mcn (gestational conditions)

• Vaginal bleeding during pregnancy is always potentially serious and may occur at any point during pregnancy. Major causes of bleeding:

  • First and second trimesters: abortion
  • Third trimester: placenta previa and abruptio placenta
• Ectopic Pregnancy:

  • Implantation occurs outside the uterine cavity
• Hydatidiform mole (Gestational Trophoblastic Disease):

  • Abnormal proliferation and degeneration of trophoblastic villi
  • As the cells degenerate, they become filled with fluid and appear as clear fluid- filled, grape -sized vesicles.
• Cervical Insufficiency:

  • Also known as Premature cervical dilation/ incompetent cervix
• Placenta:

  • Temporary organ connecting baby to the uterus during pregnancy
• Placenta Previa:

  • Condition where the placenta is implanted abnormally in the uterus
  • Most common cause of bleeding in the third trimester
• Abruptio Placenta:

  • Premature separation of the placenta
  • Symptoms include bleeding and abdominal pain, especially during the third trimester
• Disseminated Intravascular Coagulation (DIC):

  • Serious disorder where blood clotting proteins become overactive
  • Can result in extreme blood loss
• Preterm Labor:

  • Labor before the end of week 37 of gestation
  • Common symptoms include backache, vaginal spotting, pelvic pressure, abdominal tightening, cramping, increased vaginal discharge, uterine contractions, and intestinal cramping
  • Therapeutic management includes hospitalization, bed rest, IV fluid therapy, tocolytic agents, and limiting strenuous activities
• Premature Rupture of Membranes (PROM):

  • Rupture of fetal membranes with loss of amniotic fluid before 37 weeks
  • Symptoms include leaking or gush of watery fluid from the vagina and constant wetness in underwear
  • Diagnosis through cervical examination, pH testing of fluid, dried fluid analysis, and ultrasound
  • Treatment includes hospitalization, expectant management, monitoring for infection, corticosteroids, antibiotics, and tocolytics
• Pregnancy-Induced Hypertension:

  • Vasospasm during pregnancy in small and large arteries
  • Signs include hypertension, proteinuria, and edema
  • Risk factors include multiple pregnancies, young or older age, low socioeconomic background, hydramnios, and underlying diseases
  • Gestational hypertension involves elevated BP without proteinuria or edema
• Pre-eclampsia:

  • Pregnancy complication with high blood pressure and organ damage signs
  • Mild pre-eclampsia involves proteinuria and BP rise
  • Severe pre-eclampsia includes higher BP levels, proteinuria, and extensive edema
  • Symptoms may include epigastric pain, nausea, vomiting, shortness of breath, visual disturbances, and ankle clonus
• Eclampsia:

  • Most severe form of pregnancy-induced hypertension
  • Characterized by grand-mal seizure or coma due to acute cerebral edema
  • Maternal mortality rate increases due to complications like cerebral hemorrhage, circulatory collapse, or renal failure
  • Nursing management involves monitoring antiplatelet therapy, promoting bed rest, good nutrition, blood pressure monitoring, and administering medications to prevent eclampsia
• HELLP Syndrome:

  • Hemolysis leading to anemia, elevated liver enzymes causing epigastric pain, and low platelets leading to abnormal bleeding/clotting
  • Risk factors include age, obesity, history of preeclampsia, diabetes, multiple births, and high blood pressure
  • Symptoms include abdominal pain, increased BP, blurred vision, malaise, fatigue, edema, weight gain, N&V
  • Lab studies reveal hemolysis, thrombocytopenia, and elevated liver enzyme levels
• Amniotic fluid:

  • At first, consists of water from the mother's body
  • Gradually, larger proportion is made up of the baby's urine
  • Keeps a steady temperature around the baby
  • Helps baby's lungs grow and develop because the baby breathes in the fluid
  • Helps baby's digestive system develop because the baby swallows the fluid
  • Helps baby's muscles and bones develop because the baby can move around in the fluid
  • Keeps the umbilical cord from being squeezed
  • Contains important nutrients, hormones, and antibodies to protect the baby from bumps and injury
• Polyhydramnios:

  • Excessive accumulation of amniotic fluid around the baby in the uterus
  • More than 2,000 ml amniotic fluid volume
  • Can cause fetal malpresentation
  • Can lead to PROM from increased pressure with possible prostaglandin release
  • Symptoms include rapid enlargement of the uterus, shortness of breath, varicosities and hemorrhoids, uterine discomfort or contractions, and fetal malposition such as breech presentation
• Oligohydramnios:

  • Refers to a pregnancy with less than the average amount of amniotic fluid
  • Can lead to weak muscles at birth, hypoplastic lungs, and distorted features of the face
  • Treatment includes amnio transfusion or installation of fluid into the uterus by amniocentesis
• Rh Incompatibility:

  • Develops when a pregnant woman has Rh-negative blood and the baby has Rh-positive blood
  • Rh-positive blood has a protein factor (D antigen) that Rh-negative people do not
  • Mother's immune system reacts and creates Rh antibodies, leading to Rh sensitization
  • Can cause hemolytic disease of the newborn or erythroblastosis fetalis
  • Treatment includes Rh immunoglobulin injections
• Fetal Death:

  • Intrauterine fetal death (IUFD) can be a difficult experience for mothers and families
• Key Points for Review:

  • PROM is tearing of the fetal membranes with loss of amniotic fluid before term
  • PIH is a disorder with hypertension, edema, and proteinuria
  • HELLP syndrome is marked by hemolysis of RBCs, elevated liver enzymes, and low platelet count
  • Post-term pregnancy extends beyond 42 weeks
  • Polyhydramnios is overproduction of amniotic fluid, while oligohydramnios is a lessened amount
• Isoimmunization (Rh incompatibility) occurs when a woman who is Rh negative is sensitized and carries a fetus who is Rh positive
• Ruptured ectopic pregnancy signs:

  • Rigid abdomen
  • Cullen sign (bluish tinged umbilicus)
  • Extensive or dull vaginal or abdominal pain
  • Pain in shoulders
  • Tender mass palpable in Douglas cul-de-sac on vaginal examination
• • Cullen sign (bluish tinged umbilicus)
• • Tender mass palpable in Douglas cul-de-sac on vaginal examination
• Types of placental separation:

  • Partial placental abruption
  • Apparent or revealed placental abruption
  • Complete or total placental abruption
• Two types of molar growth:

  • Complete mole “Diploid” - 46 chromosomes
  • Partial mole “Triploid” - 69 chromosomes
• degrees of placenta previa:

  1. Low-lying placenta
  2. Marginal implantation
  3. Partial placenta previa
  4. Total placenta previa
• Other complications that can cause bleeding are ectopic pregnancy and gestational trophoblastic disease.
• Abortion

  Is the medical term for any interruption of a pregnancy before a fetus is viable ( able to survive outside the uterus if born at that time).
• A viable fetus is usually defined as a fetus of more than 20 to 24 weeks of gestation or one that weighs at least 500 g.
• Elective abortion, is the planned medical termination of a pregnancy
• Spontaneous miscarriage - Is an early miscarriage that occurs between weeks 16 and 24. The presenting symptom is almost always vaginal spotting.
• Spontaneous causes:

  • Abnormal fetal development due to teratogenic factor or to a chromosomal aberration.
  • Implantation abnormalities with inadequate implantation, the placental circulation does not develop adequately, leading to poor fetal nutrition.
  • Systemic infection
• Spontaneous miscarriage occurs in 15% to 30% of all pregnancies and arises from natural causes.
• TYPES OF SPONTANEOUS MISCARRIAGE (ABORTION)

  • Threatened miscarriage
  • Imminent Miscarriage
  • Complete miscarriage
  • Incomplete miscarriage
  • Missed miscarriage
  • Recurrent Pregnancy loss
• Threatened miscarriage

  • Is a term used to describe abnormal bleeding and abdominal pain that occurs while the pregnancy still continues.
  • A woman may notice slight cramping, but no cervical dilation is present on vaginal examination.
• Imminent Miscarriage

  • A threatened miscarriage becomes imminent (inevitable) miscarriage if uterine contractions and cervical dilation occur.
  • With cervical dilation.
  • Discharge of clear fluid from vagina.
• Complete miscarriage

  • The entire products of conception (fetus, membranes and placenta) are expelled spontaneously without any assistance.
• Incomplete miscarriage

  • In a incomplete miscarriage, part of the conceptus ( usually the fetus) is expelled, but the membrane or placenta is retained in the uterus.
• Missed miscarriage

  • Also referred as “early pregnancy failure”, the fetus dies in the utero but is not expelled.