Pulmonary hypertension may be primary, of unknown etiology, or secondary to existing cardiorespiratory disease. In general, the prognosis is poor, but the superimposed physiologic changes of pregnancy, labor, and delivery may produce a lethal condition. Pregnancy prevention is better than any proposed care. If pregnancy occurs, termination is suggested in the first or early second trimesters. If the choice is to continue the pregnancy, a well-coordinated intensive management plan is necessary. This plan should include midsecond trimester hospital admission of the patient, continuous hemodynamic monitoring during the intrapartum period and immediately after delivery, and preferably elective induction with hemodynamically stable epidural anesthesia for labor and delivery.
Breastfeeding the premature infant is both possible and desirable. Premature infants derive benefits from breast milk that they can not receive from formula. Nutritional issues look at the components of breast milk as they relate to brain growth and development and disease protection in the acute setting and later in childhood. Recommendations for clinical practice are provided, as are information on expressing and collecting milk, breastfeeding readiness, putting the infant to breast, and discharge planning.
Previously considered a pediatric disorder, cystic fibrosis (CF) is becoming a more common complication of pregnancy as these patients have increasing life expectancies. CF produces profound physiologic alterations in major organ systems. These alterations augment the physiologic changes of pregnancy. Perinatal nurses can meet the complex needs of these patients by increasing their understanding of the disease process, pregnancy-related alterations, and current treatment modalities.
Pulmonary embolism is the leading cause of maternal death in the United States. Amniotic fluid embolism (AFE) represents the least preventable and most lethal of complications. AFE has a reported mortality of 86% and an associated fetal demise of 50%. AFE is widely accepted as a clinical entity but is not completely understood. A combination of clinical presentation, laboratory findings, and exclusion of other abnormalities leads to the diagnosis of AFE. The mainstays of treatment are oxygenation, maintenance of cardiac output, and correction of coagulopathy. The prognosis for the patient experiencing AFE remains bleak because the course of the disorder is largely unpredictable, and AFE cannot be corrected. Only supportive measures can be given.
Women wish to continue to be sexually active long after their desire to bear children. The risks associated with unintended pregnancy easily can be avoided by providing women with information about, and access to, contraceptives that are safe and effective. Because fertility naturally declines with age, different contraceptives may be more suitable for women toward the end of their reproductive years than were appropriate at periods of peak fertility. This article discusses the risks and benefits of various contraceptives for midlife women and the implications of this information on nursing practice.
