This document provides information on intrauterine fetal therapies. It begins with an introduction defining fetal therapy as interventions to correct or treat fetal anomalies. It then discusses the personnel and tools required for fetal therapies. The document outlines two main types of fetal therapy - pharmacological and surgical. Pharmacological therapies include preventive therapies using medications and therapeutic therapies for conditions like cardiac arrhythmias. Surgical invasive therapies discussed include intrauterine blood transfusions, fetal image-guided procedures, and fetal endoscopic surgery.
Misoprostol use in Obstetrics and GynaecologyChimezie Obi
This document discusses the use of misoprostol in obstetrics and gynecology. It outlines the pharmacology of misoprostol and its various uses such as cervical ripening and induction of labor, treatment and prevention of postpartum hemorrhage, and termination of early pregnancy. The document also discusses controversies surrounding misoprostol use and provides recommendations for its administration.
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
This document discusses obstetric shock, its causes, signs, stages, and management. Shock is a life-threatening medical emergency characterized by inadequate tissue perfusion and oxygenation. The major causes of obstetric shock are hemorrhage, sepsis, cardiogenic issues, neurogenic issues, and anaphylaxis. Untreated shock progresses through compensated, decompensated, and irreversible stages. Initial management focuses on airway, breathing, circulation, oxygenation, intravenous fluids, blood transfusion, and identifying and treating the underlying cause. Prompt recognition and treatment of obstetric shock can improve maternal and fetal outcomes.
This document discusses various destructive operations that can be performed on a dead fetus to facilitate delivery through the birth canal when the fetus is too large to pass intact. It defines destructive operations and describes their purposes. It then discusses different procedures like craniotomy, decapitation, evisceration, cleidotomy, and spondylectomy. For each procedure, it provides indications, prerequisites, steps to perform the procedure, and risks. It notes that most destructive operations are no longer recommended and have been replaced by caesarean section for safety reasons.
This document provides information on Methergine and Clomiphene Citrate.
Methergine is an ergot alkaloid administered postpartum to help deliver the placenta and control bleeding by improving uterine muscle tone and contractions. It has potential side effects like nausea and leg cramps. Nurses must monitor vital signs and uterine response after administration and educate patients on signs of problems.
Clomiphene Citrate is used to induce ovulation in women with infertility. It works by inhibiting estrogen receptors in the brain to stimulate ovulation. It has potential visual and ovarian side effects and drug interactions. Nurses must monitor patients for abnormal bleeding or vision changes and educate them on proper administration and signs of problems.
This document discusses epilepsy and pregnancy. Some key points:
- Epilepsy affects 0.5% of women of childbearing age and is the most common neurological disorder complicating pregnancy.
- Seizure frequency may increase, decrease or remain unchanged during pregnancy, depending on the individual. The risk of seizures is highest around delivery.
- Antiepileptic medications used to treat epilepsy can cause birth defects, especially sodium valproate which has been linked to neural tube defects. The risk increases with multiple medications and higher valproate doses.
- Women with epilepsy need folic acid, careful monitoring of seizure frequency and medication levels during pregnancy, and fetal screening for birth defects. Managing epilepsy treatment aims to control
Drugs used in pregnancy, labor and puerperiumAnamika Ramawat
The document discusses drugs used during pregnancy, labor, and the postpartum period. It provides information on folic acid, iron, calcium, antihypertensive drugs, diuretics, tocolytic agents, oxytocics, analgesics, and anticoagulants. For each drug, it describes preparations, mode of action, indications, contraindications, adverse effects, dosage, and important nursing considerations. The document is intended to give nurses thorough knowledge of medications commonly administered during obstetric care.
This document discusses the nature, pharmacokinetics, adverse reactions, and uses of the drug misoprostol. Misoprostol is a synthetic prostaglandin E1 analog that is administered orally, sublingually, vaginally, or rectally. It is metabolized in the liver and has few serious side effects at common doses but can cause hyperthermia, rhabdomyolysis, and hypoxemia at very high doses. Misoprostol has various obstetric and gynecological uses including termination of pregnancy in the first, second, and third trimesters, prevention and treatment of postpartum hemorrhage, cervical ripening, and prevention of ulcers caused by NSA
Misoprostol use in Obstetrics and GynaecologyChimezie Obi
This document discusses the use of misoprostol in obstetrics and gynecology. It outlines the pharmacology of misoprostol and its various uses such as cervical ripening and induction of labor, treatment and prevention of postpartum hemorrhage, and termination of early pregnancy. The document also discusses controversies surrounding misoprostol use and provides recommendations for its administration.
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
This document discusses obstetric shock, its causes, signs, stages, and management. Shock is a life-threatening medical emergency characterized by inadequate tissue perfusion and oxygenation. The major causes of obstetric shock are hemorrhage, sepsis, cardiogenic issues, neurogenic issues, and anaphylaxis. Untreated shock progresses through compensated, decompensated, and irreversible stages. Initial management focuses on airway, breathing, circulation, oxygenation, intravenous fluids, blood transfusion, and identifying and treating the underlying cause. Prompt recognition and treatment of obstetric shock can improve maternal and fetal outcomes.
This document discusses various destructive operations that can be performed on a dead fetus to facilitate delivery through the birth canal when the fetus is too large to pass intact. It defines destructive operations and describes their purposes. It then discusses different procedures like craniotomy, decapitation, evisceration, cleidotomy, and spondylectomy. For each procedure, it provides indications, prerequisites, steps to perform the procedure, and risks. It notes that most destructive operations are no longer recommended and have been replaced by caesarean section for safety reasons.
This document provides information on Methergine and Clomiphene Citrate.
Methergine is an ergot alkaloid administered postpartum to help deliver the placenta and control bleeding by improving uterine muscle tone and contractions. It has potential side effects like nausea and leg cramps. Nurses must monitor vital signs and uterine response after administration and educate patients on signs of problems.
Clomiphene Citrate is used to induce ovulation in women with infertility. It works by inhibiting estrogen receptors in the brain to stimulate ovulation. It has potential visual and ovarian side effects and drug interactions. Nurses must monitor patients for abnormal bleeding or vision changes and educate them on proper administration and signs of problems.
This document discusses epilepsy and pregnancy. Some key points:
- Epilepsy affects 0.5% of women of childbearing age and is the most common neurological disorder complicating pregnancy.
- Seizure frequency may increase, decrease or remain unchanged during pregnancy, depending on the individual. The risk of seizures is highest around delivery.
- Antiepileptic medications used to treat epilepsy can cause birth defects, especially sodium valproate which has been linked to neural tube defects. The risk increases with multiple medications and higher valproate doses.
- Women with epilepsy need folic acid, careful monitoring of seizure frequency and medication levels during pregnancy, and fetal screening for birth defects. Managing epilepsy treatment aims to control
Drugs used in pregnancy, labor and puerperiumAnamika Ramawat
The document discusses drugs used during pregnancy, labor, and the postpartum period. It provides information on folic acid, iron, calcium, antihypertensive drugs, diuretics, tocolytic agents, oxytocics, analgesics, and anticoagulants. For each drug, it describes preparations, mode of action, indications, contraindications, adverse effects, dosage, and important nursing considerations. The document is intended to give nurses thorough knowledge of medications commonly administered during obstetric care.
This document discusses the nature, pharmacokinetics, adverse reactions, and uses of the drug misoprostol. Misoprostol is a synthetic prostaglandin E1 analog that is administered orally, sublingually, vaginally, or rectally. It is metabolized in the liver and has few serious side effects at common doses but can cause hyperthermia, rhabdomyolysis, and hypoxemia at very high doses. Misoprostol has various obstetric and gynecological uses including termination of pregnancy in the first, second, and third trimesters, prevention and treatment of postpartum hemorrhage, cervical ripening, and prevention of ulcers caused by NSA
Magnesium sulfate is the drug of choice for preventing and treating convulsions in severe pre-eclampsia and eclampsia. It acts as an anticonvulsant by blocking calcium channels in the nervous system. For treatment, it is administered intravenously as a loading dose followed by intramuscular maintenance doses every four hours. Nurses must monitor patients for signs of toxicity such as decreased respiratory rate and absent patellar reflexes. While magnesium sulfate can be dangerous if not properly monitored, studies show the benefits outweigh the risks for both mother and baby when administered and monitored correctly. However, eclampsia remains a major cause of maternal deaths in Nepal possibly due to lack of availability, proper administration
AFE is a rare but life-threatening complication of pregnancy caused when amniotic fluid, fetal cells or debris enter the maternal circulation. It has a high mortality rate and serious implications for both mother and infant. AFE should be suspected in pregnant patients experiencing sudden respiratory distress, cardiac collapse, seizures or abnormal bleeding. Prompt diagnosis and aggressive treatment including ventilation, fluid resuscitation, vasopressors and coagulopathy management are required but outcomes remain poor.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
This document presents a PowerPoint presentation on multiple pregnancy by Prativa Dhakal. It defines multiple pregnancy as when more than one fetus develops simultaneously in the uterus. It discusses the different types of twin pregnancies, including dizygotic and monozygotic twins. It also covers the incidence, factors influencing twinning, maternal physiological changes, diagnosis, complications, prognosis, and management of twin pregnancies. Key diagnostic tools include ultrasound and biochemical tests. Major complications discussed are preterm birth and preeclampsia. Management involves careful monitoring, interventions to prevent preterm delivery, and ensuring availability of neonatal care.
This document discusses various drugs used during pregnancy, labor, the postpartum period, and for newborns. It describes oxytocics like oxytocin, ergot derivatives, and prostaglandins that are used to induce and augment labor. It also discusses antihypertensive drugs like methyldopa, labetalol, and nifedipine that are used to treat high blood pressure during pregnancy. Finally, it provides details on indications, mechanisms of action, dosages, and side effects of these important obstetric medications.
This document describes the procedure for manual removal of the placenta (MRP). MRP is performed when the placenta fails to deliver within 30 minutes of childbirth. It involves inserting fingers into the uterus to locate and detach the placenta from the uterine wall while supporting the fundus. Once detached, the placenta is withdrawn from the uterus while continuing to provide counter-traction. Oxytocin is administered to encourage uterine contraction and prevent hemorrhage. The placenta is examined for completeness and the uterus is checked for contraction to ensure the procedure was successful. Potential complications include shock, postpartum hemorrhage, puerperal sepsis, and inversion or hysterectomy.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
This document discusses pain management during labor and childbirth. It explains that labor pain is unique compared to other types of pain. Sources of labor pain include cervical dilation, uterine contractions, and fetal descent. Factors like preparation, culture, anxiety and fatigue can influence a woman's experience of pain. Non-pharmacological methods for managing pain include breathing, positioning, water therapy and relaxation techniques. Pharmacological options include opioids, epidural anesthesia and spinal anesthesia, each with advantages and disadvantages. Complications of regional anesthesia include hypotension and fetal distress. General anesthesia is riskier for mother and fetus due to issues like failed intubation or aspiration.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures
, nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Management of Post-partum hemorrhage (PPH)Sandesh Kamdi
Post-partum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, accounting for nearly one quarter of all maternal deaths. PPH can occur within 24 hours of delivery (primary) or 24 hours to 6 weeks after delivery (secondary). Active management of the third stage of labor, including administration of uterotonic drugs like oxytocin, decreases the risk of PPH. While oxytocin is the gold standard for treating PPH, misoprostol has been shown to be a safe and effective alternative in settings where oxytocin is unavailable. Secondary PPH is often associated with infection and is generally treated with antibiotics along with uterotonics or balloon tamponade if bleeding continues. Surgical
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound imaging. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the stability of the patient and characteristics of the ectopic pregnancy.
This document discusses obstetric forceps, which are metal instruments used to extract a baby's head during delivery. It describes different types of forceps and their proper application techniques. Forceps are indicated for prolonged second stage of labor, maternal distress, or fetal distress. Correct application involves inserting one blade along each side of the baby's head. Potential complications include laceration, hemorrhage, nerve injury, or problems for the baby such as skull fractures. Failure to deliver with forceps may require removal and assessment to determine if cesarean section is needed.
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
This document provides information on various obstetrical emergencies presented in a seminar, including definitions, symptoms, diagnosis, management, and nursing considerations. Vasa previa is defined as blood vessels from the umbilical cord or placenta crossing the cervix without Wharton's jelly covering. Symptoms include vaginal bleeding. Diagnosis is via color Doppler and emergency c-section is required if membranes rupture. Amniotic fluid embolism causes pulmonary vasospasm and coagulopathies. Symptoms include respiratory distress and hemorrhage. Management focuses on hemodynamic support and delivery. Other emergencies discussed include obstetric shock, cord prolapse, and uterine inversion.
Fetal therapy involves both non-invasive and invasive procedures to diagnose and treat conditions affecting the unborn baby. Non-invasive procedures include administering medications to the mother that will benefit the fetus, such as steroids to promote lung maturity. Invasive procedures include intravascular transfusions to treat fetal anemia and correct blood counts, as well as fetoscopy to biopsy tissues and treat abnormalities. These invasive procedures require ultrasound guidance and careful monitoring to minimize risks to the mother and fetus. Fetal therapy is a multidisciplinary effort involving many specialists working together to diagnose and treat issues during pregnancy and improve outcomes for the unborn baby.
TREATMENT GUIDELINES OF SOCIETY OF MATERNAL AND FETAL MEDICINEAboubakr Elnashar
This document outlines treatment guidelines from 2019 provided by Prof. Aboubakr Elnashar of Benha University in Egypt. It discusses recommendations from the Society for Maternal-Fetal Medicine (SMFM) on conditions such as preeclampsia, placenta accreta, twin-twin transfusion syndrome, hydrops fetalis, amniotic fluid embolism, preterm birth, and fetal anemia. The SMFM provides evidence-based guidelines on evaluating, monitoring, and managing these high-risk pregnancies and conditions.
Magnesium sulfate is the drug of choice for preventing and treating convulsions in severe pre-eclampsia and eclampsia. It acts as an anticonvulsant by blocking calcium channels in the nervous system. For treatment, it is administered intravenously as a loading dose followed by intramuscular maintenance doses every four hours. Nurses must monitor patients for signs of toxicity such as decreased respiratory rate and absent patellar reflexes. While magnesium sulfate can be dangerous if not properly monitored, studies show the benefits outweigh the risks for both mother and baby when administered and monitored correctly. However, eclampsia remains a major cause of maternal deaths in Nepal possibly due to lack of availability, proper administration
AFE is a rare but life-threatening complication of pregnancy caused when amniotic fluid, fetal cells or debris enter the maternal circulation. It has a high mortality rate and serious implications for both mother and infant. AFE should be suspected in pregnant patients experiencing sudden respiratory distress, cardiac collapse, seizures or abnormal bleeding. Prompt diagnosis and aggressive treatment including ventilation, fluid resuscitation, vasopressors and coagulopathy management are required but outcomes remain poor.
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
This document presents a PowerPoint presentation on multiple pregnancy by Prativa Dhakal. It defines multiple pregnancy as when more than one fetus develops simultaneously in the uterus. It discusses the different types of twin pregnancies, including dizygotic and monozygotic twins. It also covers the incidence, factors influencing twinning, maternal physiological changes, diagnosis, complications, prognosis, and management of twin pregnancies. Key diagnostic tools include ultrasound and biochemical tests. Major complications discussed are preterm birth and preeclampsia. Management involves careful monitoring, interventions to prevent preterm delivery, and ensuring availability of neonatal care.
This document discusses various drugs used during pregnancy, labor, the postpartum period, and for newborns. It describes oxytocics like oxytocin, ergot derivatives, and prostaglandins that are used to induce and augment labor. It also discusses antihypertensive drugs like methyldopa, labetalol, and nifedipine that are used to treat high blood pressure during pregnancy. Finally, it provides details on indications, mechanisms of action, dosages, and side effects of these important obstetric medications.
This document describes the procedure for manual removal of the placenta (MRP). MRP is performed when the placenta fails to deliver within 30 minutes of childbirth. It involves inserting fingers into the uterus to locate and detach the placenta from the uterine wall while supporting the fundus. Once detached, the placenta is withdrawn from the uterus while continuing to provide counter-traction. Oxytocin is administered to encourage uterine contraction and prevent hemorrhage. The placenta is examined for completeness and the uterus is checked for contraction to ensure the procedure was successful. Potential complications include shock, postpartum hemorrhage, puerperal sepsis, and inversion or hysterectomy.
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
This document discusses pain management during labor and childbirth. It explains that labor pain is unique compared to other types of pain. Sources of labor pain include cervical dilation, uterine contractions, and fetal descent. Factors like preparation, culture, anxiety and fatigue can influence a woman's experience of pain. Non-pharmacological methods for managing pain include breathing, positioning, water therapy and relaxation techniques. Pharmacological options include opioids, epidural anesthesia and spinal anesthesia, each with advantages and disadvantages. Complications of regional anesthesia include hypotension and fetal distress. General anesthesia is riskier for mother and fetus due to issues like failed intubation or aspiration.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures
, nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Management of Post-partum hemorrhage (PPH)Sandesh Kamdi
Post-partum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, accounting for nearly one quarter of all maternal deaths. PPH can occur within 24 hours of delivery (primary) or 24 hours to 6 weeks after delivery (secondary). Active management of the third stage of labor, including administration of uterotonic drugs like oxytocin, decreases the risk of PPH. While oxytocin is the gold standard for treating PPH, misoprostol has been shown to be a safe and effective alternative in settings where oxytocin is unavailable. Secondary PPH is often associated with infection and is generally treated with antibiotics along with uterotonics or balloon tamponade if bleeding continues. Surgical
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous ectopic pregnancy, infections, scarring of the fallopian tubes, and fertility treatments. Ectopic pregnancies can cause life-threatening bleeding if not treated properly. Diagnosis involves beta-hCG levels and ultrasound imaging. Treatment options include medication with methotrexate, expectant management with close monitoring, or surgery depending on the stability of the patient and characteristics of the ectopic pregnancy.
This document discusses obstetric forceps, which are metal instruments used to extract a baby's head during delivery. It describes different types of forceps and their proper application techniques. Forceps are indicated for prolonged second stage of labor, maternal distress, or fetal distress. Correct application involves inserting one blade along each side of the baby's head. Potential complications include laceration, hemorrhage, nerve injury, or problems for the baby such as skull fractures. Failure to deliver with forceps may require removal and assessment to determine if cesarean section is needed.
Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.
This document provides information on various obstetrical emergencies presented in a seminar, including definitions, symptoms, diagnosis, management, and nursing considerations. Vasa previa is defined as blood vessels from the umbilical cord or placenta crossing the cervix without Wharton's jelly covering. Symptoms include vaginal bleeding. Diagnosis is via color Doppler and emergency c-section is required if membranes rupture. Amniotic fluid embolism causes pulmonary vasospasm and coagulopathies. Symptoms include respiratory distress and hemorrhage. Management focuses on hemodynamic support and delivery. Other emergencies discussed include obstetric shock, cord prolapse, and uterine inversion.
Fetal therapy involves both non-invasive and invasive procedures to diagnose and treat conditions affecting the unborn baby. Non-invasive procedures include administering medications to the mother that will benefit the fetus, such as steroids to promote lung maturity. Invasive procedures include intravascular transfusions to treat fetal anemia and correct blood counts, as well as fetoscopy to biopsy tissues and treat abnormalities. These invasive procedures require ultrasound guidance and careful monitoring to minimize risks to the mother and fetus. Fetal therapy is a multidisciplinary effort involving many specialists working together to diagnose and treat issues during pregnancy and improve outcomes for the unborn baby.
TREATMENT GUIDELINES OF SOCIETY OF MATERNAL AND FETAL MEDICINEAboubakr Elnashar
This document outlines treatment guidelines from 2019 provided by Prof. Aboubakr Elnashar of Benha University in Egypt. It discusses recommendations from the Society for Maternal-Fetal Medicine (SMFM) on conditions such as preeclampsia, placenta accreta, twin-twin transfusion syndrome, hydrops fetalis, amniotic fluid embolism, preterm birth, and fetal anemia. The SMFM provides evidence-based guidelines on evaluating, monitoring, and managing these high-risk pregnancies and conditions.
This document discusses gestational trophoblastic disease (GTD), including classifications, genetics, risk factors, clinical features, investigations, management, and follow up. GTD includes benign, non-neoplastic lesions like molar pregnancies as well as gestational trophoblastic neoplasms. Molar pregnancies are classified as complete or partial moles. Complete moles usually arise from abnormal fertilization, while partial moles are usually triploid. Follow up of molar pregnancies involves monitoring beta-hCG levels to detect persistent trophoblastic disease.
Multifetal pregnancies, especially those of higher order multiples, pose significant risks to both mother and fetuses. These risks include maternal complications such as preeclampsia and gestational diabetes as well as fetal complications like premature birth, low birth weight, and developmental impairments. Multifetal pregnancy reduction (MFPR) aims to reduce these risks by terminating one or more fetuses, leaving the remaining fetuses with improved health outcomes. While controversial, MFPR is generally considered ethically acceptable for reducing high order multiples and may provide benefits for triplet pregnancies. The procedure involves using ultrasound guidance to transvaginally inject a needle into the selected fetus between 7-12 weeks gestation.
This document provides an overview of perinatology and fetal therapy. It discusses various pharmacological and surgical fetal therapies used to treat conditions such as cardiac arrhythmias, complete atrioventricular block, congenital adrenal hyperplasia, fetal anemia, twin-twin transfusion syndrome, congenital diaphragmatic hernia, and pleural effusions. Invasive fetal therapies discussed include intrauterine blood transfusion, fetoscopy, laser coagulation of vessels, and intra-amniotic gene transfer. Fetal therapy requires a multidisciplinary team and tools such as ultrasound, MRI, and fetoscopes to properly diagnose and treat conditions in-utero.
THE SICKLE CELL DISEASE IN PREGNANCY.pptxDr Issah J.K
This presentation talks about Haematological disorder in pregnancy specifically sickle cell disease in pregnancy. It's epidemiology, clinical presentation, diagnosis, management and it's prognosis
Assessment of Mother, Fetus and Newborn with.pptxdrshonarkar
This document provides an overview of assessing the mother, fetus, and newborn. Key points include:
1) Identifying high-risk pregnancies is important to monitor for complications and institute treatments. Conditions that increase risk include growth issues, congenital anomalies, prematurity, and maternal medical complications.
2) A newborn's transition to extrauterine life requires assessment of the delivery and mother's history to anticipate any issues. Routine newborn care includes eye prophylaxis, skin antisepsis, and vitamin K administration.
3) The Apgar score rapidly assesses a newborn's condition at 1 and 5 minutes. Low scores may indicate the need for resuscitation per the AB
1. Pregnancy in patients with lupus requires careful management by an obstetrician and rheumatologist due to the high risk nature.
2. Patients with active lupus or kidney disease are more likely to have complications and it is recommended to avoid pregnancy until the disease is well controlled.
3. With proper management of medications and disease activity, many lupus patients can have successful pregnancies and deliveries. Close monitoring is important throughout the pregnancy and postpartum period.
Doppler us in the evaluation of fetal growthSumiya Arshad
This document discusses the use of Doppler ultrasound to diagnose and monitor fetal growth restriction. It outlines the current definitions of fetal growth restriction, techniques for obtaining Doppler waveforms of various fetal vessels, and what abnormal Doppler readings indicate in terms of fetal wellbeing and risk of adverse outcomes. Specifically, it describes how umbilical, middle cerebral, and ductus venosus artery Dopplers can identify fetuses with placental insufficiency and help guide management decisions.
Maternal hyperglycemia can negatively impact the fetus and neonate, increasing risks of congenital anomalies, macrosomia, and perinatal complications. Specifically, it is associated with a 4-8x increased risk of major birth defects. It also increases risks of neural tube defects, congenital heart disease, macrosomia, shoulder dystocia, neonatal hypoglycemia, jaundice, and respiratory distress. Close monitoring and control of maternal blood glucose levels is important for reducing these risks.
This document discusses transfusion of blood products and management of coagulation disorders in obstetrics. It provides information on fresh frozen plasma (FFP), cryoprecipitate, platelet concentrates, packed red blood cells (PRBC), recombinant factor VIIa, autotransfusion, alternative oxygen carriers, heparin, and fibrinolytic inhibitors. It emphasizes the importance of promptly replacing blood volume and coagulation factors in managing coagulation disorders during pregnancy and delivery.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Candida infections in neonatal intensive care units can cause significant morbidity and mortality, so the document recommends measures to prevent, diagnose, and treat candidiasis in high-risk infants through practices like limiting unnecessary antibiotic use, considering fluconazole prophylaxis if infection rates remain high, and initiating empirical antifungal therapy in infants with risk factors like previous broad-spectrum antibiotic exposure. A diagnosis of candidiasis should prompt removal of foreign materials, treatment with antifungals like fluconazole or amphotericin B, and monitoring until cultures are cleared from sites like blood and urine.
Nonimmune hydrops fetalis . Dr B M RakshitBibek Rakshit
This document discusses nonimmune hydrops fetalis (NIHF), which accounts for 90% of cases of hydrops fetalis. NIHF has numerous potential underlying causes and carries significant risks for both the fetus and mother. The document defines NIHF, discusses its differential diagnosis and evaluation, potential etiologies, presentation, prognosis, management options, and recommendations from clinical practice guidelines.
This document discusses rheumatologic emergencies in pediatric patients that require prompt recognition and treatment. It summarizes five such conditions:
1) Neonatal complete heart block secondary to neonatal lupus erythematosus, which can cause significant morbidity and mortality without treatment.
2) Febrile children presenting with pancytopenia, which has a rheumatologic differential of macrophage activation syndrome (MAS). MAS is a potentially fatal complication of conditions like systemic lupus erythematosus and can cause rapid deterioration.
3) Diagnostic and initial treatment approaches are provided for these two conditions to assist physicians in timely management. The document focuses on rheumatologic emergencies that may be the
The document discusses dental management considerations for pregnant women. It notes that dental treatment may be modified during pregnancy if risk is properly assessed for the patient and fetus. Key changes include increased blood volume, heart rate and the potential for supine hypotensive syndrome in later stages. Treatment timing, dental radiation exposure, medications and nitrous oxide use all require special precautions. Periodontal disease is associated with preterm birth and low birth weight so maintenance is important. With proper risk assessment and positioning, dental care can be provided safely during pregnancy.
This document discusses chemotherapy use during pregnancy, including definitions, epidemiology, preclinical and clinical studies, and long-term outcomes after in utero exposure. It provides details on management of specific cancers in pregnancy, factors affecting placental transfer of drugs, and safety of various chemotherapy agents during different trimesters. Guidelines are presented for timing of chemotherapy in relation to gestational age and delivery to balance maternal cancer treatment with fetal protection.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
4. INTRODUCTION
–A therapeutic intervention for the purpose
of correcting or treating a fetal anomaly or
condition is called fetal therapy. In almost
every case, the fetus is at risk of intrauterine
death from the abnormality. 10/29/2019
4
5. DEFINITION
–“Fetal therapy A therapeutic intervention
for the purpose of correcting or treating a
fetal anomaly or condition is called fetal
therapy.”
–“Any intervention Aiming for correcting
or treating a fetal abnormalities.” 10/29/2019
5
6. PERSONALS REQUIRED FOR
FETAL THERAPY
Obstetrician
Paediatrician
Anaesthetists
Ultrasonologist
Neurosurgeon
Social worker etc. 10/29/2019
6
11. Neural tube
defects
10/29/2019
All the women planning a
pregnancy should be given folic
acid in dose 0.4mg/day for at
least one month.
Women with a prior child with
NTD , should receive folic acid 4
mg/day for at least one month
pre - conceptually and three
months after the pregnancy.
11
12. Antenatal
steroid to
enhance
fetal lung
maturity.
– The high risk pregnancy associated
with risk of preterm delivery should be
given steroid at least 48 hours before
delivery so as to accelerate lung
maturity as well as renal maturity.
– Dose:
Betamethasone 12 mg twice at 24
hours interval
– or
Dexona 6 mg at 12 hours interval , for
total 4 doses are given
This will reduce need of surfactant
and ventilatory therapy to baby.
10/29/2019
12
14. Fetus with maternal SLE.
Fetus at risk to develop Complete heart block
because of damage to AV bundle.
This can be prevented by giving Dexamethasone
4 mg per day during pregnancy.
10/29/2019
14
22. COMPLETE
A-V BLOCK
- CAVB
22
–Prevalence: 1/15,000-
1/22,000 live birth.
–Path-physiology : The fetal
mortality rate of isolated
CAVB may be as much as 30-
50%. Patients diagnosed and
treated in the neonatal period
have a survival rate of 94%,
and patients who are
diagnosed and treated in
childhood have a survival rate
of 100%.10/29/2019
23. Fetus with isolated Complete A –
V block Rx
23
10/29/2019
HR > 55/min with normal LV function:-
• Dexamethasone - orally to mother
HR < 55/min with abnormal LV function:-
• Dexamethasone - orally with β agonist
• Weekly follow up by obstetrician with fetal
echocardiography
25. 10/29/2019
25
COMPLETE FETALA – V BLOCK
At the time of diagnosis of heart block in
FETUS maternal dexamethasone (4 or 8 mg/d
for 2 weeks,
Then 4 mg/day should be initiated maintained
for the duration of the pregnancy, tapering at
times (2 mg/d) in the third trimester.
If the average heart rate declined below 55 bpm,
A ß-sympathomimetic agent should be given
salbutamol 40mg/ day for 2 weeks. Contd….
26. 10/29/2019
26
In the presence of maternal anti-Ro/La
antibodies , there are no known markers that
will predict which fetus will develop an AV
conduction defect.
Little evidence suggests that the administration
of steroids, immunoglobulins or plasmapheresis
in the mother can reverse third-degree AV block.
However, these therapies are helpful if given in
early to Rx first-degree and second-degree heart
block.
27. Fetus with
isolated
Complete A
–V block
27
10/29/2019
Treatment:-
• Delivery at tertiary care centre.
• Uneventful fetal course - LSCS at
37 weeks.
• If fetus develop hydrops-
Paracentesis , LSCS
• Low CO out - Immediate Pacing -
Isoprenline
• Features of SLE - oral
prednisolone
• Endocardial fibroelastosis – I V
IgG
33. FETAL THYROID GOITER33
–Treatment
–Fetal cord blood for thyroid status TSH,T3,T4
–If Hyperthyroidism :- Treatment - Carbimazole
methimazole
–If hypothyroidism between 29-37 weeks 250-500
mg levothyroxin intra amniotic weekly this will
result in regression of thyroid goitre
10/29/2019
36. Congenital
adrenal
hyperplasia
(CAH)
36
10/29/2019
Congenital adrenal
hyperplasia (CAH) is a
family disorder caused
by reduced activity of
enzymes required for
cortisol biosynthesis
in the adrenal cortex.
The most common
defect is 21-
hydroxylase (21-OH)
deficiency, which
accounts for >90% of
all cases of CAH.
Classic 21-hydroxylase
deficiency is found in
about 1:12 000 to
1:15 000 births.
The frequency of
nonclassic deficiency
is unknown, although
it may occur in up to
3% of individuals in
certain groups.
37. CONGENITALADRENAL
HYPERPLASIA
Clinical consequences of 21-OH deficiency arise primarily from
overproduction and accumulation of precursors proximal to the blocked
enzymatic step.
These precursors are shunted into the androgen biosynthesis pathway,
producing virilization in the female fetus or infant and rapid postnatal
growth with accelerated skeletal maturation, precocious puberty, and
short adult stature in both males and females
Treatment should begin as early as the 4th to 6th week of pregnancy.
10/29/2019
37
38. CONGENITAL ADRENAL
HYPERPLASIA
The dose of dexamethasone usually ranged between 0.5 and 2 mg/d or O.3 to o.7 mg/sq
m in 1 to 4 divided doses.
CVS 11-12 wks
AMNIOCENTESIS at 15 wks for DNA analysis for CYP21B,C4 & HLA class I & II
genes.
Then treatment is continued to term in female positive for genes and stopped in male
after confirmation of diagnosis by CVS or Amniocentesis.
At birth, the external genitalia is normal in the infant whose mother was given
dexamethasone and minimally virilized in the infant whose mother received
hydrocortisone. 10/29/2019
38
40. FETUS WITH MATERNAL
SLE
If mother is suffering from SLE, then fetus is at risk to
develop Complete heart block because of damage to AV
node.
This can be prevented by giving Tab Dexamethasone 4 mg
per day during pregnancy because it cannot be metabolized
by placenta and is Available to the fetus in an active form.
10/29/2019
40
45. INTRA UTERINE BLOOD
TRANSFUSION
45
The fetal anaemia now can be predicted by
doing middle cerebral Artery doppler flow
study and intra uterine transfusion (IUT) is
done with gamma Irradiated blood.
VOLUME OF BLOOD TO BE GIVEN TO
FETUS IS CALCULATED BY:-
– Fetoplacental volume X (desired Ht – Fetal
Ht) ÷ Donor hematocrit
Feto placental volume = USG estimated
weight of fetus X 0.14
The amount of blood given to fetus is 20,30,40
and 50 ml to the fetus at 22,26,30 and 35
weeks of gestational age respectively.
– 10/29/2019
51. AMNIOCENTESIS.51
10/29/2019
Amniocentesis is a procedure in
which amniotic fluid is removed
from the uterus for testing or
treatment. Amniotic fluid is the fluid
that surrounds and protects a baby
during pregnancy. This fluid contains
fetal cells and various proteins.
Although amniocentesis can provide
valuable information about the
baby's health, it's important to
understand the risks of
amniocentesis — and be prepared
for the results.
52. AMNIOINFUSION
– An amnioinfusion is a technique of instilling an
isotonic fluid, such as a normal saline or lactated
ringer’s solution, into the amniotic cavity with the
purpose of thinning out a thick meconium that has
been found to pass into the amniotic fluid.
10/29/2019
52
54. SEPTOSTOMY
It is the creation of a small hole in the membrane between the
babies using a fine, hollow needle.
This allows the amniotic fluid to move from one baby to the
other, so both babies have a more equal amount of amniotic
fluid.
The surgeon may also remove some of the amniotic fluid
through the needle. 10/29/2019
54
56. SELECTIVE FETAL
REDUCTION
Selective reduction is the practice of reducing the
number of fetuses in a multiple pregnancy, say
quadruplets, to a twin or singleton pregnancy.
The procedure is also called multifetal pregnancy
reduction.
10/29/2019
56
57. SELECTIVE FETAL
REDUCTION
The procedure is most commonly done to reduce the
number of fetuses in a multiple pregnancy to a safe
number, when the multiple pregnancy is the result of use of
assisted reproductive technology; outcomes for both the
mother and the babies are generally worse, the higher the
number of fetuses.
10/29/2019
57
58. SELECTIVE FETAL
REDUCTION
The procedure is also used in multiple pregnancies when one of the
fetuses has a serious and incurable disease, or in the case where one of
the fetuses is outside the uterus, in which case it is called selective
termination.
The procedure generally takes two days; the first day for testing in order
to select which fetuses to reduce, and the second day for the procedure
itself, in which potassium chloride is injected into the heart of each
selected fetus under the guidance of ultrasound imaging.
10/29/2019
58
59. SELECTIVE FETAL
REDUCTION
Risks of the procedure include bleeding requiring transfusion,
rupture of the uterus, retained placenta, infection, a miscarriage,
and prelabor rupture of membranes. Each of these appears to be
rare.
Selective reduction was developed in the mid-1980s, as people in
the field of assisted reproductive technology became aware of the
risks that multiple pregnancies carried for the mother and for the
fetuses. 10/29/2019
59
62. EMBRYOSCOPY:-
– is performed in the first trimester of pregnancy (up to 12
weeks’ gestation).
In this technique, a rigid endoscope is inserted via the
cervix in the space between the amnion and the chorion,
under sterile conditions and ultrasound guidance, to
visualize the embryo for the diagnosis of structural
malformations.
10/29/2019
62
65. FETOSCOPY:-
It is performed during the second trimester (after 16 weeks’
gestation).
In this technique, a fine-caliber endoscope is inserted into
the amniotic cavity through a small maternal abdominal
incision, under sterile conditions and ultrasound guidance,
for the visualization of the embryo to detect the presence of
subtle structural abnormalities.
10/29/2019
65
66. FETOSCOPY:-
– An injection will be given in the lower abdomen to numb
the skin where the fetoscope will be inserted.
– An ultrasound will be used to determine the position of
both the fetus and the placenta.
– The fetus is seen through a small incision made in the
belly, and a fetal ultrasound guides the placement of the
fetoscope.
– A camera is attached to the fetoscope to take pictures.10/29/2019
66
67. TTTS (TWIN TO TWIN TRANSFUSION
SYNDROME)
67 10/29/2019
68. TTTS (TWIN TO TWIN
TRANSFUSION SYNDROME)
68
10/29/2019
Occurs only in monozygotic, monochorionic, diamniotic
Laser coagulation of vessels
Laser ablation of umbilical cord in cases of acardiac Twins
Amniotic bands division
Posterior urethral valve laser ablation.
77. PLEURAL
EFFUSION
77
10/29/2019
One option in the management of
foetuses with pleural effusion is
thoracentesis and drainage of the
effusions.
However, in the majority of cases
the fluid reaccumulates within 24-48
hours requiring repeated procedures
and it is therefore preferable to
achieve chronic drainage by the
insertion of pleural- amniotic shunt
80. EXIT PROCEDURE (EX-UTERO
INTRAPARTUM TREATMENT
PROCEDURE)
80
It is the intervention that occurs at the
time of delivery.
It is primarily used in cases where
baby’s airway requires surgical
intervention as:
– › CHAOS (Congenital High Airway
Obstruction Syndrome)
– › Removal of balloon after
treatment of diaphragmatic hernia.
10/29/2019
82. OPEN
FETAL
SURGERY
82
10/29/2019
Congenital cystic adenomatous malformation.
› Progressive increase in the size.
› Mediastinal shift.
› Hydrops.
› Polyhydramnios.
Sacrococcygeal teratoma.
› Fetal Hydrops due to vascular shunts. ( high
output heart failure)
Open spina bifida
97. HIGH
INTENSITY
FOCUSED
ULTRASOUND
(HIFU)
97 10/29/2019
Only one case report in human. It was
used to occlude umbilical cord vessel in
Acardiac twin.
Still under research in animal study for
treating TTTs, Acardiac twin &
sacrococcygeal teratoma.
HIFU is a non-invasive alternative
method of vessel occlusion which may
avoid complications inherent to surgery.
99. 10/29/2019
99
GENE THERAPY
It means replacement of missing gene by introduction
of foreign Nucleic acid sequence.
It is divided into two categories,
classic gene therapy and
stem cell gene therapy.
A carrier molecule called a vector (virus- lentivirus)
must be used to deliver the therapeutic gene to the
patient’s target cells.
In most gene therapy a normal gene is inserted into
genome to replace an abnormal, disease causing gene.
100. 10/29/2019
100
There have been several modes of gene delivery
used in experimental efforts at fetal gene transfer.
These include intratracheal, intravascular,
intraventricular, intracardiac, intraperitoneal,
intraplacental, intramuscular and intra-amniotic
injection.
Intra-amniotic gene transfer (IAGT) has been
used to target organs exposed to amniotic fluid,
that is, the skin, amniotic membranes and the
respiratory and digestive systems
102. Stem cell therapy102
10/29/2019
Hematopoeitic stem cells
can give rise to complete
blood system.
Potential for treatment or
even cure of many
hematopoeitic diseases
• ( ex. alph thalassemia, 1ry
immunodeficiency syndrome).
Theoretically, rejection
should not be a problem
of “fetal tolerance”.
Fetus remains in a sterile
environment, so post-
transfusion isolation after
transplant is automatic.
104. 10/29/2019
104
NURSING MANAGEMENT OF
HIGH RISK PREGNANCIES
Steps to promote healthy pregnancy
Schedule preconception appointment
Eat healthy
Gain weight
Avoid risky substance
105. 10/29/2019
105
NURSING MANAGEMENT
Assess the condition of the mother during
pregnancy
Screen out the high risk mothers
Advice to do the regular follow up
Provide the information regarding warning
signs of pregnancy and signs of pregnancy and
any signs are noted report to the hospital
106. 10/29/2019
106Detail history collection and physical examination
Collect the laboratory findings
Abdominal examination – obstetrical examination
Monitor the vital signs
Provide bed rest
Assist in screening of fetal wellbeing diagnosis of
fetal such as amniocentesis, chorionic villi
sampling
107. 10/29/2019
107
Assist in fetal therapy procedure
Discuss the fetal risk associated with
pregnancy
Instruct the client on use of prescribed
medication for particular disease condition
Motivate for life style modifications
108. 10/29/2019
108
Instruct about self-care techniques
Report any deviation from normal fetal or maternal
conditions immediately
Encourage in expression of feelings
Determine the demographic and social factors in the
poor outcome of pregnancy
Review obstetrical history for pregnancy risk
Anticipatory guidance participation
Refer to high risk support group of the mother
Monitor physical psychological status throughout the
pregnancy.
110. 10/29/2019
110 CONCLUSION
A high risk pregnancy is one of greater
risk to the mother or her fetus than an
uncomplicated pregnancy.
Pregnancy places additional physical
and emotional stress on a woman’s body.
Health problems that occur before a
woman becomes pregnant or during
pregnancy may also increase the
likelihood for a high risk pregnancy.