MOTHER

SUBSTANCE ABUSE

I. Definition

Substance abuse refers to the harmful or hazardous use of psychoactive substances,

including alcohol and illicit drugs. (WHO, 2016)

Psychoactive substance use can lead to dependence syndrome - a cluster of

behavioral, cognitive, and physiological phenomena that develop after repeated substance
use and that typically include a strong desire to take the drug, difficulties in controlling its use,
persisting in its use despite harmful consequences, a higher priority given to drug use than to
other activities and obligations, increased tolerance, and sometimes a physical withdrawal
state. (WHO, 2016)

II. Incidence

The number of women who use illicit substances during pregnancy is unknown, but as
many as 375,000 infants may be affected yearly. As many as 10% to 20% of pregnant women
admit using illicit substances during pregnancy such as marijuana, cocaine, alcohol and
methamphetamine. (Silbert-Flagg J. and Pillitteri A., 2018)

Wilson, J. and Thorp, J. (2008) stated that the highest rates of alcohol and drug use
are among women in their childbearing years, with 6 million women experiencing alcohol
problems, and more than 5 million currently using illicit substances. Greater than 50% of
women aged 18 to 35 years responding to the National Institute on Drug Abuse Household
Survey reported that they had used alcohol in the past month, and 5% reporting illicit drug
use in the same interval, with marijuana the most frequently used substance. They also stated
that 4 million women who become pregnant each year, at least 20% smoke cigarettes, 19%
drink alcohol, 20% use legal drugs, and 10% use illicit drugs during their pregnancy.
III. Risk Factors

The use of illicit substances may affect the respiratory, such as bacterial infections,
cardiovascular, including hypertension and endocarditis, neurologic, with seizures,
cerebrovascular accidents, and psychoses, infectious, such as sexually transmitted diseases
and human immunodeficiency virus, renal and gastrointestinal, including acute tubular
necrosis and hepatitis, and/or metabolic, such as malnutrition and vitamin deficiencies.
(Wilson, J. and Thorp, J., 2008)

III. Risk Factors

According to Silbert-Flagg According to Forray, A. IV. Manifestations
J. and Pillitteri A. (2018), (2016)
Cocaine exceptionally harmful premature rupture of Hyperactivity,
during pregnancy because membranes, placental euphoria, irritability,
the extreme abruption, preterm anxiety, excessive
vasoconstriction can birth, low birthweight, talking followed by
severely compromise and small for depression or
placenta circulation, gestational age infants excessive sleeping at
leading to premature odd times, go long
separation of the placenta periods of time
circulation, which then without eating or
results in preterm labor or sleeping, dilated
fetal death. pupils, weight loss,
dry mouth and nose.
(American Council
for Drug Education,
2020)

Marijuana it is associated with loss of Glassy, red eyes,

short-term memory, an loud talking and
increase incidence of inappropriate
 respiratory infection in laughter followed by
adults, and a possible side sleepiness, a sweet
effects during burnt scent, loss of
breastfeeding. interest, motivation,
weight gain or loss.
(American Council
for Drug Education,
2020)
Alcohol it causes fetal alcohol Risks of miscarriage, Clumsiness,
spectrum syndrome, a stillbirth and infant difficulty walking,
syndrome with mortality, congenital slurred speech,
recognizable facial anomalies, low sleepiness, poor
features, possible birthweight, reduced judgment, dilated
cognitive challenges and gestational age, pupils. (American
memory deficits preterm delivery, and Council for Drug
small-for-gestational Education, 2020)
age
Phencyclidine it causes irritation, Numbness,
possibly long-term dizziness, nausea,
hallucination, and its vomiting. high
substance tends to leave blood pressure, fast
the maternal circulation breathing, high
and concentrate in fetal body temperature.
cells (Elkins, 2018)

Smoking  chest pain,

including damage to
the umbilical cord
 shortness of breath,
structure, miscarriage,
 persistent cough.
increased risk for
 coughing up blood,
ectopic pregnancy,
 low  frequent colds and
birthweight,
placental abruption, upper respiratory
preterm birth, and infections,
increased infant
 persistent
mortality hoarseness.
(American Council
for Drug Education,
2020)

V. Management
FETAL DISTRESS

I. Definition

According to Shiel, W. (2018), fetal distress is commonly used to describe

fetal hypoxia (low oxygen levels in the fetus), which can result in fetal damage or death if it is
not reversed or if the fetus is not promptly delivered. This may include changes in the baby’s
heart rate, decreased fetal movement, and meconium in the amniotic fluid, among other
signs.

II. Incidence
III. Risk Factors

According to Murkoff, H. (2018) According to Brown, L. (2018)

Intrauterine growth restriction Mother is 35 or older
Hydramnios or oligohydramnios Mother does not have the right amount of
amniotic fluid
Preeclampsia or eclampsia Mother has preeclampsia
Gestational diabetes Mother has gestational diabetes
Multiple pregnancy Mother is carrying more than one child
(multiple birth)
Mother suffers from a chronic illness

IV. Manifestation

According to Reiter, J. (2018), the signs of fetal distress are;

1. Decreased fetal movement in the womb

- Fetal movement within the womb is an important indicator of the baby’s
health
2. Abnormal fetal heart rate
- An abnormally fast heart rate (tachycardia), an abnormally slow heart rate
(bradycardia), abrupt decreases in heart rate (variable decelerations), late
returns to the baseline heart rate after a contraction (late decelerations)
 these fetal heart rate patterns are examples of non-reassuring patterns
and warrant further investigation and medical intervention
3. Abnormal amniotic fluid level
- If there is abnormally low amniotic fluid, this is a condition
called oligohydramnios, which can lead to oxygen deprivation and birth
injuries like HIE and cerebral palsy (CP). A trending decrease in amniotic
fluid may also warn of oligohydramnios and should be watched closely. If
there is an abnormally high amniotic fluid volume, this is known
as polyhydramnios. Polyhydramnios can also cause oxygen deprivation and
subsequent birth injuries.
4. Abnormal results of biophysical profile (BPP)
- Baby’s biophysical profile (BPP) is also often taken if the results of a non-
stress test or NST are non-reassuring. In addition to considering NST
results, the BPP includes an ultrasound to assess fetal movement,
breathing, tone, and amniotic fluid volume.
5. Vaginal bleeding
- Bleeding can be an indication of placental abruption, which occurs when
the placenta tears away from the womb that causes the baby to be
deprived of oxygen. Placental abruption and other placental problems that
cause bleeding require very close monitoring, and in many cases, the
mother should be admitted to the hospital and given an emergency C-
section
6. Cramping
- Some cramping is relatively normal during pregnancy. However, in some
cases cramping is an indication of something more serious, such as
miscarriage, placental abruption, preeclampsia, a urinary tract infection,
or preterm labor.
7. Insufficient or excessive maternal weight gain
- If a mother gains much less than what is typical, the fetus may be in distress
and have a condition called intrauterine growth restriction (IUGR).
Excessive maternal weight gain is associated with giving birth to a baby that
is abnormally large, which is a condition known as macrosomia.
 Macrosomia can create a risky birth situation, such as cephalopelvic
disproportion (CPD), wherein the mother’s pelvis is too small to
accommodate the size of the baby’s head, or shoulder dystocia, which is
when the baby’s shoulder gets stuck on the mother’s pelvic bone during
delivery.

V. Managements

Medical Managements (Payne J., 2016)

Signs of antenatal fetal distress require monitoring with a view to induction of labor or planned
caesarean section.
Immediate delivery of a preterm fetus with suspected fetal distress may reduce the risk of
intrauterine hypoxia but increases the risks associated with prematurity.
Amnioinfusion has been shown to be beneficial in suspected umbilical cord compression
(particularly when there is oligohydramnios), with a reduced risk of caesarean section.
Amnioinfusion has been used to reduce the risk of meconium aspiration by diluting the
meconium present
Pharmacological (American Pregnancy Association, 2014)
Amnioinfusion (the insertion of fluid into the amniotic cavity to alleviate compression of the
umbilical cord)
Tocolysis (a therapy used to delay preterm labor by temporarily stopping contractions)
Intravenous hypertonic dextrose
Nursing Responsibilities (Turner E., 2016)
Check for FHT
Changing the mother’s position
Oxygen by mask or NC, DC
Prepare for emergency or urgent delivery
SEXUAL DYSFUNCTION AND INFERTILITY

I. Definition

Infertility means not being able to get pregnant after one year of trying (or six months
if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may
also be infertile. Female infertility can result from age, physical problems, hormone problems,
and lifestyle or environmental factors. (Eisenberg, Brumbaugh, Brown-Bryant, & Warner,
2019)

Sexual dysfunction, also called Psychosexual Dysfunction, the inability of a person to

experience sexual arousal or to achieve sexual satisfaction under appropriate circumstances,
as a result of either physical disorder or, more commonly, psychological problems. The most
common forms of sexual dysfunction have traditionally been classified as impotence (inability
of a man to achieve or maintain penile erection) and frigidity (inability of a woman to achieve
arousal or orgasm during sexual intercourse). (Bhutia, 2018)

II. Incidence

III. Risk Factors

Sexual Dysfunction (McCabe, Sharlip, & Infertility (Burd & Freeborn, 2018)
Lewis, 2016)
Diabetes Age. Women in their late 30s and older are
generally less fertile than women in their
early 20s.
Heart Disease Endometriosis
Urinary Tract Disorder Chronic diseases such as diabetes, lupus,
arthritis, hypertension, and asthma
Chronic Illnesses Hormone imbalance
Depression Environmental factors. These include
cigarette smoking, drinking alcohol, and
exposure to workplace hazards or toxins.
Anxiety Too much body fat or very low body fat
 Substance Abused Abnormal Pap smears that have been
treated with cryosurgery or cone biopsy
Multiple miscarriages
Sexually transmitted diseases
Fallopian tube disease

IV. Manifestation

Sexual Dysfunction Infertility (Todd, 2019)

(Cleveland Clinic , 2015)
Inability to achieve orgasm Abnormal periods, Irregular periods, No
periods, Painful periods
Inadequate vaginal lubrication before and Skin changes, including more acne
during intercourse
Inability to relax the vaginal muscles enough Changes in sex drive and desire
to allow intercourse
Lack of interest in or desire for sex Dark hair growth on the lips, chest, and chin
Inability to become aroused Loss of hair or thinning hair
Pain with intercourse Weight gain
Milky white discharge from nipples unrelated
to breastfeeding
Pain during sex

V. Management

Medical Managements (Infertility)

Treatment options are usually dependent on the underlying etiology of infertility. For
female causes, options include surgical management of tubal occlusion, surgical treatment of
endometriosis, ovarian "drilling" for treatment of PCOS, use of ovulation-induction agents
including oral (clomiphene citrate or letrozole) and injected drugs (gonadotropins), artificial
insemination with either partner or donor sperm (depending on partner fertility status), and
ART, which includes both IVF and intra-cytoplasmic sperm injection (ICSI). (AHRQ, 2016)

Pharmacology (Infertility)

According to Mayo Clinic (2019), fertility drugs generally work like the natural
hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger
ovulation. They're also used in women who ovulate to try to stimulate a better egg or an extra
egg or eggs. Fertility drugs may include:

 Clomiphene citrate. Clomiphene citrate is taken by mouth and stimulates

ovulation by causing the pituitary gland to release more FSH and LH, which
stimulate the growth of an ovarian follicle containing an egg.
 Gonadotropins. Instead of stimulating the pituitary gland to release more
hormones, these injected treatments stimulate the ovary directly to produce
multiple eggs.
 Metformin. Metformin is used when insulin resistance is a known or suspected
cause of infertility, usually in women with a diagnosis of PCOS.
 Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase
inhibitors and works in a similar fashion to clomiphene.
 Bromocriptine. Bromocriptine (Cycloset), a dopamine agonist, may be used
when ovulation problems are caused by excess production of prolactin
(hyperprolactinemia) by the pituitary gland.

Nursing Responsibilities (Infertility)

Registered Nurse.org (2019) stated that a fertility nurse may handle day-to-day tasks
like the following;

1. Assist female patients going through menopause

2. Counsel patients and their loved ones on fertility
3. Help patients understand procedures and medical terminology
4. Offer patients non-judgmental emotional support
5. Administer In-Vitro Fertilization (IVF) treatments
6. Teach patients how to administer IVF treatments
 7. Counseling couples and donors throughout the entire process

Medical Managements and Pharmacology (Sexual Dysfunction)

According to Mayo Clinic (2018), effective treatment for sexual dysfunction often
requires addressing an underlying medical condition or hormonal change. Treating female
sexual dysfunction linked to a hormonal cause might include:

 Estrogen therapy (e.g. Estrogens (Premarin), estradiol (Estrace), and

Estratab). Localized estrogen therapy comes in the form of a vaginal ring, cream or
tablet. This therapy benefits sexual function by improving vaginal tone and elasticity,
increasing vaginal blood flow and enhancing lubrication.

The risks of hormone therapy may vary depending on your age, your risk of other
health issues such as heart and blood vessel disease and cancer, the dose and type of
hormone and whether estrogen is given alone or with a progestin.

Talk with your doctor about benefits and risks. In some cases, hormonal therapy might
require close monitoring by your doctor.

 Ospemifene (Osphena). This medication is a selective estrogen receptor modulator. It

helps reduce pain during sex for women with vulvovaginal atrophy.

 Flibanserin (Addyi). Originally developed as an antidepressant, flibanserin is approved

by the Food and Drug Administration as a treatment for low sexual desire in
premenopausal women.

A daily pill, Addyi may boost sex drive in women who experience low sexual desire and
find it distressing. Potentially serious side effects include low blood pressure,
sleepiness, nausea, fatigue, dizziness and fainting, particularly if the drug is mixed with
alcohol. Experts recommend that you stop taking the drug if you don't notice an
improvement in your sex drive after eight weeks.

Nursing Responsibilities (Sexual Dysfunction) (Benjamin, 2019)

1. Assess client's sexual history and previous level of satisfaction in sexual relationship.
2. Assess client's perception of the problem.
3. Assess client's level of energy.
4. Review medication regimen and observe for side effects
5. Provide information regarding sexuality and sexual functioning.
6. Refer for additional counseling or sex therapy if required.
References
American Council for Drug Education. (2020). Signs and Symptoms of Substance Abuse. Retrieved
from Phoenix House: https://www.phoenixhouse.org/prevention/signs-and-symptoms-of-
substance-abuse/

American Pregnancy Association. (2014). Fetal Distress. Retrieved from American Pregnancy
Association: https://americanpregnancy.org/labor-and-birth/fetal-distress/

Bhutia, T. (2018, May 13). Sexual dysfunction. Retrieved from ENCYCLOPÆDIA BRITANNICA:
https://www.britannica.com/science/sexual-dysfunction

Brown, L. (2018). Fetal Intolerance to Labor. Retrieved from Birth Injury Safety:
https://www.birthinjurysafety.org/birth-injuries/causes-of-birth-injuries/labor-
intolerance.html

Eisenberg, E., Brumbaugh, K., Brown-Bryant, R., & Warner, L. (2019, April 01). Infertility. Retrieved
from OWH: https://www.womenshealth.gov/a-z-topics/infertility

Elkins, C. (2018, May 11). PCP Addiction. Retrieved from DrugRehub:

https://www.drugrehab.com/addiction/drugs/pcp/

Forray, A. (2016, May 13). Substance use during pregnancy. Retrieved from NCBI:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870985/

Murkoff, H. (2018, September 23). Fetal Distress During Pregnancy & Labor. Retrieved from What To
Expect: https://www.whattoexpect.com/pregnancy/pregnancy-health/complications/fetal-
distress.aspx

Payne, J. (2016 , September 28). Fetal Distress. Retrieved from Patient:

https://patient.info/doctor/fetal-distress#nav-3

Reiter, J. (2018). What Signs Indicate My Baby Is In Distress? How Is Fetal Distress Treated? Retrieved
from ABC Law Center: https://www.abclawcenters.com/frequently-asked-questions/what-
are-some-signs-that-my-baby-is-in-distress/

Shiel, W. C. (2018, December 12). Medical Definition of Fetal distress. Retrieved from MedicineNet:
https://www.medicinenet.com/early_pregnancy_symptoms_pictures_slideshow/article.htm

Silbert-Flagg J. and Pillitteri A. (2018). Maternal & Child Health Nursing. Chicago: Wolters Kluwe.

Turner, E. (2016). Maternal child health nursing. Retrieved from SlidePlayer:

https://slideplayer.com/slide/6031986/
WHO. (2016). Substance abuse. Retrieved from World Health Organization:
https://www.who.int/topics/substance_abuse/en/

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