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SMOKING IN PREGNANCY
Cigarette smoke contains more than 4,000 chemicals, including Nicotine, Carbon
monoxide, Cyanide, Lead, and at least 60 Carcinogenic (cancer-causing ) compounds.
All these chemicals mix with mothers bloodstream and passed to babies to cause
complications like -
20 to 30 percent of low-birth weight babies
up to 14 percent of preterm deliveries and
about 10 percent of all infant deaths
Maternal smoking has also been linked to asthma among infants and young children.
Mother's age
Teen mothers (especially those younger than 15) have a much higher risk of having a
baby with low birthweight.
Multiple birth
Multiple birth babies are at increased risk of low birthweight because they often are
premature.
Mother's health
Babies of mothers who are exposed to illicit drugs, alcohol and cigarettes are more likely
to have low birthweight. Mothers of lower socioeconomic status are also more likely to
have poorer pregnancy nutrition, inadequate prenatal care, and pregnancy
complications.
Color changes
A bluish color around your childs mouth, on the inside of her lips or on her fingernails
may occur when she is not getting enough oxygen. Her skin may also appear pale or
gray.
Grunting
You may hear a grunting sound each time your child exhales. The grunting is her body's
way of trying to keep air in the lungs so they will stay open.
Noseflaring
If your childs nostrils spread open while she breathes, she may be having to work
harder to breathe.
Retractions
our childs chest will appear to sink in just below the neck or under his breastbone with
each breath. This is another way of trying to bring more air into her lungs.
Sweating
There may be an increase of sweat on your childs head, but without his skin feeling
warm to the touch. More often, his skin will feel cool or clammy. This may happen when
his breathing rate is very fast.
Wheezing
If you hear a tight, whistling or musical sound each time your child breathes, this may
indicate that the air passages are smaller, which makes it harder to breathe.
STILLBIRTH
If the baby dies before 24 completed weeks, it's known as a miscarriage or late foetal
loss.
Cause of Stillbirth:
Stillbirths are linked to placental complications. This means that for some reason the
placenta (the organ that links the baby's blood supply to the mother's and nourishes the
baby in the womb) isn't functioning properly.
RESPIRATORY PROBLEMS
Shortness of breath.
Grunting, which is heard during the breathing out (exhaling) phase of breathing.
Wheezing.
Flaring the nostrils and using the neck, chest, and abdominal muscles to breathe,
causing a "sucking in" between or under the ribs (retractions).
Chest pain with exertion or when you take a deep breath
PLACENTAL ABRUPTION
A placental abruption is a serious condition in which the placenta partially or completely
separates from your uterus before your baby's born.
The condition can deprive your baby of oxygen and nutrients, and cause severe
bleeding that can be dangerous to you both.
A placental abruption also increases the risk that your baby will have growth problems (if
the abruption is small and goes unnoticed), be born prematurely, or be stillborn.
Management:
Monitoring of the patient's haemodynamic status by monitoring BP, pulse, volume intake,
and urine output.
Continuous fetal monitoring.
Anti-D immunoglobulin in Rh-negative women.
Fluid, blood, or blood-product replacement, as indicated.
Sonographic examination for placental location and for evidence of abruption. Placenta
praevia found on sonography makes placental abruption unlikely.
PLACENTA PREVIA
Placenta is lying unusually low in your uterus, next to or covering your cervix.
The placenta is the pancake-shaped organ normally located near the top of the uterus
that supplies your baby with nutrients through the umbilical cord.
Management:
Treatment of placenta previa depends upon the extent and severity of bleeding, the
gestational age and condition of the fetus, the position of the placenta and fetus, and
whether the bleeding has stopped.
Cesarean delivery (C-section) is required for complete placenta previa and may be
necessary for other types of placenta previa.
Women who are actively bleeding or who have bleeding that cannot be stopped will be
admitted to the hospital for further care. I
Women with placenta previa who experience heavy bleeding may require blood
transfusions and intravenous fluids
Management
Based on the Gestational Age
AFTER 37 WEEKS
If your pregnancy is past 37 weeks, your baby is ready to be born. You will need to go
into labor soon. The longer it takes for labor to start, the greater your chance of getting
an infection.
ECTOPIC PREGNANCY
the fertilized egg stays in your fallopian tube. In that case, it's called an ectopic
pregnancy or a tubal pregnancy. In rare cases, the fertilized egg attaches to one of your
ovaries, another organ in your abdomen, the cornua (or horn) of the uterus or even the
cervix.
In any case, instead of celebrating your pregnancy, you find your life is in danger.
Ectopic pregnancies require emergency treatment.
NURSING RESPONSIBILITIES
Render Health teaching
Give some tips to stop smoking
Hide the matches, lighters, and ashtrays.
Designate the home a non-smoking area.
Ask people who smoke not to smoke around you.
Drink fewer caffeinated beverages; caffeine may stimulate the urge to smoke.
Avoid alcohol, as it may also increase the urge to smoke.
Change the habits connected with smoking. If you smoked while driving or
when feeling stressed, try other activities to replace smoking.
Keep mints or gum (preferably sugarless) on hand for those times when you
get the urge to smoke.
Stay active to keep the mind off smoking and help relieve tension.
Take a walk, exercise, read a book, or try a new a hobby.
Look for support from others. Join a support group or
smoking cessation program.
Do not go places where many people are smoking such as
bars or clubs, and smoking sections of restaurants.
REFERENCES
http://bestpractice.bmj.com/best-practice/monograph/1117/treatment/step-by-step.html
Breathing Problems: Causes, Tests, and Treatments
www.webmd.com
http://www.webmd.com/lung/breathing-problems-causes-tests-treatments#1
www.webmd.com
CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e
Alan H. DeCherney, Lauren Nathan, Neri Laufer, Ashley S. Roman
CURRENT Diagnosis & Treatment: Pediatrics, 21e
William W. Hay, Jr., Myron J. Levin, Robin R. Deterding, Mark J. Abzug, Judith M. Sondheimer
Behavioral Medicine: A Guide for Clinical Practice, 3e
Mitchell D. Feldman, John F. Christensen
Harrison's Online
Featuring the complete contents of Harrison's Principles of Internal Medicine, 18e
Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, J. Larry Jameson,
Joseph Loscalzo, Eds.
https://www.ncbi.nlm.nih.gov/pubmed/1353943
Anatomy and Physiology
Fetal Circulation
Prior to birth the fetus is not capable of respiratory function and thus relies on the maternal
circulation to carry out gas, nutrient and waste exchange. The foetal and maternal blood never mix,
instead they interface at the placenta. Consequently the liver and the lungs are non-functional, and a
series of shunts exist in the foetal circulation so that these organs are almost completely by-passed.
Umbilical Cord
2 Umbilical Arteries: return oxygenated blood, fecal waste, CO2 to placenta
1 Umbilical Vein: brings oxygenated blood and nutrients to the fetus
Special Structure in Fetal Circulation
Placenta: where gas exchange takes place during fetal life
Umbilical Arteries: deoxygenated blood coming from the fetus to the placenta
Umbilical Vein: brings oxygenated blood coming from the placenta to the fetus
Foramen Ovale: connects the left and right atrium. It pushes blood from right atrium to the
left atrium
Ductus Venosus: carry oxygenated blood from umbilical vein to inferior vena cava, bypassing
the fetal liver
Ductus Arteriosus: carry oxygenated blood from pulmonary artery to aorta, bypassing fetal
lungs