COMPLICATIONS OF PREGNANCY

FIRST TRIMESTER BLEEDING

SPONTANEOUS MISCARRIAGEo ABORTION

o INTERRUPTION OF PREGNANCY BEFORE FETUS IS VIABLE

o MEDICALLY OR SURGICALLY INTERRUPTED

o MISCARRIAGEo INTERRUPTION OCCURS SPONTANEOUSLY

o NONVIABLE FETUS : 20 – 24 WEEKS AOG 500 g

or less

FIRST TRIMESTER BLEEDING

SPONTANEOUS MISCARRIAGE 15 % - 30 % CAUSES:

ABNORMAL FETAL FORMATION IMMUNOLOGIC FACTORS IMPLANTATION ABNORMALITIES INFECTION TERATOGENIC DRUGS

FIRST TRIMESTER BLEEDING

SPONTANEOUS MISCARRIAGE PRESENTING SYMPTOM: VAGINAL

SPOTTING MANAGEMENT

DEPENDS ON THE SYMPTOMS

FIRST TRIMESTER BLEEDING

TYPES OF SPONTANEOUS ABORTIONTHREATENED MISCARRIAGE

MANIFESTED BY VAGINAL BLEEDING, SLIGHT CRAMPING

NO CERVICAL DILATATION MANAGEMENT

NO STRENOUS ACTIVITY (24-48 HOURS)

FIRST TRIMESTER BLEEDING

IMMINENT (INEVITABLE) MISCARRIAGE PRESENCE OF UTERINE

CONTRACTION & CERVICAL DILATION SIGNS & SYMPTOM

MANAGEMENT: DILATATION & CURETTAGE

FIRST TRIMESTER BLEEDING

COMPLETE MISCARRIAGE

ENTIRE PRODUCTS OF CONCEPTION ARE EXPELLED SPONTANEOUSLY

FIRST TRIMESTER BLEEDING

INCOMPLET MISCARRIAGE• PART OF THE CONCEPTUS IS

EXPELLED, MEMBRANES OR PLACENTA IS RETAINED IN THE UTERUS

• MATERNAL HEMORRHAGE• MANAGEMENT

DILATION & CURETTAGE

FIRST TRIMESTER BLEEDING

MISSED MISCARRIAGE• EARLY PREGNANCY FAILURE• FETUS DIES IN UTERO BUT IS NOT

EXPELLED• SIGNS

NO INCREASE IN FUNDAL HEIGHTNO FETAL MOVEMENT

• DIAGNOSTIC: ULTRASOUND

FIRST TRIMESTER BLEEDING

MISSED MISCARRIAGE• MANAGEMENT

> 14 WEEKS: INDUCE LABOR

FIRST TRIMESTER BLEEDING

RECURRENT PREGNANCY LOSS• THREE SPONTANEOUS MISCARRIAGE

THAT OCCURRED AT THE SAME GESTATIONAL AGE

• 1% • POSSIBLE CAUSES:

DEFECTIVE SPERMATOZOA OR OVAENDOCRINE FACTORSDEVIATION OF UTERUS INFECTIONAUTOIMMUNE DISORDERS

FIRST TRIMESTER BLEEDING

ECTOPIC PREGNANCY• IMPLANTATION OCCURS OUTSIDE THE

UTERINE CAVITY• 2% OF PREGNANCIES• MOST COMMON SITE: FALLOPIAN TUBE

AMPULLAR PORTION : 80% ISTHMUS: 12% INTERSTIAL OR FRIMBRIAE: 8%

FIRST TRIMESTER BLEEDING

ECTOPIC PREGNANCY• CAUSES

ADHESION OF FALLOPIAN TUBE FROM

• PREVIOUS INFECTIONCONGENITAL MALFORMATIONUTERINE TUMORS

FIRST TRIMESTER BLEEDING

ECTOPIC PREGNANCY• ASSESSMENT

ABDOMINAL PAINVAGINAL SPOTTING

• MANAGEMENTLAPAROSCOPY

2nd TRIMESTER BLEEDING

GESTATIONAL TROPHOBLASTIC DISEASE HYDATIDIFORM MOLE PROLIFERATION AND DEGENERATION

OF TROPHOBLASTIC VILLI ASSOCIATED WITH CHORIOCARCINOMA 1 IN 2,000 PREGNANCIES

2nd TRIMESTER BLEEDING

GESTATIONAL TROPHOBLASTIC DISEASE• RISK FACTORS

LOW PROTEIN INTAKE< 18 YEARS OLD> 35 YEARS OF AGEASIAN

2nd TRIMESTER BLEEDING

2nd TRIMESTER BLEEDING

GESTATIONAL TROPHOBLASTIC DISEASE• ASSESSMENT

UTERUS LARGER THAN USUALNO FETAK HEART SOUNDS

• DIAGNOSTICS:UTZ – SNOWFLAKE PATTERNHCG - INCREASE

2nd TRIMESTER BLEEDING

GESTATIONAL TROPHOBLASTIC DISEASE• MANAGEMENT

SUCTION CURETTAGE

2nd TRIMESTER BLEEDING

PREMATURE CERVICAL DILATATION• INCOMPLETE CERVIX• CERVIX THAT DILATES PREMATURELY• SIGNS & SYMPTOMS:

PINK-STAINED VAGINAL DISCHARGERUPTURE OF MEMBRANESDISCHARGE OF AMNIOTIC FLUID

• COMMONLY OCCURS AT 20 WKS AOG

2nd TRIMESTER BLEEDING

PREMATURE CERVICAL DILATATION• ASSOCIATED WITH

INC. MATERNAL AGECONGENITAL STRUCTURAL

DEFECTTRAUMA TO CERVIX

• MANAGEMENTCERVICAL CERCLAGE

CERVICAL CERCLAGE

3RD TRIMESTER BLEEDING

PLACENTA PREVIA• LOW IMPLANTATION OF THE PLACENTA• FOUR DEGREES

1. LOW-LYING PLACECNTA2. MARGINAL IMPLANTATION3. PARTIAL PLACENTA PREVIA4. TOTAL PLACENTA PREVIA

3RD TRIMESTER BLEEDING

PLACENTA PREVIA• ASSOCIATED WITH

INCREASED PARITYADVANCED MATERNAL AGEPAST CEASARIAN BIRTHSPAST UTERINE CYRETTAGEMULTIPLE GESTATION

• 5 PER 1,000 PREGNANCIES

3RD TRIMESTER BLEEDING

PLACENTA PREVIA• ASSESSMENT

ABRUPT, PAINLESS BLEEDING• DIAGNOSTIC: UTZ• MANAGEMENT

IMMEDIATE CARE MEASURES• BED REST IN SIDE-LYING

POSITION

ABRUPTIO PALCENTAE

BIRTH

ABRUPTIO PALCENTAE• PREMATURE SEPARATION OF

MEMENBRANES• 10% OF PREGNANCIES• MOST FREQUENT CAUSE OF

PERINATAL DEATH• CAUSE: UNKNOWN

ABRUPTIO PALCENTAE PREDISPOSING FACTORS

HIGH PARITYHYPERTENSIONDIRECT TRAUMACOCAINE USE

BIRTH

ABRUPTIO PLACENTAE• ASSESSMENT

SHARP, STABBING PAINHEAVY BLEEDING

• THERAPEUTIC MANAGEMENTFLUID REPLACEMENTOXYGEN

PRETERM LABORLABOR OCCURS BEFORE 37 WEEKS9% - 10% OF PREGNANCIESCAUSE : UNKNOWNASSOCIATED WITH

CHORIOAMNIONITISDEHYDRATIONUTI

PRETERM LABORCOMMON SYMPTOMS

PERSISTENT, DULL, LOW BACKACHEVAGINAL SPOTTINGABDOMINAL PRESSURE OR TIGHTENINGUTERINE CONTRACTION

THERAPEUTIC MANAGEMENTTOCOLYTIC AGENTS

PRETERM RUPTURE OF MEMBRANESRUPTURE OF FEYAL MEMBRANE WITH

LOSS OF AMNIOTIC FLUIDCAUSE; UNKNOWN2 % TO 18%ASSESSMENT

SUDDEN GUSH OF CLEAR FLUID

PRETERM RUPTURE OF MEMBRANESASSOCIATED WITH

VAGINAL INFECTION THERAPEUTIC MANAGEMENT

ANBIOTICS

PREGNANCY-INDUCED HPNVASOPASM DURING PREGNACY

SIGNS OF HPNPROTEINURIAEDEMA

5% -10%CAUSE: UNKNOWN<20 YEARS OLD & > 30 YEARS OLD

PREGNANCY-INDUCED HPCLASSIFIED INTO

GESTATIONAL HPNMILD PREECCLAMPSIASEVERE PREECLAMPSIAECLAMPSIA

TYPE SYMPTOMS

GESTATIONAL

HPN

BP 140/90

30 mmHg Systolic

15mmHg Diastolic

NO PROTEINURIA OR EDEMA

BP RETURNS TO NORMAL AFTER DELIVERY

TYPE SYMPTOMS

MILD

PREECCLAMPSIA

BP 140/90

30 mmHg Systolic

15mmHg Diastolic

PROTEINURIA 1-2+

WEIGHT GAIN > 2 LBS/WK

MILD EDEMA

(UPPER EXTREMITIES OR FACE)

TYPE SYMPTOMS

SEVERE

PREECCLAMPSIA

BP 160/110

PROTEINURIA 3-4

OLIGURIA

CEREBRAL OR VISUAL

DISTURBANCES

EXTENSIVE PERIPHERAL EDEMA

TYPE SYMPTOMS

ECLAMPSIA CONVULSION OR COMA

+ SIGNS OF SEVERE

PREECCLAMPSIA

NURSING INTERVENTIONBED RESTMONITOR FETAL WELL-BEINGNUTITRIOUS DIETADMINISTER MEDS

HELLP SYNDROMEHEMOLYSISELEVATED LIVER ENZYMESLOW PLATELETS4% - 12% PIHMATERNAL MORTALITY INFANT MORTALITY

HELLP SYNDROMESYMPTOMS

NAUSEAEPIGASTRIC PAINGENERAL MALAISER UPPER QUADRANT TENDERNESS

LAB TESTHEMOLYSIS OF RBC<100,000/mm3 PLATELET COUNT

HELLP SYNDROMELAB TEST

ELEVATED LIVER ENZYMES ALANINE AMINOTRANSFERASE SERUM ASPARTATE AMINOTRANSFERASE

MANAGEMENTFRESH FROZEN PLASMA OR PLATELETS

MULTIPLE PREGNANCY2% OF PREGNANCIESTYPES

MONZYGOTICDIZYGOTIC

ASSESSMENT INC IN SIZE AT A RATE FASTER THAN

USUALALPHA FETOPROTEIN LEVEL ELEVATED

MULTIPLE PREGNANCYDIAGNOSTICS ; UTZ

MANAGEMENTCLOSER PRENATAL SUPERVISION

HYDRAMNIOSEXCESSIVE AMNIOTIC FLUID

FORMATIONNORMALLY 500-1,000 ML> 2,000 mlCAN CAUSE

FETAL MALPRESENTATIONPROM

ASSESSMENT: ENLARGEMENT OF UTERUS

DIAGNOSTICS: UTZMANAGEMENT

BED RESTAMNIOCENTESIS

POST-TERM PREGNANCY38 – 42 WEEKS LONG3% - 12% OF PREGNANCIESASSOCIATED WITH

SALICYLATE INTAKEMYOMETRIAL QUIESCENCE

MANAGEMENT: INDUCTION OF LABOR

ISOIMMUNIZATION RH - MOTHER CARRIES A RH POSITIVE

FETUSHEMOLYTIC DISEASE OF THE NWBORN

OR ERYTHROBLASTOSIS FETALISMANAGEMENT

Rh Immune Globulin

FETAL DEATHCAUSES

CHROMOSOMAL ABNORMALITIESCONGENITAL MALFORMATION INFECTIONSCOMPICATION OF MATERNAL DISEASE

ASSESSMENTABSENT FETAL MOV’T

MANAGEMENTPROSTAGLANDIN GEL