A nurse is planning care for hyperemesis gravidarum. Which interventions are appropriate? (Select all that apply.)

Chorionic Villus Sampling (CVS) is a diagnostic procedure performed between 10 and 13 weeks to detect chromosomal abnormalities. It involves aspirating a small sample of placental tissue either transcervically or transabdominally. While providing early results, it carries a slightly higher risk profile than mid-trimester amniocentesis.

A. Bleeding: The insertion of a catheter or needle into the developing placenta can cause subchorionic or vaginal bleeding. Most post-procedure bleeding is minor, but it must be monitored to ensure it does not lead to pregnancy loss. This risk is inherent to invasive sampling techniques.

B. Infection: Any procedure that bypasses the natural protective barriers of the cervix or skin can introduce bacteria into the uterine cavity. Chorioamnionitis is a rare but serious complication that can jeopardize both the pregnancy and maternal health. Strict aseptic technique is required during the procedure.

C. Fetal anemia: This is not a typical risk associated with CVS, as the sample is taken from the placenta rather than the fetal circulation. Fetal anemia is a more common risk of percutaneous umbilical blood sampling (PUBS). CVS focuses on genetic material within the trophoblastic cells.

D. Hypertension: The CVS procedure does not cause systemic maternal hypertension or preeclampsia. While a client may experience transient stress-induced tachycardia, there is no physiological link between placental tissue sampling and the development of gestational hypertension. It does not alter blood pressure.

E. Miscarriage: CVS carries an estimated procedure-related pregnancy loss risk of approximately 0.2% to 1.0%. The mechanical disruption of the gestational environment or subsequent infection can trigger spontaneous abortion. Counseling must include this risk to ensure informed consent by the client.

The management of preeclampsia at a pre-viable or early preterm gestation focuses on expectant management to allow for fetal growth. This involves close monitoring for maternal end-organ damage while maximizing the time the fetus remains in utero. The strategy balances maternal safety against the risks of neonatal prematurity.

A. Stop fetal growth: Preeclampsia often causes placental insufficiency, which may lead to intrauterine growth restriction (IUGR). However, the goal of medical care is to optimize perfusion and support growth, not to stop it. Fetal biophysical profiles are used to monitor growth.

B. Prolong pregnancy safely: At 28 weeks, the neonate faces significant morbidity from prematurity. Clinicians attempt to maintain the pregnancy to reach a more mature gestational age while blood pressure is controlled. Stabilization prevents acute maternal complications while the fetus gains weight.

C. Immediate delivery: Delivery is the only definitive cure for preeclampsia, but at 28 weeks, it is reserved only for "severe features" that are life-threatening. If the mother and fetus are stable, immediate delivery is avoided to prevent extreme neonatal complications. Delay allows for steroid administration.

D. Eliminate BP monitoring: Frequent blood pressure assessment is the most critical component of managing preeclampsia. Monitoring detects hypertensive crises and guides the administration of antihypertensive medications like labetalol. Eliminating this would lead to unmonitored vasospasm and stroke risk.