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.