Sudden Pregnancy Complications

A woman’s journey during pregnancy must be a healthy and memorable one. Nurses must see to it that these goals will be achieved; however, certain roadblocks along the way might hinder these goals. Sudden pregnancy complications might occur, and the health care providers must be prompt in attending to a woman who undergoes this problem along the way.

Hydramnios and Oligohydramnios

Hydramnios

• The usual amount of amniotic fluid during pregnancy is 500 to 1000 mL at term.
• Excess fluid of more than 2000 mL is considered hydramnios.
• Too much amniotic fluid might cause fetal malpresentation, premature rupture of membranes, infection due to PROM, and preterm birth.
• The first sign of hydramnios is rapid enlargement of the uterus.
• There is also a difficulty in palpating the small parts of the fetus because the uterus is unusually tense.
• Fetal heart rate auscultation can be also difficult because of the increased amount of fluid surrounding the fetus.
• The woman may develop extreme shortness of breath as the uterus presses up her diaphragm.
• Poor venous return would result to lower extremity varicosities and hemorrhoids.
• An ultrasound would determine the presence of hydramnios and also the reason for the excessive amount of fluid.
• A woman with hydramnios would be advised to take bed rest to increase uteroplacental circulation and reduce the pressure on the cervix.
• Help the woman avoid constipation, as straining could increase uterine pressure and cause rupture of the membranes.
• Encourage the woman to eat a high fiber diet, and if the diet is not effective, she can use stool softeners as prescribed.
• Assess the woman’s vital signs and lower extremity edema frequently.
• Amniocentesis can be performed to reduce the volume of the amniotic fluid.
• Tocolysis may be begun to prevent preterm labor.
• After birth, the infant must be assessed fully to determine the factors that interfere with its ability to swallow effectively in utero.

Oligohydramnios

• Oligohydramnios is a pregnancy with less than the average amount of amniotic fluid.
• This is usually caused by a bladder or renal disorder in the fetus that interferes with voiding.
• The disorder can occur because of in utero growth restriction, the muscles are left weak at birth, the lungs fail to develop leading to severe difficulty in breathing, and the facial features are distorted.
• These symptoms are associated with a syndrome called Potter’s syndrome.
• Oligohydramnios is suspected when the uterus fails to meet its expected growth rate.
• It is confirmed through ultrasound as pockets of amniotic fluid are less than the average.
• Amnio Transfusion or instillation of fluid into the uterus by amniocentesis can relieve oligohydramnios.
• Infants need careful observation at birth to rule out kidney disease and compromised lung development.

Post-Term Pregnancy

• A term pregnancy is 38 to 42 weeks long, and a pregnancy that exceeds these limits is termed as post term pregnancy or prolonged pregnancy.
• Then infant is considered post mature or dysmature, especially if placental insufficiency has interfered with fetal growth.
• Prolonged pregnancy may occur with high intake of salicylates, which interferes with the synthesis of prostaglandins and may be responsible for the initiation of labor.
• Meconium aspiration would likely occur as fetal intestinal contents are more likely to reach the rectum.
• Macrosomia is also another problem if the fetus continues to grow.
• The fetus is exposed to decreased blood perfusion as the placenta only has adequate functioning ability for 40 to 42 weeks.
• The fetus might also suffer from lack of oxygen, fluid, and nutrients.
• A maternal vaginal fibronectin level, a nonstress test, and a biophysical profile may be ordered to document the state of placental perfusion and the amount of amniotic fluid present.
• Prostaglandin gel or misoprostol may be applied to the cervix to initiate ripening, or stripping of membranes followed by an oxytocin infusion can be used too.
• Cesarean birth will be necessary if all measures are ineffective.
• Monitor fetal heart rate closely during labor to be certain placental insufficiency would not occur from aging of the placenta.

RH Incompatibility

• Rh incompatibility occurs when an Rh-negative mother carries a fetus with an Rh-positive blood type.
• The father of the child must either be homozygous or heterozygous Rh-positive.
• The Rh-positive fetus inside the Rh-negative mother would be treated as a foreign body, and the mother’s body would react as if the invading factor is a substance such as a virus.
• The mother’s body would form antibodies against the invading substance.
• The maternal antibodies would cross the placenta and cause red blood cells destruction of fetal red blood cells.
• There is insufficient oxygen transport to body cells, and this condition is termed as hemolytic disease of the newborn or erythroblastosis fetalis.
• On the first pregnancy visit, the woman must have an anti-D antibody titer.
• If the results are normal, the test would be repeated at week 28 of the pregnancy, and no therapy is needed.
• If the result is an elevated titer, the well-being of the fetus would be monitored every 2 weeks or more often by Doppler velocity of the fetal middle cerebral artery which could predict when the fetal red blood cells are being destroyed.
• If the artery velocity is high, the fetus is not developing anemia and most likely is an Rh-negative fetus.
• If the reading is low, it means the fetus is in danger and immediate birth will be carried out if the fetus is near term.
• If it is not near term, efforts to reduce the number of antibodies in the woman or replace damaged red cells in the fetus are started.
• Administration of Rh (D) immune globulin is done to women who are Rh-negative at 28 weeks of pregnancy.
• RhIG is given as an injection to the mother in the first 72 hours after birth of an Rh-positive child to further prevent the woman from forming natural antibodies.

Practice Quiz: Sudden Pregnancy Complications

Quiz time! Here’s a 5-item quiz about sudden pregnancy complications.

1. What is the first sign of hydramnios in a pregnant woman?

A. Shortness of breath
B. Varicosities and hemorrhoids
C. Difficulty in auscultating the fetal heart rate
D. Rapid growth of the uterus

2. What is the common reason for oligohydramnios?

A. A bladder or renal disorder in the fetus that interferes with voiding
B. Decrease production of amniotic fluid
C. A small uterine capacity to hold the amniotic fluid
D. Perforation of the amniotic sac

3. What precipitates meconium aspiration in a fetus?

A. Hydramnios
B. Oligohydramnios
C. Preterm labor
D. Post term birth

4. How would you know if the findings in a Doppler velocity test are normal?

A. The reading is low
B. The reading is high
C. The reading at first is high, then becomes low at the second reading
D. The reading is low at first, then becomes high at the second reading

5. When does administration of RhIG occur?

A. Before the birth of the fetus
B. During labor
C. On the first hour after birth
D. 72 hours after birth of the newborn

Answers and Rationale

1. Answer: D. Rapid growth of the uterus

• Rapid growth of the uterus is the first noticeable sign of hydramnios.
• Option A: This symptom occurs later in the development of the disease.
• Option B: Varicosities and hemorrhoids are symptoms yet they do not appear first.
• Option C: Difficulty in auscultating the heart rate is also a symptom yet develops later in the progress of the disease.

2. Answer: A. A bladder or renal disorder in the fetus that interferes with voiding

• The fetus may have difficulty in voiding as it swallows the amniotic fluid leading to a decrease in the amount of amniotic fluid.
• Option B: The production of the amniotic fluid is normal.
• Option C: The uterine capacity does not affect the amount of amniotic fluid produced.
• Option D: There is no perforation of the amniotic sac in oligohydramnios.

3. Answer: D. Post term birth

• Post term birth can cause meconium aspiration because the fetal contents are more likely to reach the rectum.
• Option A: Hydramnios refers to excessive amniotic fluid and does not lead to meconium aspiration.
• Option B: Oligohydramnios refers to the less than average amount of amniotic fluid and does not cause meconium aspiration.
• Option C: preterm labor cannot precipitate meconium aspiration because the fetal contents are still up in the fetus’ intestines.

4. Answer: B. The reading is high

• When the reading is high, the fetus would not develop anemia and is a Rh-negative fetus.
• Option A: A low reading indicates that the fetus is in danger and immediate birth is necessary if it has reached term.
• Option C: The reading is not repeated for the second time.
• Option D: The reading is not repeated for the second time

5. Answer: D. 72 hours after birth of the newborn

• 72 hours after the birth of an Rh-positive child, administration of RhIG occurs to prevent the mother from producing more natural antibodies.
• Option A: RhIG is not given before birth, it is given afterwards.
• Option B: Labor would be too early a time for administration of RhIG.
• Option C: The exact time would be 72 hours after the birth to make sure that the production of natural antibodies is halted.

The dangers of pregnancy can cause anxiety to the woman and her family, so it is the role of nurses to properly educate them and also provide support for them whenever we can. We are patient advocates and we always lean towards the safety and satisfaction of our clients no matter what stage or condition they are in.