complication of pregnancy
TRANSCRIPT
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