- Always ask about any symptoms that might indicate a complication (pain or vaginal fluing leaking or bleeding) -Thorough health history (headaches, blurred vision, back pain)

- Fear of preterm labor ending the pregnancy -Anxiety related to guarded pregnancy outcome - Risk of infection related to incomplete miscarriage - Fluid volume deficit related to third-trimester bleeding - Risk of ineffective tissue perfusion related to gestational hypertension

- Welfare of the Mother and fetus

- Continued healthy growth of the pregnant patient and fetus - A patient's and family's psychological health - Continuation of the pregnancy for as long as possible

- Patient's BP is maintained within acceptable parameters for remainder of pregnancy. - Parents state they feel able to cope with anxiety associated with the pregnancy complication - Patient's sign and symptoms of hypertension of pregnancy do not progress to eclampsia - Patient accurately verbalizes crucial signs and symptoms they should immediately reports to the primary healthcare provider. - Parents express feeling of sadness over pregnancy loss - Patient is able to adhere to the medical treatment regimen and experiences no adverse effects from the treatment.

Chapter 21: Nursing Care of a Family Experiencing a Sudden Pregnancy Complication Flashcards by Jessica Britney

Leading complications related directly to pregnancy

Thromboembolism
Hemorrhage
Infection
Hypertension of Pregnancy
Ectopic pregnancy

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Assessment

Always ask about any symptoms that might indicate a complication (pain or vaginal fluing leaking or bleeding)

-Thorough health history (headaches, blurred vision, back pain)

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Nursing diagnosis

Fear of preterm labor ending the pregnancy

-Anxiety related to guarded pregnancy outcome

Risk of infection related to incomplete miscarriage
Fluid volume deficit related to third-trimester bleeding
Risk of ineffective tissue perfusion related to gestational hypertension

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Outcome

Welfare of the Mother and fetus

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Implementation

Continued healthy growth of the pregnant patient and fetus
A patient’s and family’s psychological health
Continuation of the pregnancy for as long as possible

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Outcome Evaluation

Patient’s BP is maintained within acceptable parameters for remainder of pregnancy.
Parents state they feel able to cope with anxiety associated with the pregnancy complication
Patient’s sign and symptoms of hypertension of pregnancy do not progress to eclampsia
Patient accurately verbalizes crucial signs and symptoms they should immediately reports to the primary healthcare provider.
Parents express feeling of sadness over pregnancy loss
Patient is able to adhere to the medical treatment regimen and experiences no adverse effects from the treatment.

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Vaginal bleeding during pregnancy

Is always potentially serious and may occur at any point of the pregnancy

May mean that the placenta has loosened or cut off nourishment to the fetus

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Primary Causes of Bleeding in first & second trimester

Threatened Spontaneous Miscarriage
Imminent (inevitable) Miscarriage
Missed Miscarriage
Incomplete spontaneous Miscarriage
Complete spontaneous Miscarriage
Ectopic or Tubal pregnancy

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Primary Causes of Bleeding in Second trimester

Gestational Trophoblastic Disease (Hydatidiform mole)
Premature Cervical Dilatation

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Primary Causes of Bleeding in Third trimester

Placenta Previa
Premature separation of the placenta (abrubptio placentae)
Preterm labor

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When does hypovolemic shock occur?

When 10% of blood volume/ approximately 2 units of blood is lost.

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Signs and symptoms of Hypovolemic Shock

Increased pulse rate - heart attempts to circulate decreased BV

Decreased blood pressure - less peripheral resistance is present due to decreased BV

Increased respiratory rate - system attempts to increase gas exchange to better oxygenate decreased red blood cell volume.

Cold, clammy skin - vasoconstriction occurs to maintain BV in central body core

Decreased urine output - inadequate blood is entering kidneys because of decrease BV

Dizziness/decreased LOC - inadequate blood is reaching cerebrum because of decrease BV

Decreased central venous pressure - decreased blood returning to heart because of reduced BV

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Pathophysiology of Hypovolemic Shock

Blood loss
Decreased Intravascular volume
Decreased venous return, decreased cardiac output and BP
Body compensates by increasing heart rate to circulate decreased BV faster
Vasoconstriction in peripheral vessels occur to save blood for vital organs
Cold, clammy skin, decreased uterine perfusion
Reduced renal, uterine and brain perfusion
Renal failure
Maternal and fetal death

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Medical term for any interruption of a pregnancy before fetus is viable.

Abortion/Spontaneous Miscarriage

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Fetus more than 20-24 AOG, weighs 500g

Viable fetus

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Fetus born before 20-24 weeks AOG

Miscarriage

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Fetus born before 16 weeks AOG

Early miscarriage

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Fetus born before 16-20 weeks AOG

Late Miscarriage

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Pregnancy is jeopardized by bleeding and cramping but cervix is closed

Threatened miscarriage

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Uterine contractions and cervical dilatation occurs, loss of products of conception cannot be halted

Imminent (Inevitable) miscarriage

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All POC are expelled spontaneously

Complete Miscarriage

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Part of the conceptus (usually fetus) is expelled

Incomplete Miscarriage

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Early pregnancy failure, fetus dies in utero but not expelled

Missed Miscarriage

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Misoprostol drug class and MOA

Synthetic prostaglandin analog
Binds to prostaglandin receptors in uterus, leading to uterine contractions and cervical ripening

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Mifepristone drug class and mechanism of action

- Progesterone receptor antagonist - Binds to progesterone receptors in uterus, preventing progesterone from binding to its receptors, leading to discontinuation of pregnancy.

Three spontaneous miscarriage that occurs at the same AOG, formerly called habitual aborters

Recurrent Pregnancy Loss

Methergine drug class and MOA

- Ergot Alkaloid - Methylergometrine directly acts on smooth muscles of uterus and increases uterine tone and contractions by binding to dopamine D1 receptors, resulting in stronger, sustained contractions. This effect helps shorten the third stage of labor and reduce postpartum blood loss.

How much bleeding is abnormal

more than 1 PAD PER HOUR

To do when hemorrhage occurs

Monitor VS Place patient in flat position Massage fundus D&C Blood transfusion Prescribe methergine educate

To check for infections

Check for fever Abdominal pain Foul smelling vagina Educate patient wipe front to back and never use tampons

Abortion complicated by infection

Septic abortion

Metronidazole drug class and MOA

- Nitroimidazole antimicrobial - Enters the microorganism's cells, where it is reduced to active metabolites that binds to the microorganism's DNA, disrupting their structure which leads to cell death and clear infections.

To do for Septic abortion

Check for fever, abdominal pain CBC with BT, serum creatinine and electrolytes Antibiotic therapy

When fetus is RH+ and mother is RH-, when placenta is dislodged, some blood from the placental villi will enter the mother's circulation What should RH- mother receive after miscarriage?

- Isoimmunization - Rh (D antigen) immunoglobulin (RhIG) or RhoGAM

Implantation occurred outside uterine cavity

Ectopic pregnancy

Second most frequent cause of bleeding in pregnancy

Ectopic pregnancy

Pregnancy anywhere within the peritoneal cavity

Abdominal pregnancy

Most common location of abdominal pregnancy

Pouch of Douglas

Diagnosis of Abdominal pregnancy

MRI and UTZ

Methotrexate drug class and MOA

- Antimetabolite - Blocks the enzymes in the body that maintain the pregnancy. It helps stop the growth of the embryo, leading to its reabsorption or expulsion from the body.

Management of Abdominal pregnancy

Laparotomy Methotrexate

Abnormal proliferation and degeneration of trophoblastic villi

Gestation Trophoblastic Disease (Hydatidiform mole) Hydatid - drop of water Mole - spot

Labor that occurs before the end of week 37 of gestation

Preterm labor

Type of H mole

Partial and complete molar

Treatment of H mole

oxytocin d&c If mole becomes cancerous: chemotherapy and removal of cancerous tissue vacuum aspiration

Cervix that dilates prematurely, incompetent cervix

Premature cervical dilatation

Management of PCD

Cervical cerclage and Mcdonald procedure

Placenta is implanted abnormally in the lower part of uterus

Placenta previa

Types of placenta previa

Low - lower portion of uterus Partial - portion of cervical os Marginal - extend to edge of cervix Total - cervical os completely covered.

Management for Placenta Previa

Bed rest Avoid intercourse limit or no travelling avoid pelvic exams monitor i&o Check FHR

Premature separation of placent

Abruptio Placentae

Abruptio Placentae management

Blood transfusion check for presence of shock and fetal distress emergency c/s ivf oxygen

An acquired disorder of blood clotting in which fibrinogen levels falls to below effective limits

Disseminated Intravascular Coagulation

Management of DIC

Administration of heparin, blood or platelet transfusion, fresh frozen plasma/platelet

Management for preterm labor

ivf therapy bed rest monitor uterine contractions

Terbutaline drug class and MOA

- Beta 2 adrenergic agonist - stimulating beta-2 adrenergic receptors on uterine smooth muscle, increasing cyclic AMP levels, which leads to muscle relaxation and inhibition of uterine contractions.

MAGNESIUM SULFATE drug class and MOA

- Tocolytic - acting as a calcium antagonist, reducing calcium influx into smooth muscle cells and promoting muscle relaxation.

Betamethasone drug class and MOA

- Corticosteroid promotes fetal lung maturation and surfactant production by activating glucocorticoid receptors, helping reduce respiratory distress syndrome in preterm infants.

condition in which vasospasm occurs inn both small and large arteries during pregnancy

Gestational Hypertension

pregnancy related disease process evidenced by increased bp and proteinuria

preeclampsia

Variation of gestational hypertensive process

HELLP syndrome Hemolysis leads to anemia Elevated liver enzymes lead to epigastric pain Low platelets lead to abnormal bleeding/clotting

a complication of pregnancy because body need to adjust to effects of more than one fetus

multiple gestation dizygotic monozygotic

occurs when there is excess fluid of more than 2000 ml

polyhydramnios

less than average amount amniotic fluid

oligohydramnios

pregnancy that exceeds limit

post term pregnancy

done by injectingg rbc by amniocentesis technique directly into a vessel in the fetal cord

intrauterine transfusion

mother and baby blood type not compatibel

hemolytic disease