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• High Risk Pregnancy I (Bleeding Disorders)
• Emergency Interventions

  1. Alert health care team of emergency situation

  2. Place woman flat in bed on her side

  3. Begin IVF as ordered (LR using G16 or G18 needle)

  4. Administer O2 (6-10 LPM) via face mask

  5. Monitor uterine contractions and FHR by external monitor

  6. Avoid vaginal examination

  7. Withhold oral fluid

  8. Blood typing and crossmatching of 2 units whole blood as ordered

  9. Measure input (I) and output (O)

  10. Assess vital signs (VS) q 15 mins; apply pulse oximeter and automatic BP cuff as necessary

  11. Assist with placement of central venous pressure or pulmonary artery catheter and blood determinations

  12. Measure maternal blood loss by weighing perineal pads; save any tissue passed

  13. Set aside 5 mL of blood drawn intravenously in a clean test tube; observe in 5 mins for clot formation

  14. Assist with ultrasound examination

  15. Maintain positive attitude about fetal outcome

  16. Provide emotional support
• Types of Ectopic Pregnancy

  • Tubal (Fallopian tube – interstitial, isthmic, infundibulum and fibrial portion)
  • Cervical
  • Abdominal
  • Ovarian
• Causes of Abortion/Miscarriage

  • Abnormal fetal development (teratogenic factor or chromosomal aberration)
  • Immunologic factor (rejection of embryo through immune response)
  • Implantation abnormalities
  • Inadequate progesterone
  • Systemic infection (Rubella, syphilis, poliomyelitis, cytomegalovirus, toxoplasmosis)
  • Ingestion of teratogenic drug
• Assessment Findings of Ectopic Pregnancy

  • Amenorrhea or abnormal menstrual period/spotting
  • Early signs of pregnancy
  • Tubal rupture signs – sudden, acute low abdominal pain radiating to the shoulder (Kehr’s sign) or neck pain
  • Nausea and vomiting
  • Bluish navel (Cullen’s sign)
• Spontaneous Miscarriage/Abortion

  1. Abortion: Medical term for interruption of a pregnancy before the fetus is viable

  2. Miscarriage: Interruption of a pregnancy occurs spontaneously
• Predisposing Factors for Ectopic Pregnancy

  • Fallopian tube narrowing or constriction
  • Pelvic Inflammatory Disease (PID)
  • Puerperal and postpartal sepsis
  • Surgery of the fallopian tubes
  • Congenital anomalies of the fallopian tubes
  • Adhesions, spasms, tumors
  • IUD usage
• Hydatidiform mole


  Abnormal proliferation and degeneration of the trophoblastic villi
• Hydatidiform mole is an abnormal proliferation and degeneration of the trophoblastic villi
• Possible causes of tubal rupture


  • Adhesions, spasms, tumors, IUD usage
• Methotrexate


  Prevents the zygote from growing by blocking enzymes in the body that maintain the pregnancy, thus preventing rupturing of the fallopian tube
• Risk factors for hydatidiform mole

  • Low protein intake
  • Women older than 35 years old
  • Asian women
  • Women with blood group A who marry men with blood group O
• Leucovorin


  Used to protect cells from effects of methotrexate and decrease its side effects
• Abruptio Placenta is the premature separation of the implanted placenta before the birth of the fetus
• Nursing Management for Choriocarcinoma

  1. Advise bed rest

  2. Monitor vital signs, blood loss, molar/tissue passage, intake and output

  3. Maintain fluid and electrolyte balance, plasma, and blood volume through replacements as ordered

  4. Prepare for suction D&C or hysterectomy as ordered

  5. Provide psychological support

  6. Prepare for discharge emphasizing the need for follow-up HCG titer determination for 1 year and instructions related to contraception
• Nursing Management for Premature Cervical Dilatation (Incompetent Cervix)

  1. Provide psychological support to clients who may have negative feelings

  2. Provide post-cerclage procedure care

  3. Advise limitation of physical activities within 2 weeks after treatment

  4. Monitor maternal and fetal growth

  5. Instruct to report promptly signs of labor

  6. Assess signs of labor, infection, or premature rupture of membranes

  7. In labor, prepare STITCH REMOVAL SET in addition to delivery set (post-McDonalds surgery)
• Treatment for Choriocarcinoma

  1. Evacuation by suction dilatation and currettage (D&C) or hysterectomy if no spontaneous evacuation

  2. Hysterectomy if above 45 years old and no future pregnancy is desired

  3. HCG titer monitoring for one year (no pregnancy for one year)

  4. Medical replacement: blood, fluid, plasma

  5. Chemotherapy for malignancy: Methotrexate is drug of choice

  6. Chest X-ray
• Treatment for Premature Cervical Dilatation (Incompetent Cervix)

  1. Conservative management: bed rest, avoidance of heavy lifting, no coitus

  2. For women with previous losses: elective cervical cerclage (late first trimester or early second trimester) including Shirodkar procedure and McDonald procedure
• Predisposing factors for Abruptio Placenta

  • Types of Abruptio Placenta
  • Types of Placental Separation: Marginal/Low Separation, Moderate/High Separation, Severe/Complete Separation
• Choriocarcinoma is associated with the premature separation of the implanted placenta before the birth of the fetus
• Any woman having persistent uterine contraction (4 q 20 mins) is associated with preterm labor
• Preterm labor occurs after the 20th week and before the 37th week of gestation
• Types of Placental Separation

  1. Marginal/Low Separation

  2. Moderate/High Separation

  3. Severe/Complete Separation
• Preterm labor occurs in approximately 9-11% of all pregnancies
• In over 30% of cases, the exact cause of preterm labor is unknown
• Factors associated with Preterm Labor

  • Dehydration
  • Urinary Tract Infection
  • Periodontal disease
  • Chorioamnionitis
  • Strenuous job or extreme fatigue
• Types of Abruptio Placenta

  1. Marginal/Low Separation

  2. Moderate/High Separation

  3. Severe/Complete Separation