Maternal child health nursing

1. Maternal child health nursing Module 4

2. Objectives • Discuss infection in pregnancy, Rh and ABO incompatibilities, multiples pregnancies, preterm, true and false labors • discuss substance abuse in pregnancy • Discuss FDA drug categories

3. Pregnancy: Infections Congenital Rubella Syndrome with rash • TORCH group • Toxoplasmosis • Other • Rubella • Cytomegalovirus • Herpes genitalis (Herpes Simplex Virus Type 2) • FON p 903 box 28-5

4. HIV/AIDs • Review: • Human immunodeficiency virus emerged as one of most significant diseases of 20th century • Acquired immune deficiency syndrome results from HIV -> profound depression of immune system • s/s may present differently in women than in men • Common presentation of chronic vaginitis, candidiasis • Transmission precautions: mother, infant, care providers

5. A word about standard precautions • Standard precautions in healthcare were developed to their present form in response to increasing awareness of blood- and body-fluid-borne illnesses

6. HIV/AIDs • Human immunodeficiency virus • Causative organism responsible for AIDs • Severely depressed immune system • Transmitted through body fluids • Chronic vaginitis and candidiasis are common presenting problems in women • Difficult to determine obstetric risk

7. HIV/AIDs • Prevent transmission from mother to child during birth and postpartum • Avoid breaking skin barriers • Delivery within 4 hours of ROM • Breastfeeding not recommended where clean formula available • HIV can cause microcephaly and facial deformities in fetus, as well as infecting fetus with virus • Later signs of infant infection may include failure to thrive, recurrent infection, interstitial pneumonia, neurological problems

8. Other infections • STDs • Vaginal • Urinary tract

9. Nursing care: infections • Anti-infective: is Mom responding well? Is she having side effects? • Hydration: is mom drinking enough fluids? • Elimination: constipated? Diarrhea? • Urination: is Mom’s urine dark, concentrated? • Nutrition: is Mom getting the right nutrition to help her get well? • Immune function: is she resting? Anxious? Showing signs of other infection? Exercising?

10. Rh incompatibility • Rh negative mom, Rh positive fetus • First vs subsequent pregnancies • Antibodies, antigens from first pregnancy • Attack second pregnancy: erythroblastosis fetalis • Hyperbilirubinemia • Can cause RBCs to break down too quickly in newborn • Kernicterus is buildup of bilirubin in CNS

11. Rh incompatibility

12. Rh incompatibility • Coomb’s test • Direct: tests infant’s blood for antibody-coated RBCs • Indirect: tests mother’s blood for number of antibodies • RhoGAM • IM injection of anti-Rh gamma globulin • Given to Mom at 28 weeks and at 72 hours postpartum to prevent antibody development • Also given if Rh-negative mom has abortion, ectopic pregnancy or amniocentesis

13. Rh incompatibility • Phototherapies • Fluorescent lights make bilirubin easier to excrete • May be in form of blanket (Wallaby fiberoptic) • teaching • How disease works • RhoGAM: how it works, when to have it, who should have it, keep records with Mom • Phototherapies: eye protection under lamps, skin exposure

14. Fluorescent light therapy

15. ABO incompatibility • Most often: Type O mother leaks antibodies to type A, B or AB baby • Rare • Can happen with first pregnancy • May also cause erythroblastosis fetalis • Treatment similar as for Rh incompatibility

16. Multiples pregnancies

17. multiples • Twins (33.1 per 1,000 live births) • Monozygotic: fertilized egg splits at embryonic stage -> identical twins • Dizygotic: two eggs fertilized -> fraternal twins • Triplets or higher order births (137.6: 100,000 live births) • Quadruplets or greater number usually result from fertility drugs • Prematurity a risk for multiple births

18. multiples • Risks: abortion, maternal anemia, PIH, placenta previa, abruptio placentae, hydramnios • Resources: parents of multiples groups, financial resources, resources for baby supplies, may need referrals to lactation consultant • Education: self-care, time management, needs unique to pre-term babies

19. multiples • Increase with certain fertility treatments • Fertility treatments may be given to older mother • Stressed resources, energy, health • May have had more complicated pregnancy due to advanced maternal age • Lessened support: older grandparents, peers raising older children • Parents may have more education and earning power

20. Substance abuse in pregnancy

21. Substance abuse in pregnancy • Substance abuse includes both legal (nicotine, alcohol) and illegal (cocaine, marijuana) drugs • Prescription drugs and other medications can also cross the placental barrier and affect the fetus • Alcohol, tobacco and marijuana most commonly used during pregnancy

22. Substance abuse in pregnancy • Cocaine: constricts blood vessels • Detached placenta • Intracranial bleeding • Tobacco • Low birth weight • Increased risk of SIDS • Narcotics • Withdrawal symptoms • Preterm labor, spontaneous abortion

23. Substance abuse in pregnancy • Alcohol • No safe amount for pregnancy has been determined • Results: abortion, fetal demise, IUGR, fetal alcohol syndrome, fetal alcohol effects • FAS: facial/cranial abnormalities, delayed development, mental retardation, short attention span

24. Substance abuse in pregnancy • Sedatives (barbiturates, tranquilizers) • Delayed lung maturity • Neonatal abstinence syndrome • Amphetamines (speed, crystal, ice) • Placental abruption • Cleft palate • Marijuana • Often used with other drugs • IUGR

25. Substance abuse in pregnancy • Caffeine: stimulates fetus

26. Nursing care: substance abuse • Safe withdrawal • Nonjudgmental attitude • Prevention of injury • Prevent shaken baby syndrome • Assessment (mother and baby): vital signs, changes in baseline, s/s withdrawal • Education of infant needs and provide social support

27. Neonatal abstinence syndrome • Fetus exposed to addictive drugs in utero and born dependent on them • When baby is born, supply is abruptly cut off • May cause long-term developmental and neurological problems • S/S: tremors, hyperirritability, wakefulness, diarrhea, poor feeding, sneezing, yawning • Treatment: IV fluids, small amounts of similar substances to control symptoms • Nursing: minimize stimuli, swaddling, seizure precautions

28. FDA drug categories • Assigns A, B, C, D or X designation to drugs to differentiate risk • Proposal has been made to update drug information to more accurately reflect risk • Note that drug categories do not necessarily reflect ascending risk

29. FDA drug categories

30. Preterm labor

31. Preterm labor • Preterm: 0-37 weeks • Late preterm: 34-37 weeks • May be prompted by known or unknown cause • Maternal infection or dehydration, fetal disease • Terbutaline SQ, magnesium sulfate IV titration • Non-Braxton Hicks contractions, cervical dilation, s/s true labor

32. preterm labor • Terbutaline/Brethine • SQ, PO • Acts on smooth muscle and inhibits uterine muscle activity • FDA warns against using injected terbutaline longer than 48-72 to stop preterm labor • Maternal heart problems

33. Nursing care: preterm labor • Encourage hydration • Monitor FHR, status • Note time, color, amount, odor of any amniotic fluid • Monitor maternal v/s • Treat underlying cause

34. True and false labor • Contractions • Regular pattern v irregular • Increase in intensity, duration, frequency over period of hours or days (not weeks) v stop with ambulation or position change • Start in lower back, travel to lower abdomen v fundus or back • Do not stop after interventions v decrease with interventions

35. True and false labor • Cervical softening, effacement, dilation v possible softening without effacement or dilation • Fetal descent into pelvis v no significant change in fetal position • Educate regarding physiological benefit to fetus when pregnancy allowed to continue to 40 weeks