Structural Disorders Fetal Demise / Intrauterine Fetal Death. DEFINITION: Death of a fetus after the age of viability. Interventions and Nursing Care Allow patient to decide when she wants to deliver
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Death of a fetus afterthe age of viability
1. First indication is usually NO fetal
2. NO fetal heart tones
Confirmed by ultrasound
3. Decrease in the signs and symptoms of
A hypertensive disease of pregnancy. Known as pre-eclampsia and eclampsia.
Pre-eclampsia = hypertension, proteinuria,
Eclampsia = other signs plus convulsions
It develops between the 20th and 24th week of gestation and disappears after the tenth day postpartum
UNDER 17 AND OVER 35
LOWER SOCIOECONOMIC STATUS
Severe malnutrition, decrease Protein intake
Inadequate or late prenatal care
PIH is due to:
IMPEDED BLOOD FLOW
( in blood pressure)
(decrease in diameter
of blood vessel)
Multi-system failure Disease
Earliest and The Most
B/P = 140 / 90 if have no baseline.
1. 30 mm. Hg. systolic increase or
a 15 mm. Hg. diastolic increase
(two occasions four to six hours apart)
2. Increase in MAP > 20 mm.Hg
over baseline or >105 mm. Hg.
with no baseline
Positive Roll Over Test
The blood pressure rises due to:
ARTERIOLAR VASOSPASMS AND
(Narrowing of the blood vessels)
an increase in peripheral resistance
fluid forced out of vessels
Increase blood viscosity = Increased hematocrit
HEMOCONCENTRATION develops because:
Vessels became narrowed forcing fluid to
Fluid leaves the intracellular spaces
and moves to extracellular spaces
Now the blood viscosity is increased
(Hemocrit is increased)
**Very difficult to circulate thick blood
Which of these readings indicates hypertension in the patient whose blood pressure normally is 100 / 60 and MAP of 77?
a. 120 / 76; MAP 96
b. 110 / 70; MAP 83
c. 130 / 80; MAP 98
d. 125 / 70; MAP 88
With Renal vasospasms, narrowing of glomular capillaries which leads to decreased renal perfusion and decreased glomerular filtration rate (damage to glomeruli)
Protein leaks across the membrane, tubules cannot reabsorb
The degree of PROTEINURIA reflects the severity
of the disease
Spilling of 1+ of protein is significant to begin treatment
Oliguria and tubular necrosis may precipitate
acute renal failure
The difference between dependent edema and generalized edema is important.
The patient with PIH has generalized edema because fluid is in all tissues.
With Vasospasms and Vasoconstriction of the
the vessels in the placenta.
Decreased Placental Perfusion and Placental Aging
Positive OCT / Late Decelerations
With Prolonged decreased Placental Perfusion:
Fetal Growth is retarded - IUGR, SGA
Retinal Edema and spasms leads to:
B/P 140/90 160/110
Protein 1+ 2+ 3+ 4+
Edema 1+, lower legs 3+ 4+
Weight <1 lb. / week >2lb. / week
Reflexes 1+ 2+ brisk 3+ 4+ (Hyperreflexia)
Retina 0 Blurred vision, Scotoma
GI, Hepatic 0 N & V, Epigastric pain,
changes in liver enzymes
CNS 0 Headache, LOC changes
Fetus 0 Premature aging of placenta
IUGR; late decelerations
and phone calls
1. Decrease CNS Irritability
2. Control Blood Pressure
3. Promote Diuresis
4. Monitor Fetal Well-Being
5. Deliver the Infant
CNS Depressant, reduces CNS irritability
Calcium channel blocker- inhibits cerebral
IV effect is immediate and lasts 30 min.
IM onset in 1 hour and lasts 3-4 hours
1. Monitor respirations > 14-16; < 12 is critical
2. Assess reflexes for hyporeflexia -- D/C for
3. Measure Urinary Output >100cc in 4 hrs.
4. Measure Magnesium levels – normal is 1.5-2.5 mg/dl
Therapeutic is 4-8mg/dl. Toxicity - >9mg/dl; Absence of reflexes
is >10 mg/dl; Respiratory arrest is 12-15 mg/dl; cardiac arrest is
> 15 mg/dl.
A Woman taking Magnesium Sulfate has a
respiratory rate of 10. In addition to discontinuing the medication, the nurse should:
a. Vigorously stimulate the woman
b. Administer Calcium gluconate
c. Instruct her to take deep breaths
d. Increase her IV fluids
* Do NOT want to decrease the B/P too low or
too rapidly. Best to keep diastolic ~90.
Need to maintain uteroplacental perfusion!
**Don’t give Diuretic, masks the symptoms of PIH
SEVERE COMPLICATIONS OF PIH:
Hemolysis occurs from destruction of RBC’s
Release of bilirubin
Elevated liver enzymes occur from blood flow that is obstructed in the liver due to fibrin deposits
Vascular vasoconstriction endothelial damage platelet aggregation at the sites of damage low platelets.
1. Right upper quadrant pain and tenderness
2. Nausea and vomiting
a.anemia – low Hemoglobin
b.thrombocytopenia – low platelets. < 100,000.
c.elevated liver enzymes:
-AST asparatate aminotransferase (formerly SGOT)
exists within the liver cells and with damage to liver
cells, the AST levels rise > 20 u/L.
- LDH – when cells of the liver are lysed, they spill into
the bloodstream and there is an increase in serum.
> 90 u/L/
abdominal pressure could lead to rupture
of the liver capsule hematoma.
Heart Disease in
Every Pregnancy affects the cardiovascular
A woman with a healthy heart can tolerate the stress
of pregnancy, but a woman with a compromised
heart is challenged Hemodynamically and will have
The Stress of Pregnancy on an already weakened heart may lead to cardiac decompensation (failure).
The effect may be varied depending upon the classification of the disease
high in iron, protein
low in sodium and calories ( fat )
Watch weight gain
Teach how to take their medicine
Reinforce physicians care
Never eat foods high in Vitamin K while on
( raw green leafy vegetables)
Report fetal distress or cardiac failure
a. Class I
b. Class II
c. Class III
d. Class IV