Antepartum Adaptations and Pregnancy Complications

Group B Streptococcus (GBS)

GBS is a common bacterial colonization that may or may not cause symptoms in the mother. To prevent transmission to the newborn during birth, pregnant women are screened for GBS between 35–37 weeks of gestation. If the test is positive, intrapartum antibiotics such as Ampicillin, Penicillin, or Clindamycin (if the patient is allergic to penicillin) are administered during labor.

Endocrine Complications: Gestational Diabetes

Gestational diabetes is characterized by glucose intolerance that is first recognized during pregnancy. This is driven by hormonal shifts, specifically the increase in human chorionic somatomammotropin (hPL), which acts as an insulin antagonist.

Screening and Diagnosis

A Glucose Tolerance Test (GTT) is typically performed at 24–28 weeks of gestation. A normal reading for a 1-hour GTT is $< 140\text{ mg/dL}$.

Maternal and Fetal Risks

The metabolic changes of pregnancy can lead to several complications:

• Maternal Risks: These include polyhydramnios (excess amniotic fluid caused by fetal polyuria), pre-eclampsia, ketoacidosis, and dystocia (difficult labor) due to the size of the baby.
• Fetal Risks: High maternal glucose can lead to macrosomia (excessive birth weight), congenital anomalies, intrauterine growth restriction (IUGR), and respiratory distress syndrome (RDS).

Clinical Alert: Newborn Hypoglycemia When the umbilical cord is severed, the continuous maternal glucose supply is abruptly stopped. However, because the fetus has been producing high levels of insulin in response to maternal hyperglycemia, the newborn's insulin levels remain elevated. This results in newborn hypoglycemia, typically occurring 2–4 hours after birth.

Infectious Complications: TORCH Testing

Infectious diseases can pose severe risks to fetal development. Healthcare providers use TORCH testing to screen for a specific group of pathogens that can cross the placenta:

• T: Toxoplasmosis
• O: Other (including Syphilis, HIV, Varicella, and Parvovirus B19)
• R: Rubella (German measles)
• C: Cytomegalovirus (CMV)
• H: Herpes and Hepatitis B

Hypertensive Disorders

Hypertension in pregnancy involves vasospasm and reduced blood flow to vital organs like the brain, liver, and placenta.

1. Gestational Hypertension: Blood pressure $> 140/90$ occurring after 20 weeks of gestation.
2. Preeclampsia: Defined as gestational hypertension plus new-onset proteinuria or other systemic signs (e.g., elevated liver enzymes, thrombocytopenia, or cerebral/visual symptoms).
3. Eclampsia: The onset of grand mal seizures in a woman with preeclampsia.

Nursing Management and Fetal Assessment

Nursing care focuses on prevention, education, and vigilant monitoring of both mother and fetus.

Fetal Monitoring Tools

• Non-Stress Test (NST): An indirect measurement of uteroplacental function. A "reactive" result is indicated by at least two accelerations of $\ge 15\text{ BPM}$ lasting $\ge 15\text{ seconds}$ within a 20-minute period.
• Biophysical Profile (BPP): A comprehensive assessment using ultrasound to score five variables: fetal breathing, gross body movements, fetal tone, reactive heart rate, and amniotic fluid volume.
• Alpha-fetoprotein (AFP): A glycoprotein screened at 16–18 weeks to identify markers for neural tube defects.
• Contraction Stress Test (CST): Used to determine how the fetal heart rate responds to uterine contractions.

Patient Education

Nurses should provide guidance on nutrition (including folic acid and iron), exercise, and the importance of daily fetal movement (kick counts), as decreased movement can be a sign of fetal hypoxia.