Chapter 6: Caring for the Woman Experiencing Complications During Pregnancy

Early pregnancy complications include threatened abortion and hydatidiform mole, where nursing care focuses on emotional support and symptom monitoring. Third-trimester hemorrhage from abruptio placentae and placenta previa represents a leading cause of maternal mortality, requiring nurses to recognize that maternal tachycardia and fetal heart rate abnormalities often signal hemodynamic compromise before blood pressure changes become evident. Preterm labor, defined as regular contractions with cervical changes before 37 weeks, demands intervention with progesterone supplementation, antenatal corticosteroids to promote fetal lung maturity, and tocolytic agents to delay delivery. Premature rupture of membranes, whether occurring at term or preterm, necessitates vigilant monitoring for chorioamnionitis through assessment of maternal fever, vaginal discharge characteristics, and vital sign changes in both mother and fetus. Hypertensive disorders progress from gestational hypertension through preeclampsia to the life-threatening eclampsia, with the SPASMS framework guiding nurses in identifying disease progression through blood pressure changes, proteinuria, vasospasm-related edema, and laboratory abnormalities. HELLP syndrome represents a severe manifestation involving hemolysis, elevated liver enzymes, and thrombocytopenia. Magnesium sulfate administration requires meticulous monitoring of deep tendon reflexes, respiratory status, and urine output to prevent toxicity. Infections such as Group B Streptococcus pose risks to both mother and neonate, while Rh incompatibility demands timely RhoGAM administration and Kleihauer-Betke testing to quantify fetal-maternal hemorrhage. Medical comorbidities including pregestational and gestational diabetes, as well as venous thromboembolism, require specialized management within pregnancy's altered physiology. Multiple gestations necessitate increased nutritional support and enhanced fetal surveillance. Fetal well-being assessment through biophysical profile and nonstress testing guides clinical decision-making. Special consideration addresses the needs of adolescent pregnant patients, those experiencing intimate partner violence, and those requiring prolonged bedrest, ensuring culturally sensitive, individualized, and holistic nursing care throughout pregnancy complications.