GESTATIONAL CONDITION infections, tubal surgery, or previous

ectopic pregnancy.
HYPEREMESIS GRAVIDARUM - Sharp abdominal pain and referred
- Excessive nausea and vomiting shoulder pain.
during pregnancy, which lead to - Ultrasound will confirm extrauterine
electrolyte, metabolic, and nutritional pregnancy.
imbalances.
- High hCG level RISK FACTORS
- More common in first pregnancies ❑Advanced Maternal Age
- Thyroid dysfunction ❑PID
- Can lead to dehydration and ❑Prior Ectopic Pregnancy
ultimately decrease the amount of ❑Hx Pelvic surgery or tubal ligation
blood and nutrients circulated the ❑IUD
developing fetus. ❑IVF
- Ketone high
NURSING MANAGEMENT
Signs and symptoms occur during 16 weeks ❑Maternal prognosis is good with early
of pregnancy diagnosis and prompt treatment, such as
❑Unremitting nausea and vomiting. laparotomy, to ligate bleeding vessels and
❑Vomitus initially containing repair or remove the damaged fallopian
undigested food, bile, and mucus; later tube.
containing blood and material that ❑Pharmacologic agents, such as
resembles coffee grounds methotrexate followed by leucovorin, may
❑Weight loss be given orally when ectopic pregnancy is
❑Pale, dry skin diagnosed by routine sonogram before the
❑Rapid pulse tube has ruptured. A hysterosalpingogram
❑Fetid, fruity breath odor from usually follows this therapy to confirm tubal
acidosis patency.
❑Central nervous system effects, ❑Rh-negative women must receive
such as confusion, delirium, headache, and RhoGAM to provide protection from
lethargy, stupor, or coma. isoimmunization for future pregnancies

Antiemetics for pregnancy GESTATIONAL TROPHOBLASTIC

1. Prochlorperazine (compazine)
2. Trimethobenzamide (tigan)
ECTOPIC PREGNANCY
- Implantation of products
conception in a site other than the
uterine cavity (e.g., fallopian tube,
ovary, cervix, or peritoneal cavity.)
- hinder ovum passage through the
fallopian tube and into the uterine
cavity, such as:
• Salpingitis
• Diverticula
• Tumors
• Adhesions from previous surgery
• Transmission of the ovum from one
ovary to the opposite fallopian tube.
- Uterus is the only organ capable of
containing and sustaining
pregnancy.
- Suspect ectopic pregnancy in a
client whose history includes a
missed menstrual period, spotting,
or bleeding pelvic or shoulder pain,
use of intrauterine device, pelvic
DISEASE (H-MOLE)
- Hydatidiform mole is an alteration of
early embryonic growth causing
placental disruption, rapid
of proliferation of abnormal cells, and
destruction of the embryo.
- In a complete mole, the
chromosomes are either 46XX or
46XY but are contributed by only
one parent and the chromosome
material duplicated.This type usually
leads to choriocarcinoma.
- A partial mole has 69
chromosomes. There are three
chromosomes for every pair instead
of two. This type of mole rarely leads
to choriocarcinoma.
- A hydatidiform mole is a placental
a tumor that develops after pregnancy
has occurred; it may be benign or
malignant. The risk of malignancy is
greater with a complete mole.
- The embryo dies and the
trophoblastic cells continue to grow,
forming an invasive tumor.
 - characterized by proliferation of uterus before the fetus is capable of
placental villi that become living outside of the uterus.
edematous and form grapelike
clusters. TYPES
- Blood Vessels are absent, as are a ❑Threatened abortion – is characterized by
fetus and an amniotic sac. cramping and vaginal bleeding in early
- Uterus larger than expected for the pregnancy with no cervical dilation. It may
duration of the pregnancy. subside or an incomplete abortion may
- Signs and symptoms of follow.
preeclampsia before 20 weeks ❑Imminent or inevitable abortion – is
gestation characterized by bleeding, cramping and
- hCG serum levels are abnormally cervical dilation. Termination cannot be
high. prevented.
- Prepare for suction curettage ❑Incomplete abortion – is characterized by
evacuation of the uterus (induction expulsion of only part of the products of
of labor with oxytocic agents or conception (usually the fetus). Bleeding
prostaglandins is not recommended occurs with cervical dilation.
because of the increased risk of ❑Complete abortion – is characterized by
hemorrhage). complete expulsion of all products of
- Inform the client that oral birth conception.
control agents are not recommended ❑Missed abortion – is characterized by
because they suppress pituitary early fetal intrauterine death without
luteinizing hormone, which may expulsion of the products of conception. The
interfere with serum hCG cervix is closed, and the client may report
measurement. dark brown vaginal discharge. Pregnancy
test findings are negative.
INCOMPETENT CERVIX ❑Recurrent (habitual) abortion – is
spontaneous abortion of three or more
Normal cervix - closed cervix consecutive pregnancies.
Incompetent cervix - open cervix ❑Spontaneous abortion may result from
unidentified natural causes or from fetal,
- Characterized by a painless dilation placental or maternal factors.
of the cervical os without
contractions of the uterus FETAL FACTORS
- Commonly occurs at about the 20th ❑Defective embryologic development
weeks of pregnancy ❑Faulty ovum implantation
❑Rejection of the ovum by the
ETIOLOGY endometrium
❑History of traumatic birth ❑Chromosomal abnormalities
❑Repeated dilation and curettage
❑Client’s mother treated with PLACENTAL FACTORS
diethylstilbestrol (DES) when ❑Premature separation of the normally
pregnant with the client implanted placenta
❑Congenitally short cervix ❑Abnormal placental implantation
❑Uterine anomalies ❑Abnormal placental function
❑Unknown etiology
❑Connective tissue structure of the MATERNAL FACTORS
cervix is not strong enough to maintain ❑Infection
closure of the cervical os during pregnancy. ❑Severe malnutrition
❑Reproductive system abnormalities (eg,
- A common clinical manifestation is incompetent cervix)
appreciable cervical dilation with ❑Endocrine problems (eg, thyroid
prolapsed of the membranes dysfunction)
through the cervix withouT ❑Trauma
contractions. ❑Drug ingestion

SPONTANEOUS ABORTION
- expulsion of the fetus and other
products of conception from the
 ❑Uterine incision
❑Prior placenta previa (incidence is 12
times greater in women with previous
placenta previa)

PATHOPHYSIOLOGY
❑Pathologic process seems to be related to
the conditions that alter the normal function
of the uterine deciduas and its
vascularization.
❑Vaginal bleeding in the first 20 weeks of ❑Bleeding, which results from tearing of the
pregnancy placental villi from the uterine wall as the
❑Complaints of cramping in the lower lower uterine segment contracts and dilates,
abdomen can be slight or profuse.
❑Fever, malaise or other symptoms of
infection - Double set up procedure
❑Serum beta hCG levels are quantitatively
low ❑Bright red, painless vaginal bleeding
❑Prepare for PhoGAM administration to an ❑Soft, nontender abdomen; relaxes
Rh-negative mother, as prescribed. between contractions, if present.
❑Recommended iron supplements and ❑FHR stable and within normal limits.
increased dietary iron as indicated to help
prevent anemia. - Transabdominalultrasonography
confirms suspicion of placenta
PLACENTA PREVIA previa.
- Low lying placenta - place the woman at bed rest in a
- The placenta implants in the lower side-lying position.
uterine segment, near the cervical
os. The degree to which it covers the ABRUPTIO PREVIA
os leads to three different - Premature separation of a normally
classifications. implanted placenta after the 20th
- Total placenta previa occurs when week of pregnancy, typically with
the placenta completely covers the severe hemorrhage.
internal os.
- Partial placenta previa occurs when Risk factors include:
the placenta partially covers the ❑Uterine anomalies
internal os. ❑Multiparity
- Low-lying or low-implantation ❑Preeclampsia
placenta previa occurs when the ❑Previous cesarean delivery
placental border reaches the border ❑Renal or vascular disease
of the internal os. ❑Trauma to the abdomen
❑Previous third trimester bleeding
❑Abnormally large placenta
❑Short umbilical cord

- The placenta detaches in whole or in

part from the implantation site. This
occurs in the area of the deciduas
basalis.
❑Renal failure
❑Disseminated intravascular coagulation
❑Maternal and fetal death
Predisposing factors include:
❑Intense, localized uterine pain, with or
❑Multiparity (80% of affected clients are
without vaginal bleeding.
multiparous)
❑Concealed or external dark red bleeding
❑Advanced maternal age (older than 35
❑Uterus firm to boardlike, with severe
years in 33% of cases)
continuous pain
❑Multiple gestation
❑Uterine contractions
❑Previous cesarean birth
❑Uterine outline possibly enlarged or
changing shape
❑FHR present or absent.
❑Fetal presenting part may be engaged.
❑Never perform a vaginal or rectal
examination or take any action that would
stimulate uterine activity.
- Lateral position to prevent pressure
on the vena cava
❑Insert a large gauge intravenous catheter
into a large vein for fluid replacement.
Obtain a blood sample for fibrinogen level.
❑Monitor the FHR externally and measure
maternal vital signs every 5 to 15 minutes.
Administer oxygen to the mother by mask.
❑Prepare for cesarean section, which is the
method of choice for the birth.
PREMATURE RUPTURE OF THE
MEMBRANES
- PROM is rupture of the chorion and
amnion 1 hour or more before the
onset of labor. The gestational age
of the fetus and estimates of viability
affect management.
- Associated with malpresentation,
possible weak areas in the amnion
and chorion, subclinical infection,
and, possibly, incompetent cervix.
- Basic and effective defense against
the fetus contracting an infection is
lost and the risk of ascending
intrauterine infection, known as
chorioamnionitis, is increased.
- Leading cause of death associated
with PROM is infection.
- When the latent period (time
between rupture of membranes and
onset of labor) is less than 24 hours,
the risk of infection is low.
❑Pooling of amniotic fluid in the vagina will
be visualized during a speculum
examination.
❑Maternal fever, fetal tachycardia, and
malodorous discharge may indicate
infection.
Laboratory and diagnostic study findings.
Rupture of membranes is confirmed by the
following.
❑Ferning is evident.
❑Nitrazine test tape turns a blue-green
color.
❑Obtain smear specimens from vagina and
rectum as prescribed to test for
betahemolytic streptococci, an organism
that increases the risk to the fetus.
❑Maintain the client on bed rest if the fetal
head is not engaged.
PREGNANCY INDUCED HYPERTENSION
❑Preeclampsia is a hypertensive disorder
of pregnancy developing after 20 weeks’
gestation and characterized by edema,
hypertension, and proteinuria.
❑Eclampsia is an extension of
preeclampsia and is characterized by the
client experiencing seizures.
❑Possible contributing factors include:
❑Genetic or immunologic
❑Primigravid status
❑Conditions that create excess
trophoblastic tissue, such as multiple
gestation, diabetes, or hydatidiform
mole.
❑Age younger than 18 or older than
35 years.
Clinical manifestations of mild preeclampsia
❑Blood pressure exceeding 140/90 mmHg;
or increase above baseline of 30 mm Hg in
systolic pressure or 15 mmHg in diastolic
pressure on two readings taken 6 hours
apart.
❑Generalized edema in the face, hands,
and ankles (a classic sign)
❑Weight gain of about 1.5 kg (3.3 lb) per
month in the second trimester or more than
1.3 to 2.3 kg (3 to 5 lb) per week in the
third trimester
❑Proteinuria 1+ to 2+, or 300 mg/dL, in a
24 hour sample
WARNING SIGNS OF WORSENING
PREECLAMPSIA
❑Rapid rise in blood pressure
❑Rapid weight gain
❑Generalized edema
❑Increased proteinuria
❑Epigastric pain, marked hyperreflexia,
and severe headache, which usually
precede convulsions in eclampsia
❑Visual disturbances
❑Oliguria (<120 mL in 4 hours)
❑Irritability
❑Severe nausea and vomiting
CLINICAL MANIFESTATIONS OF
SEVERE PREECLAMPSIA
❑Blood pressure exceeding 160/110
mm Hg noted on two readings taken 6
hours apart with the client on bed rest.
❑Proteinuria exceeding 5 g/24 hours
❑Oliguria (less than 400 mL/24 hours)
❑Headache
❑Blurred vision, spots before eyes, and
retinal edema
❑Pitting edema of the sacrum, face, and
upper extremities
❑Dyspnea
❑Epigastric pain
❑Nausea and vomiting
❑Hyperreflexia
- Eclampsia exists once the patient
has experienced a grand mal
seizure. The patient may progress to
more serious complications such as
cerebral hemorrhage, liver rupture,
and coma.
HELLP
❑Hemolysis
❑Elevated Liver Enzymes
❑Low Platelets
❖HELLP is difficult to diagnose, especially
when high blood pressure and protein in the
urine aren’t present.
❖Its symptoms are sometimes mistaken for
gastritis, flu, acute hepatitis, gall bladder
disease or other conditions
NURSING MANAGEMENT
1. Monitor for, and promote the resolution
of,
complications.
❑Monitor vital signs and FHR.
❑Minimize external stimuli; promote rest
and relaxation.
❑Measure and record urine output, protein
level, and specific gravity.
❑Assess for edema of face, arms, hands,
legs, ankles, and feet. Also assess for
pulmonary edema.
❑Weigh the client daily.
❑Assess deep tendon reflexes every 4
hours.
❑Assess for placental separation,
headache and visual disturbance, epigastric
pain, and altered level of consciousness.
2. Provide treatment as prescribed.
❑Mild preeclampsia treatment consists of
bed rest in left lateral recumbent position,
balanced diet with moderate to high protein
and low to moderate sodium, and
administration of magnesium sulfate.
❑Severe preeclampsia treatment consist of
complete bed
rest, balanced diet with high protein and low
to moderate sodium, administration of
sulfate, fluid and electrolyte replacements,
and sedative antihypertensives, such as
diazepam or Phenobarbital, or an
anticonvulsant such as phenytoin.
❑Eclampsia treatment consists of
administration of magnesium sulfate
intravenously.
3. Institute seizure precautions. Seizures
may occur
up to 72 hours after delivery.
4. Address emotional and psychosocial
needs.