2. Complications affecting comfort, rest, mobility
   • Polyhydramnios - amniotic fluid over 2000 mL (normal volume: 500-1200 mL).
     1. Etiology: unknown. Risk factors:
        • Maternal diabetes.
        • Multifetal gestation.
        • Erythroblastosis fetalis.
        • Preeclampsia/eclampsia.
        • Congenital anomalies (e.g., anencephaly, upper-GI anomalies, such as esophageal atresia).
     2. Assessment:
        • Fundal height: excessive for gestational estimate.
        • Fetal parts: difficult to palpate, small in proportion to uterine size.
        • Increased discomfort - due to large, heavy uterus.
        • Increased edema in vulva and legs.
        • Shortness of breath.
        • GI discomfor - heartburn, constipation.
        • Susceptibility to supine hypotensive syndrome - due to compression of inferior vena cava and descending aorta while in supine position.
        • Medical diagnosis - procedures:
          • Sonography - to diagnose multifetal pregnancy, gross fetal anomaly, locate placental site.
          • Amniocentesis - to diagnose anomalies, erythroblastosis.
     3. Potential complications:
        • Maternal respiratory impairment.
        • Premature rupture of membranes (PROM) with prolapsed cord or amnionitis.
        • Preterm labor.
        • Postpartum hemorrhage - due to overdistention and uterine atony.
     4. Analysis/nursing diagnosis:
        • Pain related to excessive size of uterus impinging on diaphragm, stomach, bladder.
        • Impaired physical mobility related to increased lordotic curvature of back, increased weight on legs.
        • Altered tissue perfusion related to decreased venous return from lower extremities, compression of body structures by overdistended uterus.
        • Potential fluid volume deficit related to potential uterine atony in immediate postpartum, secondary to loss of contractility due to overdistention.
        • Sleep pattern disturbance related to respiratory impairment and discomfort in side-lying position.
        • Anxiety related to discomfort, potential for complications, associated with congenital anomalies.
        • Altered urinary elimination (frequency) related to pressure of overdistended uterus on bladder.
     5. Nursing care plan/implementation:
        • Medical management
          1. Amniocentesis - remove excess fluid very slowly, to prevent abruptio placentae.
          2. Termination of pregnancy - if fetal abnormality present and woman desires.
        • Nursing management
          1. Goal: health teaching.
             • Need for lateral Sims' position during resting; semi-Fowler’s may alleviate respiratory embarrassment.
             • Explain diagnostic or treatment procedures.
             • Signs and symptoms to be reported immediately: bleeding, loss of fluid through vagina, cramping.
          2. Goal: prepare for diagnostic and/or treatment procedures.
             • Permit for amniocentesis.
          3. Goal: emotional support for loss of pregnancy (if applicable).
             • Encourage verbalization of feelings.
             • Facilitate grieving: permit parents to see, hold infant; if desired, take photograph, footprints for them.
     6. Evaluation/outcome criteria:
        • Woman complies with medical/nursing management.
        • Woman’s symptoms of respiratory impairment, etc., reduced; comfort promoted.
        • Woman experiences normal, uncomplicated pregnancy, labor, birth, and postpartum.