Contents
Physiologic Changes of Pregnancy
Hormones and Other Mediators
C ardiovas c ula r S y st em
H ema t o logic Cha n g es
Resp ira t o r y S y st em 53
Renal S y st em 55
Gastr o in t estinal S y st em 57
M et a b o lic Cha n g es 58
Endo cr ine S y st em 59
I m m u ne S y st em 61
Neuromuscular and Sensory Systems 62
I n t egumen t a r y S y st em 62
Rep r o d uc ti v e Or ga n s 63
S umma r y 64
CHAPTER 4
Antenatal Care . . . . . . . . . . . . . . . . . . . .66
E l lis e D . A d a m s
I n tr o d uc tio n 66
P r eco n cep tio n C a r e 66
P r ena t al C a r e 68
Prenatal Risk Assessment 71
Ongoing Prenatal Care 85
F e t a l S ur v eilla n ce 90
Nursing Assessment and Interventions 91
S umma r y 94
CHAPTER 5
H y p er t en si v e Dis o r der s
of Pregnancy . . . . . . . . . . . . . . . . . . . . . .99
A dr i ane Burgess
H yp er t en si v e Dis o r der s 99
C ur r en t Classifi cation and Defi nitions 99
Contributors vi
Reviewers viii
Previous Edition Contributors x
Previous Edition Reviewers xi
Preface xii
CHAPTER 1
Perinatal Patient Safety and Quality . . .1
K a t h leen Rice S im p s o n
I n tr o d uc tio n 1
Maternal–Infant Outcomes in the United States 2
Th reats to Patient Safety 9
E v o l v in g S o l u t io n s 9
S umma r y 15
CHAPTER 2
I n t egra t in g C u l t ural B e liefs
and Practices When Caring for
Childbearing Women and Families . . .18
L y nn Cla r k C allist er
I n tr o d uc tio n 18
C u l t ural F ra m e w o r ks a n d C u l t ural
Assessment Tools 20
Practices Associated with Childbearing 23
G ender Ro les 23
Childbirth Pain and Culture 24
Major Cultural Groups 24
H e a l t h D iff erences in Populations of
Childbearing Women 33
Barriers to Culturally Competent Care 34
T e c hniq ues t o I n t egra t e C u l t ur e in t o
Nursing Care 36
S umma r y 42 xiv Contents
CHAPTER 8
Diabetes in Pregnancy . . . . . . . . . . . . .182
Cher y l K. Ro t h
S ig nifi cance and Incidence 182
D e fi nitions and Classifi cation 184
S c r e enin g a n d Diagnosis o f G est a t io nal
Diabetes Mellitus 185
Clinical M a nif est a tio n s 186
N ur sin g A s s essmen ts a n d I n t er v en tio n s f o r
Diabetes Mellitus 187
Ambulatory and Home Care Management 187
Timing and Mode of Birth 193
I n pa tien t M a nag emen t 193
P ost pa r t um M a nag emen t 196
S umma r y 197
CHAPTER 9
Cardiac Disease in Pregnancy . . . . . .200
J u lie Ara f e h
S ig nifi cance and Incidence 200
Th e Cardiovascular System 201
Cardiac Adaptations of Pregnancy 203
Obstetric Outcomes and Assessment of Risk 205
Congenital Heart Disease in Pregnancy 208
Acquired Cardiac Disease in Pregnancy 209
Clinical M a nag emen t 211
N ur sin g C a r e 218
S umma r y 219
CHAPTER 10
Pulmo n a r y C o m p lica t io n s in
Pregnancy . . . . . . . . . . . . . . . . . . . . . . .221
Cher y l K. Ro t h
I n tr o d uc tio n 221
Anatomic and Physiologic Changes of Pregnancy
that Aff ect the Respiratory System 221
Recognizing Respiratory Compromise 222
F et a l S u r v eilla n ce wi t h M a t er n al Pulmo n a r y
Complications 222
A s t hma 225
P n eumo nia 231
Pulmo n a r y Edema 236
Amniotic Fluid Embolism 238
V e n o u s Th romboembolism 239
C y stic Fib r osis 244
Special Considerations for the Respiratory System
in Pregnancy 245
S umma r y 246
S ig nifi cance and Incidence 101
Morbidity and Mortality 102
Risk F ac t o r s 104
P r e v en tio n S t ra t e gies 104
Pathophysiology of Preeclampsia 105
Clinical M a nif est a tio n s o f
Preeclampsia–Eclampsia 108
P r eec la m psia wi t h o u t S e v er e F e a t ur es v er s us
Preeclampsia with Severe Features 109
N ur sin g A s s essmen t a n d I n t er v en tio n s f o r
Preeclampsia 110
HELLP S y ndr o me 118
Ec la m psia 119
Cardiovascular Implications of Preeclampsia 119
Quality Care of Women with Preeclampsia 120
S umma r y 120
CHAPTER 6
Bleeding in Pregnancy . . . . . . . . . . . . .124
J e a n Salera-V ieira
S ig nifi cance and Incidence 124
D efi nitions and Clinical Manifestations 126
N u r sin g A s s essmen t 133
N ur sin g I n t er v en tio n s 135
Hemorrhagic and Hypovolemic Shock 136
Th rombophilias in Pregnancy 137
M a t er n al T r a uma 138
S umma r y 139
CHAPTER 7
Preterm Labor and Birth . . . . . . . . . . .142
S h er y l E. P a r fi tt
S ig nifi cance and Incidence 142
Late Preterm Births 144
Early Term Births 145
Why Has the Rate of Preterm Birth
Increased? 146
What Is Preterm Labor? 148
Pathophysiology of Preterm Labor and Birth 149
Risk Factors for Preterm Labor and Birth 150
Preterm Birth Risk in the Context of the
Life Course 152
Can Preterm Labor and Birth Be Prevented? 154
I s Th ere Any Good News? 168
Nursing Care for the Prevention of
Preterm Birth 168
Intrapartum Nursing Care of the Woman in
Preterm Labor 173
F ur t her Res e a r c h 174
S umma r y 174 Contents xv
CHAPTER 14
Labor and Birth . . . . . . . . . . . . . . . . . .326
Kathleen Rice Simpson and Nancy O’Brien-Abel
I n tr o d uc tio n 326
Overview of Labor and Birth 326
Emo t io nal a n d Ph ysical S u p p o r t d ur in g
Labor and Birth 363
Clinical Interventions for Women in Labor 367
Dosage and Rate Increase Intervals 380
A dministra tio n 381
V a ginal B ir t h 389
C es a r e a n B ir t h 389
S umma r y 400
CHAPTER 15
Fetal Assessment during Labor . . . . .413
Nancy O’Brien-Abel and Kathleen Rice Simpson
I n tr o d uc tio n 413
H i st o r ical P er s p e c t i v es 413
D e fi nitions and Appropriate Use of Terms
Describing Fetal Heart Rate Patterns 415
Techniques of Fetal Heart Rate Monitoring 418
Physiologic Basis for Fetal Heart Rate
Monitoring 424
Cha rac t e r i stics o f t h e N o r m al F e t a l
Heart Rate 428
I n t er v en tio n s f o r I n det er mina t e o r A b no r m al
Fetal Heart Rate Patterns 430
Fetal Heart Rate Patterns 434
Clinical I m p lica t io n s f o r M o ni t o r in g t h e
Fetus Less Th an 32 Weeks’ Gestation
during Labor 445
Assessment of Pattern Evolution 448
Ancillary Methods for Assessing Fetal Acid–Base
Status 450
N ur sin g A s s e ssmen t a n d M a nag e men t
Strategies 453
Issues in the Use of Fetal Heart Rate Monitoring
during Labor 457
S umma r y 459
CHAPTER 16
P a in in L a b o r : N o n p ha r m aco logic
and Pharmacologic Management. . . .466
C a r o l B urk e
I n tr o d uc tio n 466
Physiologic Basis for Pain 466
N o n p ha r m aco logic A p p r oac h es 470
Pha r maco logic A p p r oac h es 485
S umma r y 499
CHAPTER 11
Multiple Gestation . . . . . . . . . . . . . . . .249
N a nc y A. B o w er s
I n tr o d uc tio n 249
E p idemio log y 249
Physiology of Twinning 249
Role of Infertility and Assisted Reproductive
Technology 251
Diagnosis of Multiple Gestations 254
M a t er n al A d a p t a tio n 255
P e r ina t a l C o m p lica t io n s 256
An t epa r t um M a nag e men t 264
I n tra p a r t um M a nag e men t 268
P ost pa r t um C a r e 273
Multiple Birth Infants 274
P sy c ho logical I ssues wi t h M u l t i p le
Gestations 281
S umma r y 286
CHAPTER 12
Obesity in Pregnancy . . . . . . . . . . . . . .296
M a r y Ann M a her
S ig nifi cance and Incidence 296
Obesity-Related Risks to the Mother and
Fetus 298
P r eco n cep tio n C a r e 300
An t e na t a l C a r e 301
I n tra p a r t um C a r e 302
I n trao p era ti v e C a r e 305
P ost pa r t um C a r e 307
Bariatric Surgery and Pregnancy 308
S umma r y 310
CHAPTER 13
Maternal–Fetal Transport . . . . . . . . . .315
J ud y W i ls o n-G r i ffi n
I n tr o d uc tio n 315
Emer g enc y M e dical T r e a tmen t a n d A c ti v e
Labor Act 315
Types of Inter-Maternal–Fetal Transport 316
Mode of Transport 317
T ra n sp o r t Eq ui p m en t 317
T r a n sp o r t P er s o nnel 318
C o mm unica t io n Pla n 318
Transport Plan and Patient Preparation 318
S umma r y 325 xvi Contents
C a r dio vas c ula r A s s essmen t 593
A b do minal A s s essmen t 595
G eni t o ur ina r y A s s essmen t 597
M u s c ulosk e let al A s s essmen t 599
N eur o logic A s s essmen t 602
S umma r y 604
CHAPTER 20
Newborn Nutrition . . . . . . . . . . . . . . .609
J ill J a nk e
O v er vie w 609
Infant Feeding Decision 609
B e n e fi ts of Breastfeeding 609
Incidence of Breastfeeding 610
B r e a stf eedin g P r o m o t io n 615
Physiology of Milk Production 615
B iosp e cifi city of Human Milk 617
N u tr i t io nal C o m p o n en ts 617
Preterm Milk and Lactation 618
B r e a stf eedin g P r o cess 619
B r e a stf eedin g M a nag emen t 623
Potential Breastfeeding Problems 631
L a t e P r et er m 638
Medications and Breastfeeding 638
Postpartum Surgery and Breastfeeding 639
F o r m ula F eedin g 639
L ac t a t io n S u p p r essio n 642
S umma r y 643
CHAPTER 21
Co m m o n N e o n a t al Co m p l i c a t i o n s . . . 651
Annie J . Ro ha n
I n tr o d uc tio n 651
Neonatal Resuscitation and Stabilization 651
Resp ira t o r y Distr ess 652
Congenital Heart Disease 655
H yp o g l y cemia 658
H yp erb ilir ub inemia 660
N e o n a t al S epsis 665
Perinatal HIV Infection 667
Neonatal Substance Exposure 670
P a t h o p h ysio log y 671
Late Preterm Infants 674
Hypoxic Ischemic Encephalopathy 680
Transport and Return Transport 683
S umma r y 683
APPENDIX
I t em B a nk Questio n s a n d
Answer Key . . . . . . . . . . . . . . . . . . . . . .689
N a nc y O ’ B r ien-A b e l
Index . . . . . . . . . . . . . . . . . . . . . . . . . . .732
CHAPTER 17
Postpartum Care . . . . . . . . . . . . . . . . . .509
Dotti C. James and Patricia D. Suplee
I n tr o d uc tio n 509
Planning for the Transition to Parenthood 509
Anatomic and Physiologic Changes during the
Postpartum Period 515
N ur sin g A s s essmen t a n d C a r e d ur in g
Postpartum 521
Complications during Postpartum 526
I n di vid u alizin g C a r e f o r W o men wi t h
Special Needs 544
Postpartum Learning Needs 547
P sy c ho logical A d a p t a tio n t o t h e
Postpartum Period 550
F a tigue 552
Family Transition to Parenthood 552
Postpartum Discharge Follow-up 554
S umma r y 561
CHAPTER 18
N e w b or n A d a p t a t ion t o
Extrauterine Life . . . . . . . . . . . . . . . . . .564
D e bb ie F ras er
I n tr o d uc tio n 564
M a t er n al M e dical a n d Obst etr ic C o ndi t io n s
Infl uencing Newborn Adaptation 564
U niq ue M e c h a nism s o f N e w b o r n Ph ysio logic
Adaptation 564
A pga r S co r e 572
Ph ysical A s s essmen t 572
N e w b o r n I den tifi cation 574
V i t a min K 574
E y e P r o p h y laxis 574
Umbilical Cord Care 575
P sy c ho logical A d a p t a tio n 575
C o m p lica t io n s Aff ecting Transition 576
H e pa ti tis B 577
S umma r y 577
CHAPTER 19
Newborn Physical Assessment . . . . . .579
Annie J . Ro ha n
I n tr o d uc tio n 579
S t a t e , W eig h t, a n d G e st a t io nal A g e
Assessment 579
S k in A s s essmen t 581
H e ad A s s essmen t 584
E y e A s s e ssmen t 586
E a r A s s e ssmen t 588
N os e A s s essmen t 589
M o u t h A s s essmen t 590
N e c k A s s essmen t 591
Chest and Lung Assessment 592
