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During pregnanacy
• If the maternal pancreas is unable to increase insulin production sufficiently, gestational diabetes mellitus results
• Maternal hyperglycemia results in glucose crossing the placenta and the fetus manufacturing insulin
• Insulin in the fetus acts as a growth hormone producing a large-size infant
• Shoulder dystocia is the most common complication of vaginal delivery in large-size infants
• Maternal insulin needs are dramatically reduced following delivery
• Newborns of diabetic mothers may incur birth injury, hyperbilirubinemia, hypoglycemia, and neurologic damage
• Euglycemia is the most important factor in avoiding maternal/fetal complications
• Anemia in pregnancy is associated with abortion, infection, pregnancy induced hypertension, preterm labor and heart failure
• Fetal problems from anemia of mother include growth retardation with associated morbidity and mortality
• Daily logs of dietary intake may help the client focus on positive improvement
• Pica is the craving by pregnant client for nonfood substances from low iron
• Failure to correct nutritional imbalances in pregnancy can result in intrauterine growth retardation, central nervous system malformations and fetal death
• Failure to correct nutritional imbalances in pregnancy can result in severe dehydration, metabolic alkalosis, ketosis, cardiac dysrhythmias and death for the woman
• Maternal understanding of the disease process and recommended therapies may provide impetus for self-care
• Normal pregnancy cardiovascular changes increase the heart’s workload
• Cardiac disease in pregnancy can deteriorate rapidly
• Client must verbalize understanding of cardiac findings indicating complications
• Pregnant cardiac clients must be monitored closely for decompensation
• Cardiac output maximizes at approximatley 28 weeks; is increased during labor and is at its highest during first hour postpartum
• Class II-IV cardiac clients should labor side-lying, semi-Fowler’s to facilitate cardiac emptying; pulse oximetry should be used to monitor tissue prefusion; and cardiac monitoring should be maintained
• Class II-IV cardiac clients should have induction, regional anesthesia, should not push during birth, legs should never be higher than the heart and should be monitored intensively following delivery
• Failure to detect blood incompatability with the fetus can result in RBC hemolysis and severe morbidity or mortality
• RhoGAM should be administered to all sensitized client’s within 72 hours following delivery, miscarriage, or abortion
Complications during labor and delivery
• Normal labor progress in active labor is 1.2cm/hr for primiparas and 1.5cm/hr for multiparas
• Prolonged labor at any stage should be evaluated for fetal, pelvic or uterine dysfunction
• Pain and anxiety can impede labor progress
• Vaginal birth is the birth method of choice and interventions should be directed at accomplishing that goal
• Cesarean birth is utilized to rescue the infant when fetal, pelvic or uterine dysfunction cannot be overcome
• Maintenance of a calm, soothing environment is necessary
• Efficient and effective gathering of supplies and personnel is imperative
• Maintain eye contact and verbal contact with woman to provide support
• Assist mother to birth as slowly as possible to prevent maternal/newborn trauma
• Be prepared to assist newborn transition to extrauterine environment
• Anticipate predisposing factors for prolapsed cord
• Gentle displacement of cord with sterile glove to relieve pressure
• Inform and support mother in emergency
• Prepare for expeditious birth - vaginal or cesarean
• Surgical intervention has associated complications of increased infection, increased postoperative hemorrhage, increased morbidity and potential of increased mortality
• Surgical delivery of the newborn reduces mechanical compression of the chest. It may potentiate respiratory difficulties in the newborn such as Transient Tachypnea of the Newborn.
• Surgical delivery is to be avoided except to rescue the fetus or to alleviate maternal morbidity
• Severe postpartum hemorrhage may result in organ failure, DIC, and/or mortality
• Estimation of bleeding is critical
• Uterine massage is the first line of defense against excessive hemorrhage
• Oxytocins are used to contract the uterus