Chapter 10 Complications of Pregnancy Flashcards
Exam 2
Describe the development & management of hemorrhagioc conditions of early pregnancy, including spontaneous abortion, ectopic pregnancy, & gestational trophoblastic disease.
Explain physiology & management of placenta previa and placental abruption.
Discuss the effects & management of hyperemesis gravidarum.
Describe the pathophysiology, effects, and management of hypertensive disorders of pregnancy.
Compare Rh and ABO blood incompatibilities in terms of etiology, fetal & neonatal complications, & management.
Describe the effects of pregnancy on glucose metabolism.
Discuss the effects and management of preexisting diabetes mellitus during pregnancy.
Explain the physiology & management of gestational diabetes mellitus during pregnancy.
Describe the effects of obesity during pregnancy.
Explain the effects of specific anemias & the required management during pregnancy.
Identify the effects, management, and nursing considerations of specificc preexisting autoimmune & neurologic conditions.
Discuss the effects of selected prenatal infections.
Explain nursing considerations for each complication of pregnancy.
high-risk pregnancy
- jeopardy to mother, fetus, or both
- condition due to pregnancy or result of condition present before pregnancy
- essential these conditions are IDed early
What are the 3 most common causes of hemorrhage during the first half of pregnancy?
- abortion
- ectopic pregnancy
- gestational trophoblastic disease
:explusion of the fetus BEFORE 20wks gestation
abortion (AB)
:occur naturally
spontaneous abortion
:caused by medical or surgical means
induced abortion
:loss of fetus AFTER 20 wks gestation
Stillbirth
> 20wks gestation
viable
categories of miscarriages
- threatened
- inevitable
- incomplete
- complete
- missed abortion
- habitual/ recurrent abortion
miscarriage
vaginal bleeding before 20 wks without dilation
threatened
miscarriage
cannot be stopped; possible see ROM and dilation of cervix; natureal expulsion of uterine contents
inevitable
miscarriage
some, but not all of the products of conception (retained tissue prevents contraction; D&C; Oxytocin, methylergonovine, misoprostol)
incomplete
miscarriage
all fetal tissue is passed, cervix closes, slight bleeding, mild cramping
complete
miscarriage
fetus has died in utero, miscarriage has not occurred yet (uterus emptied by most appropriate method for gestational age/ size); <20 wks
missed abortion
miscarriage
loss of three or more consecutive pregnancies
habitual/ recurrent
Incidence/ Etiology of Spontaneous Abortions (Miscarriages)
- Chromosomal Abnormalities
- Faulty implantation of placenta
- Maternal infections/ Maternal diseases
- Placental abnormalities
- clotting disorders
:inflammation of the amniotic sac (fetal membranes); usually caused by bacterial and viral infections. (also called amnionitis or Triple I-intrauterine infection or inflammation of both)
chorioamnionitis
expected meds for an incomplate miscarriage (abortion)
oxytocin, methylergonovine, misoprostol (to contract and expel contents of uterus)
risk of hemorrhage for which types of miscarriages (abortions)
inevitable, incomplete
Assessment question for Spontaneous Abortion (miscarriage)
- s/s = vaginal bleeding? Color and amount? Cramping? Back pain?
- passage of tissue = save any tissue or clots passes and bring with you to facility (appointment)
Management of Spontaneous Abortions (miscarriage)
- could be hospitalized for IVF or blood administration
- dilatation & curettage (D&C)
- Rhogam IF mom is Rh -
- bedrest & abstinence from sex (esp. a threatened)
- psychological needs (grief, guilt)
- cerclage (weak cervix- sewn closed)
T or F
Most 1st trimester spontaneous abortions result from maternal conditions.
False, chromosomal
:implantation of a fertilized ovum in any area other than the uterus; the most common site is the fallopian tube.
ectopic pregnancy
physiology of ectopic pregnancies
- initial symptoms of pregnancy
- postive HCG present in blood and urine and ultrasound to visualize the pregnancy
- chorionic villi (back of the placenta) grow into tube wall or implantation site & establish blood supply
- unilateral severe pain, rupture & bleeding into the abdominal cavity
Ectopic Pregnancy (rupture)
- result is sharp unilateral pain and syncope
- referred shoulder pain or scapular pain
- lower abdominal pain
- HALLMARK SIGN: abdominal pain with spotting within 6-8 wks after missed menses
- DX: transvaginal U/S or laparoscopy
- Medical therapy: intramuscular methotrexalate if tube unruptured
- Surgical therapy: Salpingostomy; Salpingectomy
methotrexate
- given IM
- stops the division of cells
- folic acid antagonist
education of pt: methotrexate
- NO alcohol
- cancer drug: double flush (use precautions)
- no sexual activity while on this med
:spectrum of diseases that includes both benign hydatidiform mole & gestational trophoblastic tumors such as invasive moles & choriocarcinoma
gestatioinal trophoblastic disease
pathologic proliferation of trophoblastic cells
gestational trophoblastic disease
disorder of placental development
hydatidiform mole disorder
neoplasm of trophoblast; a form of cancer
choriocarcinoma
initially, clinical picture similar to pregnancy; embryo not viable; no circulation established; no embryonic tissue found
gestational trophoblastic disease
Classic signs of gestational trophoblastic disease
- Uterine enlargement greater than gestational age; U/S shows vesicles & absence of fetal sac
-
Vaginal bleeding
* Hyperemesis gravidarum- from high hCG levels
therapy for gestational trophoblastic disease
- CXR to detect metastatic disease (risk of it traveling to the lungs)
- uterine curettage for removal of placental fragments (D&C) or vacuum aspiration
- Hysterectomy for excessive bleeding
F/U after therapy gestational trophoblastic disease
- evaluation of hCG levels every 1-2 wks until no longer detectable
- then monthly hCG levels
- No pregnancy for 1 yr! (ed pt- birth control methods)
After 20 wks of pregnancy, what are the 2 major causes of hemorrhage?
disorders of the placenta called:
* placenta previa
* placental abruption
:abnormal implantation of the placenta in the lower uterus at or very near the cervical os
placenta previa
implanted in lower uterus but at least 2cm from cervical os
low lying placenta
3 types of placenta previa
- marginal
- partial
- complete
What are the clinical manifestations of placenta previa?
- bleeding is BRIGHT RED, PAINLESS because it is not occurring in a closed cavity & does not cause pressure on adjacent tissue
- it may be scanty or profuse, and it may cease and recur latert