Nursing Procedures for Pregnancy

Definition

A high-risk pregnancy is one in which the mother, fetus, or newborn is at a higher risk at any stage of pregnancy, childbirth, and the postpartum period.

Although pregnancy and childbirth are natural physiological functions, a small percentage of women remain more vulnerable to problems and complications. These women need special medical care to protect them from life-threatening complications. Successful health care must focus on detecting risk indicators and referring cases to the hospital for specialized care to reduce mortality rates.

Identifying High-Risk Pregnancies

Risk indicators can be identified by taking a health history, conducting a comprehensive clinical examination, and performing laboratory tests during the first and subsequent follow-up visits.

Symptoms and Signs that Make a Pregnancy High-Risk:

·        Maternal age over 35 years: More prone to high blood pressure, congenital anomalies, delayed intrauterine fetal growth, and obstructed labor.

·        Maternal age under 18 years: Due to incomplete maturity of the reproductive system and pelvic bones, they are more prone to miscarriage, premature birth, and cesarean delivery. They may also have less experience in caring for their health, nutrition, and the newborn.

·        Maternal Medical History: Chronic heart diseases, chronic kidney and urinary tract diseases, diabetes, glandular diseases, venereal diseases, pulmonary tuberculosis, epilepsy, cancerous diseases, positive syphilis blood test, and chronic anemia unresponsive to treatment.

·        History of Previous Pregnancies and Births:

   More than 3 pregnancies (more prone to weak uterine contractions, obstructed labor, uterine rupture, postpartum hemorrhage).

   Less than two years between the expected date of delivery and the previous birth date.

   Previous cesarean or forceps delivery.

   Stillbirth.

   Live birth that died in the first week.

   Premature birth (less than 37 weeks) or prolonged pregnancy (more than 42 weeks).

   More than one miscarriage.

 Birth of a child with congenital anomalies.

   Previous twin pregnancy.

   Complications in the postpartum period after a previous birth.

  Previous pre-eclampsia.

  Cervical tear in a previous birth.

   Previous birth where the newborn required intensive care.

   Medical factors that led to the termination of a previous pregnancy.

·        Symptoms that may appear in the current pregnancy:

   Uterine bleeding.

   General swelling or swelling in the legs.

   Complaints of continuous headache, blurred vision, and pain in the pit of the stomach.

   Delayed fetal growth.

  Abnormal fetal position persisting until birth.

   Abdomen size smaller than expected (low amniotic fluid, delayed growth, fetal death).

   Abdomen size larger than expected (excess amniotic fluid, twin pregnancy, large fetus).

   Hemoglobin drop below 9 g/dL.

   Leakage of amniotic fluid from the vagina.

   Premature birth (more than 3 weeks before the expected date).

   Pregnancy duration exceeding 42 weeks.

   Small pelvic size compared to the fetus or short stature (less than 150 cm).

   Cessation or noticeable slowing of fetal movement.

   Persistent intractable vomiting.

   Severe high fever.

  Severe abdominal pain, especially in the second half of pregnancy.

 

Vaccination of Pregnant Women against Tetanus

According to the following schedule:

Dose	When Given	Protection Percentage	Duration of Immunity
First Dose	At the first visit early in pregnancy (after the 3rd month)	0%	-
Second Dose	At least 4 weeks after the 1st dose, and 2 weeks before birth	80%	3 years
Third Dose	At least 6 months after the 2nd dose, or during the next pregnancy	95%	5 years
Fourth Dose	At least 1 year after the 3rd dose, or during the next pregnancy	99%	10 years
Fifth Dose	At least 1 year after the 4th dose, or during a new pregnancy	99%	Lifetime

 

Notes:

- The first dose should be avoided in the first three months of pregnancy, not because it causes miscarriage or deformities, but to prevent rumors.

- For the second dose to be effective, it must be given more than two weeks before the expected date of birth.

- Live vaccines must be strictly avoided during pregnancy.

Importance of Tetanus Vaccination

1.     Providing immunity to the mother and newborn against the tetanus microbe.

2.     Protecting the newborn from neonatal tetanus, a leading cause of neonatal mortality.

How to Administer the Vaccine

·        Must be stored in a refrigerator (second shelf at 4-8°C).

·        Check the expiration date.

·        The vaccine must be homogeneous with no sediments.

·        Administered as a 0.5 ml intramuscular injection in the upper left arm.

Pregnancy Follow-up Visits Schedule

·        Once a month until the sixth month of pregnancy.

·        Twice a month during the seventh and eighth months.

·        Once a week during the ninth month.

·        Plus a visit at any time if the pregnant woman feels she needs medical care or experiences any danger signs.

Danger Signs Requiring Immediate Medical Attention

·        Vaginal bleeding, no matter how small.

·        Blurred vision.

·        Convulsions.

·        Fluid leaking from the vagina.

·        Continuous vomiting.

·        Severe and continuous headache.

·        Swelling of the face or hands.

·        High body temperature. 

Methods of Evaluating Fetal Health in the Womb

·        Mother's weight: Low or no weight gain threatens fetal development.

·        Fetal size: By estimating the fundal height (uterine age) and comparing it to the expected age.

·        Fetal movements: Starts at 18 weeks in multiparous women and 20 weeks in primiparous women. Normal count is at least 10 movements in 12 hours. Note: Movement stops completely 48 hours before intrauterine fetal death.

·        Hearing the fetal heartbeat.

·        Ultrasound (Sonar) importance: Differential diagnosis, estimating fetal age and growth, identifying twins or anomalies, checking amniotic fluid, evaluating placenta position, and determining fetal presentation.