Nursing Management of Pregnancy at Risk

Nursing Management of Pregnancy at Risk

Nursing management of labor and birth at risk

1. Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared. (Learning Objectives 1, 2, 4, and 5)

a. Why is Teresa’s pregnancy considered a high-risk pregnancy?

b. Discuss potential pregnancy-related complications for Teresa.

c. Discuss the potential risks to the babies.




Nursing Management of Pregnancy at Risk




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Nursing Management of Pregnancy at Risk

Nursing management of labor and birth at risk

“To be pregnant is to be vitally alive, thoroughly woman, and distressingly inhabited.” (Anne Christian Buchanan). Pregnancy is an actual occurrence in a woman’s life requiring careful consideration and management, to ensure a healthy outcome for the mother and the baby. Various risk factors are increasing the likelihood of complications during pregnancy. The risk factors range from pre-existing medical conditions, including diabetes or hypertension, and lifestyle factors, like smoking or substance abuse (Ramlakhan et al., 2020). The healthcare team, such as the nurses, is responsible for identifying the risk factors early and managing them appropriately to improve outcomes. Nursing management of the risks during pregnancy involves a multidisciplinary approach, including careful monitoring, education, and intervention to prevent potential complications. This essay will explore a case study on Teresa, a 36-year-old primigravida who is expecting twins and is 26 weeks pregnant. From the case study, the pay will explain why Teresa’s pregnancy is considered a high-risk pregnancy, the potential complications during pregnancy related to Teresa, and the potential risks to the babies.

Reasons Why Teresa’s Pregnancy is Considered a High-Risk Pregnancy

Numerous factors make Teresa’s pregnancy to be considered a high-risk pregnancy. The case study states that Teresa is a primigravida, meaning she is pregnant for the first time, increasing her risks of complications during pregnancy and childbirth. The case study also explains that Teresa carries twins in a multiple gestation pregnancy, increasing the risk of preterm birth, gestational diabetes, and high blood pressure, among other complications (Hiersch et al., 2019). It is indicated that Teresa has been struggling to get pregnant, resulting in her conceiving through in vitro fertilization, an assisted reproductive technology involving multiplex and encroaching process compared to natural conception. In vitro fertilization, pregnancies have high risks of ectopic pregnancy, miscarriage, preterm labor, and congenital disabilities. Such factors make Teresa’s pregnancy a high-risk pregnancy. She needs close monitoring and care that is more specialized, ensuring a safe delivery for her and the twins.

Potential Pregnancy-Related Complications for Teresa

Teresa, a primigravida pregnant with twins, is at risk of encountering numerous pregnancy-related complications. Teresa may encounter preterm labor, which is a worry as it may lead to premature birth increasing the risk of breathing difficulties and infections, among other complications to the babies (Jiang et al., 2018). She can also experience gestational diabetes, which occurs due to the increased demands of twin pregnancies, and it can eventually cause high blood sugar levels for Teresa, affecting fetal growth. Teresa can also encounter preeclampsia, a severe complication during pregnancy indicated by high blood pressure, and some organs like the kidneys and the liver can be damaged. Another complication that Teresa may encounter during her pregnancy is placenta previa which occurs when the placenta covers the cervix, making her bleed, hence demanding a cesarean delivery (Anderson-Bagga & Sze, 2019). A last complication she can experience is fetal growth restriction, which happens when one or both babies are not growing as expected. Such complications indicate the importance of close patient monitoring and timely detection of problems during her pregnancy.

Potential Risks to Teresa’s Babies

Teresa is a primigravida who is expecting twins, which she conceived through in vitro fertilization putting her and her babies to be at high risk of complications during her pregnancy. The possible risks the babies will likely encounter include congenital disabilities, growth restriction, low birth weight, and preterm birth. Teresa is pregnant with twins, where twins are usually at risk of encountering complications like twin-to-twin transfusion syndrome, where one of the babies receives more blood than the other, leading to poor development of the babies, among other compilations (Bamberg & Hecher, 2019). Teresa being pregnant with twins increases the risk of preeclampsia, gestational diabetes, and premature fissure of membranes. Healthcare providers should provide Teresa with a cross-monitoring practice to detect any potential problems in time, ensuring the best possible outcome for her babies.


Nursing management for pregnancy at risk needs an extensive apprehension of possible complications for both mothers and their babies. Teresa’s case study indicates challenges faced by pregnant mothers who are expecting twins and conceived through in vitro fertilization, which puts their pregnancies at risk. Some potential pregnancy-related complications for Teresa are gestational diabetes, preeclampsia, and preterm labor. Teresa’s twins are also at risk of encountering some complications, which may include premature birth, and developmental delays, among other complications. Nurses are responsible for providing Teresa with education, support, and close monitoring, ensuring that they achieve the best outcomes for Teresa and her babies, and joint working, Teresa and the healthcare team can alleviate possible risks and promote a safe and healthy pregnancy.





Anderson-Bagga, F. M., & Sze, A. (2019). Placenta previa.

Bamberg, C., & Hecher, K. (2019). Update on twin-to-twin transfusion syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology58, 55-65.

Hiersch, L., Berger, H., Okby, R., Ray, J. G., Geary, M., McDonald, S. D., … & Melamed, N. (2019). Gestational diabetes mellitus is associated with adverse outcomes in twin pregnancies. American Journal of Obstetrics and Gynecology220(1), 102-e1.

Jiang, M., Mishu, M. M., Lu, D., & Yin, X. (2018). A case-control study of risk factors and neonatal outcomes of preterm birth. Taiwanese Journal of Obstetrics and Gynecology57(6), 814-818.

Ramlakhan, K. P., Johnson, M. R., & Roos-Hesselink, J. W. (2020). Pregnancy and cardiovascular disease. Nature Reviews Cardiology17(11), 718-731.

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