NCLEX: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

Health Promotion and Maintenance; Nursing Care of the Childbearing Family: Common Complications of Pregnancy

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

First-Trimester Complications

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

III. COMPLICATIONS AFFECTING PROTECTIVE FUNCTION: SEXUALLY-TRANSMITTED INFECTIONS (STIS). This category measures applications of knowledge about conditions related to client’s capacity to maintain defenses and prevent physical and chemical trauma, injury, infection, and threats to health status.

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Vaginitis—inflammation of vagina.

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Pathophysiology—local inflammatory reaction (redness, heat, irritation/tenderness, pain). May cause preterm labor in pregnancy.

2. Etiology:

a. Common causative organisms:

  • Bacteria—streptococci, Escherichia coli, gonococci, Chlamydia, bacterial vaginosis.
  • Viruses—herpes simplex virus type 2, CMV, HPV
  • Protozoa—Trichomonas vaginalis.
  • Fungi—Candida albicans.

b. Atrophic changes—due to declining hormone level (women who are postmenopausal).

3. Assessment: differentiate among common vaginal infections:

a. Vulvovaginal erythema.

b. Pruritus, dysuria, dyspareunia.

c. Vaginal discharge—color, consistency.

4. Analysis/nursing diagnosis: pain related to inflammation, discharge.

5. Nursing care plan/implementation:

a. Goal: emotional support.

b. Goal: health teaching. Instruct woman in self-care measures to promote comfort and healing:

  • Perineal care.
  • Sitz baths.
  • Douching (as ordered). Not recommended during pregnancy.
  • Exposing vulva to air.
  • Cotton briefs.
  • Proper insertion of vaginal suppository.
  • Antibiotic use, as ordered.

c. Goal: prevent reinfection.

  • Suggest sexual partner use condom until infection is eliminated—or abstain from intercourse.
  • Recommend sexual partner seek examination and treatment.

d. Goal: medical consultation/treatment. Refer for diagnosis and treatment.

6. Evaluation/outcome criteria:

a. Woman is asymptomatic; unable to recover organism from body fluids or tissue.

b. Woman avoids reinfection.

c. Woman carries pregnancy to term without complications.

B. Gonorrhea

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Pathophysiology:

a. Men—early infection usually confined to urethra, vestibular glands, anus, or pharynx. Untreated: ascending infection may involve testes, causing sterility.

b. Women—early infection usually confined to vestibular glands, endocervix, urethra, anus (vagina is resistant). May ascend to involve pelvic structures (e.g., PID: fallopian tubes, ovaries); scarring may cause sterility.

c. Women who are pregnant—may result in preterm rupture of membranes, amnionitis, preterm labor, postpartum salpingitis.

d. Sequelae (untreated):

  • May develop carrier state (asymptomatic; organism resident in vestibular glands).
  • Systemic spread may result in gonococcal:
    (a) Arthritis.
    (b) Endocarditis.
    (c) Meningitis.
    (d) Septicemia.

e. Newborn—ophthalmia neonatorum (gonococcal conjunctivitis). Untreated sequela: blindness.

2. Etiology: gram-negative diplococcus (Neisseria gonorrhoeae).

3. Epidemiology:

a. Portal of entry—oral or genitourinary mucous membranes.

b. Mode of transmission—usually sexual contact.

c. Incubation period: 2 to 5 days; may be asymptomatic.

d. Communicable period—as long as organisms are present; to 4 days after antibiotic therapy begun.

4. Assessment:

a. History of known (or suspected) contact.

b. Men:

  • Complaint of mucoid or mucopurulent discharge.
  • Medical diagnosis—procedure: urethral discharge Gram stain.

c. Women:

  • Often asymptomatic; acute infection: severe vulvovaginal inflammation, venereal warts, greenish-yellow vaginal discharge.
  • Medical diagnosis—procedure: endocervical culture.

d. Gonococcal urethritis (men and women)—sudden severe dysuria, frequency, burning, edema.

e. Salpingitis/oophoritis—severe, sudden abdominal pain, fever (with or without vaginal discharge).

5. Analysis/nursing diagnosis: impaired tissue integrity related to tissue inflammation.

6. Nursing care plan/implementation:

a. Goal: emotional support.

b. Goal: health teaching to prevent transmission, sequelae, reinfection.

  • Need for accurate diagnosis and effective treatment, follow-up examination in 7 to 14 days, and culture.
  • All sexual partners need examination, treatment.
  • Possible sequelae/complications (sterility, carrier state).

c. Goal: medical consultation/treatment.

  • Determine allergy to antibiotics.
  • Refer for diagnosis and treatment.
    (a) Diagnosis: culture.
    (b) Treatment—ceftriaxone IM, plus doxycycline PO. May use erythromycin or spectinomycin in pregnancy.
    (c) Follow-up culture before birth.
    (d) Notification of sexual partners.

7. Evaluation/outcome criteria:

a. Verbalizes understanding of mode of transmission, prevention, importance of examination, treatment of sexual contacts.

b. Informs sexual contacts of need for examination.

c. Returns for follow-up examinations.

d. Successfully treated; weekly follow-up cultures: negative on two successive visits.

e. Avoids reinfection.

C. Chlamydia trachomatis

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Pathophysiology:

a. Most common sexually transmitted infection in United States.

b. Initial infection mild in women; inflammation of cervix with discharge.

c. If untreated, may lead to urethritis, dysuria, PID, tubal occlusion, infertility.

2. Etiology:

a. Chlamydia trachomatis has maternal-fetal effects.

b. Bacteria can exist only within living cells.

c. Transmission is by direct contact from one person to another.

3. Assessment—maternal:

a. Inflamed cervix (may be asymptomatic).

b. Cervical congestion, edema.

c. Mucopurulent discharge.

4. Assessment—fetal-neonatal:

a. Increased incidence of stillbirth.

b. Preterm birth may result.

c. Contact with infected mucus occurs during birth.

d. Newborn may be asymptomatic.

e. Conjunctivitis; may lead to scarring.

f. Chlamydial pneumonia.

5. Analysis/nursing diagnosis:

a. Pain related to inflamed reproductive organs.

b. Fatigue related to inflammation.

c. Knowledge deficit related to mode of treatment, disease transmission.

6. Nursing care plan/implementation:

a. Treatment with antibiotics, generally doxycycline or azithromycin. Erythromycin in pregnancy.

b. Provide pain relief, analgesics.

c. Counsel regarding use of condoms, spermicidal agents (containing nonoxynol-9) to prevent reinfection.

7. Evaluation/outcome criteria:

a. Woman understands treatment and shows compliance.

b. Woman understands portal of entry and risk for reinfection.

D. Herpes genitalis

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Pathophysiology—initial infection: varies in severity of symptoms, may be local or systemic; duration: prolonged; morbidity: severe.

2. Etiology—Herpes simplex virus type 2.

3. Epidemiology:

a. Portal of entry—skin, mucous membranes.

b. Mode of transmission—usually sexual.

c. Incubation: 3 to 14 days.

d. Communicable period—while organisms are present.

4. Assessment:

a. Lesions—painful, red papules; pustular vesicles that break and form wet ulcers that later crust; self-limiting (3 weeks).

b. Severe itching, tingling, or pain.

c. Discharge—copious; foul smelling.

d. Dysuria.

e. Lymph nodes—enlarged, inflammatory, inguinal.

f. Woman who is pregnant—vaginal bleeding, spontaneous abortion, fetal death.

g. May shed virus for 7 weeks.

h. Medical diagnosis: multinucleated giant cells in microscopic examination of lesion exudate; culture for herpes simplex virus (HSV).

5. Analysis/nursing diagnosis:

a. Pain related to inflammation process.

b. Fear related to longevity of disease.

c. Fear related to no cure for disease.

d. Knowledge deficit related to transmission to future partners, suppressive treatment.

6. Nursing care plan/implementation:

a. Goal: emotional support.

b. Goal: health teaching.

  • Virus remains in body for life (dormant, noninfectious) in 25% to 30% of population; small percentage have symptoms.
  • Recurrence probable; usually shorter and milder.
  • Need for close surveillance during pregnancy; cesarean birth may be indicated if woman has active genital lesions or positive culture.

c. Goal: promote comfort.

d. Goal: accurate definitive treatment. Refer for diagnosis and treatment.

  • Diagnosis—cervical smears, labial and vaginal smears.
  • Treatment—acyclovir; used for suppressive treatment only.

7. Evaluation/outcome criteria:

a. Woman remains asymptomatic.

b. Pregnancy continues to term with no newborn effects.

E. Syphilis

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Pathophysiology:

a. Primary stage: nonreactive RPR.

  • Men: 3 to 4 weeks after contact, painless, localized penile/anal ulcer (chancre); lymph nodes—enlarged, regional.
  • Women: often asymptomatic; labial, vaginal, or cervical chancre.
  • Medical diagnosis—procedure: dark-field microscopic examination of lesion exudate.

b. Secondary stage: reactive Venereal Disease Research Laboratories (VDRL).

  • 6 to 8 weeks after infection.
  • Rash—macular, papular; on trunk, palms, soles.
  • Malaise, headache, sore throat, weight loss, low-grade temperature.

c. Latent stage: reactive serologic test for syphilis (STS). Asymptomatic; noninfectious.

d. Tertiary stage:

  • Gumma formation in skin, cardiovascular system, or central nervous system.
  • Psychosis.

2. Etiology: Treponema pallidum (spirochete).

3. Epidemiology:

a. Portal of entry—skin, mucous membranes.

b. Mode of transmission—usually sexual.

c. Incubation period—9 days to 3 months.

d. Communicable period—primary and secondary stages.

4. Assessment:

a. Primary—chancre, when detectable.

  • Medical diagnosis—procedure: dark-field examination of lesion exudate.

b. Secondary:

  • Malaise, lymphadenopathy, headache, elevated temperature.
  • Macular, papular rash on palms and soles; may be disseminated.
  • Medical diagnosis—(see d., following).

c. Tertiary:

  • Subcutaneous nodules (gumma).
  • Note: Gumma formation may affect any body system; symptoms associated with area of involvement.

d. Medical diagnosis—procedures: stages other than primary—STS: VDRL, RPR, T. pallidum immobilization (TPI), fluorescent treponemal antibody absorption (FTA). False-positive STS in: collagen diseases, infectious mononucleosis, malaria, systemic tuberculosis.

5. Analysis/nursing diagnosis:

a. Pain related to inflammation process.

b. Knowledge deficit related to treatment and transmission of the disease.

6. Nursing care plan/implementation:

a. Goal: emotional support.

  • Nonjudgmental.
  • Caring, supportive manner.

b. Goal: health teaching.

  • Need for accurate diagnosis and treatment, follow-up examinations.
  • All sexual partners need examination and treatment.

c. Goal: medical consultation/treatment.

  • Refer for diagnosis and treatment. Note: In pregnancy—treatment by 18th gestational week prevents congenital syphilis in neonate; however, treat at time of diagnosis.
  • Treatment:
    (a) Primary, secondary—benzathine penicillin G, 2.4 million units. (b)Other stages—7.2 million units over 3-week period. (c) Erythromycin or doxycycline for clients who are allergic to penicillin.

7. Evaluation/outcome criteria:

a. If treated by 18th week of pregnancy, congenital syphilis is prevented.

b. Appropriate treatment after 18th week cures both mother and fetus; however, any fetal damage occurring before treatment is irreversible.

c. Follow-up VDRL: nonreactive at 1, 3, 6, 9, and 12 months.

d. Tertiary—cerebrospinal fluid examination negative at 6 months and 1 year following treatment.

e. Verbalizes understanding of mode of transmission, potential sequelae without treatment, importance of examination/treatment of sexual contacts, preventive techniques.

f. Informs contacts of need for examination.

g. Returns for follow-up visit.

h. Avoids reinfection.

F. Pelvic inflammatory disease (PID)

1. Pathophysiology—ascending pelvic infection; may involve fallopian tubes (salpingitis), ovaries (oophoritis); may develop pelvic abscess (most common complication), pelvic cellulitis, pelvic thrombophlebitis, peritonitis.

2. Etiology:

a. Chlamydia trachomatis.

b. Gonococci.

c. Streptococci.

d. Staphylococci.

3. Assessment:

a. Pain: acute, abdominal.

b. Vaginal discharge: foul smelling.

c. Fever, chills, malaise.

d. Elevated white blood cell (WBC) count.

4. Analysis/nursing diagnosis:

a. Pain related to occluded tubules.

b. Infertility related to permanent block of tubes.

c. Knowledge deficit related to transmission of disease.

d. Altered urinary elimination related to dysuria.

5. Nursing care plan/implementation—for woman who is hospitalized:

a. Goal: emotional support.

b. Goal: limit extension of infection.

  • Bedrest—position: semi-Fowler’s, to promote drainage.
  • Force fluids to 3000 mL/day.
  • Administer antibiotics, as ordered.

c. Goal: prevent autoinocculation/transmission.

  • Strict aseptic technique (hand washing, perineal care).
  • Contact-item isolation.

d. Goal: Health teaching: if untreated: high risk of tubal scarring, sterility, or ectopic pregnancy; pelvic adhesions; transmission of disease.

e. Goal: promote comfort.

  • Analgesics, as ordered.
  • External heat, as ordered.

6. Evaluation/outcome criteria:

a. Woman responds to therapy; uneventful recovery.

b. Woman avoids reinfection.

Third-Trimester Complications (see Emergency Conditions)

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

I. COMPLICATIONS AFFECTING FLUID-GAS TRANSPORT

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Placenta previa—abnormal implantation; near or over internal cervical os. Increased incidence with multiparas, multiple gestation, previous uterine surgery.

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Assessment:

a. Painless, bright red vaginal bleeding (may be intermittent); absence of contractions, abdomen soft.

b. If in labor, contractions usually normal.

c. Boggy lower uterine segment—palpated on vaginal examination. (Note: If placenta previa is suspected, internal examinations are contraindicated.)

d. Medical diagnosis—procedure: sonography—to determine placental site.

2. Analysis/nursing diagnosis:

a. Anxiety related to bleeding, outcome.

b. Fluid volume deficit related to excessive blood loss.

c. Altered tissue perfusion related to blood loss.

d. Altered urinary elimination related to hypovolemia.

e. Fear related to fetal injury or loss.

3. Nursing care plan/implementation:

a. Medical management

  • Sterile vaginal examination under double setup.
  • Vaginal birth possible if bleeding minimal, marginal implantation; if fetal vertex is presenting so that presenting part acts as tamponade.
  • Cesarean birth for complete previa.

b. Nursing management. Goal: safeguard status.

4. Evaluation/outcome criteria: (Comparison of Placenta Previa and Abruptio Placenta) (see following section on abruptio placentae).

B. Abruptio placentae—premature separation of normally implanted placenta from uterine wall.

1. Assessment:

a. Sudden-onset, severe abdominal pain.

b. Increased uterine tone—may contract unevenly, fails to relax between contractions; very tender.

c. Shock usually more profound than expected on basis of external bleeding or internal bleeding.

d. Medical evaluation—procedures: DIC screening (bleeding time, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen); sonogram to see placental hemoseparation.

Health Promotion and Maintenance; Nursing Care of the Childbearing FamilyHealth Promotion and Maintenance; Nursing Care of the Childbearing Family

2. Analysis/nursing diagnosis:

a. Fluid volume deficit related to bleeding.

b. Potential for fetal injury related to uteroplacental insufficiency.

c. Fear related to unknown outcome.

3. Potential complications:

a. Afibrinogenemia and DIC.

b. Couvelaire uterus—bleeding into uterine muscle.

c. Amniotic fluid embolus.

d. Hypovolemic shock.

e. Renal failure.

f. Uterine atony, hemorrhage, infection in postpartum.

4. Nursing care plan/implementation:

a. Medical management

  • Control: hemorrhage, hypovolemic shock; replace blood loss.
  • Cesarean birth.
  • Fibrinogen, crystalloids, blood replacement.
  • IV heparin—by infusion pump—to reduce coagulation and fibrinolysis.

b. Nursing management. Goal: safeguard status.

5. Evaluation/outcome criteria:

a. Experiences successful termination of pregnancy.

  • Woman gives birth to viable newborn (by vaginal or cesarean method).
  • Woman has minimal blood loss.
  • Woman’s assessment findings within normal limits.
  • Woman retains capacity for further childbearing.

b. No evidence of complications (anemia, hypotonia, DIC) during postpartum period.

II. COMPLICATIONS AFFECTING COMFORT, REST, MOBILITY

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Polyhydramnios—amniotic fluid over 2000 mL
(normal volume: 500–1200 mL).

1. Etiology: unknown. Risk factors:

a. Maternal diabetes.

b. Multifetal gestation.

c. Erythroblastosis fetalis.

d. Preeclampsia/eclampsia.

e. Congenital anomalies (e.g., anencephaly, upper-GI anomalies, such as esophageal atresia).

2. Assessment:

a. Fundal height: excessive for gestational estimate.

b. Fetal parts: difficult to palpate, small in proportion to uterine size.

c. Increased discomfort—due to large, heavy uterus.

d. Increased edema in vulva and legs.

e. Shortness of breath.

f. GI discomfort—heartburn, constipation.

g. Susceptibility to supine hypotensive syndrome—due to compression of inferior vena cava and descending aorta while in supine position.

h. Medical diagnosis—procedures:

  • Sonography—to diagnose multifetal pregnancy, gross fetal anomaly, locate placental site.
  • Amniocentesis—to diagnose anomalies, erythroblastosis.

3. Potential complications:

a. Maternal respiratory impairment.

b. Premature rupture of membranes (PROM) with prolapsed cord or amnionitis.

c. Preterm labor.

d. Postpartum hemorrhage—due to over-distention and uterine atony.

4. Analysis/nursing diagnosis:

a. Pain related to excessive size of uterus impinging on diaphragm, stomach, bladder.

b. Impaired physical mobility related to increased lordotic curvature of back, increased weight on legs.

c. Altered tissue perfusion related to decreased venous return from lower extremities, compression of body structures by over-distended uterus.

d. Potential fluid volume deficit related to potential uterine atony in immediate postpartum, secondary to loss of contractility due to over-distention.

e. Sleep pattern disturbance related to respiratory impairment and discomfort in side-lying position.

f. Anxiety related to discomfort, potential for complications associated with congenital anomalies.

g. Altered urinary elimination (frequency) related to pressure of over-distended uterus on bladder.

5. Nursing care plan/implementation:

a. Medical management

  • Amniocentesis—remove excess fluid very slowly, to prevent abruptio placentae.
  • Termination of pregnancy—if fetal abnormality present and woman desires.

b. Nursing management

  • Goal: health teaching.
    (a) Need for lateral Sims’ position during resting; semi-Fowler’s may alleviate respiratory embarrassment.
    (b) Explain diagnostic or treatment procedures.
    (c) Signs and symptoms to be reported immediately: bleeding, loss of fluid through vagina, cramping.
  • Goal: prepare for diagnostic and/or treatment procedures.
    (a) Permission for amniocentesis.
  • Goal: emotional support for loss of pregnancy (if applicable).
    (a) Encourage verbalization of feelings.
    (b)Facilitate grieving: permit parents to see, hold infant; if desired, take photograph, footprints for them.

6. Evaluation/outcome criteria:

a. Woman complies with medical/nursing management.

b. Woman’s symptoms of respiratory impairment, etc., reduced; comfort promoted.

c. Woman experiences normal, uncomplicated pregnancy, labor, birth, and postpartum.

III. DIAGNOSTIC TESTS TO EVALUATE FETAL GROWTH AND WELL-BEING

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

A. Daily fetal movement count (DFMC)

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Assesses fetal activity.

2. Noninvasive test done by woman who is pregnant.

3. Five to 10 movements per hour: normal activity.

4. Five movements or less per hour may indicate fetal jeopardy or sudden change in movement pattern.

5. Assess for fetal sleep patterns.

B. Nonstress test (NST)

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Correlates fetal movement with FHR. Requires electronic monitoring.

2. Reactive test—three accelerations of FHR to 15 beats/min above baseline FHR, lasting for 15 seconds or more, over 20-minute time period.

3. Nonreactive test—no accelerations or acceleration less than 15 beats/min above baseline FHR. May indicate fetal jeopardy. Vibroacoustic simulator (VAS) to differentiate hypoxia from fetal sleep.

4. Unsatisfactory test—data that cannot be interpreted or inadequate fetal activity; repeat.

C. Contraction stress test (CST); oxytocin challenge test (OCT)

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Correlates fetal heart rate response to spontaneous or induced uterine contractions.

2. Requires electronic monitoring.

3. Indicator of uteroplacental sufficiency.

4. Identifies pregnancies at risk for fetal compromise from uteroplacental insufficiency.

5. Increasing doses of oxytocin are administered to stimulate uterine contractions until three in 10-minute period.

6. Interpretation: negative results indicate absence of late decelerations with all contractions.

7. Positive results indicate late FHR decelerations with contractions.

8. Nipple stimulation (breast self-stimulation test) may also release enough systemic oxytocin to contract uterus to obtain CST. Instruct not to do at home.

D. Biophysical profile (BPP)

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Observation by ultrasound of four variables for 30 minutes and results of nonstress testing:

  • Fetal body movements.
  • Fetal tone.
  • Amniotic fluid volume.
  • Fetal breathing movements.

2. Variables are scored at 2 for each variable if present, score of 0 if not present; score of less than 6 is associated with perinatal mortality.

E. Ultrasound

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Noninvasive procedure involving passage of high-frequency sound waves through uterus to obtain data regarding fetal growth, placental positioning, and the uterine cavity.

2. Purpose may include:

  • Pregnancy confirmation.
  • Fetal viability.
  • Estimation of fetal age.
  • Biparietal diameter (BPD) measurement.
  • Placenta location.
  • Detection of fetal abnormalities.
  • Confirmation of fetal death.
  • Identification of multifetal gestations.
  • Amniotic fluid index.

3. No risk to mother with infrequent use. Fetal risk not determined on long-term basis.

F. Amniocentesis

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Invasive procedure for amniotic fluid analysis to assess fetal lung maturity or disease; done after 14 weeks of gestation.

2. Needle placed through abdominal-uterine wall; designated amount of fluid is withdrawn for examination.

3. Empty bladder if gestation greater than 20 weeks.

4. Risk of complications less than 1%. Ultrasound always precedes this procedure.

5. Possible complications: onset of contractions; infections (probably amnionitis); placental punctures; cord puncture; bladder or fetal puncture.

6. Advise women to observe and report the following to physician: fetal hypoactivity or hyperactivity, vaginal bleeding, vaginal discharge (clear or colored), signs of labor, signs of infection.

G. Analysis of amniotic fluid

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Chromosomal studies to detect genetic aberrations.

2. Biochemical analysis of fetal cells to detect inborn errors of metabolism.

3. Determination of fetal lung maturity by assessing lecithin/sphingomyelin ratio.

4. Evaluation of phospholipids; aids in determining lung maturity.

5. Determination of creatinine levels; aids in determining fetal age. (Greater than 1.8 mg/dL indicates fetal maturity and the fetal age.)

6. Assesses isoimmune disease.

7. Presence of meconium may indicate fetal hypoxia.

H. Chorionic villus sampling (CVS)

Focus topic: Health Promotion and Maintenance; Nursing Care of the Childbearing Family

1. Cervically invasive procedure.

2. Advantage—results can be obtained after 10 weeks of gestation due to fast-growing fetal cells.

3. Procedure—removal of small piece of tissue (chorionic villus) from fetal portion of placenta. Tissue reflects genetic makeup of fetus.

4. Determines some genetic aberrations and allows for earlier decision for induced abortion (if desired) from abnormal results. Does not diagnose neural tube defects; clients who have CVS need further diagnoses with ultrasound.

5. Protects “pregnancy privacy” because results can be obtained before the pregnancy is apparent and decisions can be made regarding abortion or continuation of gestation.

6. Risks involve: spontaneous abortion, infection, hematoma, intrauterine death, Rh isoimmunization, and fetal limb defects, if done before 9 weeks of gestation.

FURTHER READING/STUDY:

Resources:

 

Leave a Reply

Your email address will not be published. Required fields are marked *