FAR EASTERN UNIVERSITY

INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

MODULE #2 – NURSING CARE OF THE HIGH RISK PREGNANT CLIENT

(BLEEDING DISORDERS IN PREGNANCY)

INTRODUCTION

Unexpected deviations or complications from the course of normal pregnancy may

occur which will place a severe burden on a woman and her family as well as her care
providers. The nurse needs to be knowledgeable to help these families work through the
stages of pregnancy and prepare them to become new parents.

This module discusses the common complications during pregnancy and the application of the
nursing process in the care of the high-risk pregnant client and her family.

LEARNING OUTCOMES:

After the successful completion of the module you should be able to:

LO1 Integrate concepts, theories and principles of sciences and humanities in the formulation
and application of appropriate nursing care to mothers with complications during pregnancy to
achieve quality maternal and child nursing care.

LO2 Apply maternal and child nursing concepts and principles in the prevention of
complications during pregnancy that place the woman and her fetus at high risk. holistically and
comprehensively.

LO3 Assess mothers who is experiencing complication of pregnancy with the use of specific
methods and tools to address existing health needs.

LO4 Formulate nursing diagnoses to address needs / problems of mothers and her family
experiencing complication of pregnancy.

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
LO5 Implement safe and quality nursing interventions to meet the needs and promote optimal
outcomes for mothers and her family during a complication of pregnancy.

LO7 Evaluate with mothers and family the expected outcomes for the effectiveness and
achievement of care.

LO8 Institute appropriate corrective actions to prevent or minimize complications during

pregnancy.

TOPIC OUTLINE:

I. I. Bleeding during pregnancy

1. 1. Abortion
2. 2. Hydatidiform mole
3. 3. Ectopic pregnancy
4. 4. Premature dilatation of cervix
5. 5. Placenta previa
6. 6. Abruptio placenta
7. 7. Disseminated Intravascular coagulation
II. II. Nursing Process

CONTENT

In the Philippines, the leading complications related directly to pregnancy are bleeding
(hemorrhage), infection, hypertension of pregnancy, and other medical problems arising from
poor birth spacing, maternal malnutrition, unsafe abortions, and presence of concurrent
infections like tuberculosis, malaria and sexually transmitted diseases as well as lifestyle
diseases like diabetes and hypertension. (DOH, 2011). All of these have the potential to
threaten both the life of the mother and the fetus.

I. Bleeding during pregnancy

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Vaginal bleeding during pregnancy is always abnormal, may occur at any point
during pregnancy, and always frightening. It must always be carefully investigated
because if it occurs in sufficient amount or for a sufficient cause, it can impair both
the outcome of the pregnancy and a woman’s life or health. Although vaginal
bleeding may be innocent, any degree of this during pregnancy is potentially serious
because it may mean that the placenta has loosened, cutting off nourishment to the
fetus. Also, the amount visualized may be only a fraction of the blood actually being
lost. This happens because an undilated cervix and intact membranes can contain
blood within the uterus. A woman with any degree of bleeding, therefore, needs to
be evaluated for the possibility that she is experiencing a significant blood loss or is
developing hypovolemic shock. The process of shock because of blood loss is shown
in Figure 1. Because the uterus is a nonessential body organ, danger to the fetal
blood supply occurs when a woman’s body begins to decrease blood flow to
peripheral organs (although the increased blood volume of pregnancy allows more
than normal blood loss before hypovolemic shock processes begin). Signs of
hypovolemic shock (Table 1) occur when 10% of blood volume, or approximately 2
units of blood, have been lost; fetal distress occurs when 25% of blood volume is
lost.

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Figure 1. The process of shock because of blood loss (hypovolemia).

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Table 1. Signs and Symptoms of Hypovolemic Shock

Assessment Significance

Increased pulse rate Heart is attempting to circulate decreased blood volume

Decreased blood pressure Less peripheral resistance because of decreased blood volume

Increased respiratory rate Increases gas exchange to better oxygenate decreased red blood cell volume

Cold, clammy skin Vasoconstriction occurs to maintain blood volume in central body core

Decreased urine output Inadequate blood is entering kidneys because of decreased blood volume

Dizziness or decreased level Inadequate blood is reaching cerebrum because of decreased blood volume
of consciousness

Decreased central venous Decreased blood is returning to heart because of reduced blood volume
pressure

Table 2. Common causes of bleeding according to trimester.

First Trimester Second Trimester Third Trimester

• Abortion • Gestational trophoblastic disease • Placenta previa

o Threatened (hydatidiform mole) • Abruptio
o Imminent • Premature cervical dilatation placentae
o Complete • Disseminated intravascular • Preterm labor
o Missed coagulation (DIC)
o Incomplete
• Ectopic pregnancy
• Abdominal pregnancy

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

A. Abortion
A pregnancy that ends before 20 weeks’ gestation, spontaneously or electively
- Types
1. Spontaneous: Pregnancy ends because of natural causes.
2. Induced: Therapeutic or elective reasons exist for terminating pregnancy
3. Threatened: Spotting and cramping occur without cervical change.
4. Inevitable: Spotting and cramping occur, and cervix begins to dilate and efface.
5. Incomplete: Loss of some of the products of conception occurs, with part of the
products retained (most often placenta is retained).
6. Complete: Loss of all products of conception.
7. Missed: Products of conception are retained in utero after fetal death.
8. Habitual: Spontaneous abortions occur in 3 or more successive pregnancies.
- Causes
1. Abnormal fetal development due to alcohol ingestion or chromosomal
abnormalities
2. Abnormal placental implantation
3. Systemic infections such as rubella, syphilis, poliomyelitis, cytomegalovirus, and
toxoplasmosis
4. Drugs such as misoprostol and mifepristone
- Assessment
1. Spontaneous vaginal bleeding
2. Low uterine cramping or contractions
3. Blood clots or tissue through the vagina
4. Hemorrhage and shock can result if bleeding is excessive.
- Interventions
1. Maintain bed rest as prescribed.
2. Monitor vital signs.
3. Monitor for cramping and bleeding.

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
4. Count perineal pads to evaluate blood loss and save expelled tissues and clots.
5. Maintain intravenous (IV) fluids as prescribed; monitor for signs of hemorrhage or
shock.
6. Prepare the client for dilation and curettage (D and C) as prescribed for incomplete
abortion.
7. Administer Rho(D) immune globulin, as prescribed, for an Rh-negative woman.
8. Provide psychological support.
- Complications and management
1. Hemorrhage
a. Monitor vital signs for changes to detect possible hypovolemic shock.
b. If excessive vaginal bleeding is occurring, immediately position a woman flat and
massage the uterine fundus to try to aid contraction
c. D&C or suction curettage to empty the uterus of the material that is preventing
it from contracting and achieving hemostasis.
d. Blood transfusion may be necessary to replace blood loss. Direct replacement of
fibrinogen or another clotting factor may be used to increase coagulation ability.
2. Infection
a. The organism responsible for infection after miscarriage is usually Escherichia
coli (spread from the rectum forward into the vagina).
b. Caution a woman to wipe her perineal area from front to back after voiding and
particularly after defecation to prevent the spread of bacteria from the rectal
area.
c. Assess for danger signs of infection, such as fever, abdominal pain or tenderness,
and a foul vaginal discharge
d. Endometritis may be more extensive, however, and parametritis, peritonitis,
thrombophlebitis, and septicemia can develop.
3. Septic abortion

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
a. It is an abortion complicated by infection which can occur after a spontaneous
abortion or more frequently in women who have tried to a self-abort or were
aborted illegally using a nonsterile instrument.
b. Symptoms usually are fever and crampy abdominal and tender uterus upon
palpation.
c. Obtain CBC, serum electrolytes, creatinine, blood type and cross match, and
cervical, vaginal and urine culture.
d. IVF and broad-spectrum antibiotic are used to treat infection.
e. D and C will be performed to remove all infected or necrotic tissue from the
uterus.
f. Septic abortion may lead to infertility.
4. Isoimmunization
a. Fetal blood transfer to maternal blood which produces antibody against fetal
blood (if fetus is Rh positive and mother is Rh negative)
b. Rhogam is administered to prevent the buildup of antibodies.
5. Powerlessness or anxiety
a. Sadness grief over the loss or a feeling that a woman has lost control of her life is
to be expected.
b. Assess a woman’s adjustment to a spontaneous abortion including her partner’s
feelings.
B. Ectopic pregnancy
- Implantation of the fertilized ovum outside of the uterine cavity. Most common
location is ampulla of the fallopian tube where the tissue is incapable of the growth
needed to accommodate pregnancy. The fallopian tube ruptures before 12 weeks.
Sites of ectopic pregnancy are fallopian tube, cervix, ovaries, abdomen, broad
ligaments (Fig.1).

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Figure 1. Sites at which an ectopic pregnancy may occur

- Major Risk factors

1. Prior tubal surgery/ectopic pregnancy
2. Use of intrauterine device
3. Tissue insult resulting from pelvic inflammatory disease (PID)
Minor Risk Factors
4. Prior abdominal or pelvic surgery
5. Prior appendicitis
6. Salphingitis
7. In utero diethystilbestrol (DES) exposure
8. In vitro fertilization and embryo transfer (IVF-ET)
Other risk factors

9. Cigarette smoking
10. Sex steroids
- Assessment
1. Missed menstrual period

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
2. Nausea and vomiting
3. Positive pregnancy test however the hCG is lower than intrauterine pregnancy
4. Abdominal pain between 6-12 weeks because the embryo ruptures the fallopian
tube. The characteristic of abdominal pain is usually unilateral, cramping,
localized pain, knife-like pain radiating to the shoulder
5. Vaginal spotting to bleeding that is dark red or brown
6. Rupture: Increased pain, referred shoulder pain, signs of shock
7. Cullen’s sign – bluish tinge at the periumbilical area
8. Mass at the cul-de-sac of Douglas with blood during needle aspiration (the
procedure is known as Culdocentesis)
- Interventions
1. Obtain assessment data and vital signs.
2. Monitor bleeding and initiate measures to prevent rupture and shock.
3. Methotrexate, a folic acid antagonist, maybe prescribed to inhibit cell division in
the developing embryo.
4. Prepare the client for laparotomy and removal of the pregnancy and tube
(Salphingectomy), if necessary, or repair of the tube (Salphingostomy)
5. Administer antibiotics; Rho(D) immune globulin is prescribed for Rh-negative
women.
C. Hydatidiform Mole
- Hydatidiform mole is a form of gestational trophoblastic disease that occurs when
the trophoblasts, which are the peripheral cells that attach the fertilized ovum to the
uterine wall, develop abnormally. The mole manifests as an edematous grapelike
cluster that may be nonmalignant or may develop into choriocarcinoma.
- Two types of molar growth can be identified by chromosome analysis.
a. complete mole, all trophoblastic villi swell and become cystic.
b. partial mole, some of the villi form normally. The syncytiotrophoblastic layer of
villi, however, is swollen and misshapen. A macerated embryo of approximately

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
9 weeks’ gestation may be present and fetal blood may be present in the villi. A
partial mole has 69 chromosomes.
- Assessment
1. Fetal heart rate not detectable
2. Vaginal bleeding, which may occur by the fourth week or not until the second
trimester; may be bright red or dark brown in color and may be slight, profuse,
or intermittent
3. Signs of preeclampsia(elevated blood pressure and proteinuria) before the
twentieth week of gestation
4. Fundal height greater than expected for gestational date
5. Elevated human chorionic gonadotropin levels and positive pregnancy test.
6. Characteristic snowstorm pattern shown of ultrasound
- Interventions
1. Prepare the client for uterine evacuation (before evacuation, diagnostic tests are
done to detect metastatic disease).
2. Evacuation of the mole is done by vacuum aspiration; oxytocin is administered
after evacuation to contract the uterus.
3. Monitor for post procedure hemorrhage and infection.
4. Tissue is sent to the laboratory for evaluation, and follow-up is important to
detect changes suggestive of malignancy.
5. Human chorionic gonadotropin levels are monitored every 1 to 2 weeks until
normal pre pregnancy levels are attained; levels are checked every 1 to 2 months
for 1 year.
D. Cervical insufficiency (Premature dilatation of the cervix)
- Previously termed as incompetent cervix, refers to the cervix that dilates
prematurely and therefore cannot retain a fetus until term. It occurs most often in
the fourth or fifth month of pregnancy and is associated with structural or functional
defects of the cervix. Treatment involves surgical placement of a cervical cerclage.

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
- Risk factors
1. increased maternal age
2. congenital structural defects
3. trauma to the cervix (repeated D and C’s)
- Assessment
1. Vaginal bleeding
2. Increased pelvic pressure
3. Discharge of amniotic fluid
4. Fetal membranes visible through the cervix
- Interventions
1. Provide bed rest, hydration, and tocolysis, as prescribed, to inhibit uterine
contractions.
2. Prepare for cervical cerclage (at 10 to 14 weeks of gestation), in which a band of
fascia or nonabsorbable ribbon is placed around the cervix beneath the mucosa
to constrict the internal os. McDonald or Shirodkar procedure
3. After cervical cerclage, the client is told to refrain from intercourse and to avoid
prolonged standing and heavy lifting.
4. The cervical cerclage is removed at 37 weeks of gestation or left in place and a
cesarean birth is performed; if removed, cerclage must be repeated with each
successive pregnancy.
5. After placement of the cervical cerclage, monitor for contractions, rupture of the
membranes, and signs of infection. Instruct the client to report immediately any
postprocedure vaginal bleeding or increased uterine contractions.
E. Placenta previa
- It is an improperly implanted placenta in the lower uterine segment near or over the
internal cervical os.
- Degrees of Placenta Previa (Fig. 2)

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
1. Low-lying placenta - implantation in the lower rather than in the upper portion
of the uterus;
2. Marginal implantation - the placenta edge approaches that of the cervical os
3. Partial placenta previa - implantation that occludes a portion of the cervical os
4. Total placenta previa - implantation that totally obstructs the cervical os. The
internal cervical os is covered entirely by the placenta when the cervix is dilated
fully.

Figure 2. Degrees of placenta previa: (A) low implantation; (B) partial placenta previa; (C) total
- Rplacenta previa.
i
Risk factors
1. Increased parity
2. advanced maternal age
3. past cesarean births
4. past uterine curettage
5. multiple gestation
- Assessment

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
1. Sudden onset of painless, bright red vaginal bleeding occurs in the last half of
pregnancy.
2. Uterus is soft, relaxed, and nontender.
3. Fundal height may be more than expected for gestational age.
4. Because the placenta is loosened, the fetal oxygen supply may be compromised,
placing the fetus at risk also. With the placental loosening, preterm labor (labor
that occurs before the end of week 37 of gestation) may begin, posing the
additional threat of preterm birth to the fetus.
- Interventions
1. Monitor maternal vital signs, fetal heart rate, and fetal activity.
2. Prepare for ultrasound to confirm the diagnosis.
3. Vaginal examinations or any other actions that would stimulate uterine activity
are avoided.
4. Maintain bed rest in a side-lying position as prescribed.
5. Monitor amount of bleeding (treat signs of shock).
6. Administer intravenous (IV) fluids, blood products, or tocolytic medications as
prescribed
7. Rho(D) immune globulin may be prescribed.
8. If bleeding is heavy, a cesarean delivery may be performed.
9. Vaginal exams are contraindicated if the client is suspected of having or has a
known placenta previa.
F. Abruptio Placenta
- Premature separation of the placenta from the uterine wall after the twentieth
week of gestation and before the fetus is delivered (Fig. 3)

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

Figure 3. Premature separation of the placenta.

- Risk Factors
1. High parity
2. Advanced maternal age
3. Short umbilical cord,
4. Chronic hypertensive disease and pregnancy-induced hypertension
5. Direct trauma (as from an automobile accident or intimate partner abuse),
6. Vasoconstriction from cocaine or cigarette use
7. Thrombophilitic conditions that lead to thrombosis such as autoimmune
antibodies, protein C, and factor V Leiden (an inherited thrombophilia)
- Assessment
1. Dark red vaginal bleeding. If the bleeding is high in the uterus or is minimal,
there can be an absence of visible blood.
2. Uterine pain or tenderness or both
3. Uterine rigidity or Couvelaire uterus
4. Severe abdominal pain
5. Signs of fetal distress

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
6. Signs of maternal shock if bleeding is excessive
- Interventions
1. Monitor maternal vital signs and fetal heart rate.
2. Assess for excessive vaginal bleeding, abdominal pain, and an increase in fundal
height.
3. Maintain bed rest; administer oxygen, IV fluids, and blood products as
prescribed.
4. Place the client in Trendelenburg position if indicated to decrease the pressure
of the fetus on the placenta, or place in the lateral position with the head of the
bed flat if hypovolemic shock occurs.
5. Monitor and report any uterine activity.
6. Prepare for delivery of the fetus as quickly as possible, with vaginal delivery
preferable if the fetus is healthy and stable and the presenting part is in the
pelvis; emergency cesarean delivery is performed if the fetus is alive but shows
signs of distress.
7. Monitor for signs of disseminated intravascular coagulation in the postpartum
period.
G. Disseminated Intravascular Coagulation (DIC)
- DIC is a maternal condition in which the clotting cascade is activated, resulting in
the formation of clots in the microcirculation. It occurs when there is such extreme
bleeding and so many platelets and fibrin from the general circulation rush to the
site that there is not enough left in the rest of the body. This results in a paradox: At
one point in the circulatory system, the person has increased coagulation, but
throughout the rest of the system, a bleeding defect exists.
The rapid and extensive formation of clots that occurs in DIC causes the platelets
and clotting factors to be depleted. This results in bleeding and the potential
vascular occlusion of organs from thromboembolus formation.

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM

- Predisposing conditions
1. Abruptio placentae
2. Amniotic fluid embolism
3. Gestational hypertension
4. HELLP syndrome
5. Intrauterine fetal death
6. Liver disease
7. Sepsis
- Assessment
1. Uncontrolled bleeding
2. Bruising, purpura, petechiae, and ecchymosis
3. Presence of occult blood in excretions such as stool
4. Hematuria, hematemesis, or vaginal bleeding
5. Signs of shock
6. Decreased fibrinogen level, platelet count, and hematocrit level
7. Increased prothrombin time and partial thromboplastin time, clotting time, and
fibrin degradation products.
- Interventions
1. Remove underlying cause.
2. Monitor vital signs; assess for bleeding and signs of shock.
3. Prepare for oxygen therapy, volume replacement, blood component therapy,
and possibly heparin therapy.
4. Monitor for complications associated with fluid and blood replacement and
heparin therapy.
5. Monitor urine output and maintain at least30 mL/ hour (renal failure is a
complication of DIC).
II. Nursing Process for a woman who develops a complication of pregnancy

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
A. Assessment
- Nurses often are the first health care providers to discover that a complication of
pregnancy is beginning because they are the people who talk to clients first at
prenatal visits. Always ask women at such visits about any symptoms that might
indicate a complication such as pain or bleeding. Provide enough time for a
thorough health history so more subtle problems such as headache, blurred vision,
or vaginal spotting can be discovered and investigated thoroughly. In addition, at
the close of a visit, review the danger signs of pregnancy with a woman so she can
recognize potential problems and contact the health care center if a problem should
occur. Assure women that they are free to call whenever they are concerned.
Otherwise, they may wait until a symptom is acute rather than call when they first
notice it.
B. Nursing Diagnosis
- Nursing diagnoses pertaining to a woman with a pregnancy complication should
reflect both the physical problem and the family’s concern. Some examples are:
1. Anxiety related to guarded pregnancy outcome
2. Deficient fluid volume related to third-trimester bleeding
3. Risk for infection related to incomplete miscarriage
4. Risk for ineffective tissue perfusion related to pregnancy- induced hypertension
5. Deficient knowledge related to signs and symptoms of possible complications
6. Fear of preterm labor ending the pregnancy
C. Outcome Identification and Planning
- Complications of pregnancy produce emergency situations, so outcomes usually
focus on a short timeframe. Be sure that outcomes address both fetal and maternal
welfare and often total family welfare. Treatment protocols, such as those related to
bleeding, preterm labor, and pregnancy induced hypertension, should be regularly
updated and maintained so they remain current. Be certain that they reflect a
current nursing management level so nurses can act swiftly and independently as

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
needed with life-saving measures. Once a woman’s condition stabilizes, outcome
identification can then focus on long-term objectives. Many women who develop a
pregnancy complication spend a few days in the hospital for therapy and monitoring
followed by discharge to their homes. Waiting for a pregnancy that has been
threatened this way to come to term can be difficult and anxious. Readmission to
the health care facility, especially when a new complication occurs, compounds
these feelings. Be certain that planning considers the many feelings this experience
can cause. Offer referrals for counseling and/or community support groups.
D. Implementation
- Interventions for a woman experiencing a complication of pregnancy include
measures to maintain several different areas:
11. Continued healthy fetal growth
12. Continued maternal physical health
13. A woman’s and family’s psychological health
14. Continuation of the pregnancy as long as possible
- Maintaining an optimistic attitude of fetal progress is important so a woman does
not begin anticipatory grieving for her fetus and halt the growth of bonding. If the
complication can be contained and the pregnancy continues uninterrupted, this will
help protect the mental health of the whole family. If the pregnancy cannot be
continued, be available to offer support to a family who grieves for the loss of an
unborn child and, in rare instances, loss of future childbearing potential or the
woman herself.
After a pregnancy with complications, a woman has reason to be especially worried
about her infant’s health at the time of birth. The infant may be hospitalized in a
special care nursery. Help her spend enough time with her child to see that
although, perhaps born before term, her infant is well and healthy. This may be
difficult because she still may be ill herself. It is helpful to assess the infant for such

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
things as ability to follow a light and respond to a voice while the woman is present.
This helps to demonstrate that the infant is well.
E. Outcome Evaluation
Although the success or failure of some nursing interventions cannot be fully
evaluated until a child is born or even into the postnatal period, outcomes
should be evaluated throughout the pregnancy if possible. Be aware that after a
complication of early pregnancy, a woman cannot help but worry for the
remainder of the pregnancy that the complication will recur or that the original
insult to the fetus was severe enough to cause long-term effects. Evaluate a
woman’s attitude and physical status at each health care visit to be certain she is
coping with the situation and the fear and strain she lives under until the child is
born.
Unfortunately, even with sustained care, not all fetal outcomes will be optimal.
Evaluation will then include the ability of the family to care for an ill infant or
grieve because a newborn die. Examples of expected outcomes are:
1. Client’s blood pressure is maintained within acceptable parameters.
2. Couple state they feel able to cope with anxiety associated with the
pregnancy complication.
3. Client’s signs and symptoms of pregnancy-induced hypertension do not
progress to eclampsia.
4. Client accurately verbalizes crucial signs and symptoms she should
immediately report to her primary health care provider.
5. Couple expresses feelings of sadness over pregnancy loss

LEARNING RESOURCES:

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NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021
 FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING
SECOND SEMESTER – AY 2020 – 2021
NUR 1210 – NCM 109 CARE OF THE MOTHER AND CHILD AT RISK OR WITH PROBLEM
Watch the following videos:
1. D & C : https://www.youtube.com/watch?v=1IwrAyonFA4
2. Placenta previa: https://www.youtube.com/watch?v=nEa6E-BtYRw
3. Abruptio placenta: https://www.youtube.com/watch?v=Z9dBS1xLQMc

LEARNING ACTIVITIES:

REFERENCES:

Cunningham, F.G., Leveno, K.J., Bloom, S.L., Spong, C.Y., Dashe, J. S., Hoffman, B. L., Casey, B.

M., Sheffield, J. S., author. Williams obstetrics. 24th Edition. New York, NY : McGraw-Hill
Education, 2014.

Pillitteri A. Maternal and child health nursing. Care of the childbearing and childrearing family.
Eight edition. Philadelphia; Lippincott Williams & Wilkins: 2018.

21 | P a g e
NUR 1210 – MATERNAL CONCEPT (Melanie C. Tapnio, MAN, RN)
Prepared by MCN FEU Faculty Lecturers January 2021