Pregnancy Related Complications

• 3 most common reasons for bleeding in the first half of pregnancy

  1. Abortion
  2. Ectopic Pregnancy
  3. Gestational trophoblastic disease (hydatiform mole)
• Causes of spontaneous abortions

  • 50-60% are from chromosomal abnormalities
  • Maternal infections
  • Hypothyroidism and IDDM
• Threatened abortion

  • Bleeding is the first sign
  • Experience light or spotted bleeding
  • Hallmark signs: cervix remains closed, hCG levels rise & uterine size increases
  • Management: no intercourse until bleeding stops and count pads plus note quantity, color or if any tissue has passed. (Bedrest not effective)
• Imminent/Inevitable Abortion

  • Usually cannot be stopped
  • Membranes often rupture
  • Cervix is typically dilating
  • Active bleeding may be present and heavy
  • Management: making sure all POC have been expelled
• Incomplete Abortion

  • Some but not all POC are expelled
  • Active bleeding and severe abdominal cramping
  • Cervix is open
  • Management: cardiovascular stability due to bleeding, type & screen, IV line for fluid replacement, D&C-not done after 14 weeks, and uterotonics.
• Complete Abortion

  • All POC's are expelled
  • Contractions and bleeding stop
  • Cervix closes
• Missed abortion

  • Fetus dies in the first half of pregnancy, but the fetus is retained in the uterus
  • Symptoms of pregnancy disappear
  • D&C may be done, or labor is induced
• Recurrent spontaneous abortions

  • AKA habitual abortions: 3 or more consecutive spontaneous abortions
  • Nursing considerations: Monitor for hypovolemic shock (tachycardia-early sign), lightheadedness, syncope, falling blood pressure-late sign, pale skin & mucous membranes, confusion, restlessness & cool & clammy skin.
• Ectopic Pregnancy

  • Implantation of a fertilized ovum in an area outside the uterine cavity, more than 95% occur in the fallopian tube
  • Most common in non-white women, especially more than 35 years
  • Fallopian scarring or anatomical defects
  • Signs/Symptoms: missed menstrual period, abdominal & pelvic pain, vaginal bleeding and positive urine test
  • Nursing care: abstain from drinking alcohol or taking vitamins that contain folic acid, refrain from sexual intercourse, pelvic, shoulder or neck pain.
• Ruptured Fallopian Tube

  • Usually sudden and severe pain
  • Intraabdominal hemorrhage
  • Irritation of the diaphragm and may radiate to the neck & shoulder, pain is worse on inspiration
  • Dx: transvaginal US & serum hCG
  • Tx: methotrexate (cytotoxic drug, N/V) & surgery if ruptured
• Hydatidiform Mole

  • AKA molar pregnancy
  • Occurs when the trophoblast (fertilized ovum) attaches to the uterine wall and the cells develop abnormally and form only the placenta and not the fetus.
  • Uterus fills with grape-like clusters
  • Abdomen measures larger than expected
  • Complete mole: no fetus present
  • Partial mole: fetal tissue or membranes can be present
• S/S of Hydatidiform Moles

  • Vaginal bleeding (brown but can be bright red)
  • Over enlarged uterus
  • Increased nausea and vomiting
  • Dx: ultrasound
• Placenta Previa

  • Implantation of the placenta in the lower segment of the uterus
  • Painless, bright red bleeding
  • Dx: ultrasound
  • Treat with restricted activity; bedrest if prior to 37 weeks
  • NO vaginal exams
  • Etiology: older women, multipara, Hx of c-section, male infant, smoking and cocaine use
• S/S of Placenta Previa

  • sudden onset of painless bleeding in the latter half of pregnancy
  • Bleeding occurs when the placental villi are torn from the uterine wall when the cervical os starts to dilate
  • SVE can cause further placental separation or tear the placenta causing severe maternal and fetal bleeding
• Nursing considerations Placenta Previa

  • Maintain bedrest
  • No sexual intercourse
  • Assess vaginal discharge
  • Non-stress tests
  • BPP
• Abruptio Placentae

  • Separation of the placenta before the baby is born
  • Etiology: HTN, smoking, multigravida, abdominal trauma, cocaine use (vasoconstriction), and Hx of previous abruption
  • 5 classic signs: 1) vaginal bleeding 2) abdominal & low back pain 3) uterine irritability with frequent low intensity contractions 4) high uterine resting tone 5) uterine tenderness
• Hyperemesis Gravidarum

  • Severe nausea & vomiting
  • Electrolyte imbalance, weight loss, dehydration
  • High hCG levels
  • Tx: hospitalization, NPO, IV therapy until 48 hrs after vomiting stops
• Cytomegalovirus

  • Results in severely retarded; SGA, learning disabilities
  • Leading cause of hearing loss
• Rubella

  • Transmitted by droplets or direct contact
  • Fever, general malaise & maculopapular rash
  • Congenital rubella syndrome if exposed in the 1st trimester
  • Hearing loss, intellectual disabilities, cataracts, cardiac defects, growth restriction and microcephaly
  • Infants can shed virus for months
  • Advised not to get pregnant for 4 weeks
• Genital Herpes (Herpes Simplex Virus)

  • Primary infection poses greatest risk to both mother and infant
  • Acyclovir to suppress outbreak of lesions
  • C-section if visible lesions within 30 days of EDB
  • Vertical transmission: ROM & during birth
  • Fetal effects: local infection, encephalitis (inflammation of the brain) or disseminated HSV
• Hepatitis B

  • Transmitted through: blood, saliva, vaginal secretions, semen or breast milk
  • Readily crosses the placenta
  • Fetal effects: HBV infection lead to prematurity, LBW and neonatal death
  • Prevention: handwashing, standard precautions with body fluids and safe sex
  • Hep B vaccine recommended 2 months and 6 months
• HIV

  • Use of antiretroviral therapy (ARV) during pregnancy reduces risk of transmitted HIV to fetus
  • Frequent prenatal visits
  • Zidovudine (ZDV) reduces transmission of HIV infection to fetus
  • Newborn treatment begins within 8-12 hours after birth until 6 weeks
  • Baby may have + antibody titer for 15-18 months
  • C/S at 38 weeks
  • No breastfeeding
• Toxoplasmosis

  • Protozoal infection transmitted through raw or undercooked meat, contact with infected cat feces, and across placental barrier
  • Spontaneous abortion or severe congenital anomalies
• Group B Strep

  • Normal vaginal flora
  • Causes neonatal pneumonia
  • Cervical culture at 36 weeks
• UTI

  • Can result in cystitis or pyelonephritis
  • Implicated in preterm labor
  • Monitor urine at every prenatal visit