Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

Early pregnancy hemorrhage presents distinct diagnostic and management challenges, with spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease, and cervical insufficiency representing the primary causative conditions requiring differentiation through clinical history, physical examination, and imaging studies. Later in gestation, hemorrhagic emergencies including placenta previa, placental abruption, and placenta accreta demand rapid assessment and delivery planning to prevent maternal exsanguination and fetal compromise. Hyperemesis gravidarum, characterized by intractable nausea and vomiting, results in severe dehydration, metabolic acidosis from ketosis, and electrolyte depletion that necessitates nutritional and fluid replacement interventions. The hypertensive disorders of pregnancy form a continuum from gestational hypertension through preeclampsia to eclampsia, with pathophysiology centered on endothelial dysfunction, widespread vasospasm, and organ hypoperfusion that may culminate in seizure activity, cerebral hemorrhage, or acute renal failure. HELLP syndrome represents a severe multisystem manifestation involving hemolysis, hepatic enzyme elevation, and thrombocytopenia that carries substantial maternal and fetal mortality risk. Maternal-fetal blood group incompatibilities, particularly Rh sensitization, require immunoprophylaxis with anti-D immune globulin to prevent hemolytic disease of the fetus and newborn. Amniotic fluid volume abnormalities such as polyhydramnios and oligohydramnios create mechanical complications and alter fetal development trajectories. Multiple gestation introduces overlapping risks including preterm labor, intrauterine growth restriction, and twin-to-twin transfusion syndrome. Premature rupture of membranes and its preterm manifestation increase infection risk and umbilical cord prolapse, necessitating intensive fetal surveillance and judicious timing of delivery intervention.