Nursing Care for Pregnancy-related Complications

Pregnancy-related complications can cause harm to both the mother and fetus, and include preeclampsia, placental abruption, and placenta previa.

As the nurse, you’ll collaborate with the registered nurse, or RN, to provide care for your patient experiencing pregnancy-related complications.

Preeclampsia is a pregnancy-specific, multisystem condition characterized by new onset hypertension, which is defined as a systolic blood pressure greater than or equal to 140 mmHg, a diastolic blood pressure greater than or equal to 90 mmHg, or both, in a previously normotensive patient.

It also includes proteinuria, or protein in the urine, or other evidence of organ damage. It typically occurs after 20 weeks of gestation, but it can also first occur during the postpartum period.

If left untreated, it can progress to eclampsia, which is when a patient with preeclampsia develops seizures. The ultimate treatment is to deliver the fetus and placenta; however, the decision to induce delivery depends on both the gestational age of the fetus and the severity of the condition.

Now, when caring for a patient with preeclampsia, collaborate with the RN to administer the prescribed IV fluids to maintain hydration, antihypertensives to control their blood pressure, and magnesium sulfate to help prevent seizures.

Also be sure to have calcium gluconate, which is the antidote for magnesium sulfate toxicity, readily available. Then, apply an external fetal monitor, insert an indwelling urinary catheter, and institute seizure precautions.

Work with the RN to closely monitor the patient’s condition, while keeping a close eye on the fetal heart rate. Immediately notify the RN if you observe signs or symptoms that the patient could be progressing to eclampsia, such as altered level of consciousness, severe headache, epigastric pain, or visual changes, as well as the presence of clonus, which is a repetitive muscle contraction.

Then, assist the patient into a left, lateral position to help increase blood flow to the placenta. Also, increase the IV flow rate, provide supplemental oxygen, and stay with the patient, while providing reassurance.

Placental abruption, also called abruptio placentae, is an obstetric emergency where there’s premature detachment of all or part of a normally implanted placenta from the uterine wall.

This results in hemorrhage, which can lead to hypovolemic shock, fetal hypoxia, and premature birth. Placental abruption is most often caused by degeneration of the uterine arteries that supply the placenta with nutrient- and oxygen-rich blood, usually secondary to a chronic disease process in the placenta.

Risk factors for placental abruption include hypertension, preeclampsia, and multiple gestation, as well as smoking and use of illicit drugs, like cocaine.

Additionally, events that cause blunt trauma to the abdomen, like a car crash or fall, may also increase the risk of placental abruption.

Clinical manifestations of placental abruption include dark or bright red vaginal bleeding accompanied by symptoms like pain over the area of the abruption, and sometimes back pain.

The uterus will often contract and become rigid as it clamps down on the uterine vessels in an attempt to reduce the bleeding.

Sometimes, the bleeding can be concealed behind the placenta, so you’ll also monitor your patient for a tender, firm uterus; and frequent, crampy uterine contractions.

When caring for your pregnant patient, notify the RN immediately if you suspect a placental abruption. Then assist the RN to prepare your patient for delivery; and administer oxygen, IV fluids, and blood products as prescribed.

Placenta previa occurs when the placenta implants lower in the uterus, where it either partially or completely covers the cervical os, or cervical opening.

This can lead to vaginal bleeding and subsequent hypovolemic shock in the mother and intrauterine hypoxia in the fetus. The cause of placenta previa is not fully known but risk factors include multiple gestation; uterine abnormalities, like uterine fibroids; previous uterine surgeries, like cesarean section or myomectomy; smoking; maternal age over 35 years; and multiparity, or a history of two or more previous pregnancies.

Clinical manifestations of placenta previa include painless bright red vaginal bleeding; along with a soft, non-tender uterus.

When caring for your pregnant patient, notify the RN immediately if you suspect placenta previa. Then, assist the RN to prepare your patient for delivery; and administer oxygen, IV fluids, and blood products as prescribed.

Alright, as a quick recap… Pregnancy-related complications can cause harm to both the mother and fetus; and include preeclampsia, placental abruption, and placenta previa.

As the nurse, you’ll collaborate with the registered nurse, or RN, to provide care for your patient experiencing pregnancy-related