This document discusses abnormal pregnancies, including minor disorders like nausea and vomiting, as well as more serious conditions like hyperemesis gravidarum. Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting that causes dehydration and weight loss of over 5% of pre-pregnancy weight. It is caused by high levels of hCG and other hormones and can create a vicious cycle of dehydration and exacerbated symptoms. Treatment involves hospitalization, IV fluids, electrolyte replacement, and antiemetics to reverse the effects and prevent long-term complications in both mother and baby. Midwives assess for risk factors and monitor signs and symptoms closely to identify hyperemesis gravid
This document discusses abnormal pregnancies, including minor disorders like nausea and vomiting, as well as more serious conditions like hyperemesis gravidarum. Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting that causes dehydration and weight loss of over 5% of pre-pregnancy weight. It is caused by high levels of hCG and other hormones and can create a vicious cycle of dehydration and exacerbated symptoms. Treatment involves hospitalization, IV fluids, electrolyte replacement, and antiemetics to reverse the effects and prevent long-term complications in both mother and baby. Midwives assess for risk factors and monitor signs and symptoms closely to identify hyperemesis gravid
This document discusses abnormal pregnancies, including minor disorders like nausea and vomiting, as well as more serious conditions like hyperemesis gravidarum. Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting that causes dehydration and weight loss of over 5% of pre-pregnancy weight. It is caused by high levels of hCG and other hormones and can create a vicious cycle of dehydration and exacerbated symptoms. Treatment involves hospitalization, IV fluids, electrolyte replacement, and antiemetics to reverse the effects and prevent long-term complications in both mother and baby. Midwives assess for risk factors and monitor signs and symptoms closely to identify hyperemesis gravid
This document discusses abnormal pregnancies, including minor disorders like nausea and vomiting, as well as more serious conditions like hyperemesis gravidarum. Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting that causes dehydration and weight loss of over 5% of pre-pregnancy weight. It is caused by high levels of hCG and other hormones and can create a vicious cycle of dehydration and exacerbated symptoms. Treatment involves hospitalization, IV fluids, electrolyte replacement, and antiemetics to reverse the effects and prevent long-term complications in both mother and baby. Midwives assess for risk factors and monitor signs and symptoms closely to identify hyperemesis gravid
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ABNORMAL PREGNANCY
Prepared by Yeshi Assefa
(MSC,BSC,R/N) March/2021 OUTLINES: Minor disorders of pregnancy Hyper emesis gravidram Hypertensive disease during pregnancy Ante partum hemorrhage Amniotic fluid disorder Premature rapture of membranes Fetal growth abnormality o Intra uterine fetal death Preterm labor Prolonged pregnancy Multiple pregnancy and associated complication RH incompatibility MINOR DISORDERS OF PREGNANCY • Minor disorders are only disorders that occur during pregnancy and are not life threatening. 1. Nausea and vomiting- This presents between 4 and 12 weeks of gestation. - Hormonal influences are the most likely causes. - usually occurs in the morning but can occur any time during the day, aggravated by smelling of food. Management: - - Reassure the mother - Small frequent meals (dry meals) - Reduce fatty and fried containing foods. - Rest . Cont… 2. Heart burn: - is a burning sensation in the mid chest region. Progesterone relaxes the cardiac sphincter of the stomach and allows reflex of gastric contents into esophagus. Heart burn is most troublesome at 30-40 weeks gestation due to the pressure from the growing uterus • Management: - Small and frequent meal, sleeping with more pillows than usual. - For persistence/sever case/ prescribe antacids 3. Pica: - This is the term used when mother craves certain foods of unnatural substances such as coal, soil...etc. The cause is unknown but hormones and changes in metabolism are blamed. Management: - Seek medical advice if the substance craved is potentially harmful to the unborn baby. Cont… 4. Constipation: - Progesterone causes relaxation and decreased peristaltic activity of the gut, which is also displaced by the growing uterus. Management: - Increase the intake of water, fresh fruit, vegetables and roughages in the diet. - Exercise is helpful especially walking 5. Backache - The hormones sometime soften the segments to such a degree that some support is needed. Management: - Advice the mother to sleep on firm bed. - Advice support mechanisms of the back. 6. Fainting: - • In early pregnancy fainting may be due to the vasodilatation occurs under the influence of progesterone before there has been a compensatory increase in blood volume. • The weight of the uterine contents presses on the inferior venacava and slows the return of blood to the heart. Management: - Avoid long period of standing - Sit or lie down when she feels slight dizziness - Advice not to lie on her back except during abdominal examination 7. Varicosities- Progesterone relaxes the smooth muscles of the veins and result in sluggish circulation. The valves of the dilated veins become insufficient and varicosities result. It occurs in legs, anus (hemorrhoids) and vulva. Management: - Exercising the calf muscles by rising on the toes - Elevate the leg and rest on the table - Support thighs and legs - Avoid constipation and advise adequate fluid intake. - Sanitary pad give support for vulva varicositis Cont… • Most minor disorders can be advanced into a more serious complication of pregnancy. The disorders require immediate actions are as follows (Danger signals of pregnancy)
• - Vaginal bleeding - ---
Reduced fetal movements - Frontal or recurring headaches - Sudden swelling - Rupture of the membrane - Premature onset of contractions - Maternal anxiety for whatever reason HYPEREMESIS GRAVIDARUM Definition Hyper emesis gravidarium is a complication of pregnancy characterized by persistent, uncontrollable nausea and vomiting that begins in the first trimester and causes dehydration, ketosis, and weight loss of more than 5% of prepregnancy body weight. occurs in approximately 5 out of 1,000 pregnancies. • The prevalence increases in molar pregnancies and multiple gestations. • The peak incidence is at 8 to 12 weeks of pregnancy, and symptoms usually resolve by 20th week Etiology • The exact cause is unknown. but it is known to be associated with: - Multiple pregnancies, - Hydatidiform mole, - A history of women who experience this condition will have a recurrence in subsequent pregnancies • A few theories that have been proposed to explain its etiology include: • Endocrine theory—high levels of HCG and estrogen during pregnancy • Metabolic theory—vitamin B6 deficiency • Psychological theory—psychological stress increases the symptoms Pathophysiology • Elevated levels of HCG are present in all pregnant women during early pregnancy, usually declining after 12 weeks. This corresponds to the usual duration of morning sickness. • In hyper emesis gravidarium, the HCG levels are often higher and extend beyond the first trimester. Symptoms exacerbate the disease. • Decreased fluid intake and prolonged vomiting cause dehydration; - Dehydration increases the serum concentration of HCG, which in turn exacerbates nausea and vomiting—a vicious cycle. Cont… its effects :– - Decreased placental blood flow, - Decreased maternal blood flow and - Acidosis—can threaten the health of the mother and fetus. - Dehydration can lead to preterm labor Assessing the mother’s condition - Ask the woman whether normal diet has been resumed and tolerated. - Identify any events producing stress or anxiety, as these may exacerbate any vomiting. - Ascertain whether the nausea and vomiting are accompanied by pain; the location of any pain should be elicited. - Dryness or inelasticity of the skin - The mother’s weight will be less than expected for gestation. - The pulse rate will be weak and rapid and B/P becomes low. - Urine- becomes scanty and dark in colour and smells of acetone - It is usual for a mother suffering from hyper emesis gravidarum to be admitted to hospital. Diagnosis • CBC • Urine ketones—positive when the body breaks down fat to provide energy in the absence of adequate intake • Blood urea nitrogen (BUN)—increased in the presence of salt and water depletion Cont… Urine specific gravity—greater than 1.025, indicating concentrated urine linked to inadequate fluid intake or excessive fluid loss - ketonuria Serum electrolytes—decreased levels of potassium, sodium, and chloride resulting from excessive vomiting and loss of hydrochloric acid in stomach Ultrasound—evaluation for molar pregnancy or multiple gestation Therapeutic Management • Hyper emesis gravidarium is a diagnosis of exclusion. Careful consideration of other conditions must be assessed • when a client experiences nausea and vomiting for the first time after 9 weeks’ gestation, Conservative management at home is the first line of treatment. • This usually focuses on dietary and lifestyle changes. • If it fails to alleviate the symptoms , hospitalization is necessary to reverse the effects of severe nausea and vomiting. • On admission to the hospital, - blood tests to assess the severity of the client’s condition electrolyte imbalance, ketosis, and malnutrition. - Parenteral fluids and drugs are ordered for rehydration - The first choice 5% dextrose in Ringer’s lactated solution with vitamins (pyridoxine [B6]) and electrolytes. - Oral food and fluids are withheld for the first 24 to 36 hours to allow rest to GI tract . - Antiemetic administered rectally or intravenously to control nausea and vomiting Cont…. • Once her condition stabilizes medications administered orally. • if tolerated a light diet may follow. • Normal food is gradually introduced and intravenous therapy discontinued. • Vitamin B12 and C, folic acid and iron required to correct anemia • If there is no improvement after several days of bed rest, “gut rest,” IV fluids, and antiemetic, total parenteral nutrition or feeding to prevent malnutrition • Most drugs are given parenterally or rectally • If it is untreated, it may cause - Neurologic disturbances, - Renal damage, - Retinal hemorrhage, or death. • Note! Every pregnant woman needs to be instructed to report any episodes of severe nausea and vomiting or episodes that extend beyond the first trimester Midwifery Assessment
• History and physical examination to identify
signs and symptoms associated with this disorder. - The client is extremely uncomfortable. - She may experience many hours of lost work productivity and sleep, - hyper emesis may damage family relationships. Health History and Physical Examination • take history fromthe client about:- • The onset, duration, and course of her nausea and vomiting. • Any medications or treatments used and its effectiveness • Diet history , including a dietary recall in the past week. • Note the client’s knowledge of nutrition and need for appropriate nutritional intake. • Be alert for patterns that may contribute /cause her distress. • Ask about any complaints of ptyalism (excessive salivation), anorexia, indigestion, and abdominal pain or distention. • Ask if she has noticed any blood or mucus in her stool. Cont… • Review the client’s history for possible risk factors, such as young age, nausea and vomiting with previous pregnancy • History of intolerance of oral contraceptives, - trophoblastic disease, multiple gestation - emotional or psychological stress, - gastro esophageal reflux disease, - primigravida status, obesity, hyperthyroidism, - helicobacter pylori seropositivity . • Weigh the client and compare with the weight before experiencing symptoms Cont… • Inspect the mucous membranes for dryness • Check skin turgor for fluid loss and dehydration. • Assess B/P for hypotension, that may suggest a fluid volume deficit. • Note any complaints of weakness, fatigue, activity, intolerance, dizziness, or sleep disturbances. • Assess client’s perception of the situation. • Note any evidence of depression, anxiety, irritability, mood changes, and decreased ability to concentrate, which can add to her emotional distress . • Determine woman’s support systems available for help. • Check lab results Midwifery Management • Management focuses on promoting comfort and adequate nutrition. providing support and educating the client and her family Promoting Comfort and Nutrition
• During the initial period, expect to withhold all oral food
and fluids, maintaining NPO status to allow the GI tract to rest. • Administer prescribed drugs and IV fluids . • Monitor the rate of infusion to prevent overload • Assess IV insertion site to prevent infiltration or infection. • Administer electrolyte replacement therapy as ordered to correct any imbalances • Observe the B/P, pulse rate and temperature 4/hourly. • periodically check serum electrolyte levels to evaluate the effectiveness of therapy Cont... • Provide physical comfort measures such as hygiene measures and oral care. • Pay special attention to the environment, making sure to keep the area free of pungent odors. • As the client’s nausea and vomiting subside, gradually introduce oral fluids and foods in small amounts. • Monitor intake and output and assess the client’s tolerance to the increase in intake Providing Support and Education • Women with hyper emesis gravidarium commonly are fatigued physically and emotionally. exhausted, frustrated, and anxious. • Reassure the mother that all interventions are directed toward promoting positive pregnancy outcomes • Inform about the expected plan of care to alleviate anxiety. • Listen to her concerns and feelings, answer all questions honestly. • Educate the woman & her family about the condition and treatment options • Teach the client about therapeutic lifestyle changes, such as avoiding stressors and fatigue that trigger nausea and vomiting Educate the mother to :- Avoid noxious stimuli—such as strong flavors, perfumes, or strong odors such as frying that might trigger nausea and vomiting. • Avoid tight waistbands to minimize pressure on abdomen. • Eat small, frequent meals throughout the day ( six small meals). • Separate fluids from solids by consuming fluids in between meals. • Avoid lying down for at least 2 hours after eating. • Use high-protein supplement drinks. • Avoid foods high in fat. Cont…. • Increase intake of carbonated beverages. • Increase exposure to fresh air to improve symptoms. • Eat when hungry, regardless of normal mealtimes. • Drink herbal teas containing peppermint or ginger. • Avoid fatigue and learn how to manage stress in life. • Schedule daily rest periods to avoid becoming overtired. • Eat foods that settle the stomach, such as dry crackers, toast, or soda. THANKYOU