LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this continuing education course, you will be able to identify the normal changes, possible complications, and implications for care for the pregnant and postpartum patient. Specific learning objectives to address potential knowledge gaps include:

• Describe the ways in which pregnancy affects patient care.
• Differentiate normal from abnormal lab values in pregnancy.
• Identify signs and symptoms indicating possible pregnancy complications.
• Discuss the medical management and nursing care typically provided in response to the most common complications of pregnancy.
• Summarize relevant patient teaching offered to patients with gestational diabetes.
• Name the complications that can arise when amniotic membranes rupture prematurely.
• Discuss issues related to preterm labor and birth.
• List the most common postpartum complications.

HOW PREGNANCY AFFECTS PATIENT CARE

Nurses encounter pregnant and postpartum patients in a wide variety of settings, such as obstetric offices, emergency departments, urgent care clinics, primary care offices, mental health settings, and more. Thus, it is imperative for nurses to know when a patient’s pregnancy may have implications for procedures, diagnostics, medications, etc. It is also important for nurses to be able to distinguish normal from abnormal changes in pregnancy and to recognize signs and symptoms of pregnancy complications in order to provide appropriate care. With a patient who is pregnant, potential impacts on the health of the fetus must also be taken into consideration.

Pregnancy complications are occurring in increasing numbers, with more than 50,000 women in the United States affected annually by the most severe complications. Approximately 700 women die annually in the United States from pregnancy-related complications. Leading causes of death vary by timing relative to the end of pregnancy, and approximately 3 in 5 pregnancy-related deaths are thought to be preventable. Improving access to care and providing quality prenatal care—including managing chronic conditions and educating patients about warning signs—can help to prevent maternal death (CDC, 2019a).

Research has shown that there are “significant knowledge deficits in the care of patients presenting [to the emergency department] with high-risk conditions associated with pregnancy.” To address this issue, researchers recommend incorporating a specific list of obstetric complaints in the emergency department triage and acuity scale, including hypertension, headache, edema, abdominal pain, visual disturbances, and signs of stroke or pulmonary embolism (Wolf et al., 2021).

The use of medications must be reviewed for pregnancy risk. Information with regard to pregnancy, lactation, and females and males of reproductive potential are included as narratives in drug manuals. Examples of medications with potential adverse fetal effects include androgens, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, certain antiseizure medications, certain antidepressants, some antibiotics, retinoids, and warfarin (Lockwood & Magriples, 2022).

When the use of diagnostic imaging is indicated during pregnancy, its potential risks and the potential risks of not having the imaging must be considered. For instance, ionizing radiation received from X-rays and CT scans increases the risk for miscarriage, congenital anomalies, genetic disease, growth restriction, and developmental disorders. However, MRI and diagnostic ultrasound do not show any adverse maternal or fetal effects. Gadolinium, a contrast agent, should generally be avoided in pregnancy disorders (Kruskal, 2022).

In order to provide adequate care to pregnant and postpartum patients, it is necessary to be informed about high-risk situations in pregnancy. Learning the timing of issues that cause pregnancy-related deaths can help (see table below).

Conditions prior to conception that can complicate a pregnancy include:

• Asthma
• Depression
• Diabetes
• Eating disorders
• Epilepsy and seizure disorders
• High blood pressure
• HIV
• Migraine
• Overweight and obesity
• Sexually transmitted infections
• Thyroid disease
• Uterine fibroids

The most prevalent complications that arise during pregnancy include:

• Anemia
• Depression
• Ectopic pregnancy
• Fetal problems
• Gestational diabetes
• High blood pressure
• Hyperemesis gravidarum
• Infections
• Miscarriage
• Placenta previa
• Placental abruption
• Preeclampsia
• Preterm labor
  (Office on Women’s Health, 2021)

Nurses working with pregnant patients are in a unique position to identify, monitor, and provide care to patients who are affected by complications during pregnancy. It is essential for nurses to be familiar with these complications, as well as the maternal and fetal implications, medical treatment and management, and nursing care necessary to address these problems.