Pregnancy related complications

week 2, chapter 25

spontaneous vs induced abortions

spontaneous: unplanned, body “rejects”

• - miscarriage

induced: choosing

loss of pregnancy by what week of gestation is considered abortion

fetus of less than 20wks or weighing less than 500g

spontaneous abortions are the leading cause of pregnancy loss, why is this?

most commonly due to chromosomal abnormalities, making fetus incompatible with life

what is DIC: disseminated intravascular coagulation in pregnancy?

its a life threatening condition that results in pro-coagulation and anticoagulation factors to be simultaneously activated

• - this could be from missed abortions, abruptio placentae, and preeclampsia/hypertension

how is DIC treated?

blood replacement products and cryoprecipitate are administered to maintain circulating volume

what is an ectopic pregnancy

when a fertilized egg/ovum implants in an area outside of the uterine cavity

• - commonly forms in the fallopian tubes

how are ectopic pregnancy diagnosed? what ultrasound?

• - using a transvaginal ultrasound (not transabdominal bc it would still be under the pelvic bone)

• - ^looking for a sac

• - elevated Beta-hCG levels

what are some factors that increase the risk of ectopic pregnancy’s

• - history of STDs (gonorrhea, chlamydia)

• - history of ectopic pregnancy’s

• - failed tubal ligation

• - multiple induced abortions

• - older than 35

• - cigarette smoking

• - IUDs for contraception

what are the early signs and symptoms of ectopic pregnancy’s

basically just pregnancy

• - missed menstrual period

• - abdominal and pelvic pain

• - vaginal spotting

• - may have positive pregnancy test (from ^hCG)

what happens if the egg implants on the distal end of the fallopian tube vs the proximal end

distal= more early pregnancy signs (nausea, dizzy)

proximal= more common for rupture

• - likely to occur within 2-3 weeks of the missed period

what is the treatment for ectopic pregnancy if the tube is still intact?

a doctor, NP, midwife, NOT RN will administer a cytotoxic drug, methotrexate, which inhibits cell division in the embryo. Ultimately, killing the fetus, hence why a doctor must perform

what happens if the tube ruptures from an ectopic pregnancy, what procedure is performed?

Salpingectomy- removal of the affected tube and ligate bleeding vessels

• - try to control bleeding and prevent hypovolemic shock

true or false: shoulder, back, and neck pain can be related to ectopic pregnancy’s

true: the pain from the fallopian tube can radiate to the back, neck, and shoulders

what education should be provided when administering methotrexate

its a one-time injection, mother should be instructed to stop taking any vitamins, folic acid, and alcohol

what is gestational trophoblastic disease? (aka hydatidiform mole or molar pregnancy)

occurs when the trophoblast develops abnormally (Trophoblasts are present four days after fertilization in humans. They provide nutrients to the embryo)

• - the develop abnormal cell growth, almost cancer-like

• - results in the placenta developing but not the fetus

how does the uterus still get filled during molar pregnancy? how is the fundal height growing

from proliferation and edema of the chorionic villi

• - fluid-filled villi form grape-like vesicles that can grow large enough to fill the uterus

what are signs and symptoms of hydatidiform mole

• vaginal bleeding

• highhh levels of beta hCG

• uterus larger than expected for the duration of the pregnancy (increase fundal height)

• excessive N&V and early development of preeclampsia (from hCG)

• “snowstorm” pattern on the ultrasound

how is hydatidiform mole managed or treated

• - evacuation of the molar pregnancy (get as much out as possible)

• - baseline labs before surgery (CBC, CMP, beta hCG)

• - follow up appointments to observe for choriocarcinoma

how/why do we look for choriocarcinoma after a mole pregnancy

increased risk for cervical/uterine cancer

• - serum beta hCG levels are assessed q2wks until 3 normal pre-pregnancy levels are attained

• - if still elevated, then will repeat hCG q1-2months

pt is NOT to get pregnant for 1 yr after mole pregnancy- will increase hCG again and then not be able to differentiate if pt has cancer or if its from the pregnancy

what is hyperemesis gravidarum

persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and may continue throughout (otherwise, typically done by week 8-10)

what is pt at risk for if experiencing hyperemesis

• - loss of 5% or more of pregnancy weight

• - dehydration, electrolyte imbalance (low: Na, K, chloride)

• - acidosis from starvation (lack of nutrients)

• - low hemoglobin and hematocrit

• - elevated creatinine levels

how is HG managed/treated (medications)

• - pyridoxine (vit B6)

• - doxylamine (Unisom)

• - promethazine (antiemetic)

• - ondansetron (Zofran) or metoclopramide (Reglan) - impact CNS, can lead to cardiac and brain defects in baby if given during first trimester

• - IV fluid or TPN may be needed

NI for pt with HG

• - promote smaller meals, less odor, low fat

• - eat q2-3 hrs

• - fluid intake 2000ml/day (try not to eat and drink at same time)

• - monitor for signs of dehydration

• - provide emotional support

what are the three classifications of placenta previa

marginal- placenta is planted on lower border but is >3cm form internal cervical, may still move and correct itself

partial- placenta is within 3cm of internal cervical but does not fully cover it

total- placenta completely covers internal cervical, can lead to rupture and placenta being delivered first

what complications may occur because of placenta previa? what is fetus at risk for?

fetus may develop anemia or hypovolemic shock because of blood loss and incorrect placenta placement

• more likely to have an infection or hemorrhage after birth

how is placenta previa diagnosed/followed? what do we avoid?

NST and BPP ultrasounds provide information about the fetal condition

• AVOID STERILE VAGINAL EXAMS, if expected, can cause severe maternal and fetal bleeding

what is abruptio placenta / placental abruption

separation of a normally implanted placenta before the fetus is born

• occurs when there is bleeding and formation of a hematoma on the maternal side of the placenta

what is the treatment for placental abruption

emergency C-section due to risk for maternal shock, clotting disorders, and fetal death

• because if RBC try to clot where abruption is, it will ultimately close off the blood supply

what are risk factors for abruptio placentae

• hypertension- increase pressure can cause placenta to sheer off

• smoking ^

• multigravida status- not as much elasticity

• abdominal trauma (accident, domestic violence)

• history of abruptions

• cocaine use

• folate deficiency

placenta previa vs placenta abruptio

• pain

• bleeding (color)

• uterine consistency

• blood coagulation

what are signs of hypovolemic shock from blood loss

• increase HR and RR

• decreased BP

• fetal tachycardia (first sign)

• cool, moist skin, pallor, cyanosis

• decreased urinary output

• decreased hmg and hct

• confusion, lethargic, decreased LOC

what is the incompatibility between mother and fetus Rh blood factors

if a rh negative women conceives an rh positive child, maternal antibodies may then develop after exposure to fetal rh positive blood

• could then treat next pregnancy like a threat

how is the incompatibility of rh factors between mother and fetus treated? when>

administration of rhoGAM

• give at 28wks for anyone who is rh negative

• give again within 72hrs post birth if baby is rh positive

what incompatibility risk between mother and fetus blood could occur for ABO

if mother is blood type O and fetus is either A, B, or AB, could result in hyperbilirubinemia of the infant

how is ABO incompatibility treated

no specific prenatal care. At birth, cord blood is taken to determine the newborns blood type and is screened for jaundice which would indicate hyperbilirubinemia