Pregnancy Complications

Gestational diabetes

Diabetes from pregnancy - develops during the second half

gestational hypertension

High BP during pregnancy, w/out other systemic effects

>140/90 mm Hg

Severe: >160/110 mm Hg

High blood pressure numbers

Preeclampsia

2nd half of pregnancy (20 wks), new-onset hypertension and system effects (protein in the urine). Risk is higher if it’s the woman’s 1st pregnancy (primigravida).

• BP >140/90 mmHg

• Severe/persistent headache

• Visual problems (seeing spots, blurred vision, light sensitivity)

• Swelling (hands/feet)

• Upper abdominal pain

• Dyspnea/retrosternal chest pain

• Anxiety, altered mental status

S/sx of preeclampsia

Eclampsia

Preeclampsia w/ seizures

position them on their left side, maintain airway, O2, suction airway for vomit. Rapid transport, call ALS

Prehospital tx for eclampsia

Supine hypotensive syndrome

The uterus compresses the inferior vena cava when the pt is supine. Reduces blood returning to the heart and lowers BP

3rd

Any pt in their _______ trimester should be positioned leaning on their left side

Ectopic pregnancy

When the embryo grows outside the uterus (fallopian tube). Signs of internal bleeding when the fallopian tube ruptures.

• Sudden severe lower abdominal pain (unilateral) - may radiate to one shoulder

• Vaginal bleeding (scant brown spotting - profuse bright red)

S/sx of ectopic pregnancy

• PID

• Tubal ligation - prevents an egg from moving from the ovaries to the uterus through the fallopian tubes

• Hx of ectopic pregnancy

What conditions should heighten your suspicion of a possible ectopic pregnancy

1st trimester (6-8 wks after last missed period)

What trimester does ectopic pregnancy occur in?

Abruptio placentae

Placenta separates from the wall of the uterus too early (after 20 wks)

high BP, trauma

Abruptio placentae causes

• Lower abdominal/back pain

• Moderate vaginal bleeding - most is internal

• Possible signs of shock - weak/rapid pulse, pale/cool/diaphoretic skin (life threatening)

S/sx of abruptio placentae

Placenta previa

Placenta develops over and covers the cervix (after 20 wks)

• Painless

• Moderate - life threatening hemorrhage

• Signs of shock

S/sx of placenta previa

• Position on their left side

• High-flow O2

• Keep warm

• Sterile pad/sanitary pad over the vagina to control bleeding

Tx for vaginal bleeding

Spontaneous abortion

Loss of a pregnancy before 20 wks of gestation w/out any preceding surgical or med intervention. Aka miscarriage.

• Abdominal cramping

• Vaginal bleeding

S/sx of spontaneous abortion

• Trauma

• Drug use

• Underlying med conditions

• STDs

Risks for spontaneous abortion

• Bleeding - portions of the fetus/placenta stay inside the uterus (incomplete abortion) or when the uterine wall is injured (perforation of the uterus + adjacent bowel/bladder)

• Infection - perforation, use of nonsterile instruments

Abortion complications

Premature birth, low birth wt, severe respiratory depression

Intrauterine drug exposure increases risk of…

Fetal alcohol syndrome

Pregnant woman drinks alcohol → fetus has growth/physical problems, mental issues, congenital abnormalities

Falls

What is the third leading cause of trauma in pregnant women?

• Hormonal changes that loosen joints

• Increased wt of the uterus + shifted center of gravity

• Displacement of the abdominal organs

Factors that contribute to trauma sustained by pregnant women.

• Increased blood vol

• Elevated HR

What changes can mask the s/sx of shock in a pregnant woman?

Blood supply to the fetus is reduced - woman receives more blood

What happens to the fetus if a woman sustains trauma?

The uterus is rich in blood supply

Why is it especially dangerous if a pregnant woman sustains direct injuries to the abdomen

Manually move the uterus toward their left side to facilitate blood return to the right side of the heart

During CPR, if the patient is in the 3rd trimester it is important to remember to…

Meconium

Fetal stool/green fluid that indicates a newborn is in distress/disease. Can be aspirated into the fetus’s lungs during delivery.

3rd trimester

A woman’s blood pressure typically drops slightly during the first two trimesters of pregnancy but returns to normal during the __________.

Uterine massage

Slow down vaginal bleeding after delivery by stimulating the uterus to contract back towards its prepregnancy size