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Republic of The Philippines University of Northern Philippines College of Nursing

This document discusses post-term pregnancy, pseudocyesis, and Rh incompatibility. Post-term pregnancy is defined as extending past 42 weeks and can lead to complications like excessively large or small infants. Rh incompatibility occurs when a mother's blood is Rh-negative and the fetus's blood is Rh-positive, potentially causing hemolytic disease in the fetus or newborn. Management may include monitoring, Rhogam administration, amniocentesis, and delivery planning depending on the condition. Nursing care focuses on close assessment and monitoring of the fetus, education, and preparing for potential birth complications.

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Catherine Prado
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145 views

Republic of The Philippines University of Northern Philippines College of Nursing

This document discusses post-term pregnancy, pseudocyesis, and Rh incompatibility. Post-term pregnancy is defined as extending past 42 weeks and can lead to complications like excessively large or small infants. Rh incompatibility occurs when a mother's blood is Rh-negative and the fetus's blood is Rh-positive, potentially causing hemolytic disease in the fetus or newborn. Management may include monitoring, Rhogam administration, amniocentesis, and delivery planning depending on the condition. Nursing care focuses on close assessment and monitoring of the fetus, education, and preparing for potential birth complications.

Uploaded by

Catherine Prado
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES


College of Nursing

MCN 109: Care of the Mother with Post-term Pregnancy, Pseudocyesis and RH Incompatibility

POST-TERM PREGNANCY
 A prolonged or postdate pregnancy is a pregnancy that extends past 42 weeks’ gestation.
 The incidence of prolonged pregnancy is approximately 10%.
 Cause/s:
o Unknown
o Some studies suggest that it may be caused by estrogen deficiency
 Pathophysiology:
o Pathophysiology includes excessively large infants with resultant birth trauma or small-
for-gestational-age infants who are deprived of hydration and nutrition, because of
placental aging and dysfunction and decreased amniotic fluid.
 Assessment Findings:
o Weight loss and decreased uterine size (especially when the fetus is suffering from
placental dysfunction)
o Excessively large uterus
o Passage of meconium-stained fluid
o Non-reassuring fetal heart rate patterns
 Usually late deceleration due to uteroplacental insufficiency
 Diagnostic:
o UTZ
 Management:
o Close monitoring of fetal-wellbeing
o Complementing LMP calculation with ultrasonographic estimation of the age of
gestation
o Induction of labor
 Manual stimulation of the cervix
 Oxytocin infusion
o C-section
o Intensive neonatal monitoring and care post-delivery
 Nursing Interventions:
o Carefully assess the fetus to identify risk
 Perform careful risk assessment upon admission
 Closely monitor fetal status
o Prevent birth complications
 Assist with induction of labor
 Prepare for difficult delivery
 Notify and prepare pediatric/neonatal staff of a potential birth-related injury
baby
o Provide physical and emotional support
o Provide client and family education
 Nursing diagnosis/es:
o Acute pain (r/t prolonged labor)
o Fatigue
o Impaired physical mobility
o Anxiety
o Risk for infection
 Complications:
o Macrosomia
o Post-maturity syndrome
o Meconium aspiration
o Fetal demise

Rh INCOMPATIBILITY
 Hemolytic disease of the fetus and newborn is an immune reaction of the mother’s blood
against the blood group factor on the fetus RBCs.
 When RhoGAM (Rh immune globulin) became available in the 1960’s to treat isoimmunization
in Rh-negative women, the incidence of hemolytic disease in the fetus and newborn dropped
significantly.
 Causes:
o Hemolytic disease occurs most frequently when the mother does not have the Rh
factor present in her blood but the fetus has this factor. Another common cause of
hemolytic disease is ABO incompatibility. In most cases of ABO incompatibility, the
mother has blood type O and the fetus has blood type A. It may also occur when the
fetus has blood type B or AB.
o Hemolysis is occasionally caused by maternal anemias, such as thalassemia or from
other blood group antigens (anti-D).
 Pathophysiology:
o This disorder occurs when the fetus has a blood group antigen that the mother does
not possess. The mother’s body forms an antibody against that particular blood group
antigen, and hemolysis begins. The process of antibody formation is called maternal
sensitization.
o The fetus has resulting anemia from the hemolysis of blood cells. The fetus
compensates by producing large numbers of immature erythrocytes, a condition
known as erythroblastosis fetalis, hemolytic disease of the newborn, or hydrops fetalis.
Hydrops refers to the edema and fetalis refers to the lethal state of the infant.
o In Rh incompatibility, the hemolysis usually begins in utero. It may not affect the first
pregnancy but all pregnancies that follow will experience this problem. In ABO
incompatibility, the hemolysis does not usually does not usually begin until the birth of
the newborn.
 Assessment Findings:
o Clinical manifestations
 The hemolytic response in ABO incompatibility usually begins at birth with a
resulting newborn jaundice.
 Rh incompatibility may lead to:
 Hydramnios in the mother
 Excess bilirubin levels in the amniotic fluid.
 Varying degrees of hemolytic anemia (erythroblastosis) in the fetus. If the
condition is left unmanaged, 25% of affected infants may die or suffer
permanent brain damage.
Laboratory findings:
 The indirect Coombs test can aid in the search for agglutination of Rh-positive RBCs to
determine if antibodies are present.
 Amniocentesis is used to determine optical density and estimate fetal hemolysis.
Spectrophotometer readings are made of the amniotic fluid collected. The readings are obtained to
determine fluid density. They are plotted on a graph and correlated with gestational age. The
amount of bilirubin resulting from the hemolysis of red blood cells can then be estimated.
 An antibody titer should be drawn at the first prenatal visit on all Rh-negative women. It should
also be drawn at 28 and 36 weeks of pregnancy and again at delivery or abortion. The normal value
is 0. The result is usually reported as a ratio; normal is 1:8. If the titer is absent or minimal (1:8), no
therapy is needed. A rising titer indicates the need for RhoGAM and vigilant monitoring of fetal
well-being.
Management:
 Direct and indirect Coombs test
 UTZ
 Rhogam
 Plasmapheresis
Nursing Management:
Administer RhoGAm to the unsensitized Rh-negative client as appropriate
 Administer RhoGAM at 28 weeks’ gestation, even when titers are negative, or after any invasive
procedure, such as amniocentesis. RhoGAM protects against the effects of early transplacental
hemorrhage (as recommended by the American College of Gynecologists).
 When the Rh-negative mother is in labor, crossmatch for RhoGAM, which must given within 72
hours of delivery of the newborn.
 Provide management for the sensitized Rh-negative mother and Rh-positive fetus.
 Focus management of the sensitized Rh-negative mother on close monitoring of fetal well-
being, as reflected by Rh titers, amniocentesis results, and sonography.
 If there is evidence of erythroblastosis, notify the perineal team of the possibility for delivery of
a compromised newborn.
Provide management for ABO incompatibility.
 Phototherapy usually can resolve the newborn jaundice associated with ABO incompatibility.
 In addition, initiation of early feeding and exchange blood transfusions may be immediate
measures required to reduce indirect bilirubin levels.
 Provide client and family teaching.

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