiratory Issues 🔹 Oxygen Therapy Available During Labor (To Prevent
✔ Genetic Risk of CF (25% Chance If Both Parents Carry Maternal Hypoxia & Fetal Distress)
the CFTR Mutation)
Postpartum Considerations
Diagnosis & Monitoring in Pregnancy ✔ Increased Risk of Postpartum Exacerbations – Close
📌 Pulmonary Function Tests (PFTs) – Monitors Lung Monitoring Needed
Function ✔ Breastfeeding Encouraged (If Maternal Nutritional
📌 Oxygen Saturation Monitoring (Goal: Maintain > 95%) Status & Lung Function Allow)
📌 Nutritional Assessments (Weight, Vitamin Levels, ✔ Genetic Testing & Counseling for Baby (If Both Parents
Are CF Carriers) 🚨 Maternal Risks
✔ Continue Airway Clearance & Nutritional Support ✔ Appendiceal Rupture (Occurs More Rapidly in
Postpartum Pregnancy, Can Lead to Sepsis)
✔ Peritonitis & Septic Shock
Nursing Interventions ✔ Intestinal Obstruction
✔ Monitor Maternal Oxygen Saturation & Respiratory 🚨 Fetal Risks
Function ✔ Preterm Labor (Irritation of the Peritoneum Can Trigger
✔ Assist with Airway Clearance Techniques & Encourage Uterine Contractions)
Proper Hydration ✔ Fetal Distress (Hypoxia Due to Maternal Infection &
✔ Administer Medications (Bronchodilators, Mucolytics, Hypotension)
Antibiotics) as Prescribed ✔ Pregnancy Loss (In Cases of Severe Infection & Sepsis)
✔ Monitor Nutritional Status & Encourage High-Calorie
Intake Diagnosis
✔ Educate on CF-Related Diabetes Management & Blood 📌 Clinical Examination – Abdominal Tenderness,
Sugar Monitoring Guarding, and Rebound Tenderness
✔ Provide Emotional Support (CF Patients May Have 📌 Complete Blood Count (CBC) – Elevated White Blood
Anxiety About Pregnancy Risks) Cells (WBCs) Suggest Infection
✔ Coordinate Care with Multidisciplinary Team 📌 C-Reactive Protein (CRP) – Elevated in Inflammatory
(Pulmonologist, Obstetrician, Dietitian, Endocrinologist) Conditions
📌 Ultrasound (First-Line Imaging in Pregnancy) – Limited
Appendicitis in Pregnancy Sensitivity
Definition 📌 Magnetic Resonance Imaging (MRI) – Most Accurate
Appendicitis is an inflammation of the appendix, which can Non-Radiation Imaging for Appendicitis
lead to rupture, peritonitis, and sepsis if left untreated. It is 📌 CT Scan (If MRI is Unavailable, Use with Shielding to
the most common non-obstetric surgical emergency in Reduce Radiation Exposure)
pregnancy and requires urgent medical attention.
Treatment & Management
Causes & Risk Factors 🚨 Goal: Immediate Surgical Intervention to Prevent
Causes Rupture & Maternal/Fetal Complications
🔹 Obstruction of the Appendiceal Lumen (Due to Fecaliths, 1. Surgical Management
Lymphoid Hyperplasia, or Tumors) ✅ Laparoscopic Appendectomy (Preferred in Early
🔹 Infection (Bacterial Overgrowth Leading to Inflammation) Pregnancy & Less Invasive)
🔹 Increased Uterine Pressure (May Contribute to Appendix ✅ Open Appendectomy (If Perforation or Peritonitis is
Compression & Reduced Blood Supply) Present, Especially in Late Pregnancy)
Risk Factors
✅ History of Appendicitis or Gastrointestinal Disorders 2. Antibiotic Therapy (Before & After Surgery)
✅ Low-Fiber Diet (Increases Risk of Fecalith Formation) ✅ Preoperative & Postoperative Broad-Spectrum
✅ Constipation (Common in Pregnancy Due to Hormonal Antibiotics
Changes)  Cephalosporins (Ceftriaxone or Cefazolin) +
Metronidazole
Pathophysiology  Ampicillin-Sulbactam (Alternative Option)
1️⃣ Obstruction of the Appendix → Trapped Mucus &
Bacterial Growth 3. Supportive Care
2️⃣ Inflammation & Swelling → Blood Supply is Cut Off, ✅ IV Fluids (To Maintain Maternal Hemodynamic Stability)
Leading to Ischemia ✅ Pain Management (Acetaminophen or Opioid If Needed)
3️⃣ Appendix Rupture (If Untreated) → Peritonitis & Sepsis ✅ Fetal Monitoring (To Detect Signs of Fetal Distress)
✅ Tocolytics (If Preterm Labor Occurs Due to Uterine
Signs & Symptoms in Pregnancy Irritation)
📍 Symptoms Vary Based on Gestational Age Due to
Uterine Enlargement Postoperative Care & Nursing Interventions
🚨 First & Early Second Trimester (Typical Presentation) ✔ Monitor for Signs of Infection (Fever, Tachycardia,
✔ Right Lower Quadrant (RLQ) Pain (McBurney’s Point Worsening Pain, Purulent Drainage)
Tenderness) ✔ Assess for Preterm Labor (Monitor Uterine Contractions
✔ Nausea & Vomiting & Cervical Changes)
✔ Fever & Chills ✔ Encourage Early Ambulation (To Reduce Postoperative
✔ Loss of Appetite (Anorexia) Complications)
🚨 Late Second & Third Trimester (Atypical Presentation) ✔ Pain Management (Avoid NSAIDs in Late Pregnancy
✔ Right Upper Quadrant (RUQ) or Flank Pain (Displaced Due to Risk of Premature Closure of Ductus Arteriosus)
Appendix Due to Enlarged Uterus) ✔ Monitor Fetal Heart Rate & Uterine Activity (NST or
✔ Less Overt Peritoneal Signs (Guarding, Rebound Biophysical Profile May Be Needed Post-Surgery)
Tenderness May Be Less Prominent) ✔ Provide Emotional Support & Education on Warning
✔ Mild to Moderate Fever (High Fever Suggests Signs (Worsening Pain, Fever, Preterm Labor Symptoms)
Perforation)
🚨 Severe Cases (Ruptured Appendix & Peritonitis) Gastroesophageal Reflux Disease (GERD) in Pregnancy
⚠ Severe Diffuse Abdominal Pain Definition
⚠ Signs of Shock (Hypotension, Tachycardia, Altered Gastroesophageal reflux disease (GERD) is the chronic
Mental Status) reflux of stomach acid into the esophagus, causing
⚠ Fetal Tachycardia (Indicates Fetal Distress) heartburn, regurgitation, and discomfort. It is very
common in pregnancy due to hormonal changes and
Complications in Pregnancy
increased intra-abdominal pressure from the growing Reflux)
uterus. ✅ Maintain Healthy Weight (Excess Weight Increases
Abdominal Pressure)
Causes & Risk Factors ✅ Wear Loose-Fitting Clothes (Tight Clothes Increase
Causes Pressure on the Stomach)
🔹 Hormonal Changes – Increased progesterone relaxes the
lower esophageal sphincter (LES), allowing acid reflux. 2. Medications (If Lifestyle Changes Are Insufficient)
🔹 Increased Intra-Abdominal Pressure – Growing uterus ✅ Antacids (First-Line for Mild GERD, Safe in Pregnancy)
pushes on the stomach, promoting reflux.  Calcium Carbonate (TUMS) – Safe, Provides
🔹 Delayed Gastric Emptying – Common in pregnancy due to Immediate Relief
hormonal effects.  Avoid Magnesium-containing Antacids in 3rd
Risk Factors Trimester (Can Cause Preterm Labor)
✅ Pre-pregnancy History of GERD  Avoid Sodium Bicarbonate (Can Cause Fluid
✅ Obesity or Excessive Weight Gain in Pregnancy Retention)
✅ Consumption of Spicy, Fatty, or Acidic Foods ✅ H2 Receptor Blockers (For Moderate GERD, Safe in
✅ Large Meals & Lying Down After Eating Pregnancy)
✅ Multiple Pregnancy (Increased Abdominal Pressure)  Ranitidine (Zantac) – Withdrawn from Market Due
to Safety Concerns
Pathophysiology  Famotidine (Pepcid) – Preferred H2 Blocker,
1️⃣ Progesterone Weakens LES → Acid Reflux Into Pregnancy Category B
Esophagus ✅ Proton Pump Inhibitors (PPIs) (For Severe GERD, Use if
2️⃣ Increased Uterine Size Increases Gastric Pressure → H2 Blockers Fail)
More Reflux Episodes  Omeprazole (Prilosec) – Considered Safe When
3️⃣ Esophageal Mucosal Irritation by Acid → Symptoms of Needed
Heartburn & Discomfort  Lansoprazole (Prevacid) – Alternative Option
🚨 Avoid Long-Term Use of PPIs Unless Necessary – Can
Affect Calcium & Magnesium Absorption
Signs & Symptoms
🔥 Heartburn (Burning Sensation in Chest & Throat,
Worsens When Lying Down) Nursing Interventions
🌊 Regurgitation of Acid or Food ✔ Educate on Dietary & Lifestyle Modifications
🤢 Nausea & Dyspepsia (Indigestion) ✔ Monitor for Severe GERD Symptoms (Dysphagia,
💨 Excessive Belching & Bloating Chronic Cough, Weight Loss)
🔴 Sore Throat or Hoarseness (Due to Acid Irritation of the ✔ Encourage Proper Medication Use & Avoid Unsafe
Throat) Antacids
🚨 Severe Cases ✔ Support Maternal Comfort & Sleep Hygiene
⚠ Dysphagia (Difficulty Swallowing, Suggesting ✔ Reassure That GERD Symptoms Typically Improve
Esophageal Stricture) Postpartum
⚠ Chronic Cough or Wheezing (Acid Aspiration Into
Airways) Cholecystitis & Cholelithiasis in Pregnancy
⚠ Weight Loss (Uncommon in Pregnancy, May Indicate Definition
Severe GERD)  Cholecystitis – Inflammation of the gallbladder,
usually due to gallstones (cholelithiasis) blocking the
Complications in Pregnancy cystic duct.
🚨 Maternal Risks  Cholelithiasis – The presence of gallstones in the
✔ Esophagitis (Chronic Inflammation of Esophagus Due to gallbladder, which may be asymptomatic or cause
Acid Damage) biliary colic.
✔ Esophageal Ulcers (In Severe GERD Cases) Gallbladder disease is more common in pregnancy due to
✔ Aspiration Pneumonia (If Acid Enters Lungs, Rare but hormonal changes and slower gallbladder emptying.
Serious)
✔ Poor Sleep Quality (Due to Nocturnal Reflux Symptoms) Causes & Risk Factors
🚨 Fetal Risks Causes
✔ Minimal Direct Effects – GERD does not harm the baby 🔹 Gallstone Formation (Cholesterol & Bile Salt Imbalance)
but can lead to maternal discomfort, poor nutrition, and 🔹 Hormonal Changes – Increased Progesterone Slows
stress. Gallbladder Emptying
🔹 Obstruction of the Cystic Duct (Leading to Cholecystitis)
Diagnosis Risk Factors
📌 Clinical History & Symptoms (Main Diagnostic Tool) ✅ Pregnancy (Higher Estrogen Increases Cholesterol in
📌 Response to Lifestyle Modifications & Medications Bile, Leading to Gallstones)
📌 Endoscopy (Rarely Done in Pregnancy, Only for Severe ✅ Obesity or Rapid Weight Gain
or Complicated GERD Cases) ✅ Multiparity (Multiple Pregnancies Increase Risk)
✅ High-Fat Diet
✅ History of Gallstones or Family History
Treatment & Management
🚨 Goal: Relieve Symptoms While Avoiding Harm to Mother
& Baby Pathophysiology
1. Lifestyle & Dietary Modifications (First-Line Treatment) 1️⃣ Estrogen Increases Cholesterol Secretion → Bile
✅ Small, Frequent Meals (Prevents Overfilling the Stomach) Becomes Supersaturated
✅ Avoid Spicy, Acidic, Fried, or Fatty Foods (Triggers Acid 2️⃣ Progesterone Slows Gallbladder Emptying → Bile
Reflux) Stagnation & Gallstone Formation
✅ Avoid Lying Down After Eating (Wait at Least 2-3 Hours) 3️⃣ Gallstone Blocks Cystic Duct → Inflammation & Infection
✅ Elevate Head of Bed While Sleeping (Reduces Nighttime (Cholecystitis)
 ✔ Educate on Dietary Modifications (Low-Fat Diet, Small
Signs & Symptoms Frequent Meals)
Cholelithiasis (Gallstones Without Infection) ✔ Encourage Hydration & Early Ambulation Post-Surgery
✔ Biliary Colic (Right Upper Quadrant (RUQ) or Epigastric ✔ Monitor for Preterm Labor if Cholecystitis is Severe
Pain, Often After Fatty Meals)
✔ Nausea & Vomiting Pancreatitis in Pregnancy
✔ Indigestion or Bloating Definition
✔ Pain May Radiate to Right Shoulder or Back Pancreatitis is inflammation of the pancreas, which can
Cholecystitis (Inflamed Gallbladder) range from mild to life-threatening. It is rare in pregnancy but
🚨 More Severe & Prolonged Symptoms can cause maternal and fetal complications if not managed
⚠ Persistent RUQ Pain (Severe, Lasting >6 Hours) promptly.
⚠ Fever & Chills (Indicates Infection) 🔹 Acute Pancreatitis – Sudden inflammation, usually self-
⚠ Murphy’s Sign Positive (Pain on Deep Inspiration with limiting with proper treatment.
RUQ Palpation) 🔹 Chronic Pancreatitis – Persistent inflammation causing
⚠ Nausea & Vomiting long-term damage to pancreatic function.
⚠ Jaundice (If Common Bile Duct is Obstructed)
Causes & Risk Factors
Complications in Pregnancy Causes of Pancreatitis in Pregnancy
🚨 Maternal Risks 1️⃣ Gallstones (Most Common Cause in Pregnancy, ~70%
✔ Gallbladder Perforation (Rare, But Life-Threatening) of Cases)
✔ Sepsis (If Infection Spreads to Bloodstream) 2️⃣ Hypertriglyceridemia (Elevated Triglycerides Due to
✔ Pancreatitis (If Gallstones Block Pancreatic Duct) Pregnancy Hormones)
🚨 Fetal Risks 3️⃣ Alcohol Consumption (Rare in Pregnancy, But a
✔ Preterm Labor (Due to Severe Maternal Pain & Common Cause Outside Pregnancy)
Inflammation) 4️⃣ Medications (E.g., Steroids, Diuretics, Antiretrovirals,
✔ Fetal Distress (If Maternal Infection is Severe) Valproic Acid, Azathioprine)
5️⃣ Idiopathic (No Clear Cause Identified)
Risk Factors
Diagnosis
✅ Pregnancy-Related Hyperlipidemia (Common in 3rd
📌 Ultrasound (First-Line Imaging in Pregnancy, Detects
Trimester)
Gallstones & Gallbladder Inflammation)
✅ History of Gallbladder Disease (Cholelithiasis,
📌 Liver Function Tests (LFTs) – Elevated ALT, AST, ALP, &
Cholecystitis)
Bilirubin If Bile Duct is Obstructed
✅ Obesity & High-Fat Diet
📌 White Blood Cell Count (Elevated in Cholecystitis,
✅ Multiple Pregnancies (Increased Hormonal Changes)
Normal in Uncomplicated Gallstones)
📌 Amylase & Lipase (To Rule Out Pancreatitis If Pain is ✅ Diabetes Mellitus or Metabolic Syndrome
Severe)
🚫 Avoid CT Scans in Pregnancy Due to Radiation Pathophysiology
Exposure 1️⃣ Biliary Obstruction or Triglyceride-Induced Damage →
Pancreatic Enzyme Activation Within the Pancreas
Treatment & Management 2️⃣ Autodigestion of Pancreatic Tissue → Inflammation &
🚨 Goal: Relieve Symptoms, Prevent Complications & Edema
Avoid Unnecessary Surgery During Pregnancy 3️⃣ Release of Inflammatory Cytokines → Systemic
1. Conservative Management (First-Line if No Severe Inflammatory Response
Complications) 4️⃣ Severe Cases May Lead to Necrosis, Organ Failure, or
✅ IV Fluids & Electrolyte Replacement Sepsis
✅ NPO (Nothing by Mouth) to Rest Gallbladder
✅ Pain Management (Acetaminophen or Limited Use of Signs & Symptoms
Opioids) 🔥 Severe Epigastric or Left Upper Quadrant (LUQ) Pain –
✅ Antiemetics (To Control Nausea, e.g., Ondansetron) Radiates to the back, worsens after meals.
✅ Low-Fat Diet (To Reduce Gallbladder Stimulation) 🤢 Nausea & Vomiting – Often persistent and severe.
💨 Abdominal Distension & Bloating – Due to inflammation.
2. Antibiotic Therapy (For Cholecystitis Only) 🚨 Fever & Tachycardia – Suggests systemic inflammation.
✅ Broad-Spectrum Antibiotics (Safe in Pregnancy) 🩸 Hypotension or Shock (In Severe Cases) – Due to
 Ceftriaxone + Metronidazole systemic inflammatory response.
 Ampicillin-Sulbactam (Alternative Option) 🔴 Jaundice (If Bile Duct is Blocked by Gallstones)
💙 Cullen’s Sign & Grey Turner’s Sign (Rare, Indicate
Severe Hemorrhagic Pancreatitis)
3. Surgical Management (If Severe or Recurrent
Symptoms)
✅ Laparoscopic Cholecystectomy (Preferred Surgery in Complications in Pregnancy
2nd Trimester If Needed) 🚨 Maternal Risks
✅ ERCP (Endoscopic Retrograde ✔ Pancreatic Necrosis & Abscess Formation
Cholangiopancreatography) If Bile Duct is Obstructed ✔ Sepsis & Multi-Organ Failure (Severe Cases)
🚨 Avoid Surgery in the 1st Trimester Unless Life- ✔ Acute Respiratory Distress Syndrome (ARDS)
Threatening ✔ Preterm Labor Due to Systemic Inflammation
🚨 Fetal Risks
✔ Fetal Distress Due to Maternal Hypoxia & Hypotension
Nursing Interventions
✔ Preterm Birth or Stillbirth (If Severe Maternal Illness)
✔ Monitor for Signs of Worsening Infection (Fever,
Tachycardia, Severe Pain)
✔ Assess for Jaundice & Signs of Biliary Obstruction Diagnosis
✔ Provide Pain Relief with Pregnancy-Safe Medications
📌 Serum Amylase & Lipase (Elevated, Lipase More diseases, or drug toxicity. In pregnancy, hepatitis can lead to
Specific for Pancreatitis) maternal complications, fetal transmission, and adverse
📌 Liver Function Tests (Elevated ALT, AST, ALP, Bilirubin pregnancy outcomes.
If Gallstones Are Involved)
📌 Serum Triglycerides (>1,000 mg/dL Suggests Causes & Types of Hepatitis in Pregnancy
Hypertriglyceridemia-Induced Pancreatitis) 1. Viral Hepatitis (Most Common in Pregnancy)
📌 Complete Blood Count (Leukocytosis Suggests ✅ Hepatitis A (HAV) – Fecal-oral transmission, self-limiting, no
Inflammation/Infection) chronic stage.
📌 Abdominal Ultrasound (First-Line in Pregnancy to ✅ Hepatitis B (HBV) – Blood & sexual transmission, can
Identify Gallstones or Biliary Sludge) become chronic, high risk of vertical transmission.
📌 MRI or MRCP (Magnetic Resonance ✅ Hepatitis C (HCV) – Bloodborne, often chronic, increased
Cholangiopancreatography – Safe for Imaging the Biliary maternal & fetal risks.
Tract Without Radiation) ✅ Hepatitis D (HDV) – Only occurs with HBV, worsens liver
🚫 Avoid CT Scans Unless Absolutely Necessary Due to damage.
Radiation Risks in Pregnancy ✅ Hepatitis E (HEV) – Fecal-oral, more severe in pregnancy,
high maternal mortality.
Treatment & Management 2. Non-Viral Hepatitis
🚨 Goal: Reduce Inflammation, Relieve Symptoms, Prevent 🔹 Autoimmune Hepatitis (AIH) – Autoimmune attack on the
Complications liver, worsened by pregnancy.
1. Conservative Management (First-Line Treatment in Most 🔹 Drug-Induced Hepatitis – Caused by medications like
Cases) acetaminophen or anti-tuberculosis drugs.
✅ NPO (Nothing by Mouth) to Rest the Pancreas 🔹 Alcoholic Hepatitis – Due to excessive alcohol
✅ IV Fluids (Aggressive Hydration to Prevent Hypotension consumption.
& Support Organ Function)
✅ Pain Management (Acetaminophen or Limited Opioid Pathophysiology
Use) 1️⃣ Virus or Toxin Attacks Liver Cells (Hepatocytes) →
✅ Antiemetics (Ondansetron or Metoclopramide for Inflammation & Cell Damage
Nausea & Vomiting) 2️⃣ Liver Dysfunction → Impaired Protein Synthesis &
✅ Correction of Electrolyte Imbalances (Monitor Calcium, Detoxification
Magnesium, and Potassium) 3️⃣ Complications (Chronic Hepatitis, Cirrhosis, Liver
Failure, or Vertical Transmission to Baby)
2. Address Underlying Cause
✅ Gallstone-Induced Pancreatitis Signs & Symptoms
 If Severe, ERCP (Endoscopic Retrograde 🤢 Fatigue, Malaise, Nausea, Vomiting
Cholangiopancreatography) Can Be Performed 🟡 Jaundice (Yellowing of Skin & Eyes, Due to Bilirubin
Safely During Pregnancy Buildup)
 Cholecystectomy (Gallbladder Removal) Can Be 🦠 Dark Urine & Pale Stools (Due to Liver Dysfunction)
Done in the 2nd Trimester if Needed 🔪 Right Upper Quadrant (RUQ) Pain or Tenderness
✅ Hypertriglyceridemia-Induced Pancreatitis Fever (Common in HAV & HEV)
 IV Insulin Infusion (Reduces Triglycerides) 🚨 Severe Cases: Liver Failure, Ascites, Encephalopathy
 Low-Fat Diet & Lipid-Lowering Agents (If Safe in (Confusion, Coma)
Pregnancy, e.g., Omega-3 Fatty Acids)
Complications in Pregnancy
3. Antibiotic Therapy (Only If Signs of Infection) 🚨 Maternal Risks
✅ Broad-Spectrum Antibiotics (If Pancreatic Necrosis or ✔ Acute Liver Failure (Especially with HEV or Severe
Infection is Present) HBV/HCV)
 Piperacillin-Tazobactam ✔ Increased Risk of Preterm Labor & Preeclampsia
 Meropenem (For Severe Infections Only, Used ✔ Hemorrhage (Due to Liver Dysfunction & Clotting
With Caution in Pregnancy) Abnormalities)
🚨 Fetal Risks
4. Surgery (For Severe or Complicated Cases) ✔ Vertical Transmission (Especially with HBV & HCV)
✅ Cholecystectomy (If Gallstones Are the Cause & ✔ Preterm Birth & Low Birth Weight
Recurrent) ✔ Stillbirth (Particularly with HEV & Severe HBV)
✅ Percutaneous Drainage (If Abscess or Pancreatic
Pseudocyst Develops) Diagnosis
📌 Liver Function Tests (LFTs) – Elevated AST, ALT,
Nursing Interventions Bilirubin, ALP
✔ Monitor for Signs of Worsening Pancreatitis (Persistent 📌 Serologic Markers (HAV, HBV, HCV, HEV Antibodies &
Severe Pain, Hypotension, Organ Failure) Antigens)
✔ Strict NPO & Monitor Hydration Status (IV Fluids Are 📌 HBsAg & HBeAg (For Hepatitis B Screening in
Key) Pregnancy)
✔ Administer Pain Relief & Antiemetics as Ordered 📌 HBV DNA & HCV RNA (Viral Load Monitoring)
✔ Monitor Fetal Heart Rate (For Signs of Fetal Distress) 📌 Coagulation Profile (PT/INR to Check Liver Function)
✔ Educate on Diet Modifications (Low-Fat Diet to Prevent 📌 Abdominal Ultrasound (To Assess Liver Damage or
Recurrence) Cirrhosis)
📝 Routine Hepatitis B Screening is Done in Pregnancy to
Hepatitis in Pregnancy Prevent Vertical Transmission
Definition
Hepatitis is inflammation of the liver, often caused by viral Treatment & Management
infections (Hepatitis A, B, C, D, E), alcohol, autoimmune
🚨 Goal: Supportive Care, Prevent Maternal Complications  Hormonal & immune changes in pregnancy can
& Reduce Fetal Transmission either improve or worsen IBD symptoms.
1. General Management for All Types of Hepatitis
✅ Rest & Hydration (IV Fluids If Severe) Effects of IBD on Pregnancy
✅ Avoid Liver-Toxic Drugs (Acetaminophen, Alcohol, 🚨 Increased Risk of Complications
NSAIDs, Herbal Remedies)  Preterm Birth & Low Birth Weight
✅ Balanced Diet with Adequate Protein & Vitamins  Fetal Growth Restriction (FGR)
✅ Monitor Liver Function & Coagulation Markers Regularly  Spontaneous Abortion & Stillbirth
 Preeclampsia & Placental Insufficiency
2. Specific Treatment Based on Type  Neonatal IBD Risk (If Family History)
Hepatitis A (HAV) 🚨 Risk is Higher if IBD is Active During Pregnancy
✅ Supportive Care (Self-Limiting, No Chronic Stage)  Uncontrolled inflammation increases risks of fetal
✅ Hepatitis A Vaccine (Safe in Pregnancy If High Risk) distress and preterm labor.
Hepatitis B (HBV)  Flare-ups may require hospitalization for IV
✅ Antiviral Therapy (For High Viral Load) – Tenofovir Is steroids or surgery.
Safe in Pregnancy
✅ Newborn Needs HBV Vaccine & HBIG (Hepatitis B Pathophysiology
Immunoglobulin) Within 12 Hours of Birth 1️⃣ Dysregulated Immune Response in GI Tract → Chronic
✅ Breastfeeding Is Safe If Newborn Receives Vaccine & Inflammation
HBIG 2️⃣ Mucosal Damage → Ulcers, Strictures, Fistulas (Crohn’s
Hepatitis C (HCV) Disease), or Continuous Colonic Inflammation (Ulcerative
✅ Antivirals (Direct-Acting Antivirals Like Sofosbuvir Are Colitis)
Avoided in Pregnancy Due to Lack of Safety Data) 3️⃣ Nutrient Malabsorption & Inflammatory Cytokines →
✅ C-Section Is Not Recommended to Prevent Maternal & Fetal Malnutrition
Transmission 4️⃣ Increased Risk of Preterm Labor Due to Systemic
✅ Breastfeeding Allowed Unless Mother Has Inflammation
Cracked/Nipple Bleeding
Hepatitis D (HDV)
Signs & Symptoms
✅ Only Occurs with HBV, So HBV Treatment Applies
🔥 Diarrhea (May Contain Blood or Mucus in UC)
Hepatitis E (HEV)
🩸 Abdominal Pain & Cramping
🚨 Most Dangerous in Pregnancy, Can Cause Acute Liver
🤢 Nausea, Vomiting, & Weight Loss
Failure & High Maternal Mortality
💨 Bloating & Gas
✅ Supportive Care, Monitor Closely for Signs of Liver
🚽 Urgent Bowel Movements & Fecal Incontinence
Failure
🔄 Fatigue & Anemia (Due to Blood Loss & Malabsorption)
💧 Dehydration & Electrolyte Imbalance (During Severe
3. Prevention Strategies Flare-Ups)
🛡 Hepatitis A & B Vaccines (Safe in Pregnancy if High
Risk)
Diagnosis in Pregnancy
🛡 HBsAg Screening for All Pregnant Women
📌 Fecal Calprotectin (To Detect Intestinal Inflammation
🛡 HBV Vaccine & HBIG for Newborns if Mother is HBV-
Without Invasive Testing)
Positive
📌 Blood Tests (CRP, ESR, CBC, Albumin, Iron Studies for
🛡 Proper Hygiene & Sanitation (To Prevent HAV & HEV)
Inflammation & Nutritional Status)
🛡 Safe Sex & Blood Precautions (To Prevent HBV & HCV)
📌 Abdominal Ultrasound & MRI (Safer in Pregnancy Than
CT or Colonoscopy)
Nursing Interventions 📌 Colonoscopy (Only If Necessary & Best Performed in
✔ Monitor Liver Function & Watch for Signs of Worsening 2nd Trimester)
Hepatitis (Jaundice, Ascites, Encephalopathy)
✔ Assess for Signs of Bleeding (Due to Liver Dysfunction
Treatment & Management
& Poor Clotting)
🚨 Goal: Control Inflammation, Prevent Flare-Ups, & Ensure
✔ Educate on Avoiding Alcohol, Acetaminophen, &
a Healthy Pregnancy
Hepatotoxic Medications
1. Medications for IBD in Pregnancy
✔ Administer HBV Vaccine & HBIG for Newborns If Mother
✅ Safe & Recommended:
is HBV-Positive
✔ 5-ASA (Mesalamine, Sulfasalazine) – First-Line Therapy
✔ Encourage Hydration & Proper Nutrition
✔ Corticosteroids (Prednisone, Budesonide) – For Short-
✔ Monitor Fetal Well-Being (Ultrasounds, Fetal Heart Rate
Term Use in Flare-Ups
Monitoring, Growth Assessments)
✔ Thiopurines (Azathioprine, 6-MP) – Used in Moderate-
Severe IBD if Needed
Inflammatory Bowel Disease (IBD) in Pregnancy ✔ Biologics (Infliximab, Adalimumab, Certolizumab) – Safe
Definition in Pregnancy, Continue If Needed
Inflammatory Bowel Disease (IBD) includes Crohn’s disease 🚫 Avoid or Use with Caution:
(CD) and ulcerative colitis (UC), both of which cause chronic ❌ Methotrexate – Teratogenic (Causes Fetal Defects,
inflammation of the gastrointestinal (GI) tract. Pregnant Contraindicated in Pregnancy)
women with IBD require specialized care to prevent ❌ Tofacitinib – Not Recommended Due to Limited Safety
maternal and fetal complications. Data
❌ Ciprofloxacin & Metronidazole – Avoid in 1st Trimester
Effects of Pregnancy on IBD (Use Only If Absolutely Necessary for Infections)
🤰 Pregnancy Can Influence IBD Activity 📌 Folic Acid Supplementation is Essential (Especially with
 If IBD is in remission before conception, the risk of Sulfasalazine Use)
flare-ups is low.
 If IBD is active at conception, disease activity may 2. Nutritional Support
worsen during pregnancy.
🥗 High-Calorie, High-Protein Diet – Prevents Fetal Growth Systemic Symptoms
Restriction (FGR) 3️⃣ Cartilage & Bone Destruction → Deformities, Pain, &
💊 Iron & Vitamin B12 Supplements – For IBD-Related Reduced Mobility
Anemia 4️⃣ Immune System Changes in Pregnancy → May
🍼 Calcium & Vitamin D – Important If Taking Corticosteroids Temporarily Suppress JRA Symptoms
(Prevents Osteoporosis)
💧 Hydration & Electrolyte Balance – Avoids Preterm Labor Signs & Symptoms
Due to Dehydration 🔥 Joint Pain, Swelling, & Stiffness (Most Common in
Knees, Hands, Wrists, & Ankles)
3. Surgical Considerations 🌅 Morning Stiffness (>30 Minutes, Worsens with Inactivity)
🚨 Indications for Surgery During Pregnancy: 🤕 Limited Joint Mobility & Deformities (In Severe Cases)
✔ Severe, Uncontrolled Disease Despite Medical Therapy 😴 Fatigue, Weakness, & Low-Grade Fever (In Systemic
✔ Toxic Megacolon (Rare, Life-Threatening) JRA)
✔ Intestinal Obstruction or Perforation 💊 Flare-Ups (Pain & Swelling May Worsen Postpartum)
📌 C-Section May Be Recommended If the Patient Has:
 Perianal Disease or Fistulas (Common in Crohn’s Diagnosis in Pregnancy
Disease) 📌 Rheumatoid Factor (RF) & Anti-CCP Antibodies – Positive
 Ileal Pouch-Anal Anastomosis (IPAA) from in Some Types of JRA
Previous Surgery 📌 Erythrocyte Sedimentation Rate (ESR) & C-Reactive
Protein (CRP) – Markers of Inflammation
Nursing Interventions 📌 Complete Blood Count (CBC) – Checks for Anemia, a
✔ Monitor for IBD Flare-Ups & Report Increased Common Issue in JRA
Symptoms Promptly 📌 Joint Ultrasound or MRI – To Assess Joint Inflammation &
✔ Ensure Medication Adherence & Provide Patient Damage
Education 📝 X-rays are avoided in pregnancy unless absolutely
✔ Monitor Fetal Growth & Well-Being (Ultrasounds, Fetal necessary.
Kick Counts)
✔ Encourage a Nutrient-Rich Diet & Hydration Treatment & Management
✔ Assess for Anemia & Provide Supplements as Needed 🚨 Goal: Maintain Disease Control, Prevent Flares, &
✔ Monitor for Signs of Preterm Labor (Pain, Bleeding, Ensure a Safe Pregnancy
Contractions) 1. Medications for JRA in Pregnancy
✅ Safe & Recommended:
Juvenile Rheumatoid Arthritis (JRA) in Pregnancy ✔ NSAIDs (Until 3rd Trimester) – Ibuprofen, Naproxen for
Definition Pain & Inflammation
Juvenile Rheumatoid Arthritis (JRA), also called Juvenile ✔ Corticosteroids (Prednisone, Prednisolone) – Used for
Idiopathic Arthritis (JIA), is a chronic autoimmune disease Severe Flares
that causes joint inflammation, stiffness, and pain beginning ✔ Hydroxychloroquine (HCQ) – Safe & Used for Mild
in childhood or adolescence. Women with a history of JRA who Symptoms
become pregnant require careful management to prevent ✔ Sulfasalazine – Safe & Helps Control Inflammation
maternal and fetal complications. ✔ Biologics (Certolizumab, Etanercept, Adalimumab) –
TNF Inhibitors That Are Safe
Effects of Pregnancy on JRA 🚫 Avoid or Use with Caution:
🤰 Pregnancy Can Improve JRA Symptoms in Some ❌ Methotrexate – Highly Teratogenic (Causes Birth
Women Defects, Contraindicated in Pregnancy)
 Up to 50–75% of women with JRA experience ❌ Leflunomide – Contraindicated, Can Cause Fetal Toxicity
symptom relief during pregnancy due to immune ❌ Tofacitinib – Limited Safety Data, Avoid in Pregnancy
system changes. ❌ High-Dose NSAIDs in 3rd Trimester – Can Cause
 However, JRA symptoms may flare up postpartum Premature Closure of Ductus Arteriosus in Baby
(within 6 weeks after delivery). 📌 Folic Acid Supplementation Is Essential, Especially If
 If JRA involves severe joint damage or systemic Taking Sulfasalazine
disease, symptoms may persist or worsen.
2. Physical Therapy & Lifestyle Modifications
Effects of JRA on Pregnancy 🏃 Gentle Exercises (Yoga, Swimming, Walking) – Helps
🚨 Increased Risk of Complications If JRA is Severe or Maintain Joint Mobility
Active 🦵 Joint Protection Techniques (Assistive Devices If
✔ Preterm Birth & Low Birth Weight Needed) – Reduces Strain on Joints
✔ Growth Restriction (If JRA Is Associated with 🌿 Heat & Cold Therapy – Soothes Pain & Stiffness
Autoimmune Antibodies Like Anti-Ro/SSA, Anti-La/SSB) 💤 Adequate Rest & Sleep – Helps Manage Fatigue
✔ Joint Mobility Issues Affecting Labor & Delivery (If Hip
or Spine Are Affected) 3. Labor & Delivery Considerations
✔ Increased Risk of Preeclampsia & Hypertension 🚨 If JRA Affects the Spine, Hips, or Knees, Labor May Be
(Especially If Taking Corticosteroids) More Challenging
✔ Postpartum Flare-Ups of Arthritis Symptoms ✔ C-Section May Be Needed If Severe Joint Deformities
🔹 Women with long-standing JRA may have joint Affect Pelvic Mobility
deformities that can impact labor and require a C-section. ✔ Epidural Anesthesia is Possible Unless There is Severe
Spinal Involvement
Pathophysiology ✔ Plan for Postpartum Pain Management to Prevent Flare-
1️⃣ Immune System Attacks Synovial Joints → Chronic Ups
Inflammation
2️⃣ Cytokine Release (TNF-α, IL-6, IL-1) → Joint Damage & Nursing Interventions
✔ Monitor for Signs of Joint Flare-Ups & Adjust 📌 Antinuclear Antibody (ANA) Test – Most Common
Medications if Needed Autoimmune Marker for SLE
✔ Educate on Safe Medication Use During Pregnancy & 📌 Anti-dsDNA & Anti-Smith Antibodies – Highly Specific for
Breastfeeding SLE
✔ Encourage Gentle Exercise & Joint Protection 📌 Anti-Ro/SSA & Anti-La/SSB Antibodies – Risk of Neonatal
Techniques Lupus & Congenital Heart Block in Baby
✔ Monitor for Signs of Preeclampsia (If on 📌 Complete Blood Count (CBC) – Checks for Anemia,
Corticosteroids) Leukopenia, or Thrombocytopenia
✔ Plan for Safe Labor & Delivery Based on Joint 📌 Urinalysis & 24-Hour Urine Protein – Checks for Lupus
Involvement Nephritis & Preeclampsia Risk
✔ Assess for Postpartum Flare-Ups & Provide Early Pain 📌 Kidney & Liver Function Tests – Evaluates Disease
Management Activity & Medication Safety
📌 Echocardiogram & Fetal Ultrasound – Checks for Fetal
Systemic Lupus Erythematosus (SLE) in Pregnancy Growth Restriction & Heart Block in Baby
Definition
Systemic Lupus Erythematosus (SLE) is a chronic Treatment & Management
autoimmune disease that causes widespread inflammation 🚨 Goal: Control Disease, Prevent Flares, & Ensure
affecting multiple organs, including the skin, joints, kidneys, Maternal-Fetal Safety
heart, and lungs. Pregnancy in women with SLE is considered 1. Medications for SLE in Pregnancy
high-risk, requiring careful monitoring and management to ✅ Safe & Recommended:
prevent complications for both the mother and baby. ✔ Hydroxychloroquine (HCQ) – First-Line, Reduces Flares
& Lowers Pregnancy Risk
Effects of Pregnancy on SLE ✔ Low-Dose Aspirin – Prevents Preeclampsia in High-Risk
🤰 Pregnancy Can Worsen or Improve SLE Symptoms Patients
 If SLE is well-controlled before pregnancy, there is ✔ Corticosteroids (Prednisone) – For Flares, Use Lowest
a lower risk of flare-ups. Effective Dose
 If SLE is active at conception, pregnancy can ✔ Azathioprine – Safe for Severe Disease (If Needed to
trigger severe flares affecting the kidneys, heart, and Reduce Steroid Use)
placenta. ✔ Heparin or Low-Molecular-Weight Heparin (LMWH) – If
 The highest risk of flares is in the 2nd and 3rd Antiphospholipid Syndrome (APS) is Present
trimesters or postpartum period. 🚫 Avoid or Use with Caution:
❌ Methotrexate – Teratogenic, Causes Birth Defects
Effects of SLE on Pregnancy ❌ Cyclophosphamide – Harmful to Fetus, Only Used If Life-
🚨 Increased Risk of Maternal & Fetal Complications Threatening Lupus Activity
✔ Preeclampsia & Gestational Hypertension ❌ Mycophenolate Mofetil (CellCept) – Associated with
✔ Preterm Birth & Low Birth Weight Fetal Malformations
✔ Miscarriage & Stillbirth (Especially with Active Disease ❌ NSAIDs – Avoid in 3rd Trimester Due to Risk of
or Lupus Nephritis) Premature Ductus Arteriosus Closure in Baby
✔ Fetal Growth Restriction (FGR) Due to Placental 📌 Folic Acid Supplementation Is Essential (Especially If
Insufficiency Taking Immunosuppressants)
✔ Neonatal Lupus (If Anti-Ro/SSA & Anti-La/SSB
Antibodies Are Present, Can Cause Congenital Heart 2. Monitoring & Prenatal Care
Block in Baby) ✔ Frequent Prenatal Visits (Every 2 Weeks in 3rd
🔹 Women with Lupus Nephritis (Kidney Involvement) Have Trimester)
the Highest Risk of Pregnancy Complications ✔ Monitor for Preeclampsia (BP Checks, Urinalysis for
Proteinuria)
Pathophysiology ✔ Fetal Growth Ultrasound Every 4 Weeks
1️⃣ Autoimmune Dysfunction → Overactive Immune System ✔ Fetal Echocardiography at 18–24 Weeks (If Anti-Ro/SSA
Produces Autoantibodies (ANA, Anti-dsDNA, Anti-Ro/SSA, & Anti-La/SSB Antibodies Are Positive)
Anti-La/SSB) ✔ Monitor for Signs of Preterm Labor
2️⃣ Systemic Inflammation & Immune Complex Deposition 📌 Multidisciplinary Team Involvement (Rheumatologist +
→ Organ Damage (Kidneys, Heart, Lungs, Skin, Joints) Obstetrician + Maternal-Fetal Medicine Specialist)
3️⃣ Endothelial Dysfunction & Vascular Damage →
Increased Risk of Preeclampsia & Placental Insufficiency 3. Labor & Delivery Considerations
4️⃣ Increased Clotting Risk (If Associated with 🚨 C-Section May Be Needed If:
Antiphospholipid Syndrome - APS) → Miscarriage, Stillbirth, ✔ Severe Lupus Nephritis or Active Disease at Term
& Preterm Labor ✔ Fetal Growth Restriction (FGR) or Fetal Distress
✔ Severe Preeclampsia or APS with Clotting Risk
Signs & Symptoms of SLE in Pregnancy 📌 Vaginal Birth is Possible if SLE is Well-Controlled & No
🔥 Fatigue & Joint Pain (Arthralgia, Arthritis) Major Complications Exist
🦋 Butterfly Rash (Malar Rash) on the Face
🚽 Proteinuria & Swelling (If Lupus Nephritis is Present) Postpartum Considerations
🫀 Chest Pain & Shortness of Breath (Pericarditis or 📌 High Risk of SLE Flares Within 6 Weeks After Delivery –
Pleuritis) Close Monitoring Required
🩸 Low Platelets & Anemia 📌 Breastfeeding is Generally Safe (Hydroxychloroquine &
🛌 Flare Symptoms: Fever, Hair Loss, Mouth Ulcers, Prednisone Are Compatible)
Raynaud’s Phenomenon 📌 Avoid Pregnancy for at Least 6 Months After a Major
📌 Symptoms of SLE flares may overlap with pregnancy Flare
complications like preeclampsia—monitor closely!
Nursing Interventions
Diagnosis in Pregnancy
✔ Monitor for SLE Flares & Preeclampsia Symptoms  Myoclonic Seizures: Sudden muscle jerks
✔ Educate on Safe Medication Use During Pregnancy &  Atonic Seizures: Sudden loss of muscle tone →
Breastfeeding Falls
✔ Encourage Rest & Stress Management to Prevent Flares 📌 Seizures during pregnancy can cause direct injury, falls,
✔ Ensure Regular Fetal Monitoring & Early Detection of or fetal distress.
Growth Restriction
✔ Assess for Postpartum Depression, Common in Chronic Diagnosis in Pregnancy
Disease Patients 📌 Electroencephalogram (EEG) – Assesses Abnormal Brain
Activity
Epilepsy in Pregnancy 📌 MRI Brain Scan (Preferred Over CT Scan to Avoid
Definition Radiation)
Epilepsy is a neurological disorder characterized by 📌 Serum Anti-Epileptic Drug Levels – Ensures Adequate
recurrent, unprovoked seizures due to abnormal electrical Dosage & Prevents Toxicity
activity in the brain. Pregnancy in women with epilepsy 📌 Complete Blood Count (CBC), Liver & Kidney Function
requires careful management to ensure the safety of both the Tests – Monitors AED Side Effects
mother and the baby while balancing seizure control and 📌 Fetal Ultrasound & Echocardiogram – Detects Congenital
minimizing medication risks. Malformations Due to AEDs
📌 Genetic Counseling is Recommended if a Family History
Effects of Pregnancy on Epilepsy of Epilepsy is Present.
🤰 Pregnancy Can Affect Epilepsy in Different Ways:
 50% of women experience no change in seizure Treatment & Management
frequency. 🚨 Goal: Maintain Seizure Control While Minimizing Risks to
 25–30% have fewer seizures due to hormonal Baby
changes. 1. Medications for Epilepsy in Pregnancy
 20–30% have increased seizure frequency due to: ✅ Safe & Preferred AEDs:
o Altered metabolism of anti-epileptic drugs ✔ Lamotrigine (Lamictal) – Preferred for Focal & Generalized
(AEDs) Seizures
o Sleep deprivation ✔ Levetiracetam (Keppra) – Preferred for Generalized &
o Increased stress Myoclonic Seizures
o Poor medication adherence due to fear of 🚨 Use with Caution:
harming the baby ⚠ Carbamazepine (Tegretol) – May Cause Neural Tube
Defects but Safer Than Others
⚠ Topiramate (Topamax) – May Cause Cleft Lip/Palate, Use
Effects of Epilepsy on Pregnancy
with Close Monitoring
🚨 Increased Risk of Maternal & Fetal Complications
🚫 Avoid or Use Only If Necessary:
✔ Preterm Birth & Low Birth Weight
❌ Valproic Acid (Depakote) – HIGHLY Teratogenic (Causes
✔ Fetal Growth Restriction (FGR)
Neural Tube Defects, Autism, & Cognitive Impairment)
✔ Birth Defects (If Exposed to Certain Anti-Epileptic
❌ Phenytoin (Dilantin) – Causes Fetal Hydantoin Syndrome
Drugs)
(Growth Restriction, Cleft Palate, Cardiac Defects)
✔ Preeclampsia & Gestational Hypertension
❌ Phenobarbital – Causes Congenital Malformations &
✔ Increased Risk of Miscarriage & Stillbirth
Developmental Delay
✔ Placental Abruption (If Seizures Are Uncontrolled)
📌 Folic Acid Supplementation (4-5 mg Daily) Is Essential to
✔ Neonatal Withdrawal Symptoms (If AEDs Are Used
Reduce Neural Tube Defect Risk!
During Pregnancy)
✔ Sudden Unexplained Death in Epilepsy (SUDEP) Risk
Increased in Pregnancy 2. Monitoring & Prenatal Care
📌 Generalized tonic-clonic seizures pose the highest risk ✔ Neurology & High-Risk OB Consultations –
to both mother and baby. Multidisciplinary Care
✔ Frequent Serum AED Level Monitoring – Adjust Doses to
Prevent Seizures or Toxicity
Pathophysiology of Seizures in Pregnancy
✔ Fetal Growth & Anatomy Ultrasounds – Every 4 Weeks
1️⃣ Abnormal Neuronal Firing → Increased Excitatory &
After 20 Weeks Gestation
Decreased Inhibitory Signals
✔ Routine Non-Stress Tests (NST) & Biophysical Profile
2️⃣ Hormonal Changes (Increased Estrogen &
(BPP) in 3rd Trimester
Progesterone) → Can Alter Seizure Threshold
✔ Blood Pressure & Kidney Function Monitoring – If AEDs
3️⃣ Increased Metabolism of AEDs → Decreased Drug
Affect Renal Function
Effectiveness
📌 Vitamin K (10 mg/day) in the Last Month of Pregnancy Is
4️⃣ Physiological Changes (Increased Blood Volume &
Recommended for Women Taking Enzyme-Inducing AEDs
Renal Clearance) → Alters Drug Absorption & Clearance
(Carbamazepine, Phenytoin, Phenobarbital) to Prevent
5️⃣ Seizure-Induced Hypoxia → Fetal Oxygen Deprivation &
Neonatal Bleeding Disorders.
Possible Injury

3. Labor & Delivery Considerations

Signs & Symptoms of Seizures in Pregnancy
🚨 Seizures During Labor Are an Emergency (Risk of
🧠 Focal (Partial) Seizures
Hypoxia & Fetal Distress)
 Muscle twitching
✔ Vaginal Delivery Is Preferred Unless Seizures Are
 Sensory disturbances
Uncontrolled
 Unusual behaviors or emotions
✔ IV Lorazepam (Ativan) for Acute Seizure Management in
 Altered consciousness
Labor
⚡ Generalized Seizures
✔ Continue AEDs Regularly (Do Not Skip Doses Before or
 Absence Seizures: Brief loss of awareness
During Labor)
 Tonic-Clonic Seizures: Full-body convulsions, loss ✔ Anesthesia Team Should Be Aware (Risk of Drug
of consciousness, risk of injury
Interactions with AEDs)
📌 C-Section is Only Required If Seizures Are Uncontrolled Response
or Obstetric Indications Exist. 📌 Tensilon Test (Edrophonium Test) – Avoid in Pregnancy
Due to Safety Concerns
Postpartum Considerations 📌 Thyroid Function Tests – MG is Associated with Thyroid
📌 High Risk of Seizure Flares in the First 6 Weeks Disorders
Postpartum Due to: 📌 Fetal Ultrasound – Monitors for Fetal Growth Restriction
 Hormonal Fluctuations (FGR) & Neonatal MG Signs
 Sleep Deprivation
 Stress & Fatigue Treatment & Management
✔ Continue AEDs While Breastfeeding (Most Are 🚨 Goal: Prevent Myasthenic Crisis While Ensuring Fetal
Compatible, but Monitor Infant for Sedation) Safety
✔ Ensure Family Support & Rest to Reduce Sleep ✅ Safe Medications in Pregnancy:
Deprivation-Triggered Seizures ✔ Pyridostigmine (First-Line, Acetylcholinesterase
📌 Contraception Counseling Is Important to Avoid Inhibitor) – Controls Muscle Weakness
Unplanned Pregnancies (Some AEDs Reduce Birth ✔ Corticosteroids (Prednisone, Methylprednisolone) – For
Control Pill Effectiveness, Alternative Methods May Be Moderate-Severe MG
Needed). ✔ Azathioprine (For Severe Cases If Steroids Are Not
Enough)
Nursing Interventions 🚫 Avoid These Medications:
✔ Monitor for Seizure Activity & Maintain Seizure ❌ Magnesium Sulfate (Used for Preeclampsia, but Can
Precautions (Padded Bed Rails, Oxygen, Suction at Worsen MG)
Bedside) ❌ Aminoglycoside Antibiotics (e.g., Gentamicin,
✔ Educate on Medication Adherence & Safe AED Use in Streptomycin) – Worsen Neuromuscular Blockade
Pregnancy ❌ Beta-Blockers (e.g., Propranolol) – Worsen Muscle
✔ Ensure Folic Acid & Vitamin K Supplementation Weakness
✔ Monitor for Signs of Preterm Labor, Fetal Distress, or ❌ Neuromuscular Blocking Agents (Used in Surgery or C-
Growth Restriction Section, Require Caution)
✔ Encourage Sleep Hygiene & Stress Reduction to
Minimize Seizure Triggers Labor & Delivery Considerations
✔ Provide Postpartum Support & Seizure Precaution 🚨 Risk of Myasthenic Crisis During Labor – Plan for Airway
Education for Baby Care Management
✔ Vaginal Delivery Is Preferred If Possible
Myasthenia Gravis (MG) in Pregnancy ✔ Epidural Anesthesia Is Safer Than General Anesthesia
Definition (Avoid Muscle Relaxants)
Myasthenia Gravis (MG) is a chronic autoimmune ✔ Monitor for Neonatal Myasthenia Gravis (Baby May
neuromuscular disorder caused by antibodies attacking Need Temporary Ventilation & IVIG/Plasmapheresis If
acetylcholine receptors at the neuromuscular junction, Severe)
leading to muscle weakness and fatigue. 📌 Postpartum Flare Risk – Close Monitoring Needed After
Effects of Pregnancy on MG Delivery
🔹 Symptoms can improve, worsen, or remain stable:
 1/3 improve during pregnancy Postpartum Considerations
 1/3 worsen (usually in the first trimester & ✔ Breastfeeding is Safe with Pyridostigmine & Prednisone
postpartum) ✔ Monitor for Neonatal MG (Symptoms Resolve in 2–6
 1/3 remain unchanged Weeks After Birth)
🚨 Greatest risk of MG exacerbation is in the first trimester ✔ Encourage Rest & Avoid Overexertion to Prevent
and postpartum period (6 weeks after delivery). Postpartum Flare
Effects of MG on Pregnancy
🚨 Increased Risk of Maternal & Fetal Complications: Multiple Sclerosis (MS) in Pregnancy
✔ Respiratory Muscle Weakness (Risk of Myasthenic Definition
Crisis) Multiple Sclerosis (MS) is a chronic autoimmune disease
✔ Difficulty Swallowing (Dysphagia) → Risk of Aspiration where the immune system attacks the myelin sheath of nerve
Pneumonia cells in the brain and spinal cord, leading to neurological
✔ Exacerbation During Labor Due to Physical Stress dysfunction.
✔ Neonatal Myasthenia Gravis (Transient Muscle Effects of Pregnancy on MS
Weakness in Newborn Due to Maternal Antibodies Cross- 🔹 Pregnancy Generally Improves MS Symptoms Due to
Placenta, Occurs in 10-20% of Babies) High Levels of Pregnancy Hormones (Estrogen &
Progesterone)
Signs & Symptoms of MG in Pregnancy 🔹 Postpartum Relapse Risk is High (Within 3-6 Months
🫁 Muscle Weakness (Worsens with Activity, Improves with After Delivery)
Rest) Effects of MS on Pregnancy
😴 Fatigue, Especially in the Afternoon or Evening 🚨 Increased Risk of:
😵 Drooping Eyelids (Ptosis) & Double Vision (Diplopia) ✔ Preterm Birth & Low Birth Weight (If Severe Disability is
👄 Difficulty Swallowing (Dysphagia) & Speaking Present)
(Dysarthria) ✔ Neonatal Growth Restriction
🦵 Weakness in Arms & Legs (Can Affect Mobility) ✔ Difficulty Pushing During Labor Due to Muscle
🚨 Severe Cases: Respiratory Failure (Myasthenic Crisis) Weakness
✔ Postpartum Flare-Ups
Diagnosis in Pregnancy 📌 MS Does NOT Increase the Risk of Miscarriage, Birth
📌 Acetylcholine Receptor Antibody (AChR-Ab) Test – Defects, or Infertility!
Confirms MG
📌 Electromyography (EMG) – Detects Decreased Muscle Signs & Symptoms of MS in Pregnancy
🦵 Muscle Weakness, Numbness, or Tingling in Arms/Legs  Mild-to-moderate scoliosis generally does NOT
😵 Balance & Coordination Problems (Risk of Falls) worsen due to pregnancy.
👀 Vision Problems (Blurred Vision, Optic Neuritis, Double  Severe scoliosis may lead to increased
Vision) discomfort and posture-related issues.
💡 Fatigue & Cognitive Changes (Brain Fog, Memory
Issues) Effects of Scoliosis on Pregnancy & Labor
🚽 Bladder Dysfunction (Frequent Urination, Incontinence) 🔹 Pain & Mobility Issues – Back pain may be more severe
🚨 Severe Cases: Paralysis or Severe Disability than in women without scoliosis.
📌 Symptoms Can Mimic Normal Pregnancy Changes – 🔹 Respiratory Issues – Severe scoliosis (>60°) may reduce
Monitor Closely! lung expansion, leading to breathlessness.
🔹 Labor & Delivery Challenges – Pelvic misalignment may
Diagnosis in Pregnancy affect vaginal delivery, and some women may require a C-
📌 MRI Without Contrast (Safe in Pregnancy, Avoid section.
Gadolinium) 🔹 Epidural/Spinal Anesthesia Challenges – Scoliosis or
📌 Lumbar Puncture (Only If Needed to Confirm Diagnosis, spinal fusion may make epidural placement difficult.
Rarely Done in Pregnancy) 📌 Most women with scoliosis can have a vaginal delivery!
📌 Evoked Potentials (Tests Nerve Function) However, consultation with an anesthesiologist is
📌 Fetal Ultrasound – Monitors Growth & Development recommended early in pregnancy to assess epidural
feasibility.
Treatment & Management
🚨 Goal: Prevent Disease Progression & Manage Symptoms Signs & Symptoms of Scoliosis During Pregnancy
Safely 💢 Back Pain – May worsen due to pregnancy weight gain
✅ Safe Medications in Pregnancy: 🩹 Postural Changes – Altered center of gravity can increase
✔ Corticosteroids (For Acute MS Flares, Avoid Prolonged discomfort
Use) 😮‍💨 Shortness of Breath – If severe thoracic scoliosis is
✔ Folic Acid Supplementation (Essential for Neural Tube present
Defect Prevention) ⚖️Uneven Pelvic Alignment – May affect fetal positioning
✔ Physical Therapy (To Improve Mobility & Reduce Fall 🚨 Nerve Compression (Rare) – Tingling or numbness in legs
Risk) due to spinal curvature
🚫 Avoid These Medications During Pregnancy:
❌ Teriflunomide (Aubagio) – Teratogenic, Must Be Diagnosis in Pregnancy
Discontinued 2 Years Before Pregnancy 📌 Physical Examination – Assess spinal curvature & pain
❌ Methotrexate – Causes Birth Defects & Miscarriage level
❌ Natalizumab (Tysabri) – May Cause Fetal Hematologic 📌 X-ray (Rare in Pregnancy) – Only done if absolutely
Abnormalities necessary
❌ Most Disease-Modifying Therapies (DMTs) Should Be 📌 MRI (If Needed, Without Contrast) – Safe for evaluating
Stopped Before Conception, But Some Can Be Continued nerve involvement
Based on Risk-Benefit
📌 MS Itself Does NOT Affect Labor, But Muscle Weakness Treatment & Management
May Require Assisted Delivery (Forceps/Vacuum). Pain Management
✅ Physical Therapy & Prenatal Exercises – Improve posture
Postpartum Considerations & core strength
✔ High Risk of MS Relapse in the First 3-6 Months ✅ Pregnancy Support Belt – Reduces back strain
Postpartum ✅ Prenatal Yoga & Stretching – Helps with flexibility
✔ Breastfeeding May Be Protective Against Relapses ✅ Warm Compress & Massage Therapy – Eases muscle
✔ Resume Disease-Modifying Therapy (DMT) If Needed tension
After Delivery ✅ Acetaminophen (Tylenol) – Safe for pain relief
✔ Encourage Rest, Physical Therapy, & Emotional 🚫 Avoid:
Support ❌ NSAIDs (e.g., Ibuprofen, Naproxen) After 20 Weeks
Gestation – Risk of fetal complications
❌ High-Impact Exercises – May worsen pain
Scoliosis in Pregnancy
Definition Anesthesia Considerations for Labor & Delivery
Scoliosis is a lateral curvature of the spine that may be 🔹 Epidural or Spinal Anesthesia – May be more challenging
congenital, idiopathic, or neuromuscular. The severity is if scoliosis or spinal fusion is present
measured in degrees of curvature (Cobb angle). 🔹 Consult with an Anesthesiologist Early in Pregnancy
🔹 Alternative Pain Relief Methods – IV pain meds or general
Effects of Pregnancy on Scoliosis anesthesia (if epidural fails)
📌 Most women with mild-to-moderate scoliosis have 📌 Women with spinal fusion may still receive an epidural,
normal pregnancies and deliveries. depending on the fusion location.
📌 Severe scoliosis (>40-50° Cobb angle) may cause
complications, including: Delivery Considerations
✔ Back pain (worsened by pregnancy weight gain & ✅ Most Women with Scoliosis Can Deliver Vaginally
posture changes) ✅ C-Section May Be Needed If Severe Pelvic Misalignment
✔ Reduced lung capacity (if thoracic scoliosis is present) or Fetal Distress Occurs
✔ Pelvic misalignment (can affect labor positioning & ✅ Monitor for Respiratory Issues During Labor (If Severe
delivery) Thoracic Scoliosis)
✔ Increased risk of cesarean section (C-section) in severe 📌 Pelvic exams & fetal positioning assessments help
cases determine the safest delivery method.
🚨 Does pregnancy make scoliosis worse?
Postpartum Considerations ✅ First-Line Treatment:
✔ Posture Correction & Back Support for Breastfeeding ✔ Propylthiouracil (PTU) – Used in 1st Trimester
✔ Physical Therapy & Core Strengthening Exercises ✔ Methimazole (MMI) – Used in 2nd & 3rd Trimesters
✔ Continue Pain Management Strategies (Heat, Massage, 🚨 Avoid Radioactive Iodine (RAI) – It crosses the placenta
Safe Medications) & damages the fetal thyroid!
📌 Scoliosis does NOT affect future pregnancies, but ✔ Beta-Blockers (e.g., Propranolol) – For Severe
symptoms may return postpartum. Symptoms Like Tachycardia
✔ Surgery (Thyroidectomy) – Reserved for Severe Cases
Hyperthyroidism & Hypothyroidism in Pregnancy Unresponsive to Medications
Thyroid disorders during pregnancy can lead to maternal and 📌 Monitor TSH & Free T4 Every 4 Weeks
fetal complications if left untreated. Proper management is
essential for healthy pregnancy outcomes. Labor & Delivery Considerations for Hyperthyroidism
✔ Risk of Thyroid Storm During Labor – Monitor Heart Rate
1. Hyperthyroidism in Pregnancy Closely
Definition ✔ Neonatal Thyroid Function Testing at Birth (Due to Risk
Hyperthyroidism in pregnancy is an overactive thyroid gland, of Neonatal Hyperthyroidism)
causing an excessive production of thyroid hormones (T3 &
T4). The most common cause is Graves’ disease, an 2. Hypothyroidism in Pregnancy
autoimmune disorder. Definition
Hypothyroidism in pregnancy is an underactive thyroid
Causes of Hyperthyroidism in Pregnancy gland, leading to insufficient thyroid hormone (T3 & T4)
✔ Graves’ Disease (Most Common) – Autoimmune disorder production. The most common cause is Hashimoto’s
where antibodies stimulate the thyroid thyroiditis, an autoimmune condition.
✔ Toxic Multinodular Goiter – Overactive thyroid nodules
✔ Subacute Thyroiditis – Inflammation of the thyroid Causes of Hypothyroidism in Pregnancy
✔ Hyperemesis Gravidarum – Severe nausea & vomiting can ✔ Hashimoto’s Thyroiditis (Most Common) – Autoimmune
cause temporary gestational hyperthyroidism due to destruction of thyroid
increased hCG ✔ Iodine Deficiency – Low iodine intake can lead to
hypothyroidism
Signs & Symptoms of Hyperthyroidism in Pregnancy ✔ Previous Thyroidectomy or Radioactive Iodine
🔥 Increased Metabolism Symptoms: Treatment
✔ Heat intolerance, excessive sweating ✔ Congenital Hypothyroidism (Rare)
✔ Weight loss despite increased appetite
✔ Tachycardia (Heart rate >100 bpm), palpitations Signs & Symptoms of Hypothyroidism in Pregnancy
✔ Tremors, nervousness, anxiety, irritability 🐢 Slowed Metabolism Symptoms:
✔ Frequent bowel movements or diarrhea ✔ Fatigue, weakness, lethargy
✔ Goiter (Enlarged thyroid) ✔ Cold intolerance, dry skin, hair loss
✔ Exophthalmos (Bulging eyes) – Seen in Graves' disease ✔ Weight gain despite normal appetite
🚨 Severe Cases – Thyroid Storm (Medical Emergency) ✔ Bradycardia (Slow heart rate), constipation
 High fever ✔ Depression, memory issues ("brain fog")
 Severe tachycardia ✔ Goiter (Enlarged thyroid)
 Hypertension → Hypotension & shock 🚨 Severe Cases – Myxedema (Rare, Life-Threatening
 Confusion, delirium, seizures Hypothyroidism Crisis)
 Hypothermia
Complications of Untreated Hyperthyroidism in Pregnancy  Respiratory failure
🚨 Maternal Risks:  Coma
✔ Hypertension & Preeclampsia
✔ Heart failure (Due to high metabolic demand) Complications of Untreated Hypothyroidism in Pregnancy
✔ Thyroid storm (Life-threatening crisis) 🚨 Maternal Risks:
🚨 Fetal Risks: ✔ Preeclampsia & Gestational Hypertension
✔ Preterm birth & low birth weight ✔ Anemia (Low red blood cell count)
✔ Intrauterine Growth Restriction (IUGR) ✔ Miscarriage & Preterm Birth
✔ Fetal tachycardia (>160 bpm) ✔ Postpartum Hemorrhage
✔ Neonatal Hyperthyroidism (If maternal antibodies cross 🚨 Fetal Risks:
placenta) ✔ Congenital Hypothyroidism (Cretinism – Can Cause
Intellectual Disability)
Diagnosis of Hyperthyroidism in Pregnancy ✔ Intrauterine Growth Restriction (IUGR)
📌 ↓ TSH (Suppressed) ✔ Low Birth Weight
📌 ↑ Free T3 & T4 (Elevated) ✔ Delayed Brain Development (Due to Low Maternal
📌 Thyroid-Stimulating Immunoglobulin (TSI) Test – Thyroid Hormones)
Confirms Graves’ Disease 📌 Thyroid hormones are crucial for fetal brain
📌 Fetal Monitoring: development, especially in the first trimester!
✔ Fetal heart rate (Tachycardia >160 bpm suggests fetal
hyperthyroidism) Diagnosis of Hypothyroidism in Pregnancy
✔ Ultrasound for fetal growth monitoring 📌 ↑ TSH (Elevated)
📌 ↓ Free T3 & T4 (Low)
Treatment & Management of Hyperthyroidism in 📌 Anti-Thyroid Peroxidase (Anti-TPO) Antibodies –
Pregnancy Confirms Hashimoto’s Thyroiditis
📌 Fetal Monitoring: caused by placental hormones (e.g., human placental
✔ Monitor fetal growth via ultrasound lactogen [hPL]).
✔ Check for signs of congenital hypothyroidism
Risk Factors for GDM
Treatment & Management of Hypothyroidism in Pregnancy 📌 High-Risk Groups Include:
✅ First-Line Treatment: ✔ Obesity (BMI > 30 kg/m²)
✔ Levothyroxine (Synthroid) – SAFE in Pregnancy ✔ History of GDM in Previous Pregnancy
✔ Dose Adjustments: Increase by 25-50% in Early ✔ Family History of Diabetes
Pregnancy (Due to Increased Demand) ✔ Age > 25 Years
📌 Take Levothyroxine in the Morning on an Empty ✔ Polycystic Ovary Syndrome (PCOS)
Stomach, 30-60 Minutes Before Food or Other ✔ Macrosomia (Previous Baby > 4 kg/9 lbs)
Medications. ✔ Hypertension or Preeclampsia in Previous Pregnancy
🚨 Avoid:
❌ Iron & Calcium Supplements Within 4 Hours of Taking Pathophysiology of GDM
Levothyroxine (They Reduce Absorption) 1️⃣ Placental hormones (hPL, estrogen, cortisol,
❌ Soy & High-Fiber Foods (Can Interfere with Absorption) progesterone) cause insulin resistance
✔ Monitor TSH & Free T4 Every 4-6 Weeks 2️⃣ Pancreas increases insulin production, but may not
✔ Adjust Dosage as Needed to Maintain Normal Thyroid keep up
Function 3️⃣ Hyperglycemia develops, especially after meals
4️⃣ Glucose crosses the placenta (but insulin does NOT),
Labor & Delivery Considerations for Hypothyroidism leading to fetal hyperglycemia
✔ Monitor for Preeclampsia & Hypertension 5️⃣ Fetal pancreas produces excess insulin → Macrosomia
✔ Ensure Adequate Thyroid Hormone Levels to Prevent (big baby)
Fetal Complications
✔ Neonatal Screening for Congenital Hypothyroidism Signs & Symptoms of GDM
🔹 Most women are asymptomatic (GDM is detected through
Key Differences Between Hyperthyroidism & screening)
Hypothyroidism in Pregnancy 🔹 Possible symptoms include:
Feature Hyperthyroidism Hypothyroidism ✔ Increased thirst (Polydipsia)
Most ✔ Frequent urination (Polyuria)
Common Graves’ Disease Hashimoto’s Thyroiditis ✔ Fatigue
Cause ✔ Recurrent infections (e.g., UTIs, yeast infections)
TSH Levels ↓ Low ↑ High
T3 & T4 Screening & Diagnosis of GDM
↑ High ↓ Low 📌 Glucose Challenge Test (GCT) – 24-28 Weeks Gestation
Levels
Metabolism Fast (Weight Loss) Slow (Weight Gain)
 50g oral glucose load → Check blood glucose
after 1 hour
Heart Rate ↑ Tachycardia ↓ Bradycardia
 If ≥140 mg/dL, proceed to Oral Glucose Tolerance
Congenital
Preterm birth, Neonatal Test (OGTT)
Fetal Risks Hypothyroidism, Brain
Hyperthyroidism 📌 Oral Glucose Tolerance Test (OGTT) – Gold Standard
Damage
 Fasting blood sugar measured first
First-Line PTU (1st Trimester),  100g glucose given orally
Levothyroxine
Treatment Methimazole (2nd/3rd)  Blood sugar measured at 1, 2, & 3 hours
Medication 🔹 Diagnosis of GDM if 2 or more values are exceeded:
No Radioactive Iodine Levothyroxine is Safe
Safety  Fasting: ≥95 mg/dL
 1-hour: ≥180 mg/dL
Key Takeaways  2-hour: ≥155 mg/dL
🔹 Hyperthyroidism (Overactive) → Risk of Preeclampsia,  3-hour: ≥140 mg/dL
Preterm Birth, Neonatal Hyperthyroidism
🔹 Hypothyroidism (Underactive) → Risk of Miscarriage, Complications of GDM
Brain Damage, Congenital Hypothyroidism 🚨 Maternal Risks:
✔ Preeclampsia & Hypertension
Diabetes Mellitus (DM) in Pregnancy ✔ Increased Risk of C-Section (Due to Macrosomia)
Diabetes Mellitus (DM) in pregnancy can be classified as: ✔ Risk of Developing Type 2 Diabetes Postpartum
1️⃣ Gestational Diabetes Mellitus (GDM) – Diabetes 🚨 Fetal Risks:
diagnosed for the first time during pregnancy ✔ Macrosomia (Large Baby) → Birth Trauma (Shoulder
2️⃣ Preexisting Diabetes in Pregnancy – Includes: Dystocia, Fractures)
 Type 1 DM – Autoimmune destruction of insulin- ✔ Neonatal Hypoglycemia (Due to High Insulin Production
producing cells in Baby)
 Type 2 DM – Insulin resistance, usually linked to ✔ Respiratory Distress Syndrome (RDS)
obesity ✔ Increased Risk of Stillbirth
📌 Proper glucose control is crucial to prevent maternal and ✔ Polyhydramnios (Excess Amniotic Fluid)
fetal complications.
Management & Treatment of GDM
Gestational Diabetes Mellitus (GDM) ✅ Diet & Exercise (First-Line Treatment)
Definition ✔ Low glycemic index (GI) diet
Gestational Diabetes Mellitus (GDM) is glucose intolerance ✔ Carbohydrate control (Complex carbs > Simple sugars)
first detected during pregnancy (typically in the 2nd or 3rd ✔ Regular physical activity (e.g., walking, prenatal yoga)
trimester). It occurs due to increased insulin resistance ✅ Glucose Monitoring
✔ Fasting glucose <95 mg/dL
✔ 1-hour postprandial <140 mg/dL ✔ Breastfeeding Encouraged (May Help with Glucose
✔ 2-hour postprandial <120 mg/dL Control)
✅ Medications (If Blood Sugar is Uncontrolled)
✔ Insulin (First-line medication in pregnancy) Deep Vein Thrombosis (DVT) in Pregnancy
✔ Metformin or Glyburide (Oral alternatives in some Definition
cases) Deep Vein Thrombosis (DVT) is the formation of a blood clot
📌 Most women with GDM return to normal glucose levels (thrombus) in a deep vein, usually in the legs (calf or thigh)
postpartum, but need follow-up testing at 6-12 weeks or pelvis. Pregnancy increases the risk of DVT due to
postpartum. hypercoagulability, venous stasis, and vascular injury.

Preexisting Diabetes in Pregnancy (Type 1 & Type 2 DM) Pathophysiology

Type 1 DM – Autoimmune destruction of pancreatic beta cells Pregnancy is a hypercoagulable state due to:
→ Insulin deficiency 1️⃣ Increased clotting factors (Factors VII, VIII, X,
Type 2 DM – Insulin resistance & relative insulin deficiency fibrinogen)
📌 Women with preexisting diabetes require careful 2️⃣ Decreased fibrinolysis (Impaired breakdown of clots)
monitoring before, during, and after pregnancy. 3️⃣ Venous stasis (Enlarged uterus compresses veins,
reducing blood flow)
Complications of Preexisting Diabetes in Pregnancy 4️⃣ Endothelial damage (During delivery or cesarean section)
🚨 Maternal Risks: These changes protect against postpartum hemorrhage but
✔ Diabetic Ketoacidosis (DKA) – Medical Emergency! increase the risk of blood clots.
✔ Hypoglycemia (If Over-Treated with Insulin)
✔ Preeclampsia & Eclampsia Risk Factors for DVT in Pregnancy
✔ Preterm Labor 🔹 Personal or Family History of DVT or PE
✔ Infections (UTIs, Yeast Infections) 🔹 Thrombophilia (e.g., Factor V Leiden, Antiphospholipid
🚨 Fetal Risks: Syndrome)
✔ Congenital Malformations (Heart Defects, Neural Tube 🔹 Obesity (BMI >30 kg/m²)
Defects) 🔹 Prolonged Immobility (Bed Rest, Long Travel,
✔ Macrosomia (Large Baby, >4000g or 9 lbs) Hospitalization)
✔ Stillbirth (Higher Risk in Poorly Controlled Diabetes) 🔹 C-Section Delivery (2× Higher Risk than Vaginal Birth)
✔ Neonatal Hypoglycemia (Baby’s Pancreas Produces Too 🔹 Preeclampsia or Hypertension
Much Insulin) 🔹 Multiple Pregnancy (Twins or More)
✔ Polyhydramnios (Too Much Amniotic Fluid) 🔹 Smoking
✔ Intrauterine Growth Restriction (IUGR) – If diabetes 🔹 IVF or Hormone Therapy (Increased Estrogen Levels)
causes placental insufficiency
Signs & Symptoms of DVT in Pregnancy
Management of Preexisting Diabetes in Pregnancy 📌 Most Commonly Affects the Left Leg (80-90% of Cases)
✅ Preconception Counseling – Optimize A1C <6.5% Before ✔ Unilateral Leg Pain (Calf or Thigh)
Pregnancy ✔ Swelling (Edema) of the Affected Leg
✅ Frequent Blood Glucose Monitoring – Fasting, Post-Meal, ✔ Redness & Warmth Over the Clot
& Bedtime ✔ Pain That Worsens with Standing or Walking
✅ Diet & Exercise – Low GI Diet, Portion Control, Physical ✔ Dilated Superficial Veins
Activity ✔ Positive Homan’s Sign (Pain in Calf with Dorsiflexion of
✅ Insulin Therapy – Adjusted Based on Blood Sugar Levels Foot – NOT always reliable)
📌 Metformin & Glyburide are sometimes used in Type 2 🚨 Emergency Concern: Pulmonary Embolism (PE)
DM, but insulin is preferred for tight glucose control. If the clot dislodges & travels to the lungs, it can cause PE,
a life-threatening emergency.
Labor & Delivery Considerations for Diabetes in ⚠️Symptoms of Pulmonary Embolism (PE):
Pregnancy ❗ Sudden Shortness of Breath (Dyspnea)
✔ Early Induction May Be Needed (If Macrosomia or ❗ Chest Pain (Worse with Deep Breathing)
Poorly Controlled Diabetes) ❗ Tachycardia & Hypoxia
✔ Continuous Fetal Monitoring (Risk of Hypoxia, Stillbirth) ❗ Coughing up Blood (Hemoptysis)
✔ Blood Sugar Monitoring During Labor (Maintain Glucose
Between 70-110 mg/dL) Diagnosis of DVT in Pregnancy
✔ Neonatal Glucose Testing at Birth (Risk of Neonatal 1️⃣ Compression Ultrasound (Doppler) – Gold Standard
Hypoglycemia)  Confirms presence of clot in the deep veins
📌 C-Section May Be Recommended for Macrosomic 2️⃣ D-Dimer Test – Not Reliable in Pregnancy
Babies to Prevent Birth Trauma  False positives due to natural increase in fibrinogen
3️⃣ MRI or Venography (Used if ultrasound is
Postpartum Care for Diabetes in Pregnancy inconclusive)
📌 GDM:
✔ Most women return to normal, but 50% develop Type 2 DM Management & Treatment of DVT in Pregnancy
later in life ✅ First-Line Treatment: Low Molecular Weight Heparin
✔ 6-12 Week Postpartum Glucose Test (OGTT) (LMWH)
✔ Encourage Healthy Lifestyle to Prevent Future DM  Enoxaparin (Lovenox) or Dalteparin
📌 Type 1 & 2 DM:  Does NOT cross placenta (safe for baby)
✔ Adjust Insulin Dosage After Delivery (Lower Insulin  Given subcutaneously (SC) daily or BID
Needs Postpartum) ✅ Unfractionated Heparin (UFH) – Used in High-Risk Cases
✔ Monitor for Postpartum Depression (Higher Risk in  Shorter half-life (Easier to stop before delivery)
Diabetic Women)  Used if renal disease or planned early delivery
🚫 Warfarin (Coumadin) is Contraindicated in Pregnancy!
  Teratogenic (Crosses placenta, causes fetal
bleeding & birth defects)
 Can only be used postpartum

Delivery Considerations for DVT Patients

🔹 Planned Induction or C-Section – Stop LMWH 24 hours
before delivery
🔹 Regional Anesthesia (Epidural/Spinal) – Avoid if LMWH
Given in Last 24 Hours
🔹 Postpartum Anticoagulation – Continue for 6 Weeks
(Risk of Clots Remains High)

Nursing Interventions for DVT in Pregnancy

✔ Encourage Ambulation & Leg Exercises (Prevent Venous
Stasis)
✔ Elevate Affected Leg (Promote Venous Return)
✔ Apply Compression Stockings (If Not Contraindicated)
✔ Monitor for Signs of PE (Sudden Dyspnea, Chest Pain,
Tachycardia)
✔ Educate on LMWH Injection Technique & Importance of
Adherence
✔ Advise Hydration to Prevent Blood Thickening
✔ Avoid Prolonged Immobility (Encourage Frequent
Position Changes)

Prevention of DVT in Pregnancy

✅ Early Ambulation After Delivery
✅ Use of Compression Stockings in High-Risk Patients
✅ Hydration & Avoiding Prolonged Sitting or Standing
✅ Prophylactic LMWH in Women with a History of DVT or
Thrombophilia