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Treatments for Pregnancy

Contents
  1. Pregnancy: Introduction
  2. News about treatments
  3. Discussion of treatments for Pregnancy
  4. Buy Products Related to Treatments for Pregnancy
  5. Pregnancy: Introduction

Pregnancy: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Pregnancy may include:

Pregnancy: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Pregnancy:

Pregnancy: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Hospital statistics for Pregnancy:

These medical statistics relate to hospitals, hospitalization and Pregnancy:

  • 24.0% of hospitalisations for pregnancy, childbirth and the puerperium in public hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
  • 300,644 admissions to public hospitals because of pregnancy, childbirth and the puerperium in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
  • 5.1% of hospitalisations for pregnancy, childbirth and the puerperium disorders in private hospitals are single day in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
  • 71,979 patient days spent in private hospitals for pregnancy, childbirth and the puerperium disorders in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
  • 856,956 patient days spent in public hospitals for pregnancy, childbirth and the puerperium in Australia 2001-02 (AIHW National Hospital Morbidity Database, Australia’s Health 2004, AIHW)
  • more hospital information...»

Hospitals & Medical Clinics: Pregnancy

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Pregnancy:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Pregnancy, on hospital and medical facility performance and surgical care quality:

Medical news summaries about treatments for Pregnancy:

The following medical news items are relevant to treatment of Pregnancy:

Discussion of treatments for Pregnancy:

Folic Acid: NWHIC (Excerpt)

The Centers for Disease Control and Prevention estimate that up to 3,000 of these neural tube birth defects could be prevented each year if women consumed folic acid each day before pregnancy and during the early months of pregnancy. Since half of all pregnancies in the U.S. are not planned, many women may not find out that they are pregnant until well after the ideal time to prevent these birth defects. As a result, the Public Health Service recommends that all women of childbearing age consume 0.4 mg of folic acid each day to prevent spina bifida and anencephaly. (Source: excerpt from Folic Acid: NWHIC)

Pregnancy and Nutrition: NWHIC (Excerpt)

Even before pregnancy begins, nutrition is a primary factor in the health of mother and baby. If you are eating a well-balanced diet before you become pregnant, you will only need to make a few changes to meet the nutritional needs of pregnancy.

According to the American College of Obstetricians and Gynecologists (ACOG), pregnant women should increase their usual servings of a variety of foods from the four basic food groups to include the following:

  • Four or more servings of fruits and vegetables for vitamins and minerals

  • Four or more servings of whole-grain or enriched bread and cereal for energy

  • Four or more servings of milk and milk products for calcium

  • Three or more servings of meat, poultry, fish, eggs, nuts, dried beans and peas for protein

Eating a well-balanced diet while you are pregnant will help to keep you and your baby healthy. Most physicians agree that the Recommended Daily Allowances (RDAs), except those for iron, can be obtained through a proper diet. (Source: excerpt from Pregnancy and Nutrition: NWHIC)

Pregnancy and Nutrition: NWHIC (Excerpt)

As a pregnant woman, you need more nutrients to help your baby grow and be healthy. Besides folic acid and iron, which we have already discussed. There are other dietary additions you will need:

Calcium: Pregnant and lactating adult women require an additional 40% of calcium a day (1200-1500 mg per day). Almost all of the extra calcium goes into the baby's developing bones. To get this extra calcium, 3 extra servings (3 cups) of milk or dairy products are needed. If you are lactose intolerant, you can still get this extra calcium. There are several low-lactose or reduced-lactose products available. In some cases, your doctor might even prescribe a calcium supplement.

Sodium: This is important during pregnancy. 2,000 to 8,000 milligrams of sodium a day is recommended during pregnancy. There are 2,325 milligrams of sodium in one teaspoon of salt, and because salt is in most foods, the increased need for it during pregnancy is not too difficult to achieve. Sodium helps to regulate the water in the body.

Fluids: Drink plenty of fluids, especially water, during pregnancy. A woman's blood volume increases dramatically during pregnancy. Drinking at least eight glasses of water a day can help prevent common problems such as dehydration and constipation.

To find out what other nutrients are important during pregnancy and how much you need, ask your healthcare provider any questions you may have. (Source: excerpt from Pregnancy and Nutrition: NWHIC)

Pregnancy and Nutrition: NWHIC (Excerpt)

While you are pregnant, you will need additional nutrients to keep you and your baby healthy. However, that does not mean you need to eat twice as much. An increase of only 300 calories per day is recommended. For example, a baked potato has 120 calories, so getting those extra 300 calories should not be that difficult. Make sure not to restrict your diet during pregnancy because you might not be getting the right amounts of protein, vitamins, and minerals that are necessary to properly nourish your unborn baby. Low-calorie intake can cause the mother's stored fat to break down, leading to the production of substances called ketones. Ketones, which can be found in the mother's blood and urine, are a sign of starvation or a starvation-like state. Constant production of ketones can result in a mentally retarded child. (Source: excerpt from Pregnancy and Nutrition: NWHIC)

Drinking and Your Pregnancy: NIAAA (Excerpt)

Do not drink alcohol when you are pregnant. Why? Because when you drink alcohol, so does your baby. Think about it. Everything you drink, your baby also drinks. (Source: excerpt from Drinking and Your Pregnancy: NIAAA)

Drinking and Your Pregnancy: NIAAA (Excerpt)

Drinking any kind of alcohol when you are pregnant can hurt your baby. Alcoholic drinks are beer, wine, wine coolers, liquor, or mixed drinks. A glass of wine, a can of beer, and a mixed drink all have about the same amount of alcohol. (Source: excerpt from Drinking and Your Pregnancy: NIAAA)

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Book Excerpts: Treatment of Pregnancy

Treatments of Pregnancy: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Pregnancy.

Amenorrhea: Treatment
(In a Page: Signs and Symptoms)

  • Imperforate hymen requires surgical correction
  • Androgen insensitivity syndrome: Excise testes after puberty because of increased risk of testicular cancer
  • Absent müllerian structure or presence of Y chromosome: Psychological counseling
  • Ovarian failure: Consider hormone replacement therapy
  • Polycystic ovarian syndrome
    –Oral contraceptives decrease ovarian androgen secretion
    –Weight reduction decreases peripheral estrogen
    –Clomiphene to enhance fertility
    –Cyclic progesterone prevents endometrial hyperplasia
  • Functional hypothalamic amenorrhea
    –Weight gain and reduction in intensity of exercise
    –Consider oral contraceptives to prevent osteoporosis
    –Exogenous gonadotropins or pulsatile GnRH may be necessary

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Amenorrhea – Secondary: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • Correction of systemic illness, malnutrition, eating disorder, or other stress
  • Hyperprolactinemia
    –Prolactinoma: Treat with dopamine agonist
    –Medication-induced: Cessation of the offending agent
  • Polycystic ovary syndrome
    –Weight loss
    –Oral contraceptives
    –Antiandrogen agents such as spironolactone
    –Insulin sensitizers such as metformin
  • Ovarian failure
    –Treat with estrogen-progestin replacement
  • Asherman syndrome
    –Treat by surgical excision of adhesions

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Amenorrhea – Primary: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • Underlying chronic illnesses, malnourished states, or hypothyroidism should be treated
  • Stop medications causing hyperprolactinemia (e.g., antidepressants, phenothiazines) if safe to do so
  • Prolactinomas can be treated medically with a dopamine agonist
  • Other pituitary tumors will need treatment according to their specific type
  • Patients with ovarian insufficiency or hypogonadotropic hypogonadism need estrogen therapy for breast development, and then should cycle estrogens and progestins to establish menses

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Abdominal distention: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

If the patient displays abdominal distention, quickly check for signs of hypovolemia, such as pallor, diaphoresis, hypotension, a rapid thready pulse, rapid shallow breathing, decreased urine output, and altered mentation. Ask the patient if he’s experiencing severe abdominal pain or difficulty breathing. Find out about any recent accidents, and observe him for signs of trauma and peritoneal bleeding, such as Cullen’s sign or Turner’s sign. Then auscultate all abdominal quadrants, noting rapid and high-pitched, diminished, or absent bowel sounds. (If you don’t hear bowel sounds immediately, listen for at least 5 minutes in each of the four abdominal quadrants.) Gently palpate the abdomen for rigidity. Remember that deep or extensive palpation may increase pain.

If you detect abdominal distention and rigidity along with abnormal bowel sounds and if the patient complains of pain, begin emergency interventions. Place the patient in the supine position, administer oxygen, and insert an I.V. line for fluid replacement. Prepare to insert a nasogastric tube to relieve acute intraluminal distention. Reassure the patient and prepare him for surgery.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Abortion: Treatment
(Professional Guide to Diseases (Eighth Edition))

An accurate evaluation of uterine contents is necessary before a plan of treatment can be formulated. The progression of spontaneous abortion can’t be prevented, except possibly in cases caused by an incompetent cervix. The patient must be hospitalized to control severe hemorrhage. If bleeding is severe, a transfusion with packed red blood cells or whole blood is required. Initially, I.V. administration of oxytocin stimulates uterine contractions (if given above 20 weeks’gestation — receptors are absent before this gestational age). If any remnants remain in the uterus, dilatation and curettage or dilatation and evacuation (D & E) should be performed.

D & E is also performed in first- and second-trimester therapeutic abortions. In second-trimester therapeutic abortions, the insertion of a prostaglandin vaginal suppository induces labor and the expulsion of uterine contents. When performed competently, second-trimester D & E is a very safe procedure and allows for termination of pregnancy without the need for a lengthy induction of labor. Early first-trimester abortion may also be accomplished pharmacologically with mifepristone (RU-486) an antiprogestin, followed by a dose of a prostaglandin analogue 2 days later, or surgically, using vacuum aspiration.

After an abortion, spontaneous or induced, an Rh-negative female with a negative indirect Coombs’test should receive Rho(D) immune globulin (human) to prevent future Rh isoimmunization.

In a habitual aborter, spontaneous abortion can result from an incompetent cervix (a clinical retrospective diagnosis suggested by a history of previous second-trimester losses accompanied by membrane rupture or painless cervical dilation). Treatment involves surgical reinforcement of the cervix (cerclage) 12 to 24 weeks after the last menstrual period. A few weeks before the estimated delivery date, the sutures are removed, and the patient awaits the onset of labor. An alternative procedure is to leave the sutures in place and to deliver the infant by cesarean birth. Cerclage hasn’t been shown to be more effective than bed rest.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Amenorrhea: Treatment
(Professional Guide to Diseases (Eighth Edition))

Appropriate hormone replacement re-establishes menstruation. Treatment of amenorrhea not related to hormone deficiency depends on the cause. For example, amenorrhea that results from a tumor usually requires surgery.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Cesarean birth: Treatment
(Professional Guide to Diseases (Eighth Edition))

The most common type of cesarean birth is the lower segment cesarean, in which a transverse incision across the lower abdomen opens the visceral peritoneum over the uterus. The lower anterior uterine wall is then incised (transversely or longitudinally) behind the bladder.

The classic cesarean — in which a longitudinal incision is made into the body of the uterus, extending into the fundus and opening the top of the uterus — is rarely performed because it exaggerates the risk of infection and of uterine rupture in subsequent pregnancies. Cesarean hysterectomy removes the entire uterus and is reserved for such cases as malignant tumors, severe infection, and placenta accreta.

Patients may have general or regional anesthetic for surgery, depending on the extent of maternal or fetal distress. Possible maternal complications of cesarean delivery include respiratory tract infection, wound dehiscence, thromboembolism, paralytic ileus, hemorrhage, and genitourinary tract infection.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Adolescent pregnancy: Treatment
(Professional Guide to Diseases (Eighth Edition))

The pregnant adolescent requires the standard prenatal care that’s appropriate for an adult. However, she also needs psychological support and close observation for signs of complications.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Cardiovascular disease in pregnancy: Treatment
(Professional Guide to Diseases (Eighth Edition))

The goal of antepartum management is to prevent complications and minimize the strain on the mother’s heart, primarily through rest. This may require periodic hospitalization for patients with moderate cardiac dysfunction or with symptoms of decompensation, toxemia, or infection. Older women or those with previous decompensation may require hospitalization and bed rest throughout the pregnancy.

Drug therapy is often necessary and should always include the safest possible drug in the lowest possible dosage to minimize harmful effects to the fetus. Diuretics and drugs that increase blood pressure, blood volume, or cardiac output should be used with extreme caution. If an anticoagulant is needed, heparin is the drug of choice. Cardiac glycosides and common antiarrhythmics, such as quinidine and procainamide, are often required. The prophylactic use of antibiotics is reserved for patients who are susceptible to endocarditis.

A therapeutic abortion should be considered for patients with severe cardiac dysfunction, especially if decompensation occurs during the first trimester. Patients hospitalized with heart failure usually follow a regimen of cardiac glycosides, oxygen, rest, sedation, diuretics, and restricted intake of sodium and fluids. Patients in whom symptoms of heart failure don’t improve after treatment with bed rest and cardiac glycosides may require cardiac surgery, such as valvotomy and commissurotomy. During labor, the patient may require oxygen and an analgesic, such as meperidine or morphine, for relief of pain and apprehension without undue depression of the fetus or herself. Depending on which procedure promises to be less stressful for the patient’s heart, delivery may be vaginal or by cesarean birth. Forceps may augment vaginal delivery to minimize the need to push, which strains the heart.

Bed rest and medications already instituted should continue for at least 1 week after delivery because of a high incidence of decompensation, cardiovascular collapse, and maternal death during the early puerperal period. These complications may result from the sudden release of intra-abdominal pressure at delivery and the mobilization of extracellular fluid for excretion, which increase the strain on the heart, especially if excessive interstitial fluid has accumulated. Breast-feeding is undesirable for patients with severely compromised cardiac dysfunction because it increases fluid and metabolic demands on the heart.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pregnancy-induced hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include complete bed rest to increase placental perfusion, reduce hypertension, and evaluate response to therapy. Antihypertensive therapy doesn’t alter the potential for developing eclampsia. Diuretics aren’t appropriate during pregnancy.

If the patient’s blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases, magnesium sulfate may produce general sedation, promote diuresis, and prevent seizures. Cesarean birth or oxytocin induction may be required to terminate the pregnancy.

Emergency treatment of eclamptic seizures consists of immediate administration of magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the seizures subside and the patient’s condition stabilizes, delivery should proceed with induction of labor or cesarean birth, depending upon the circumstances.

Adequate nutrition, good prenatal care, and control of pre-existing hypertension during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Diabetic complications during pregnancy: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment of both the newly diagnosed and the established diabetic is designed to maintain blood glucose levels within acceptable limits through dietary management and insulin administration. Many females with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes.

For pregnant patients with diabetes, therapy includes:

❑ bimonthly visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester

❑ maintenance of fasting blood glucose levels at or below 100 mg/dl and 2-hour postprandial blood glucose levels at or below 120 mg/dl during the pregnancy

❑ frequent monitoring for glycosuria and ketonuria (ketosis presents a grave threat to the fetal central nervous system)

❑ weight control (gain not to exceed 3 to 3½ lb [1.4 to 1.6 kg] per month during the last 6 months of pregnancy)

❑ high-protein diet of 2 g/day/kg of body weight, or a minimum of 80 g/day during the second half of pregnancy; daily calorie intake of 30 to 40 calories/kg of body weight; daily carbohydrate intake of 200 g; and enough fat to provide 36% of total calories (however, vigorous calorie restriction can cause starvation ketosis)

❑ exogenous insulin if diet doesn’t control blood glucose levels. Be alert for changes in insulin requirements from one trimester to the next and immediately postpartum. Oral antidiabetic drugs are contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.

Generally, the optimal time for delivery is between 37 and 39 weeks’ gestation, although with reassuring antenatal testing and no evidence of macrosomia, 40 weeks or later is also feasible. The insulin-dependent diabetic may require hospitalization before delivery for frequent monitoring of blood glucose levels and prompt intervention if complications develop.

Depending on fetal status and maternal history, the obstetrician may induce labor or perform a cesarean delivery. During labor and delivery, the patient with diabetes should receive continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor. The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Ectopic pregnancy: Treatment
(Professional Guide to Diseases (Eighth Edition))

If culdocentesis is positive or the patient has peritoneal signs consistent with a surgical abdomen, laparoscopy and laparotomy are indicated. The ovary is preserved as a rule; however, ovarian pregnancy may necessitate oophorectomy. Interstitial pregnancy may rarely require hysterectomy; abdominal pregnancy requires a laparotomy to remove the fetus, except in rare cases, when the fetus survives to term or calcifies undetected in the abdominal cavity.

Supportive treatment includes transfusion with whole blood or packed red cells to replace excessive blood loss, administration of broad-spectrum antibiotics I.V. for septic infection, and administration of supplemental iron by mouth or I.M.

Methotrexate I.M. is also a therapeutic option in stable patients, avoiding surgery in most cases.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Abdominal distention: Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient displays abdominal distention, quickly check for signs of hypovolemia, such as pallor, diaphoresis, hypotension, rapid and thready pulse, rapid and shallow breathing, decreased urine output, poor capillary refill, and altered mentation. Ask the patient if he’s experiencing severe abdominal pain or difficulty breathing. Find out about any recent accidents, and observe the patient for signs of trauma and peritoneal bleeding, such as Cullen’s sign  or Turner’s sign. Then auscultate all abdominal quadrants, noting rapid and high-pitched, diminished, or absent bowel sounds. (If you don’t hear bowel sounds immediately, listen for at least 5 minutes.) Gently palpate the abdomen for rigidity. Remember that deep or extensive palpation may increase pain.

If you detect abdominal distention and rigidity along with abnormal bowel sounds, and the patient complains of pain, begin emergency interventions. Place the patient in the supine position, administer oxygen, and insert an I.V. line for fluid replacement. Prepare to insert a nasogastric tube to relieve acute intraluminal distention. Reassure the patient and prepare him for surgery.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Amenorrhea: Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))

After diagnosis, answer the patient’s questions about the type of treatment that will be provided and its expected outcome. Because amenorrhea can cause severe emotional distress, provide emotional support. Be sure to encourage the patient to discuss her fears and, if necessary, refer her for psychological counseling.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Low birth weight: Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

Because low birth weight may be associated with poorly developed body systems, particularly the respiratory system, your priority is to monitor the neonate’s respiratory status. Be alert for signs of distress, such as apnea, grunting respirations, intercostal or xiphoid retractions, or a respiratory rate exceeding 60 breaths/minute after the first hour of life. If you detect any of these signs, prepare to provide respiratory support. Endotracheal intubation or supplemental oxygen with an oxygen hood may be needed.

Monitor the neonate’s axillary temperature. Decreased fat reserves may keep him from maintaining normal body temperature, and a drop below 97.8° F (36.5° C) exacerbates respiratory distress by increasing oxygen consumption. To maintain normal body temperature, use an overbed warmer or an Isolette. (If these are unavailable, use a wrapped rubber bottle filled with warm water, but be careful to avoid hyperthermia.) Cover neonate’s head to prevent heat loss.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Abortion: Treatment
(Handbook of Diseases)

An accurate evaluation of uterine contents is necessary before a plan of treatment can be formulated. The progression of spontaneous abortion can’t be prevented. If bleeding is severe, a transfusion with packed red blood cells or whole blood is required. Initially, I.V. administration of oxytocin stimulates uterine contractions. If any remnants remain in the uterus, dilatation and curettage or dilatation and evacuation should be performed.

Dilation and evacuation is also performed in first- and second-trimester therapeutic abortions. Medical abortion, using mifepristone (RU-486) and misoprostol (a prostaglandin) is also effective (90% to 97%) for pregnancy termination less than 49 days from the last menses.

After an abortion, spontaneous or induced, an Rh-negative female with a normal indirect Coombs’test result should receive Rho(D) immune globulin (human) to prevent further Rh isoimmunization.

In a patient who has suffered from habitual abortion, spontaneous abortion can result from an incompetent cervix. Treatment involves bed rest and, in some situations, surgical reinforcement of the cervix 12 to 14 weeks after the last menses. A few weeks before the estimated delivery date, the sutures are removed and the patient awaits the onset of labor. An alternative procedure, especially for a woman who wants to have more children, is to leave the sutures in place and to deliver the infant by cesarean birth.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Cardiovascular disease in pregnancy: Treatment
(Handbook of Diseases)

Specific treatments vary before, during, and after delivery.

Before delivery

The goal of antepartum management is to prevent complications and minimize the strain on the mother’s heart, primarily through rest. This may require periodic hospitalization for patients with moderate cardiac dysfunction or with symptoms of decompensation, toxemia, or infection. Older women or those with previous decompensation may require hospitalization and bed rest throughout the pregnancy.

Drug therapy is usually necessary and should include the safest drug in the lowest possible dose to minimize harmful effects to the fetus. Diuretics and drugs that increase blood pressure, blood volume, or cardiac output should be used with extreme caution.

If an anticoagulant is needed, heparin is the drug of choice. A cardiac glycoside and an antiarrhythmic are typically required. The prophylactic use of antibiotics is reserved for patients who are susceptible to endocarditis.

A therapeutic abortion may be considered for patients with severe cardiac dysfunction, especially if decompensation occurs during the first trimester. Patients hospitalized with heart failure are usually treated with a cardiac glycoside, oxygen, rest, sedation, and a diuretic; intake of sodium and fluids is also restricted. Patients whose symptoms of heart failure don’t improve after treatment with bed rest and a cardiac glycoside may require cardiac surgery, such as valvotomy and commissurotomy.

During delivery

The patient in labor may require oxygen and an analgesic, such as meperidine or morphine, for pain relief and apprehension without undue depression of the fetus or herself. Depending on which procedure promises to be less stressful for the patient’s heart, delivery may be vaginal or by cesarean section. Operative vaginal delivery (for example, with forceps) is usually preferable to avoid the blood pressure changes that occur with pushing.

After delivery

Bed rest and medications already instituted should continue for at least 1 week after delivery because of a high incidence of decompensation, cardiovascular collapse, and maternal death during the early puerperal period. These complications may result from the sudden release of intra-abdominal pressure at delivery and the mobilization of extracellular fluid for excretion, which increase the strain on the heart, especially if excessive interstitial fluid has accumulated.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Hypertension, pregnancy-induced: Treatment
(Handbook of Diseases)

Adequate nutrition, good prenatal care, and control of preexisting hypertension with hydralazine during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.

Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach.

Conservative measures

Therapy may include sedatives, such as phenobarbital, along with complete bed rest to relieve anxiety, reduce hypertension, and evaluate response to therapy. If renal function remains adequate, a high-protein, low-sodium, low-carbohydrate diet with increased fluid intake is recommended.

If blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg or if CNS irritability increases, magnesium sulfate may produce general sedation, promote diuresis, reduce blood pressure, and prevent seizures.

Cesarean delivery

If these measures fail to improve the patient’s condition or if fetal life is endangered (as determined by stress or nonstress tests), cesarean delivery or oxytocin induction may be required to terminate the pregnancy.

Treatment for seizures

Emergency treatment of eclamptic seizures consists of immediate administration of I.V. diazepam, followed by magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the patient’s condition stabilizes, a cesarean delivery may be performed.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Diabetic complications during pregnancy: Treatment
(Handbook of Diseases)

Both the newly diagnosed and the established diabetic need dietary management and insulin administration to maintain blood glucose levels within acceptable limits. Most women with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes.

For pregnant patients with diabetes, therapy includes:

❑ frequent visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester, an internist may be consulted as necessary.

❑ maintenance of blood glucose levels at or below 95 mg/dl during the third trimester

❑ frequent monitoring for glycosuria and ketonuria (Ketosis presents a grave threat to the fetal central nervous system.)

❑ a high-protein diet of 2 g/day/kg of body weight (a minimum of 80 g/day during the second half of pregnancy), a  daily calorie intake of 30 to 40 calories/kg of body weight, a daily carbohydrate intake of 200 g, and enough fat to provide 36% of total calories (However, vigorous calorie restriction can cause starvation ketosis.)

❑ exogenous insulin if diet doesn’t control blood glucose levels. Oral antidiabetic agents are generally contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.

Delivery

Generally, the optimal time for delivery is no different from a normal pregnancy, as long as blood sugars are controlled and no fetal compromise is present.

Depending on fetal status and maternal history, labor may be spontaneous induced or a cesarean section performed. During labor and delivery, the patient with diabetes should receive a continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor.

The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Abdominal distention: Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient displays abdominal distention, quickly check for signs of hypovolemia, such as pallor; diaphoresis; hypotension; rapid, thready pulse; rapid, shallow breathing; decreased urine output; poor capillary refill; and altered mentation. Ask the patient if he’s experiencing severe abdominal pain or difficulty breathing. Find out about any recent accidents, and observe the patient for signs of trauma and peritoneal bleeding, such as Cullen’s sign or Turner’s sign. Then auscultate all abdominal quadrants, noting rapid and high-pitched, diminished, or absent bowel sounds. (If you don’t hear bowel sounds immediately, listen for at least 5 minutes.) Gently palpate the abdomen for rigidity. Remember that deep or extensive palpation may increase pain.

If you detect abdominal distention and rigidity along with abnormal bowel sounds and the patient complains of pain, begin emergency interventions. Place the patient in the supine position, administer oxygen, and insert an I.V. line for fluid replacement. Prepare to insert a nasogastric tube to relieve acute intraluminal distention. Reassure the patient, and prepare him for surgery.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Amenorrhea: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

After diagnosis, answer the patient’s questions about the type of treatment that will be provided and its expected outcome. Because amenorrhea can cause severe emotional distress, provide emotional support. Be sure to encourage the patient to discuss her fears and, if necessary, refer her for psychological counseling.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Abdominal distention: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Position the patient comfortably, using pillows for support.

▪ If the patient has flatus, place him on his left side to help flatus escape.

▪ If the patient has ascites, elevate the head of the bed to ease his breathing.

▪ Insert a nasogastric tube for bowel compression; monitor amount and type of drainage.

▪ Administer drugs to relieve pain, and offer emotional support.

▪ Prepare the patient for diagnostic tests, such as abdominal X-rays, endoscopy, laparoscopy, ultrasonography, computed tomography scan or, possibly, paracentesis.

▪ Prepare the patient for surgery, if indicated.

Patient teaching

▪ Teach the patient to use slow deep breathing to help relieve abdominal discomfort.

▪ If the patient has an obstruction or ascites, tell him which foods and fluids to avoid.

▪ Emphasize the importance of oral hygiene to prevent dry mouth.

▪ Explain the underlying disorder and treatment plan.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Amenorrhea: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ In patients with secondary amenorrhea, physical and pelvic examinations must rule out pregnancy before diagnostic testing begins.

▪ Prepare the patient for tests, such as progestin withdrawal, serum hormone and thyroid function studies, and endometrial biopsy.

Patient teaching

▪ Explain to the patient all tests and procedures.

▪ Explain the underlying disorder and treatment plan.

▪ Encourage the patient to discuss her fears and, if necessary, refer her for psychological counseling.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Low birth weight: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Initiate feedings as soon as possible and continue to feed the neonate every 2 to 3 hours.

▪ Provide gavage or I.V. nutrition for the sick or very premature neonate.

▪ Check abdominal girth daily or more frequently if indicated, and check stools for blood to detect necrotizing enterocolitis.

▪ Prepare for a sepsis workup if signs of infection are associated with low birth weight.

▪ Check the neonate's vital signs every 15 minutes for the first hour and at least once every hour thereafter until his condition stabilizes.

▪ Be alert for changes in temperature or behavior, feeding problems, respiratory distress, or periods of apnea—possible indications of infection.

▪ Monitor blood glucose levels and watch for signs and symptoms of hypoglycemia, such as irritability, jitteriness, tremors, seizures, irregular respirations, lethargy, and a high-pitched or weak cry.

▪ If the neonate is receiving supplemental oxygen, carefully monitor arterial blood gas values and the oxygen concentration of inspired air to prevent retinopathy.

▪ Monitor the neonate's urine output by weighing diapers before and after voiding.

▪ Check urine color, measure specific gravity, and test for the presence of glucose, blood, or protein.

▪ Watch for changes in the neonate's skin color because increasing jaundice may indicate hyperbilirubinemia.

Patient teaching

▪ Explain disorder and all procedures and treatments to the parents.

▪ Encourage the parents to participate in their neonate's care to strengthen bonding.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007



 » Next page: Doctors and Medical Specialists for Pregnancy

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