Diseases that usually affect a pregnant woman may develop during pregnancy or even before that. The most important task of the nurse is proper education so the couple and their family members are aware of what the pregnant woman might undergo because of the disease. This will also enable them to participate fully in the pregnant woman’s journey towards a safe delivery and a healthy fetus.
Gastrointestinal Diseases in Pregnancy
There are several gastrointestinal discomforts that a pregnant woman experiences, yet there are some symptoms that might indicate a worsening condition.
- Appendicitis is the inflammation of the appendix.
- Symptoms of appendicitis include nausea, abdominal discomfort, vomiting, and a sharp, peristaltic, lower right quadrant pain.
- Appendicitis pain grows more intense, as well as nausea and vomiting.
- The pain might be displaced up in the abdomen in a pregnant woman so that the pain might be mistaken as something from a gallbladder disease.
- The woman might have an elevated temperature and ketones in the urine.
- An ultrasound will reveal an inflamed appendix.
- Advise the woman not to take food, liquid, or laxatives while waiting to be evaluated for possible appendicitis, because increasing peristalsis might rupture the inflamed appendix.
- If the woman is almost past 36 weeks and the fetus is mature, a cesarean birth may be performed and then the inflamed appendix would be removed.
- Appendicitis in early pregnancy can be removed by laparoscopy.
- If the inflamed appendix ruptures, fecal material might escape towards the fallopian tube to the fetus.
- Peritonitis might occur, and the woman’s body would not be able to handle peritonitis and pregnancy at the same time.
Gastroesophageal Reflux Disease
- Gastroesophageal reflux disease is the reflux of acid stomach secretions into the esophagus.
- Symptoms include heartburn, gastric regurgitation, dysphagia, weight loss, and hematemesis in extreme esophageal irritation.
- These conditions are diagnosed through direct endoscopy or ultrasound.
- Antacids may relieve pain and ranitidine can inhibit gastric acid production.
- Advise the woman to wear loose clothing and sleep with her head elevated to help confine stomach secretions.
- After pregnancy, symptoms may become less noticeable or disappear because uterine pressure has decreased.
- Hepatitis is a liver disease that may occur due to the invasion of A, B, C, D, or E virus.
- Hepatitis A is spread through fecal-oral contact or by ingestion of fecally contaminated water or shellfish.
- Pregnant women exposed to hepatitis A may be given prophylactic gamma globulin to prevent the disease.
- Hepatitis B and C are acquired through exposure to contaminated blood or blood products and other body secretions.
- Maternal/fetal transmission is also an important mode of transmission of these types.
- Hepa B vaccine may be administered to those who are at high risk.
- Symptoms of hepatitis include nausea and vomiting, the liver area may feel tender upon palpation, urine color is dark yellow, light-colored stools, and jaundice as a late symptom.
- Hepatomegaly is also noted and the bilirubin level is elevated.
- The woman should be on bed rest and advised to eat a high-calorie diet.
- Cesarean birth can be done to decrease the possibility of transmitting the disease from the mother to the fetus.
- Hepatitis may lead to spontaneous abortion or preterm labor.
- After birth, the infant should be washed well to remove any maternal blood and hepa B immunoglobulin should be administered.
- The mother may still breastfeed the infant but should still be observed carefully for signs of infection during the first few months of life.
Renal Diseases in Pregnancy
A woman’s kidney function is important for both the fetal and maternal well-being because the woman is excreting waste products not only for herself but also for the fetus.
Urinary Tract Infection
- The ureters of a pregnant woman dilate because of the effect of progesterone, resulting to stasis of the urine.
- Escherichia coli are the most common organism responsible for UTI.
- The symptoms of UTI are frequency and pain upon urination.
- The woman may also have nausea and vomiting, malaise, and elevated temperature.
- Infection usually occurs at the right side because there is greater compression and urinary stasis on the right ureter from the uterus being pushed by the bulk of large intestine on the left side.
- Advise the woman to collect a sample of her urine through clean catch method for urine culture and sensitivity.
- Amoxicillin, ampicillin, and cephalosporins are effective and safe for a woman with UTI.
- For prevention of UTI, educate the woman to void frequently at least every 2 hours.
- Instruct her to wipe from front to back after voiding and moving bowels.
- Encourage the woman to wear cotton and not synthetic underwear.
- Advise the woman to void immediately after sexual intercourse.
- Advise the pregnant woman to increase the amount of fluid (about 3 to 4 L per day) she takes every day to flush out the infection from her urinary tract.
Chronic Renal Disease
- Women who already have chronic renal disease may develop severe anemia during pregnancy because their kidneys could not produce erythropoietin, however, synthetic erythropoietin is now available and can be taken by the pregnant woman.
- Many women with kidney disease have an elevated blood pressure.
- Women who take corticosteroids as their maintenance for the disease are instructed to continue taking her medications during pregnancy.
- The infant might be hyperglycemic at birth because of the suppression of insulin activity by the corticosteroid.
- Dialysis might be needed to aid the woman with her kidney functions during pregnancy; however, there is a risk of preterm labor.
- Peritoneal dialysis is preferred over hemodialysis because it causes less fluid shifts.
- Nutrition consultation is advised for the woman especially if she is on a low-potassium diet to avoid build up of potassium because the kidneys could not excrete them.
Practice Quiz: Gastrointestinal and Renal Diseases in Pregnancy
A. Women are fond of eating iron rich foods during pregnancy.
B. Most women do not have the idea on where to get foods rich in iron.
C. Women usually have a low intake of iron-rich foods before pregnancy.
D. Women have a rich intake of folic acid before pregnancy.
2. Folic-acid-deficiency anemia is classified as what type of anemia?
B. Macrocytic, hyperchromic
C. Microcytic, hypochromic
3. How does clumping of the red blood cells affect the pregnant woman’s circulation?
A. When the red blood cells clump, there is widening of the vessel which causes more blood to be delivered to the organs, overwhelming them.
B. Clumping of the red blood cells results in vessel blockage, leading to decreased oxygen delivered to the body organs.
C. Clumping affects the fluid shifts in the circulation.
D. There are no effects on the body organs when clumping occurs.
4. What is the main reason for urinary tract infection among pregnant women?
A. Pregnant women do not drink enough fluids to avoid urinary frequency.
B. They tend to hold their urine for long periods of time.
C. The ureters dilate because of increased progesterone levels, leading to stasis of urine.
D. The urinary bladder cannot hold the amount of urine produced by the pregnant woman.
5. Peritoneal dialysis is preferred over hemodialysis because:
A. Hemodialysis is much expensive than peritoneal dialysis.
B. Peritoneal dialysis is easy to perform than hemodialysis.
C. Hemodialysis is contraindicated in pregnant women.
D. Peritoneal dialysis causes less fluid shifts than hemodialysis.
Answers and Rationale
1. Answer: C. Women usually have a low intake of iron-rich foods before pregnancy.
- C: Most women ingest low amounts of iron-rich foods before they get pregnant.
- A: Iron stores would increase if they ingest iron rich foods.
- B: Iron rich foods are easy to come by, such as green leafy vegetables, meat, legumes, and fruit.
- D: Folic acid is essential for the formation of red blood cells yet it cannot increase the level of iron in a pregnant woman.
2. Answer: A. Megaloblastic
- A: It is classified as megaloblastic anemia because it has enlarged red blood cells and an elevated mean corpuscular volume.
- B: Macrocytic means large and hyperchromic means more hemoglobin than the average red blood cell.
- C: Microcytic, hypochromic anemia refers to iron-deficiency anemia wherein there are small red blood cells which contain less hemoglobin than the average red blood cell.
- D: The red blood cells in folic-acid-deficiency anemia are large, and not hypochromic.
3. Answer: B. Clumping of the red blood cells results in vessel blockage, leading to decreased oxygen delivered to the body organs.
- B: Because of their irregular shape, the red blood cells clump or group together leading to vessel blockage which reduces blood flow to the organs.
- A: The vessel does not widen due to clumping; instead it becomes blocked resulting in decreased blood flow to the organs.
- C: There are no known effects to the fluid shift when the RBCs clump in sickle cell anemia.
- D: Clumping affects the distribution of blood to the body organs because it causes vessel blockage.
4. Answer: C. The ureters dilate because of increased progesterone levels, leading to stasis of urine.
- C: Increased progesterone levels dilate the ureters which cause urinary stasis.
- A: Inadequate fluid intake might contribute to the development of UTI but it is not the main reason for acquiring UTI.
- B: Pregnant women should urinate frequently to avoid urinary stasis.
- D: The urinary bladder of a pregnant woman usually does not reach its maximum urine content because of the pressure of the uterus, leading to urinary frequency.
5. Answer: D. Peritoneal dialysis causes less fluid shifts than hemodialysis.
- D: There are less fluid shifts in peritoneal dialysis than in hemodialysis.
- A: This might be true yet not a reason why peritoneal dialysis is preferred over hemodialysis.
- B: Peritoneal dialysis can be done on an ambulatory basis throughout pregnancy.
- C: Hemodialysis is not contraindicated yet used less often than peritoneal dialysis.