Maternal Mortality – is due to - woman is still ovulating, it’s

pregnancy related complications just that her fallopian tube is

occurring at anytime during labor, damaged
pregnancy and postpartum. (whole - Male may have unhealthy
course of pregnancy) sperm or low sperm count

Hemorrhage – anytime from pregnancy

to postpartum period PROCEDURE FOR IVF
- Has the highest
percentage in causing - one or more oocytes are removed from
maternal mortality the woman’s ovary by laparoscopy &
fertilized by exposure to sperm in a lab.
How to solve MMR (Maternal
Mortality Rate: - 40 hrs after fertilization, the zygotes
are inserted into the woman’s uterus.
# of Maternal death (in specific yr)
# of live birth (in specific yr) *zygotes are placed in the uterus of the
woman so there’s a probability that she
would have multiple pregnancies.
ASSISTED REPRODUCTIVE
TECHNIQUES

-Science/Doctors help couples on how

to have a child. However, it does not
come the natural way (fertilization)
- Not done in 1 setting
- Doctors would opt into 1 of ART after a
thorough examination

1. Alternative Insemination
- instillation of sperm from a
3. GIFT (Gamete Intrafallopian
masturbatory sample into the
Transfer)
female reproductive tract by
– both ova and sperm are
means of a cannula to aid
transferred on the end of the woman’s
conception at the time of
fallopian tube through a cannula.
ovulation
- Ova are obtained from ovaries
*one time insemination cannot
exactly as in IVF. Instead of waiting for
guarantee fertilization
fertilization to occur in the laboratory,
however, both ova and sperm are
instilled, within a matter of hours, using
2. In Vitro Fertilization (IVF)
laparoscopic technique, into open end of
- used for couples who are
a potent fallopian tube which then
unable to conceived because
fertilization takes place.
the woman has obstructed or
damaged fallopian tubes,
ZIFT (Zygote Intrafallopian Transfer)
oligospermia (very low sperm
– Similar also to IVF but the fertilized
count), unexplained fertility
egg is transferred on the end of the
fallopian tube.
4. Surrogate Embryo Transfer
- for a woman who does not produce
ova or even if she do, the oocyte are
immature.
- the oocyte is donated by a friend,
relative or a donor
- the menstrual of the donor & recipient
are synchronized.
- At the time of ovulation, the donor’s
ovum is removed & fertilized in the
laboratory by the recipient partner‘s
sperm & transferred into the recipient
uterus during the embryonic stage
Alternatives to Childbirth
Surrogate Mothers
- is a woman who agrees to carry
the pregnancy to term for a sub fertile
couple or an LGBT couple
a. surrogate may provide the ova, then
fertilized by the man’s sperm in the lab
b. ova & sperm both may be donated by
the subfertile couple
c. both donor ova & sperm are used
Adoption
- Alternative for subfertile and
LGBT couples, those individuals who
have genetic-related health conditions
that would make pregnancy high risk
Child – Free Living
- For couples who have been
through the rigors & frustrations of
subfertility testing and unsuccessful
treatment regimen
- Can be fulfilling as having
children because it allows the couple
more time to help other people and
contribute to society through personal
accomplishments
Nursing Care of a Family
Experiencing Sudden Pregnancy
Complication
Bleeding During Pregnancy
Abortion – interruption of pregnancy
before a fetus is viable
Viable fetus – more than 20-24 weeks
gestation or weighs 500g
Spontaneous Miscarriage
Miscarriage – fetus born before the
period of viability
Early miscarriage – occurs before wk
16
Late miscarriage – occurs between wk
16 & 20
Common Causes
Abnormal fetal development -
teratogenic factor or chromosomal
aberration
Immunologic factor – or rejection of
the embryo through an immune
response
Implantation abnormalities
Corpus Luteum fails to produce
enough progesterone
Alcohol ingestion at the time of
conception or during early pregnancy
Urinary Tract Infection
Systemic Infection – rubella, syphilis,
polio
Diagnosis
Threatened Miscarriage
- scanty vaginal bleeding, bright red
- slight cramping
- no cervical dilatation
- avoidance of strenuous activity for 24-
48 hours is the key intervention
- bleeding should stop w/in 24-48 hours
- coitus is restricted for 2 weeks
Imminent (Inevitable) Miscarriage
- Uterine contractions & cervical
dilatation
- Loss of product of conception cannot
be halted
- D&C or D&E is done to ensure all
products of conception are removed
Complete Miscarriage
-Entire product of conceptions are
expelled spontaneously without
assistance
- Bleeding slows within 2 hrs & ceases
after a few days
Incomplete Miscarriage
- Part of the conceptus is expelled but
the membranes & placenta are retained
in the uterus
- Danger of hemorrhage
- Mothers may interpret that pregnancy
will continue
D&C
Missed Miscarriage (Early Pregnancy
Failure)
-Fetus dies in utero but is not expelled
-Discovered during prenatal – no
increase in fundic height & no FHB
-D&C or D&E
If pregnancy is more than 14 weeks,
labor can be induced
Recurrent Pregnancy Loss (Habitual
Aborters)
Women with 3 spontaneous
miscarriages at the same gestational
age
Complications of Miscarriage
Hemorrhage
Infection
Septic abortion
IsoImmunization
Powerlessness or Anxiety
Ectopic Pregnancy - implantation
occurred outside of the uterine cavity
Assessment
- Wk 6-12 zygote grows large enough it
ruptures the fallopian tube
- Sharp, stabbing pain followed by scant
vaginal spotting
- Products of conception may be
expelled into the pelvic cavity rather
than into the uterus
- As soon as placenta dislodges, more
bleeding occurs
- Hypotension, lightheadedness, rapid
PR =hypovolemic shock
Therapeutic Management
- Administration of Methotrexate
- Check for Hgb level, typing & cross
matching, hCG level
- IVF
- Laparoscopy – to ligate bleeding
vessels & remove or repair damaged
fallopian tube
- Women with Rh negative blood should
receive RhoGAM for isoimmunization in
future childbearing
Gestational Trophoblastic Disease
(H-Mole)
Is an alteration of early embryonic
growth, causing placental disruption,
rapid proliferation of abnormal cells and
destruction of the embryo
Etiology:
- Unknown, but believed to be  Very low maternal serum alpha-
chromosomal fetoprotein
- Genetic, ovular or nutritional  Hyperemesis gravidarum
abnormalities could be responsible  Pregnancy induced hypertension

Two types of hydatidiform mole: TREATMENT/FOLLOW-UP

Partial molar pregnancy
- has 69 chromosomes. There are 3
chromosomes for every pair instead of
two.
Complete molar pregnancy
- the chromosomes are either
46xxor 46xy that are contributed by only
1 parent and the chromosome materials
are duplicated.
-This type usually leads to
choriocarcinoma
 Suction evacuation of the mole
 Curettage of the uterus
 Regular measurement of the
hCG
 Baseline chest x-ray
 Physical examination, including
pelvic exam
 Effective contraception (between
6-12 months

CLINICAL SIGNS
 Vaginal bleeding: brownish
(prune juice)
 Anemia
 Hydropic vesicles (grape-shape;
cluster)
 Uterine enlargement Absence of
fetal heart sounds
 Elevated hCG