BSN 2-1 (GROUP 2)
HIGH RISK
PREGNANCY:
PROM & IUGR
WHAT WE'LL
DISCUSS TODAY
Preterm Rupture of
Membranes (PROM)
Intrauterine Growth
Restriction (IUGR)
ROUP 2 - AGUITEZ, ASILO, CEMINO, DINGLAS, FERNANDEZ, FLORES, LATIP, ORTEGO, PAREDES, PETEROS, RAMOS, TORCUATO
HIGH RISK PREGNANCY:
PRETERM RUPTURE OF
MEMBRANES (PROM)
PRETERM A rupture of fetal membranes
with loss of amniotic fluid before
RUPTURE OF 37 weeks of pregnancy
MEMBRANES Occurs in 5-10% of pregnancies
CAUSES:
unknown but is strongly associated
with infection of the membranes
I.e. chorioamnionitis - infection of the
placental tissues
> Cause of chorioamnionitis: bacteria
commonly found in the vagina, happens
more often when the amniotic sac is
broken for a long time before birth - lets
bacteria in the vagina move up into the
uterus
RISK FACTORS:
Low socioeconomic conditions
Sexually transmitted infections
Previous preterm birth
Vaginal bleeding
Cigarette smoking during pregnancy
Unknown causes
Educational status of the mother
Poor nutritional status
Cervical insufficiency
Urinary tract infections
A high volume of amniotic fluid (polyhydramnios)
Multiple gestations
History of threatened abortion
Maternal age
Connective tissue disorders
COMPLICATIONS:
1. Uterine and fetal infections
(chorioamnionitis)
2. Compression of the umbilical cord -
inhibits the nutrient supply
3. Cord prolapse - a condition that could
interfere with fetal circulation
4. Potter-like syndrome (i.e. atypical facial
features and pulmonary hypoplasia)
5. Preterm labor
6. Placental abruption
7. Cesarean birth
8. Postpartum infection
SIGNS AND SYMPTOMS:
Sudden gush of
fluid from the
vagina
MISTAKES:
Urinary
incontinence for
rupture of
membranes
Procedure/Physical
Exam:
Sterile vaginal
speculum
examination to
observe vaginal
pooling of liquid
STERILE VAGINAL SPECULUM EXAMINATION
TO OBSERVE VAGINAL POOLING OF LIQUID
1. If the fluid is tested with
Nitrazine paper
2. Fluid can also be tested fo
ferning or typical appearance of
high estrogen fluid on
microscopic examination
(amniotic fluid shows and urine
does not)
STERILE VAGINAL SPECULUM EXAMINATION
TO OBSERVE VAGINAL POOLING OF LIQUID
STERILE VAGINAL SPECULUM EXAMINATION
TO OBSERVE VAGINAL POOLING OF LIQUID
STERILE VAGINAL SPECULUM EXAMINATION
TO OBSERVE VAGINAL POOLING OF LIQUID
3. Ultrasound can be used to assess
the amniotic fluid index
4. Obtain cervical culture (Neisseria
gonorrhea, group B streptococcus,
and chlamydia)
AVOID DOING ROUTINE
VAGINAL EXAMINATION - RISK
OF INFECTION RISES WHEN
DIGITAL EXAMINATIONS ARE
PERFORMED AFTER PROM
THERAPEUTIC MAGAGEMENT:
If the fetus is not at a point of viability (< 24
weeks of gestation)
Offered immediate delivery to end
pregnancy
If the client declined delivery, placed on bed
rest
If the fetus reaches viability (24-31 weeks of
gestation)
Corticosteroid - to hasten fetal lung maturity
Prophylactic administration of broad
spectrum intibiotics effective against group
B streptococcus - delay the onset of labor
and reduce the risk of infection in the
newborn to allow corticosteroid to have its
effect
THERAPEUTIC MAGAGEMENT:
If the fetus in 34 weeks and greater, and
labor does not begin (> 34 weeks of
gestation)
Administer oxytocin to prevent
infection to the infant
Patient with no signs of infection
Administered tocolytic agent in labor
contractions begin
Amnioinfusion if effectiveness of tocolytic
agent is not well documented - reduce
pressure on the fetus or cord, and allow a
safer term birth
HIGH RISK PREGNANCY:
INTRAUTERINE
GROWTH RESTRICTION
(IUGR)
Failed to grow at the expected rate
in utero resulting to SGA or small-
for-gestational age infant
(Rahimian, 2013)
SGA is also known as microsomia,
INTRAUTERINE infant are less weight than usual
GROWTH
RESTRICTION There are two types of IUGR:
> Symmetrical IUGR - all parts of the
(IUGR)
baby's body are similarly small in size
> Asymmetrical IUGR - the baby's
head and brain are the expected size,
but the rest of the baby's body is
small.
HOW Intrauterine growth restriction affects
COMMON IS about 10% of all pregnancies. It’s
FETAL important to note that the fetus can
be smaller than average and not have
GROWTH IUGR.
RESTRICTION?
HOW IS IUGR DIAGNOSED?
Uterine fundal height
Prenatal Ultrasound
Fetal monitoring
Amniocentesis
Screening
CAUSES:
Occurs when the fetus does not receive
sufficient oxygen and nutrients needed for
growth and development
Can occur due to intrauterine infections such
as Rubella, Toxoplasmosis and syphilis.
Can occur if the blood flow in the umbilical
cord, which connects the baby to the placenta,
has a problem.
Intrauterine growth restriction also can happen
if a pregnant woman has vices, taking seizure
treatments, lupus, anemia or clotting problems,
hypertensive, and is pregnant with multiples.
RISK FACTORS:
1. Lack of Adequate Nutrition
2. Placental Abnormalities (insufficient
supply of nutrients from uterine arteries
or inefficient transport of nutrients)
3. Placental Underdevelopment or
damage (eg. placental separation w/
bleeding)
4. Women w/ severe diabetes mellitus or
gestational hypertension
5. Women w/ substance abuse such as
smoking, or use of opiates.
SIGNS AND SYMPTOMS:
appears malnourished
thin or pale skin
breathing difficulties
feeding issues
low blood sugar
body temperature issues
appears yellow (jaundice)
infection (sepsis)
WHEN IS IUGR DETECTED?
IUGR is often detected after
20 weeks of pregnancy when
your fundal height at each
prenatal visit. If this
measurement is shorter than
anticipated, your provider
may suspect IUGR and order
more tests.
COMPLICATIONS:
Difficulty during vaginal delivery
Low Apgar scores (a test done immediately after
birth to evaluate the newborn’s physical condition
to determine need for special medical care)
Meconium aspiration (inhalation of stools passed
while in the uterus), which can lead to breathing
problems
Low birth weight
Low resistance to infection
Difficulty in maintaining body temperature
Problems with breathing and feeding
Trouble keeping a steady body temperature
Abnormal blood cell counts
Low blood sugar level (hypoglycemia)
Problems fighting off infections
Neurological problems
THERAPEUTIC
MANAGEMENT/PREVENTION:
Care before pregnancy:
Providing care to women before and between
pregnancies improves the chances of mothers
and babies being healthy.
Advocating healthy eating and physical
activity to women in their daily routine to
improve weight and cardiovascular status
before pregnancy.
Diagnosis and management of chronic
diseases such as hypertension, diabetes before
pregnancy.
Correction of anemia/folic acid
supplementation before pregnancy.
THERAPEUTIC
MANAGEMENT/PREVENTION:
Care during pregnancy:
Pregnant mothers should take only those
medicines which are prescribed by doctors.
Healthy diet should be advised to pregnant
women with behavior change to encourage
healthier eating patterns during pregnancy.
Foods fortified with nutrients can be provided to
pregnant women.
Pregnant women are advised to take enough
rest with proper duration of sleep during night
and an hour or two of rest in the afternoon.
Expectant mothers should follow healthy lifestyle
habits. Tobacco use, smoking and alcohol intake
should be avoided during pregnancy.
THERAPEUTIC
MANAGEMENT/PREVENTION:
Care during pregnancy:
Pregnant mothers should take only those
medicines which are prescribed by doctors.
Healthy diet should be advised to pregnant
women with behavior change to encourage
healthier eating patterns during pregnancy.
Foods fortified with nutrients can be provided to
pregnant women.
Pregnant women are advised to take enough
rest with proper duration of sleep during night
and an hour or two of rest in the afternoon.
Expectant mothers should follow healthy lifestyle
habits. Tobacco use, smoking and alcohol intake
should be avoided during pregnancy.
THERAPEUTIC
MANAGEMENT/PREVENTION:
Care during delivery
Delivery should be
planned in health
facilities having
emergency obstetric care
and neonatal care
facilities.
THERAPEUTIC MANAGEMENT:
Antenatal Monitoring of IUGR
(Prior to Delivery):
Fetal Movement Count
Nonstress Testing (NST)
Biophysical Profile (BPP)
Ultrasound
Doppler Studies
THERAPEUTIC MANAGEMENT:
Antenatal Care in IUGR:
Bed rest
Increase food intake
Treatment of medical
condition; if necessary
Stop substance abuse; if
necessary
THERAPEUTIC MANAGEMENT:
Antenatal Care in IUGR:
Bed rest
Increase food intake
Treatment of medical
condition; if necessary
Stop substance abuse; if
necessary
THERAPEUTIC MANAGEMENT:
Management after birth
Complete physical
examination
Test for
hypoglycemia
Test for polycythemia
THANK YOU!
