2. Complications during the antepartum
   1. General aspects:
      1. Etiology:
         1. Normal alterations and increasing physiologic stress of pregnancy affect status of coexisting medical disorders.
         2. Conditions affecting mother’s general health also affect ability to adapt successfully to normal physiological stress of pregnancy.
         3. Aberrations of normal pregnancy.
      2. Goal: reduce incidence of health problems affecting maternal/fetal health and pregnancy outcome
         1. Identify presence of risk factors and signs and symptoms of complications early.
         2. Treat emerging complications promptly and effectively.
         3. Minimize effects of complications on pregnancy outcome
      3. Assessment: risk factors:
         1. Age:
            1. Adolescent.
            2. Primigravida, age 35 or older.
            3. Multigravida, age 40 or older.
         2. Socioeconomic level: lower.
         3. Ethnic group
         4. Previous pregnancy history:
            1. Habitual abortion.
            2. Multiparity greater than 5
            3. Previous stillbirths.
            4. Previous cesarean birth
            5. Preterm labor.
         5. Multifetal pregnancy.
         6. Prenatal care:
            1. Enters health care system late in pregnancy.
            2. Irregular/episodic prenatal care visits.
            3. Noncompliance with medical/nursing recommendations.
         7. Preexisting or coexisting medical disorders:
            1. Cardiovascular: hypertension, heart disease
            2. Diabetes.
            3. Other: renal, respiratory, infections, acquired immunodeficiency syndrome (AIDS).
         8. Substance abuse
      4. Nursing care plan/implementation:
         1. Goal: health teaching (discussed under specific health problem).
         2. Goal: early identification/treatment of emerging health problems (if any).
            1. Monitor status and progress of pregnancy.
            2. Refer for medical management, as necessary.
         3. Goal: emotional support.
      5. Evaluation/outcome criteria:
         1. Understands present health status, interactions of coexisting disorder and pregnancy.
         2. Accepts responsibility for own health maintenance
         3. Makes informed decisions regarding pregnancy.
         4. Minimizes potential for complications of coexisting disorder/pregnancy.
            1. Avoids factors predisposing to health problems.
            2. Understands and implements therapeutic management of coexisting disorder/ pregnancy.
            3. Increases compliance with medical/ nursing recommendations.
         5. Carries uneventful pregnancy to successful termination.