High Risk Pregnancy
A high-risk pregnancy is one in which a concurrent concu rrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, the fetus, or both. Care of Pregnant Woman with Pre-existing or Newly Acquired llness Assessment Assessment It is important to establish baseline vital signs to identify a complication related to pre-existing condition. Nursing Diagnosis Diagnosis Nursing diagnoses developed for a woman with a high-ris pregnancy address her specific, disease-related condition as well as any therapeutic restrictions her condition might re!uire. "xamples of possible nursing diagnoses are# $ Ineffective tissue perfusion %cardiopulmonary& %cardiopulmonary& related to poor heart function secondary to mitral valve prolapsed during pregnancy $ 'ain related to pyelonephritis secondary to pressure on ureters $ (ocial isolation related to prescribed bed rest during pregnancy secondary to concurrent illness $ Ineffective role performance related to increasing level of daily restrictions secondary to chronic illness and pregnancy $ )nowledge deficit related to normal changes of pregnancy versus illness complications complications $ *ear regarding pregnancy outcome related to chronic illness $ +ealth-seeing behaviors related to the effects of illness on pregnancy $ (ituational low self-esteem related to illness during pregnancy
Planning ry to mae plans with a woman who has a preexisting medical condition based on the pattern of her life before the pregnancy. A primary goal for a woman with a severe chronic condition might be to maintain her health during pregnancy, so she can remain at home as long as possible, thereby minimizing hospitalization and family disruptions. Implementation Implementation Nursing interventions for the pregnant woman with a chronic illness may focus on teaching her new or additional measures to maintain health because of the pregnancy. Imaginative solutions to problems may need to be created because a woman may be unable to adjust to the extent of changes she must mae. Evaluation Evaluation ae evaluation ongoing to ensure that you now throughout the pregnancy whether interventions are successful. (ome examples of outcomes that might be established are# $ lient states she rests for / hours morning and afternoon0 dependent edema remains at 12 or less at next prenatal visit. $ *amily member3s state they are all participating in an exercise program since mother developed gestational diabetes. $ lient reports no burning on urination or flan pain at next prenatal visit. $ lient states she understands the importance of taing daily thyroid medicine for total length of pregnancy.
Factors That Categorize a Pregnancy as High Risk Psychological Prepregnancy
Social
Physical
History of drug dependence (including alcohol) History of intimate partner abuse History of mental illness History of poor coping mechanisms %ognitively challenged urvivor of childhood sexual abuse
Occupation involving handling of toxic substances (including radiation and anesthesia gases) "nvironmental contaminants at home $solated &o'er economic level Poor access to transportation for care High altitude Highly mobile lifestyle Poor housing &ac# of support people
Visual or hearing challenges Pelvic inadequacy or misshape Uterine incompetency, position, or structure econdary ma!or illness (heart disease, diabetes mellitus, #idney disease, hypertension, chronic infection such as tuberculosis, hemopoietic or blood disorder, malignancy) Poor gynecologic or obstetric history History of previous poor pregnancy outcome (miscarriage, stillbirth, intrauterine fetal death) History of child 'ith congenital anomalies Obesity ($ _*+) Under'eight ($ _-./) Pelvic inflammatory disease History of inherited disorder mall stature Potential of blood incompatibility 0ounger than age - years or older than */ years %igarette smo#er ubstance abuser
1efusal of or neglected prenatal care "xposure to environmental teratogens 3isruptive family incident 3ecreased economic support %onception less than year after last pregnancy
ub!ect to trauma 2luid or electrolyte imbalance $nta#e of teratogen such as a drug ultiple gestation 5 bleeding disruption Poor placental formation or position 6estational diabetes 7utritional deficiency of iron, folic acid, or protein Poor 'eight gain Pregnancy4induced hypertension $nfection 5mniotic fluid abnormality Postmaturity
&ac# of support person $nadequate home for infant care Unplanned cesarean birth &ac# of access to continued health care &ac# of access to emergency personnel or equipment
Hemorrhage $nfection 2luid and electrolyte imbalance 3ystocia Precipitous birth &acerations of cervix or vagina %ephalopelvic disproportion $nternal fetal monitoring 1etained placenta
Pregnancy &oss of support person $llness of a family member 3ecrease in self4esteem 3rug abuse (including alcohol and cigarette smo#ing) Poor acceptance of pregnancy
Labor and Birth everely frightened by labor and birth experience $nability to participate because of anesthesia eparation of infant at birth &ac# of preparation for labor irth of infant 'ho is disap4 pointing in some 'ay (such as sex, appearance, or congenital anomalies) $llness in ne'born
CAR!"#A$C%&AR !$"R!'R$ AN! PR'(NANC) A Woman with Cardiac !isease Left-Sided Heart Failure -Left-sided heart failure occurs in conditions such as mitral stenosis, mitral insufficiency, and aortic coarctation. In these instances, the left ventricle cannot move the volume of blood forward that it has received by the left atrium from the pulmonary circulation. The heart becomes so overwhelmed it fails to function. The reason for the
failure is most often at the level of the mitral valve. The normal physiologic tachycardia of pregnancy shortens diastole (atrial contraction) and decreases the time available for blood to flow across this valve. The inability of the mitral valve to push blood forward causes backpressure on the pulmonary circulation, causing it to become distended systemic blood pressure decreases in the face of lowered cardiac output, and pulmonary hypertension occurs. !hen pressure in the pulmonary vein reaches a point of about "# mm $g, fluid begins to pass from the pulmonary capillary membranes into the interstitial spaces surrounding the alveoli and then into the alveoli themselves (pulmonary edema). %ulmonary edema produces profound dyspnea as it interferes with o&ygen'carbon dio&ide e&change as the fluid coats the alveolar e&change space (ashore *ranger, "++). If pulmonary capillaries rupture under the pressure, small amounts of blood leak into the alveoli and a productive cough of blood-speckled sputum develops. ecause of the limited o&ygen e&change, women with pulmonary hypertension are at e&tremely high risk for spontaneous miscarriage, preterm labor, or maternal death. Right-Sided Heart Failure -ongenital heart defects such as pulmonary valve stenosis and atrial and ventricular septal defects can result in right-sided heart failure. ight-sided failure occurs when the output of the right ventricle is less than the blood volume received by the right atrium from the vena cava. ack-pressure from this results in congestion of the systemic venous circulation and decreased cardiac output to the lungs. lood pressure decreases in the aorta because less blood is reaching it pressure is high in the vena cava from back-pressure of blood both /ugular venous distention and increased portal circulation occur. The liver and spleen become distended. Liver enlargement can cause e&treme dyspnea and pain in a pregnant woman because the enlarged liver, as it is pressed upward by the enlarged uterus, puts e&treme pressure on the diaphragm. 0istention of abdominal vessels can lead to e&udate of fluid from the vessels into the peritoneal cavity (ascites). 1luid also moves from the systemic circulation into lower e&tremity interstitial spaces (peripheral edema). Peripartum Heart Disease - peripartal cardiomyopathy can originate in pregnancy in women with no previous history of heart disease (2merican ollege of 3bstetrics and *ynecology 423*5, "++6). 2lthough the cause is unknown, it is apparently because of the effect of the pregnancy on the circulatory system. The mortality rate can be as high as #+7. In many instances, it occurs from previously undetected heart disease, although it occurs most often in 2frican 2merican multiparas in con/unction with hypertension of pregnancy. 2 woman develops signs of myocardial failure such as shortness of breath, chest pain, and edema. $er heart begins to increase in si8e (cardiomegaly). If cardiomegaly occurs, she must sharply reduce her physical activity. 9any women need a diuretic, an arrhythmia agent, and digitalis therapy to maintain heart action. Low-molecular-weight heparin may be administered to decrease the risk of thromboembolism. Immunosuppressive therapy may improve the symptoms. Classification of Heart !isease Class !escription I 4ncompromised. 5rdinary physical activity causes no discomfort. No symptoms of cardiac insufficiency and no anginal pain.
II
(lightly compromised. 5rdinary physical activity causes excessive fatigue, palpitation, and dyspnea or anginal pain. aredly compromised. 6uring less than ordinary activity, woman experiences excessive fatigue, palpitations, dyspnea, or anginal pain. (everely compromised. 8oman is unable to carry out any physical activity without experiencing discomfort. "ven at rest symptoms of cardiac insufficiency or anginal pain are present.
III
I7
Assessment Assessment of a woman with cardiac disease begins with thorough health history to document her pre-pregnancy cardiac status.
Nursing !iagnosis * '+aluation Nursing Diagnosis: 6eficient nowledge regarding steps to reduce the effects of maternal cardiovascular disease on the pregnancy and fetus ut!ome Evaluation: lient identifies danger signs and steps to tae when they occur0 maternal blood pressure is maintained above 199:;9 mm +g and fetal heart rate at 1/9 to 1;9 beats per minute. nter+entions
'romote
Artifi!ial "alve Prosthesis -sodium warfarin (oumadin) may increase the risk of congenital anomalies in infants (pregnancy risk category 0), women are usually placed on low-molecularweight heparin therapy before becoming pregnant to reduce this risk. $eparin does not cross the placenta and so does not interfere with fetal development or fetal coagulation (category ). :ubclinical bleeding from the anticoagulant in the mother can cause placental dislodgement. 3bserve a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta during pregnancy and labor. #hroni! H$pertensive "as!ular Disease -!omen with chronic hypertensive disease come into pregnancy with an elevated blood pressure (;<+=+ mm $g or above). $ypertension of this kind is usually associated with arteriosclerosis or renal disease, making it a problem of the older pregnant woman. hronic hypertension places both the woman and fetus at high risk because fetal well-being can be compromised by poor placental perfusion during the pregnancy (:chulenburg, "++6). 9anagement is prescription of beta-blockers and 2> inhibitors to reduce blood pressure by peripheral dilation to a safe level but not reduce it below the threshold that allows for good placenta circulation. 9ethyldopa (2ldomet) is a typical drug that is prescribed. "enous %hrom&oem&oli! Disease -The incidence of venous thromboembolic disease increases during pregnancy because of a combination of stasis of blood in the lower e&tremities from uterine pressure and hypercoagulability (the effect of elevated estrogen o& "+.<). !hen the pressure of the fetal head at birth puts additional pressure on lower e&tremity veins, damage can occur to the walls of the veins. !hen this triad of effects is in place (stasis, vessel damage, and hypercoagulation), the stage is set for thrombus formation in the lower e&tremities. The likelihood of deep vein thrombosis (DVT) leading to pulmonary emboli increases for women ?+ years of age or older because increased age is yet another risk factor for thrombosis formation (:egal et al., "++6).
H',A"&"(C !$"R!'R AN! PR'(NANC) -$ematologic disorders during pregnancy involve either blood formation or coagulation disorders. Anemia and Pregnancy -ecause the blood volume e&pands during pregnancy slightly ahead of the red cell count, most women have a pseudo-anemia of early pregnancy. This condition is normal and should not be confused with true types of anemia that can occur as complications of pregnancy. True anemia is present when a woman@s hemoglobin concentration is less than ;; g=dL (hematocrit _??7) in the first or third trimester of pregnancy or hemoglobin concentration is less than ;+.# g=dL (hematocrit _?"7) in the second trimester (2rnett *reenspoon, "++6). Iron-Defi!ien!$ Anemia -Iron-deficiency anemia is the most common anemia of pregnancy, complicating as many as ;#7 to "#7 of all pregnancies (evei8, *yte, uervo, "++). 9any women enter pregnancy with a deficiency of iron stores resulting from a diet low in iron, heavy menstrual periods, or unwise weight-reducing programs. Iron stores are apt to be low in women who were pregnant less than " years before the current pregnancy or those from low socioeconomic levels who have not had iron-rich diets. !hen the hemoglobin level is below ;" mg=dL (hematocrit _??7), iron deficiency is suspected. It is confirmed by a corresponding low serum iron level and an increased iron-binding capacity. Foli! A!id-Defi!ien!$ Anemia -1olic acid, or folacin, one of the vitamins, is necessary for the normal formation of red blood cells in the mother as well as being associated with preventing neural tube defects in the fetus. 1olic acid'deficiency anemia is seen in ;7 to #7 of pregnancies. It occurs most often in multiple pregnancies because of the increased fetal demand in women with a secondary hemolytic illness in which there is rapid destruction and production of new red blood cells in women who are taking hydantoin, an anticonvulsant agent that interferes
with folate absorption in women who have been taking oral contraceptives and in women who have had a gastric bypass for morbid obesity (2rnett *reenspoon, "++6). Si!'le #ell Anemia -:ickle cell anemia is a recessively inherited hemolytic anemia caused by an abnormal amino acid in the beta chain of hemoglobin. If the abnormal amino acid replaces the amino acid valine, sickle hemoglobin ($b:) results if it is substituted for the amino acid lysine, nonsickling hemoglobin ($b) results. 2n individual who is hetero8ygous (has only one gene in which the abnormal substitution has occurred) has the sickle cell trait ($b2:). If the person is homo8ygous (has two genes in which the substitution has occurred), sickle cell disease ($b::) results. %halassemia -The thalassemias are a group of autosomal recessively inherited blood disorders that lead to poor hemoglobin formation and severe anemia. (alaria -9alaria is a proto8oan infection that is transmitted to people by 2nopheles mosAuitoes (*arner *ulme8oglu, "++). The infection causes red blood cells to stick to the surface of capillaries causing obstruction of these vessels. This can result in end organ ano&ia when blood can not reach organs effectively. It is important to consider during pregnancy as it can be transmitted to a fetus by mother-to-fetus transmission. #oagulation Disorder)von *ille&rand disease+ hemophilia ,+ Idiopathi! throm&o!$topeni! purpura -von !illebrand disease is a coagulation disorder inherited as an autosomal dominant trait. !omen with the disorder have normal platelet counts, but bleeding time is prolonged. Levels of factor BIII'related antigen (BIII-) and factor BIII coagulation activity (BIII-) are both reduced. eplacement of these factors by infusion of cryoprecipitate or fresh-fro8en plasma may be necessary before labor to prevent e&cessive bleeding. -$emophilia (hristmas disease, factor IC deficiency) is a se&-linked disorder, female carriers may have such a reduced level of factor IC (only ??7 of normal) that hemorrhage with labor or a spontaneous miscarriage can be a serious complication. arriers of the disorder need to be identified before pregnancy. estoration of factor IC levels can be done by infusion of factor IC concentrate or fresh-fro8en plasma. -Idiopathic thrombocytopenic purpura (IT%), a decreased number of platelets, can occur at any time in life and so occasionally occurs during pregnancy. The cause of the condition is unknown, but it is assumed to be an autoimmune illness (an antiplatelet antibody that destroys platelets is apparently released). :ymptoms of the illness usually occur shortly after a viral invasion such as an upper respiratory infection (9c9illan, "++6).
R'NA& AN! %RNAR) !$"R!'R AN! PR'(NANC) -2deAuate kidney function is important to a successful pregnancy outcome because a woman is e&creting waste products not only for herself but also for the fetus. This dual function makes any condition that interferes with kidney or urinary function potentially serious. .rinar$ %ra!t Infe!tion -2s many as <7 to ;+7 of nonpregnant women have asymptomatic bacteriuria (organisms are present in the urine without symptoms of infection). In a pregnant woman,
because the ureters dilate from the effect of progesterone, stasis of urine occurs. The minimal glucosuria that occurs with pregnancy allows more than the usual number of organisms to grow. This causes asymptomatic urinary tract infections (DTIs) in as many as ;+7 to ;#7 of pregnant women (Ba8Aue8 Billar, "++). 2symptomatic infections are potentially dangerous because they can progress to pyelonephritis (infection of the pelvis of the kidney) and are associated with preterm labor and premature rupture of membranes. !omen with known vesicoureteral reflu& (backflow of urine into the ureters) tend to develop DTIs or pyelonephritis more often than others. The organism most commonly responsible for DTI is >scherichia coli from an ascending infection. 2 DTI can also occur as a descending infection, or begin in the kidneys from the filtration of organisms present from other body infections. If the infectious organism is determined to be :treptococcus , vaginal cultures should be obtained because streptococcal infection of the genital tract is associated with pneumonia in newborns. #hroni! Renal Disease -In the past, females with chronic renal disease did not reach childbearing age or were advised not to have children because of their high risk status during pregnancy. Today, women with chronic renal disease can have children because pregnancy does not appear to cause progressive deterioration of kidney lesions. !ith conscientious prenatalcare, even women who have had renal transplants can e&pect to have healthy pregnancies and healthy children (1ischer, "++6).
R'$PRA"R) !$"R!'R AN! PR'(NANC) -espiratory diseases range from mild (the common cold) to severe (pneumonia) to chronic (tuberculosis or chronic obstructive pulmonary disease 43%05). 2ny respiratory condition can worsen in pregnancy because the rising uterus compresses the diaphragm, reducing the si8e of the thoracic cavity and available lung space. 2ny respiratory disorder can pose serious ha8ards to the
fetus if allowed to progress to the point where the mother@s o&ygen'carbon dio&ide e&change is altered or the mother or fetus cannot receive enough o&ygen. A!ute Nasophar$ngitis -2cute nasopharyngitis (common cold) tends to be more severe during pregnancy than at other times because during pregnancy, estrogen stimulation normally causes some degree of nasal congestion. Influen/a -Influen8a is caused by a virus, identified as type 2, , or . The disease spreads in epidemic form and is accompanied by high fever, e&treme prostration, aching pains in the back and e&tremities, and generally a sore, raw throat. ontrary to early reports, influen8a infection has not been clearly correlated with congenital anomalies in children although it can be a cause of preterm labor. 1or unknown reasons, some studies have shown a link between influen8a during pregnancy and schi8ophrenia in children born of that pregnancy(Benables et al., "++6). Pneumonia -%neumonia is the bacterial or viral invasion of lung tissue by pathogens such as :. pneumoniae, $aemophilus influen8ae, and 9ycoplasma pneumoniae. Severe A!ute Respirator$ S$ndrome -:evere acute respiratory syndrome (:2:) is a newly emerged infectious disease with the clinical symptoms of persistent fever, chills, muscle aches, malaise, dry cough, headache, and dyspnea. Asthma -2sthma is a disorder marked by reversible airflow obstruction, airway hyperreactivity, and airway inflammation. It complicates about #7 to 7 of pregnancies and is potentially associated with an increased risk of perinatal complications. %u&er!ulosis -Symptoms of tuberculosis: Chronic cough Weight loss Hemoptysis(coughing of blood) Night sweats Low-grade feer Chronic fatigue #hroni! &stru!tive Pulmonar$ Disease -3%0 is constriction of the airway associated most often with long-term cigarette smoking. #$sti! Fi&rosis -ystic fibrosis is a recessively inherited disease in which there is generali8ed dysfunction of the e&ocrine glands (Dppalapati Landry, "++6). This dysfunction leads to mucous secretions, particularly in the pancreas and lungs, becoming so viscid or thick that normal lung and pancreatic function is compromised.
RH'%,AC !$"R!'R AN! PR'(NANC)
-:everal rheumatic disorders occur in young adult women and so are seen during pregnancy. ecause most of these illnesses result in discomfort, potential or actual pain related to disease pathology is the primary nursing diagnosis. Rheumatoid Arthritis - Euvenile rheumatoid arthritis (sometimes referred to as chronic rheumatoid arthritis), a disease of connective tissue with /oint inflammation and contracture, is most likely the result of an autoimmune response (*olding, $aAue, *iles, "++6). $ystemic &upus 'rythematosus - :ystemic lupus erythematosus (:L>) is a multisystem chronic disease of connective tissue that can occur in women of childbearing ageF its highest incidence is in women aged "+ to <+ years (%etri, "++6). It affects about ; in every "+++ to ?+++ pregnancies. (A$R"N'$NA& !$"R!'R AN! PR'(NANC) -2lthough minor gastrointestinal discomforts (such as nausea, heartburn, constipation) are common during pregnancy, acute abdominal pain and protracted vomiting are causes for concern. Appendi!itis -2ppendicitis is inflammation of the appendi&. Its incidence is high in young adults so occurs as freAuently as ; in ;#++ to "+++ pregnancies (%arangi et al., "++6).
0astroesophageal Reflu1 Disease or Hiatal Hernia - *astroesophageal reflu& disease (*>0) refers to the reflu& of acid stomach secretions into the esophagus. $iatal hernia is a condition in which a portion of the stomach e&tends and protrudes up through the diaphragm into the chest cavity, trapping stomach acid and causing it to reflu& into the esophagus. #hole!$stitis and #holelithiasis - holecystitis (gallbladder inflammation) and cholelithiasis (gallstone formation) are most freAuently associated with women older than <+ years, obesity, multiparity, and ingestion of a high-fat diet. :ymptoms (constant aching and pressure in the right epigastrium, perhaps accompanied by /aundice), therefore, are more apt to occur in the older pregnant woman. *allstones are formed from cholesterol. It is debated whether the hypercholesterolemia that naturally occurs during pregnancy leads to an increased
incidence of cholecystitis or cholelithiasis, but both these conditions are seen with pregnancy. Pan!reatitis - %ancreatitis, inflammation of the pancreas, tends to occur in young adults and so is also seen during pregnancy (%arangi et al., "++6). Hepatitis - $epatitis is a liver disease that may occur from invasion of the 2, , , 0, or > virus. $epatitis 2 is spread mainly by fecal'oral contact (children in day-care settings have a high incidence) or by ingestion of fecally contaminated water or shellfish. $epatitis and are spread by e&posure to contaminated blood or blood products. These two types also can be spread by contact with contaminated semen or vaginal secretions and so are considered :TIs. 9aternal=fetal transmission is now one of the most important modes of transmission. $epatitis 0 and > are apparently spread by the same methods. as hepatitis B but are rarely seen in pregnant women.
Inflammator$ ,o*el Disease - rohn@s disease (inflammation of the terminal ileus) and ulcerative colitis (inflammation of the distal colon) occur most often in young adults between ages ;" and ?+ years (childbearing years) and so are seen in pregnancy. The cause of these diseases is unknown, but an autoimmune process is thought to be responsible. They are associated with passive and active smoking (9ahid et al., "++6). N'%R"&"(C !$"R!'R AN! PR'(NANC) - Geurologic illness, as a whole, does not occur at a high incidence in women of childbearing age. $owever, any neurologic disease with symptoms of sei8ures must be carefully managed during pregnancy because the ano&ia that could be caused by severe sei8ures could deprive a fetus of o&ygen. Sei/ure Disorder ($asthenia 0ravis - 9yasthenia gravis is an autoimmune disorder characteri8ed by the presence of an Ig* antibody against acetylcholine receptors in striated muscle. This causes failure of the striated muscles to contract, particularly those of the oropharyngeal, facial, and e&traocular groups (Halidindi et al., "++6). (ultiple S!lerosis - occurs predominantly in women of childbearing age, usually between "+ and <+ years of age, nerve fibers become demyelinated and therefore lose function. ,%$C%&"$.'&'A& !$"R!'R AN! PR'(NANC) - !omen of childbearing age have falls or other accidents that lead to bone fractures or muscle sprains. S!oliosis - :coliosis (lateral curvature of the spine) begins to be noticed first in girls between ;" and ;< years of age. If it is uncorrected at this time, the curvature
progresses until it causes deformity, interfering with respiration and heart action because of chest compression.
'N!"CRN' !$"R!'R AN! PR'(NANC) - >ndocrine disorders have the potential to be serious complications of pregnancy because en8ymes or hormones controlso many specific body functions. %h$roid D$sfun!tion H$poth$roidism - is a rare condition in young adults and especially in pregnancy, because women with symptoms of untreated hypothyroidism are often anovulatory and unable to conceive. 2 woman who does conceive can have difficulty increasing thyroid functioning to a necessary pregnancy level. This can lead to early spontaneous miscarriage. H$perth$roidism)0raves2 disease - overproduction of thyroid hormone, causes symptoms such asF apid heart rate >&ophthalmos (protruding eyeballs) $eat intolerance Gervousness $eart palpitations !eight loss Dia&etes (ellitus - 0iabetes mellitus is an endocrine disorder in which the pancreas cannot produce adeAuate insulin to regulate body glucose levels. The disorder affects ?7 to #7 of all pregnancies and is the most freAuently seen medical condition in pregnancy (:trehlow et al., "++6).
Nursing Diagnosis: 8 1is# for ineffective tissue perfusion related to reduced vascular flo' 8 $mbalanced nutrition, less than body requirements, related to inability to use glucose 8 1is# for ineffective coping related to required change in lifestyle 8 1is# for infection related to impaired healing accompanying condition 8 3eficient fluid volume related to polyuria accompanying disorder
Related Interventions: • • •
• • •
"ducation regarding nutrition during pregnancy "ducation regarding exercise during pregnancy 9herapeutic anagement: o $nsulin o lood glucose monitoring o $nsulin pump therapy(continuous subcutaneous insulin infusion) 9est for placental function and fetal 'ell being 9iming for birth Postpartum ad!ustment
CANC'R AN! PR'(NANC) - ancer occurs in about ; in ;+++ pregnancies (unningham, "++Jb).The malignancies most commonly seen with pregnancy are those that occur most freAuently in women during childbearing yearsF #ervi!al ,reast varian %h$roid Leu'emia (elanoma L$mphomas ancer in a woman does not appear to metastasi8e to the fetus. This is because the placenta serves as a barrier against this spread and also because the fetus may be capable of resisting the invasion of the foreign cells. 9elanoma is the only type of cancer that seems capable of spreading to the fetus (Leachman et al., "++6). ,'NA& &&N'$$ AN! PR'(NANC) -!ental illness may precede or occur with pregnancy. :chi8ophrenia tends to have its highest incidence in adolescents and young adults and so occurs in young pregnant women. 0epression occurs almost four times more commonly in woman and often in young adults. 2 woman with a psychiatric disorder should be cared for by both a psychiatric care team and a prenatal care group to ensure that the stress of pregnancy is not e&acerbating the mental illness, and distorted perceptions or depression do not complicate the pregnancy. 2ny psychotropic medication taken by a pregnant woman should be evaluated for possible fetal harm (Louik et al., "++6).
