DR Maternal Complications

Pregnancy-Induced Hypertension (PIH)

is high blood pressure that develops after 20 weeks of gestation in a woman who previously had normal BP, without proteinuria.
If unmanaged, it can progress to preeclampsia and eclampsia.

• BP ≥ 140/90 mmHg after 20 weeks

• Headache, dizziness

• Mild edema (hands, face)

• No protein in urine (distinguishes it from preeclampsia)

PIH S/Sx

(BHMN)

• urinalysis

• cbc 

• creatinine

• liver enzymes

PIH Lab Tests

(UCCL)

1. Methyldopa

2. Labetalol, Hydralazine, Nifedipine

PIH DOC

1. __ – safe antihypertensive during pregnancy

2. Other options: (LHN)

Medical Management:

• Monitor BP and urine protein regularly

• Bed rest, left lateral position

Nursing Management:

• Monitor BP, weight, and edema

• Watch for progression to preeclampsia (proteinuria, visual changes, headache)

PIH

Medical Management:

(MB)

Nursing Management:

• (MW)

• Preeclampsia

• Eclampsia

1. Hypertension after 20 weeks with proteinuria and/or edema.

2. Preeclampsia + seizures not related to other causes.

Preeclampsia S/Sx:

• BP ≥ 140/90 mmHg

• Proteinuria (≥ +1)

• Edema (hands, face)

• Hyperreflexia (warning sign of seizure)

Eclampsia ➜ Same as above plus seizures and coma

Pre-eclampsia S/Sx:

(BPEH)

Eclampsia ➜ Same as above plus __ and __

1. Urinalysis

2. CBC

3. ↑ Liver enzymes (AST, ALT)

4. ↑ BUN and creatinine

Preeclampsia/ Eclampsia Lab Tests:

1. __: proteinuria

2. __: thrombocytopenia

3. ↑ L__

4. ↑ __ and __

1. Magnesium sulfate

2. Calcium gluconate

3. Labetalol or Hydralazine – for BP control

Preeclampsia/ Eclampsia DOC:

Drug of Choice:

1. __ – prevents seizures

2. Antidote: __

3. __ – for BP control

Medical Management:

1. Mild: Bed rest, diet, BP monitoring

2. Eclampsia: Control seizures, stabilize mother → deliver baby

Nursing Management:

1. Monitor BP, urine output, reflexes, RR

2. Seizure precautions: quiet room, padded side rails

Preeclampsia/ Eclampsia

Medical Management:

1. Mild: __

2. Eclampsia: __

Nursing Management:

(MS)

Gestational Diabetes Mellitus (GDM)

Glucose intolerance that develops during pregnancy and resolves after delivery.

• Polyuria, polydipsia, polyphagia

• Glucosuria

• Excessive fetal growth (macrosomia)

• Recurrent infections (yeast, UTI)

GDM S/Sx:

(PGER)

1. Glucose challenge test (50g OGTT)

2. 3-hour oral glucose tolerance test (OGTT)

3. ≥ 95 mg/dL

4. ≥ 180 mg/dL

5. ≥ 155 mg/dL

6. ≥ 140 mg/dL

GDM Lab tests:

1. __→ screening

2. __ → diagnostic

3. FBS ≥ __ mg/dL

4. 1-hr ≥ __ mg/dL

5. 2-hr ≥ __ mg/dL

6. 3-hr ≥ __ mg/dL

1. insulin

2. metformin

GDM DOC:

1. __ (does not cross placenta)

2. __ sometimes used in mild cases

Medical Management:

• Diet control (complex carbs, avoid sweets)

• Regular exercise

Nursing Management:

• Teach diet, insulin injection, and glucose monitoring

• Monitor blood sugar and fetal growth

GDM

Medical Management:

(DR)

Nursing Management:

(TM)

Placenta previa

Placenta implants in the lower uterine segment, partially or completely covering the cervix.

• Painless, bright red vaginal bleeding in 2nd–3rd trimester

• Soft, non-tender uterus

• No abdominal pain

Placenta Previa S/Sx:

(PSN)

1. CBC

2. Ultrasound

3. vaginal exam

Placenta Previa Lab Tests:

1. __ (for blood loss)

2. __ → confirm placental location

3. NO __! (can cause bleeding)

Medical/Surgical Management:

• Mild bleeding: bed rest, observation

• Severe: blood transfusion, possible C-section (preferred delivery method)

Nursing Management:

• Monitor bleeding and FHR

• Prepare for C-section

Placenta Previa

Medical/Surgical Management:

• Mild bleeding: (BO)

• Severe: (BP)

Nursing Management:

(MP)

abruptio Placenta

Premature separation of a normally implanted placenta from the uterine wall after 20 weeks.

• Painful, dark red vaginal bleeding

• Rigid, board-like abdomen

• Uterine tenderness

• Fetal distress

Abruptio Placenta S/Sx:

(PRUF)

1. CBC (↓ Hb, Hct)

2. Coagulation studies (DIC possible)

3. Ultrasound (placental detachment)

4. Fibrinogen ↓, PT/aPTT ↑

Abruptio Placenta Lab Tests:

1. __ (↓ Hb, Hct)

2. __ (DIC possible)

3. __ (placental detachment)

4. __  ↓, PT/aPTT ↑

Medical/Surgical Management:

• Mild: monitor mother & fetus

• Severe: Immediate delivery (C-section)

Nursing Management:

• Monitor bleeding, FHR, uterine tone

• Avoid vaginal exams

• Maintain IV line, oxygen

Abruptio Placenta

Medical/Surgical Management:

• Mild: (M)

• Severe: (I)

Nursing Management:

(MAM)

hydatidiform Mole (H-Mole/ Molar Pregnancy)

An abnormal growth of trophoblastic tissue where the placenta develops into grape-like fluid-filled vesicles instead of a normal embryo.

• Rapid uterine growth, larger than gestational age

• Absent fetal heart tones

• Brownish (prune juice-like) vaginal discharge

• High hCG levels

H-Mole S/Sx:

(RABH)

1. Serum hCG

2. Ultrasound

3. CBC

H-Mole Lab Tests:

1. __ – very high

2. __ – “snowstorm” pattern

3. __ (anemia), coagulation profile

1. Oxytocin

2. Avoid prostaglandins

H-Mole Drug of Choice:

1. __ to evacuate uterus

2. Avoid __ (risk of embolization)

Medical/Surgical Management:

• Evacuation via suction curettage or D&C

• Avoid pregnancy for 1 year (risk of choriocarcinoma)

Nursing Management:

• Monitor bleeding and vital signs

• Educate on follow-up hCG tests

H-Mole

Medical/Surgical Management:

(EA)

Nursing Management:

(ME)

Hyperemesis Gravidarum

Severe, persistent vomiting during pregnancy causing dehydration, weight loss, and electrolyte imbalance.

• Excessive vomiting

• Dehydration (dry lips, poor skin turgor)

• Weight loss (>5% pre-pregnancy weight)

• Ketonuria

• Tachycardia, hypotension

Hyperemesis Gravidarum S/Sx:

(EDWKT)

1. Urinalysis: ketones

2. Electrolytes: ↓ Na, ↓ K

3. ↑ Hematocrit (dehydration)

4. ↑ hCG

Hyperemesis Gravidarum Lab Tests:

1. __ : ketones

2. __ : ↓ Na, ↓ K

3. ↑ __ (dehydration)

4. ↑ __

1. Metoclopramide (Reglan) or Ondansetron (Zofran) for nausea

2. IV fluids with electrolytes, vitamin B₆

Hyperemesis Gravidarum DOC:

1. M__ or O__ for nausea

2. I__, V__

Medical Management:

• NPO → gradual reintroduction of small meals

• IV fluids (D5LR)

Nursing Management:

• Monitor I&O, weight, electrolyte balance

• Provide small, frequent meals when tolerated

Hyperemesis Gravidarum 

Medical Management:

(NI)

Nursing Management:

(MP)

uterine atony

Failure of the uterus to contract effectively after delivery, leading to postpartum hemorrhage (PPH).

• Soft, boggy uterus

• Excessive vaginal bleeding

• Hypotension, tachycardia

• Pallor, dizziness

Uterine atony S/Sx:

(SEHP)

1. CBC

2. Coagulation profile 

Uterine Atony Lab Tests:

1. __ (↓ Hb, Hct)

2. __  (if severe bleeding)

1. Oxytocin

2. Methylergometrine (Methergine), Carboprost (Hemabate), Misoprostol

Uterine Atony Drug of Choice:

1. O__

2. Others: M__, C__, M__

Medical/Surgical Management:

• Fundal massage

• If uncontrolled → bimanual compression, Bakri balloon, or hysterectomy

Nursing Management:

• Administer uterotonics as ordered

• Prepare for blood transfusion if needed

Uterine Atony

Medical/Surgical Management:

(FB) 

Nursing Management:

(AP)

maternal hemorrhage

• >500 mL vaginal or >1000 mL C-section

Excessive blood loss (>__ mL vaginal or >__ mL C-section) during or after delivery.

• Profuse bleeding

• Decreased BP, increased HR

• Cold, clammy skin

• Pale conjunctiva

Maternal Hemorrhage S/Sx:

(PDCP)

1. CBC

2. Coagulation profile

3. Crossmatch

Maternal Hemorrhage Lab Tests:

1. __ (↓ Hb, Hct)

2. C__

3. __ for transfusion

.

1. Oxytocin

2. Ergometrine / Misoprostol / Carboprost for uterine contraction

Maternal Hemorrhage Drug of Choice:

1. O__

2. E__ / M__ / C__ for uterine contraction

Medical/Surgical Management:

• IV fluids and blood transfusion

• Surgical interventions: uterine packing, hysterectomy

Nursing Management:

• Assess for shock (vitals, skin, LOC)

• Massage uterus if atonic

Maternal Hemorrhage

Medical/Surgical Management:

(IS)

Nursing Management:

(AM)