MATERNAL WEEK4

• Ectopic pregnancy is when implantation occurs outside the uterine cavity
• Most common site for ectopic pregnancy is in a fallopian tube
• Causes of ectopic pregnancy include obstruction, congenital malformations, scars from tubal surgery, uterine tumor pressing on the tube
• Approximately 2% of pregnancies are ectopic
• Risk factors for ectopic pregnancy include smoking, intrauterine devices (IUDs), and in vitro fertilization
• Women with one ectopic pregnancy have a 10% to 20% chance of another ectopic pregnancy
• No unusual symptoms at the time of implantation in ectopic pregnancy
• Symptoms of ectopic pregnancy include abdominal pain, vaginal bleeding, shoulder pain, weakness, dizziness, nausea, vomiting, pelvic pain, painful urination or bowel movements
• If not revealed by ultrasound, ectopic pregnancy can rupture the fallopian tube causing bleeding
• Signs of a ruptured ectopic pregnancy include rapid pulse, rapid respirations, falling blood pressure, leukocytosis, normal temperature
• Therapeutic management of ectopic pregnancy includes methotrexate treatment, hysterosalpingogram or ultrasound, laparoscopy, and blood transfusion if needed
• If a fallopian tube is removed due to ectopic pregnancy, fertility may be affected
• Nursing diagnoses for ectopic pregnancy include acute pain, anxiety, risk for fluid volume deficit, knowledge deficit, disturbed body image, risk for infection, grieving, impaired social interaction
• Gestational trophoblastic disease includes hydatidiform mole
• Incidence of gestational trophoblastic disease is approximately 1 in every 1500 pregnancies
• Types of hydatidiform mole include partial and complete with different genetic origins and chromosomal makeups
• Partial hydatidiform mole involves triploid chromosomal pattern, while complete hydatidiform mole involves diploid chromosomal pattern
• Risk factors for gestational trophoblastic disease include low protein intake, women older than 35 years, women of Asian heritage, and specific blood group combinations
• Persistent trophoblastic disease risk is lower in partial hydatidiform mole compared to complete hydatidiform mole
• Fetal tissue presence differs between partial and complete hydatidiform mole
• Therapeutic management for hydatidiform mole involves suction curettage to evacuate the mole
• After surgery for hydatidiform mole, hCG levels remain high
• Half of women still have a positive hCG reading at 3 weeks; one-fourth still have a positive test result at 40 days
• hCG levels are then analyzed every 2 weeks until levels are normal
• After that, serum hCG levels are assessed every 4 weeks for the next 6 to 12 months
• Levels that plateau for three times or increase suggest malignant transformation
• A reliable contraceptive method should be used for 12 months after surgery to prevent confusion with increasing hCG levels and a developing malignancy
• After 6 months of negative hCG levels, the risk of malignancy is theoretically eliminated
• By 12 months, a woman could plan a second pregnancy
• Nursing interventions for hydatidiform mole include regular monitoring of vital signs, bleeding assessment, fluid balance monitoring, emotional support, pain management, education, and monitoring for complications
• Nursing diagnoses for hydatidiform mole include acute pain, anxiety, risk for deficient fluid volume, knowledge deficit, risk for infection, grieving, disturbed body image, risk for altered parenting, fear, and risk for postoperative complications
• Premature cervical dilatation, also known as incompetent cervix, refers to a cervix that dilates prematurely and cannot hold a fetus until term
• Causes of premature cervical dilatation include increased maternal age, congenital structural defects, and trauma to the cervix
• Cervical cerclage can be performed after the loss of one child due to premature cervical dilatation to prevent recurrence in a second pregnancy
• Cervical cerclage involves purse-string sutures placed in the cervix to strengthen and prevent dilation
• Success rate of cerclage techniques is 80% to 90%
• After cerclage surgery, women remain on bed rest for a few days to decrease pressure on the sutures
• Placenta previa is a condition where the placenta is implanted abnormally in the uterus
• Placenta previa is the most common cause of painless bleeding in the third trimester of pregnancy
• Placenta previa occurs in four degrees: low-lying placenta, marginal implantation, partial placenta previa, and total placenta previa