Pregnancy Related Complications and 1st Trimester Complications Flashcards
1
Q
Nurse’s Role
A
help client who is at risk as well as their family, make sure the fetus will be carried up to full term
2
Q
SDG
A
- good health and wellbeing by 2030
- reduce neonatal and maternal mortality rate
3
Q
danger signs of pregnancy
A
- vaginal bleeding
- persistent vomiting
- chills and fever
- sudden escape of fluid from vagina
- abdominal or chest pain
- absence of fetal heart sounds
- swelling of face and fingers
- flashes of light
- blurring of vision
- severe headache and dizziness
4
Q
Vaginal Bleeding
A
- should be reported immediately
- evaluate degree of bleeding
- may lead to hypovolemic shock due to blood loss
- detachment of placenta
- hemorrhage
5
Q
Amenorrhea
A
absence of vaginal bleeding
6
Q
Persistent Vomiting
A
- hyperemesis gravidarum
- n&v that continues after 12 weeks of pregnancy (extended vomiting)
- depletes nutritional value to fetus
- may led to malnutrition, dehydration
7
Q
Morning Sickness
A
normal vomiting in the morning
8
Q
Chills and Fever
A
- may be due to intrauterine infections
- serious to both mother and fetus
9
Q
UTI
A
- teach px to wipe from front to back
- if untreated, infection might travel towards kidney which may cause preterm labor, low birth weight, or both might suffer from sepsis
10
Q
Chorioamnionitis
A
- chorion and amnion
- patient will experience vaginal discharges, increased heart rate
11
Q
Sudden Escape of Fluid from Vagina
A
- membranes ruptured
- mother and fetus are threatened because uterine cavity is no longer sealed against infection
- amniotic fluid leakage
- could lead to birth defects, still birth, miscarriage, premature
12
Q
Nuchal Cord
A
- umbilical cord is squeezed into the fetus;
sometimes cord is wrapped around the baby’s neck - fetal distress could lead to CS
13
Q
Rupture of Membranes
A
bacteria could enter the uterus, fetus causing infection
14
Q
Abdominal or Chest Pain
A
- may mean tubal pregnancy have ruptured
- separation of placenta
- preterm labor
- may cause: ectopic pregnancy, abruptio placenta, preterm labor
CHEST PAIN - pulmonary embolus that follows thromboplebitis
15
Q
Abdominal or Chest Pain: ASK
A
- which trimester the patient experienced abdominal
pain - if abdominal pain includes bleeding
16
Q
Deep Vein Thrombosis (DVT)
A
- Homan’s sign
- avoid massaging because thrombus can travel which
can lead to pulmonary embolism then maternal death
17
Q
Intrauterine Fetal Demise/ Still Birth
A
- after they have been
initially auscultated on the 4th and 5th month - monitor comparison of presence
of fetal heart tone - if IUFD left undetermined, could change the clotting system putting the client at higher risk for significant bleeding
18
Q
Stillborn
A
- should still be delivered
- caused by infections or chorioamnionitis
19
Q
Swelling of Face and Fingers
A
- could be a symptom of preeclampsia or presence of protein in urine
- edema on lower extremities is normal but not on face and fingers
20
Q
Flashes of Light/ Blurring of Vision/ Severe Headache and Dizziness
A
could be a symptom of pereclampsia
21
Q
Complications of Pregnancy
A
- Hyperemesis Gravidarum
- Vaginal Bleeding during Pregnancy
22
Q
Hyperemesis Gravidarum
A
- pernicious/ persistent vomiting
- excessive n&v beyond 12 weeks AOG (until 16 weeks)
- might lead to complications like dehydration, weight loss, starvations & fluid & electrolyte imbalance
23
Q
Hyperemesis Gravidarum (Causes)
A
UNKNOWN but is highly associated with:
- thyroid function
- hcG
- H. pylori (bacteria that causes ulcerations)
24
Q
Hyperemesis Gravidarum Assessment
A
- excessive n&v
- ketonuria
- elevated hematocrit concentration
- hyponatremia, hypokalemia, and hypochloremia
- hypokalemic alkalosis
- ataxia and confusion
25
Hyperemesis Gravidarum (Excessive N&V)
provide dry crackers
26
Signs of Dehydration
- thirst
- increase in PR
- significant weight loss
- concentrated and scanty urine (dark colored)
27
Hyperemesis Gravidarum (Ketonuria)
- (+) ketones in urine
- body is breaking down stored fats for nutrients
28
Hyperemesis Gravidarum (Elevated Hematocrit Concentration)
NORMAL: 36-48%
- if px is unable to retain fluid, could lead to hemoconcentration
29
Hemoconcentration
- viscous blood
- could lead to thromboembolism
30
Hyperemesis Gravidarum (Hyponatremia, Hypokalemia, and Hypochloremia)
- Normal Na+: 135-145 mEq/L
- Normal K+: 3-5 mEq/L
- Normal Cl-: 96-106 mEq/L
31
Hyperemesis Gravidarum (Hypokalemic Alkalosis)
loss of hydrochloric acid because of constant vomiting
32
Hyperemesis Gravidarum (Ataxia and Confusion)
- Signs of Wernicke - Knockaff Syndrome
- Thiamine, Vitamin B1 deficiency
- worst case that could develop to px
33
Hyperemesis Gravidarum Nursing Diagnoses
1. Imbalanced nutrition, less than body requirements, related to prolonged vomiting
2. Risk for deficient volume related to vomiting
34
Hyperemesis Gravidarum Therapeutic Management
- NPO for the first 24 hours
- Administer 3L of IV fluid (Lactated Ringers + Vitamin B1)
- Metoclopramide – antiemetic will be given
○ To help stop the vomiting
- Strict monitoring of intake and output
○ If NPO monitor intake of IV fluids and urine output; measure and check the characteristics of the urine
- If no vomiting after 24 hours of NPO, progress diet to small amounts of clean fluid, dry toast, and crackers to soft diet then to a regular diet
35
Vaginal Bleeding
- discharge of blood from vagina
- can happen any time from conception (when the egg is fertilized to the end of pregnancy
- identify what kind of bleeding the px is experiencing (spotting/bleeding/hemorrhage)
36
Vaginal Bleeding (Spotting)
- few drops of blood on underwear
- could be caused by infection, zygote being implanted in the uterus, hormone changes
37
Vaginal Bleeding (Bleeding)
- heavier flow
- saturated pads every hour
- blood loss more than 500 mL/ cc
- miscarriage, abortion, ectopic pregnancy, molar pregnancy, causesbleeding in the first trimester
38
First Trimester Bleeding indicates:
1. abortion
2. miscarriage
3. ectopic (tubal pregnancy)
4. hydatidiform mole
39
Abortion
- interruption of pregnancy before fetus is viable
- expulsion or extraction of an embryo or fetus weighing 500 grams or less from its mother (WHO)
40
Viable Fetus
20-24 weeks
41
Abortus
less than 500 grams
42
Abortion Common Causes
1. abnormal fetal development
2. implantation abnormalities
3. lack of progesterone produced
4. infections
5. ingestions of teratogens
6. stress
43
Abortion (Abnormal Fetal Development)
- may be caused by a teratogen (factors)
- immunologic problems causing rejection
44
Abortion (Implantation Abnormalities)
- 50% of zygotes are not implanted properly
- endometrium is where zygote should be implanted
- inadequate endometrial implantation = not enough circulation towards placenta
45
Abortion (Lack of Progesterone Produced)
- corpus luteum fails to produce enough progesterone = decidua basalis will not be maintain properly = bleeding
- early pregnancy spotting = progesteron therapy (Duphaston: Dydrogesterone)
46
Abortion (Infection)
- UTI, chorioamnionitis = preterm
- rubella, syphilis, toxoplasmosis, cytomegalovirus = miscarriage
- fetus will not grow, estrogen and progesterone decrease = uterus contraction = cervical dilation and expulsion of products of pregnancy
47
Abortion (Ingestion of Teratogens)
alcoholic beverages at the time of conception
48
Abortion (Stress)
- triggers release of prostaglandins
49
Prostaglandins
causes uterine contractions which leads to cervical dilation then products of pregnancy can be lost, especially in early pregnancy
50
Early Miscarriage
occurs before 16 weeks
51
Late Miscarriage
occurs between 16-20 weeks
52
Spontaneous Miscarriage
there is already cervical dilation
53
Threatened Miscarriage
- baby is not yet aborted
- cervical OS still intact and closed
54
Threatened Miscarriage Assessment
1. scanty vaginal bleeding
2. bright red vaginal bleeding
3. no cervical dilations on IE
4. slight abdominal cramping
5. (+) hcG
55
Threatened Miscarriage Therapeutic Management
- assess FHR and fetal well-being
- check what activity causes event
- avoid strenuous activity for 24- 48 hours
- need for sympathetic and supportive person
- restrict coitus for 2 weeks after bleeding episode to prevent infection
56
Imminent/ Inevitable Miscarriage
when uterine contractions and cervical dilations occur
57
Imminent/ Inevitable Miscarriage Assessment
- moderate to profuse bleeding
- moderate to severe uterine cramping
- cervix dilated
- ruptured membrane
58
Imminent/ Inevitable Miscarriage Therapeutic Management
- save any tissue fragments and bring to the hospital for
examination
○ pa-describe sa patient ang bleeding
○ kung pwede dalhin sa ospital for examination
- assess FHR and fetal well being
○ through ultrasound and/or doppler
- if no FHR, D&E (dilation and evacuation) is advised.
- administer oxytocin after D&C
- inform the patient that pregnancy is lost
59
Imminent/ Inevitable Miscarriage Risks and Adverse Effects
1. uterine perforation
2. cervical laceration
3. injury to intestines, bladder, and blood vessels
4. hemorrhage and infection
5. maternal death
6. future pregnancy complications
60
Imminent/ Inevitable Miscarriage Dilatation and Evacuation
- to clean uterus and prevent further infection
- after procedure, assess patient for vaginal bleeding and count number of pads used
61
Complete Miscarriage
entire products of conception (fetus, membranes, placenta) are expelled spontaneously without any assistance
62
Complete Miscarriage Assessment
1. lower abdominal cramping
2. vaginal bleeding
3. passage of products of conception
63
Incomplete Miscarriage
products of conception expelled but membrane or placents is retained in uterus
64
Incomplete Miscarriage Assessment
1. abdominal cramping
2. vaginal bleeding
65
Incomplete Miscarriage Therapeutic Management
- d&c or suction curettage
- inform patient that pregnancy is lost
66
Missed Miscarriage
- Early Pregnancy Failure
- fetus dies in utero but is not expelled
- usually discovered during prenatal checkup
- upon assessment of fundal height:
○ No increase in fundal height
○ No presence of fetal heart tone
67
Missed Miscarriage Assessment
1. fundic height remains the same
2. no fetal heart tones
3. painless vaginal bleeding
4. ultrasound will confirm there is no heart rate
68
Missed Miscarriage Therapeutic Management
- d&e
- less than 14 weeks = labor is induced by prostaglandin suppository or misoprostol (Cytotec); oxytocin stimulation
- provide emotional support and accepting attitude
- refer to counselling
69
Recurrent Pregnancy Loss
- habitual aborters
- woman who has a hx of 3 spontaneous miscarriage at the same AOG
- evaluate reason for successful future pregnancies
70
Recurrent Pregnancy Loss Possible Causes
1. defective spermatozoa or ova
2. endocrine factors
3. deviation of uterus
4. chorioamnionitis or uterine infection
5. autoimmune disorders
71
Complications of Miscarriage
1. hemorrhage
2. infection
3. isoimmunization
4. powerlessness and anxiety
72
Complications of Miscarriage (Hemorrhage)
- assess cause of miscarriage
- check extent of bleeding, color, and odor
- monitor vs for signs of hypodermic shock
- place patient in supine
- provide funsal massage
- demonstrate supportive attitude
- prepare for d&c if possible
- administer blood components as prescribed
- administer oral medication (Methergine) as prescribed
73
Complications of Miscarriage (Infection)
- check for fever (38C), abdominal pain, or tenderness and foul vaginal discharge
- instruct px to practice proper perineal cleaning
- avoid using tampon
- demonstrate aseptic technique in handling px
74
Complications of Miscarriage (Isoimmunization)
administer RhIG as prescribed
75
Complications of Miscarriage (Powerlessness and Anxiety)
- deal with patient with an understanding and supportive attitude
- encourage verbalization of feelings
- refer to counseling if necessary
76
Septic Abortion
abortion that is complicated by infections
77
Septic Abortion Assessment
1. foul smelling vaginal discharge
2. uterine cramping
3. fever
78
Septic Abortion Therapeutic Management
- check for signs and symptoms of infection
- assist px during intensive treatment (CBC, electrolyte evaluation, urine culture, etc)
- insert indwelling catheter as prescribed
- initiate IV insertion and monitor as prescribed
- administer antibacterial meds as prescribed
- assist in d&c or d&e procedure
- inform px of possible risks
- refer px for counselling
79
Ectopic Pregnancy
- implantation outside the uterine cavity
- usually in fallopian tube, cervix, and ovaries
○ 95% occurs in the fallopian tube
■ 80% in the ampullary portion
■ 12% in the isthmus
■ 2% in the fimbriae
- second leading cause of bleeding in early pregnancy
80
Ectopic Pregnancy Etiology
1. history of ectopic pregnancy
2. smoking
3. tubal surgery
4. previous pelvic/ abdominal surgery
5. previous genital infection (gonorrhea, chlamydia, pelvic inflammatory disease)
6. sexual intercourse early before 18 years old
81
Ectopic Pregnancy Assessment
1. amenorrhea or abnormal menstruation followed by slight bleeding
2. vaginal spotting or bleeding
3. UTZ - ruptured tube and blood at the perineum
4. sharp stabbing pain (ruptured ectopic pregnancy; tubal rupture)
5. decreasing hcG level/ serum progesterone
6. hard or rigid abdomen
7. cullen's sign
8. continuous and extensive or dull abdominal and vaginal pain
9. shoulder pain
10. palpable tender cul-de-sac mass
11. lightheadedness (late sign)
12. tachycardia, tachypnea, hypotension, pallor, cold clammy skin, cyanotic nail beds (late sign)
82
Ectopic Pregnancy Diagnostic Tests
- cuidocentesis
- ultrasound
83
Cuidocentesis
checks for abdominal fluid in the abdominal cavity behind the uterus
84
Ectopic Pregnancy Therapeutic Management
1. conservative therapy
2. surgical intervention (salpingostomy, salpingotomy, salpingectomy)
3. fimbrial evacuation
4. salpingo-oophectomy
5. administration of RhIG
85
Ectopic Pregnancy (Conservative Therapy)
- remove ectopic pregnancy and preserve reproductive function through single dose of Methotrexate (safe, effective, and associated with minimal costs when used in carefully selected px)
86
Ectopic Pregnancy (Salpingostomy)
removal of a conceptus les than 2 cm located at the distal portion of the fallopian tube by performing a linear incision over the ectopic pregnancy; conceptus will extrude from the incision and be removed manually
87
Ectopic Pregnancy (Salpingotomy)
longitudinal incision is made over the ectopic pregnancy and the conceptus is removed using forceps or gentle suction
88
Ectopic Pregnancy (Salpingectomy)
removal of the ruptured tube because the presence of a scar if tube is repaired and left can lead to another tubal pregnancy
89
Ectopic Pregnancy (Fimbrial Evacuation)
removal of conceptus by milking and suctioning the fallopian tube
90
Ectopic Pregnancy Nursing Responsibilities
- initiate IV with large bore catheter
- maintain fluid volume
- assist in obtaining blood sample (CBC, typing)
- monitor vs, i&o, blood loss
- prevent and treat hemorrhage (main danger)
- blood transfusion
- place patient flat with legs elevated
- provide comfort
- administer analgesic
- promote relaxation
- provide support during grief
91
Hydatidiform Mole (Molar Pregnancy)
- gestational trophoblastic disease
- abnormal proliferation and degeneration of trophoblastic villi
- mass of abnormal rapidly growing trophoblastic tissue in which avascular vesicles hang in like grapelike clusters that produce large amounts of HCG
- fluid-filled once degenerated
- should be identified since they are highly associated with metastatic cancer: Choriocarcinoma
92
H. Mole Predisposing Factors
1. 17 years old below and above 35 years old
2. low socioeconomic status
3. low protein intake
4. history of h. mole (partial = 15%; complete = 20%)
5. higher incidence in asian women (women blood type A and partner blood type O)
93
Complete H. Mole
- trophoblastic villi swell and become cystic
- embryo is dead (1-2 mm)
- no fetal blood present
- 46XX or 46XY
- has higher risk to progress to cancer
94
Partial H. Mole
- some villi are formed normally
- villi are swollen and misshapen
- 69 chromosomes
- 69XXX or 69XXY
- sperm did not undergo any reduction or division (did not reach meiosis; doubled)
95
H. Mole Assessment
- amenorrhea
- positive PT
- HCG about 1-2 million IU (normal: 400k IU)
- no fetal heart sound
- very rare that fetus will be born
- trophoblast cell overgrow resulting into uterine size getting bigger compared to usual pregnancy; they expand much faster
- 100-130 days HCG levels peak: declines
- HCG level should be evaluated because it doubles in amount even if it reached at 100-130 days
○ should also be assessed because it can be molar pregnancy or multiple pregnancy
■ multiple pregnancy
● increase HCG
● increase in uterine size
- n&v
- hypertension, proteinuria, edema
- UTZ reveal dense growth (snowflake pattern: no viable fetus and heart sound and movement but increasing HCG) but no fetal growth
- 16th week vaginal bleeding (spotting of dark brown blood, profuse fresh flow, prune juice in color)
- discharge of clear fluid-filled vesicles (hydropic vesicles)
96
H. Mole Management
- suction curettage to evacuate abnormal trophoblast cells
- baseline pelvic exam
- HCG serum test every 2 weeks until normal
- if above childbearing age, hysterectomy to remove uterus
- Total Abdominal Hysterectomy Bilateral Salpingo Ostectomy (TAHBSO)
- Total Abdominal Hysterectomy (TAH)
- removal of uterus, cervix, fallopian tube, and ovaries
97
H. Mole Complications
1. gestational trophoblastic tumor
2. choriocarcinoma
98
Gestationsl Trophoblastic Tumors
persistent trophoblastic proliferation after H. Mole
99
Choriocarcinoma
most severe malignant complication that involves the transformation of chorion into cancer cells that invade and erode blood vessels and uterine muscles
100
H. Mole Therapeutic Management
- suction (to see if HCG levels are declining)
- woman should not get pregnant for 1 year and should use reliable contraceptive
- hysterectomy for women above 40
- chest xray every 3 months for 6 months (check metastasis; lungs most common)
- chemotherapy (Methotrexate) if:
○ HCG titers are increased for 3 consecutive weeks or double at anytime
○ HCG titers remain elevated 3-4 months after delivery
101
H. Mole Nursing Management
- maintain fluid and electrolyte balance
- pills should not be given since it promotes regrowth of chorionic villi
- administer blood replacement as ordered
- provide emotional support
102
H. Mole Nursing Diagnoses
1. fear
2. deficient knowledge
