Chapter 5: Complications During Pregnancy: Nursing Care

Complications During Pregnancy: Nursing Care begins by outlining essential fetal diagnostic tests, such as ultrasound, amniocentesis, and non-stress tests, which identify potential anomalies and fetal well-being. A significant portion of the chapter details pregnancy-related complications, starting with hyperemesis gravidarum, where severe nausea and vomiting cause dehydration and electrolyte imbalances requiring intravenous fluid correction. The text distinguishes between bleeding disorders of early pregnancy, including various types of spontaneous abortion (threatened, inevitable, incomplete, missed), ectopic pregnancy (implantation outside the uterus), and gestational trophoblastic disease (hydatidiform mole), versus late-pregnancy hemorrhagic conditions like placenta previa (painless bleeding) and placental abruption (painful separation with a rigid uterus). Hypertensive disorders are thoroughly examined, differentiating between gestational hypertension, pre-eclampsia, and eclampsia, with specific attention to the HELLP syndrome variant (hemolysis, elevated liver enzymes, low platelets) and the administration of magnesium sulphate for seizure prophylaxis. The chapter also explains blood incompatibility issues, specifically Rh isoimmunization and the preventative use of Rho(D) immune globulin. Complex concurrent medical conditions are analyzed, including the metabolic demands of pre-existing and gestational diabetes mellitus (GDM), which require careful glucose monitoring and insulin adjustment to prevent fetal macrosomia and hypoglycemia. Cardiovascular disease management focuses on preventing heart failure during the hemodynamic shifts of labor, while anemias such as iron-deficiency and sickle cell disease are addressed through nutritional support. The discussion extends to infectious diseases using the TORCH mnemonic (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes) alongside Group B Streptococcus (GBS), HIV, and Zika virus protocols. Finally, the chapter covers environmental hazards, including the teratogenic effects of substance use and alcohol (Fetal Alcohol Spectrum Disorder), and provides guidelines for managing trauma, falls, and intimate partner violence, emphasizing that maternal stabilization is the priority in emergency trauma care.