High-Risk Pregnancy: A Woman with Special Needs

and Home Care of the Pregnant Client

Peter Aristotle C. Dela Cruz
URC Graduate School
Women with Special Needs
The Pregnant Adolescent
The Pregnant Woman Over Age 40
Women who are physically or cognitively
challenged
The Pregnant Adolescent
Factors contributing to the inability to eradicate
teenage pregnancy (DHHS, 2000)

Earlier menarche on girls
Increase in the rate of sexual
activity among teenagers
Lack of knowledge about
contraceptives
Some teenagers become pregnant
as a result of rape

Concerns in Prenatal Assessment
Many adolescents do not seek prenatal
care until late in their pregnancies
The girl may feel awkward in a prenatal
setting
Nutrition
Activity and Rest
Concerns in Health History
Best done without the girl's parents
Always be alert to the possibility of pregnancy when
describes symptoms that are vague and hard to define

Complications of Adolescent
Pregnancy
1. Pregnancy-Induced Hypertension
2. Iron-Deficiency Anemia
3. Preterm Labor
4. Cephalopelvic Disproportion
5. Postpartum Hemorrhage
6. Inability to Adapt Postpartally

Young Adult Fertility and Sexuality Study by the
U.P.P.I. (2002)
26 percent of our Filipino youth nationwide
from ages 15 to 25 admitted to have PMS
38 percent of our youth are already in a live-in
arrangement
3.6 million of our got pregnant.
92 percent of these teens, the pregnancy was
unplanned
78 percent, did not even use contraceptives
the first time they had sex.
The Pregnant Woman Over Age 40
The incidence of women delaying their first pregnancy until
their late 30s or early 40s is increasing (NCHS, 2005)

Concerns in Prenatal Assessment
women of this age group are well informed about the
advisability of early prenatal care
mistakenly believe their lack of menstruation is the result of
early menopause
Concerns in Health History
Explore feelings about being pregnant,
and how it fits their lifestyle
If a woman did not realize she was
pregnant, ask if she take any medications
Chromosomal Assessment
offered a triple-screen (alpha-fetoprotein [AFP], human
chorionic gonadotropin, and unconjugated estriol levels)
If this test is positive, an amniocentesis will be scheduled at
the 16th week of pregnancy.
Complications of Pregnancy for a
Woman Over Age 40
Pregnancy-Induced Hypertension
Labor Dystocia
Difficulty Accepting the Event
Postpartum Hemorrhage
Women who are physically or
cognitively challenged
1. Woman with a spinal cord injury
not be able to feel uterine contractions
may not be able to push effectively for the second stage
2. the hearing-challenged woman
3. visually challenged woman
Home Care of the Pregnant Client
care of pregnant women in their homes, provided by or
supervised by a community health care agency
services such as providing supplies for total parenteral
nutrition, fetal monitoring, or laboratory analysis

Advantages of Home Care
prevents extensive disruption of the family
unit
can increase a woman's self-confidence
a woman can be better assessed in her
own setting

Preparing for a Home Visit
first home visit is made within 24 hours of discharge
obtain a copy of the client's referral form to familiarize
yourself with her treatment course and her plan of care
it is best to telephone a client in advance to arrange a time for
a visit so it will be convenient for her and her family
Home Visit
1. Making the Visit
2. Postvisit Planning
3. Follow-Up Visits

Conclusion
Adolescent pregnancy is a major concern, because although it is decreasing in
incidence, it still occurs at a high rate and can interfere with the development of
both an adolescent and fetus.Helping adolescents view a pregnancy as a growth
experience can help them mature in their ability to parent.
Women who delay childbearing until age 40 may need additional discussion time
at prenatal visits to help them incorporate a pregnancy into their lifestyle. They
may need reminders to save time during the day for rest, particularly if at risk for
pregnancy-induced hypertension or varicosities.
Women who are physically, cognitively, visually, or hearing challenged or who
have a spinal cord injury are apt to have special needs during pregnancy that must
be addressed by health care providers. Providing time for discussion early in
pregnancy so these needs can be identified and anticipated is an important role
for nurses.
Home care can be more cost-effective than hospital care for women with a
pregnancy complication or women considered at high risk for complications. Like
hospital care, can be costly for people without health insurance. However, it has
the advantage of preventing extensive disruption of a family.