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Complications of Pregnancy

Common Discomforts and relief


measures during Pregnancy
Discomfort Trimester Intervention
Morning 1st Eat dry
sickness(N & V) carbohydrate in
AM, avoid fried,
odorous, and
greasy foods,
small meals, bet.
Meals eat
crackers w/o
fluid
Discomfort Trimester Intervention

Fatigue 1st Rest frequently


as needed.
Urinary 1st & 3rd Kegel exercise,
frequency and perineal pad for
urgency leakage. Void
frequently,
decrease fluids
prior to bed
time; avoid
caffeinated or
carbonated
beverages
Discomfort Trimester Intervention
Heartburn 2nd & 3rd Small meals
bland foods,
antacids if
ordered. Avoid
fat and fried,
spicy foods.
Constipation 2nd & 3rd Increase fluid
intake, eat foods
high in
roughage,
exercise
moderately, NO
laxative unless
ordered.
Discomfort Trimester Intervention
Hemorrhoids 3rd Avoid
constipation,pro
mote regular
vowel habits, do
not
strain.Supposito
ries as prescribe
Varicosities 3rd Avoid crossing
legs and long
avoid elastic periods of
garters and other sitting or
standing, rest w/
Constrictive feet and hips
clothing elevated,
Discomfort Trimester Intervention
Backache 3rd Correct posture,
low heeled
shoes,pelvic tilt
exercise
Insomnia 3rd Warm shower
before retiring
Leg cramps 3rd Warm
packs,maintain
adequate
calcium
Supine 3rd Left side-lying
hypotensive position
syndrome
Discomfort Trimester Intervention

Faintness 2nd & 3rd Sit or lie down,


avoid sudden
changes in
position,avoid
prolonged
standing
Vaginal 1st & 2nd Good hygiene,
discharge cotton
underwear, no
douching unless
prescribe.
Discomfort Trimester Intervention

Shortness of 2nd & 3rd Good posture,


breath sleep with head
elevated by
several pillows
Skin changes, All Interventions
dryness, itching symptomatic;
cool baths,
lotions, oils as
indicated.
Causes of Bleeding in Pregnancy
1. Early Pregnancy(1st Trimester )
1. Abortion
2. Ectopic Pregnancy
3. Hydatidiform Mole
2. Late Pregnancy (3rd Trimester )
1. Placenta Previa
2. Abruptio Placenta
(Abortion
-termination of pregnancy before the age of
viability.
Types:
1. Spontaneous (Table) ± miscarriage w/o
medical or mechanical intervention.
2. Induced
1. Therapeutic ± to safeguard maternal
life/health
2. Criminal/Elective- performed in abortion
clinics or hospitals
Causes of Abortion
1. Defective ovum/congenital defects.
2. Unknown causes
3. Maternal factors
1. Chronic infection, fibroid tumors.
2. Malnutrition, severe anemia
3. Trauma
4. Endocrine disturbance: progesterone and thyroid hormone
dysfunction.
5. Exposure to tetratogens.
6. Environmental hazards.
Signs of Abortion (Assessment findings)
1. Vagina Bleeding ± observe carefully for
accurate determination of amount saving all
perineal pads.
2. Contractions, pelvic cramping, backache
3. Passage of tissues/fetus
4. Cervical dilatation
5. Lowered hemoglobin if blood loss is
significant.(less than 10.5mg/dL)
6. Signs related to blood loss- pallor, tachycardia,
tachypnea, cold clammy skin, restless, oliguria,
hypotension, air hunger.
Complications of Abortion
1. Hemorrhage
2. Infection
3. Infertility
4. Uterine perforation from curettage
5. PID (Pelvic Inflammatory disease.
6. Retained products of conception, may lead to H-
mole
7. Anemia
Clinical Classification of Spontaneous Abortion
Type of Bleeding Abdomi Cervical Passage of Fever
Abortion nal Dilatation tissue
Cramps
Threatened Slight Slight if none none None
present
Inevitable Moderat Moderat With Membrane none
e to e to effacement s may
severe severe rupture,
loss of
fetus
Complete Small to none open Placenta none
moderat w/
e fetus(com
plete
Type of Bleeding Abdomina Cervical Passage of Fever
l cramps Dilatation tissue
Abortion
Incomplete Severe Severe Open w/ Fetal or None
tissue in the placental
cervix tissue;
membranes
of placenta
retained
Missed None to None none none none
severe (no
FHT)
Habitual 3 May Of any
or more represent of the
signs above
Septic Mild to severe Maybe W/ or w/o. yes
severe close or foul
open smelling dis
TYPE NRSNG
CONSIDERATIONS/TREATMENTS
THREATEND :Ultrasound for uterine sac.
:Decreased activity for 24-48 hrs, avoid
stress
:No sexual intercourse for 2 wks. After
bleeding stops.
:Monitor amount and character of
bleeding
Inevitable :Monitor for bleeding.
:Emotional support
:D & C
:Fluid replacement, IV¶s, crossmatch for
possible blood BT
TYPE NRSNG
CONSIDERATIONS/TREATMENTS
Incomplete :Administer oxytocin/IV
:D & C or suction evacuation
Complete :Possible oxytocin PO; no other Tx if no
evidence of hemorrhage or infection.
Missed :D & C w/in 4-6 wks
:After 12 wks, dilate cervix w/ several
applications of prostaglandin gel or
suppositories of laminaria (dried sterilized
seaweed that expands w/ cervical
secretions)
Habitual :Cerclage (encircling cervix w/ suture)
Ectopic Pregnancy
( Any gestation outside the uterine cavity
( Most frequent in the fallopian tubes, where the tissue
is incapable of the growth needed to accommodate
pregnancy.
Predisposing factors
1. Fallopian Tube
1. Surgery
2. Congenital anomalies of the tube
3. Adhesions, spasm, tumors
4. Postabortion sepsis
5. PID
2. IUD Usage
Types
1. Tubal ± the most common, 90 ± 95% of cases; tubal rupture
occurs before 12 weeks
2. Ovarian
3. Abdominal
4. Cervical
Signs/Assessment
1. History of missed periods and symptoms of early
pregnancy
2. Positive pregnancy test only in about 50% of cases
(hCG is low in ectopic pregnancy)
3. Vaginal bleeding
4. Cullen¶s sign ± Bluish navel due to internal bleeding
5. Abdominal pain ± unilateral radiating to the shoulders;
1st sign corresponding to the rupture of the tube.
Š If tube is unruptured ± usually, chronic bleeding with
the abdomen gradually becoming rigid and very
tender.
6. Lab results:
: Low Hgb and Hct
: Low HCG (NV: 400,000 I.U. in 24 hrs)
: Increased WBC
Diagnosis
1. Ultrasound
2. Laparoscopy ± an procedure that provides
visualization of the pelvic organs via small external
incision on the abdomen
3. Culdocentesis ± assesses intraperitoneal bleeding by
needle puncture of the cul-de-sac of Douglas.
Treatment
1. Surgery ± Salpingectomy
2. Methotrexate
Nursing Interventions
1. Monitor v/s, bleeding, I & O
2. Institute measures to control/treat shock
3. Physical and Psychological preparation of client for surgery
4. Allow client to express feelings about loss of pregnancy and
concerns about future pregnancies.
Hydatidiform mole (Gestational Trophoblastic Disease)
( A developmental anomaly of the chorion where it fails
to develop and instead degenerate and become fluid
filled vesicles.
( Common in Orient and in people of low socio-
economic status
( Cause ; unknown
Predisposing factors
1. Increase maternal age
2. Low socio-economic status
3. Low protein diet
4. Hx of abortion
5. Clomiphene therapy to induce ovulation
Signs/Assessment
1. Dark red to brownish vaginal bleeding, intermittent or profuse
bleeding by 12 weeks.
2. Size of uterus is disproportionate to the length of pregnancy;
(bigger)
3. Excessive N & V due to high level of HCG.
4. Symptoms of preeclampsia under 20 weeks.
5. No fetal heart sounds or palpation of fetal parts.
6. Ultrasound shows no fetal skeleton.
7. Anemia
Nursing Interventions
1. Monitor v/s, bleeding, I & O
2. Provide pre and postoperative care for evacuation of uterus
3. Provide emotional support for loss pregnancy of the client.
4. Prepare for discharge:
1. Emphasize the need for ff-up lad work to detect rising HCG
levels indicative of carcinoma.
2. Teach contraceptive methods to avoid pregnancy for at least
1 year.
Treatment
1. Surgical ± D & C
2. Medical- follow up supervision for 1 year.
1. Weekly serum HCG level, until they are negative, then
every other week for 3-4 months; then monthly for a year
2. Pelvic exam may be required every 2 wks. During the early
period after the D & C
Placenta Previa
( Low implantation of the placenta so that it overlays
some or all of the internal cervical os.
Predisposing factors
1. Multiparity
2. Uterine factors:
1. Poor vascularity
2. Fibroid tumors
3. Increased age ± above 35 years old
Types/stages/Degree
1. Marginal ± placenta lies over the margins of the
internal os
2. Partial ± partially covers the internal os
3. Complete ± totally covers the internal os
Signs/Assessment
1. Cardinal sign ± painless bright red vaginal bleeding.
Bleeding may be intermittent,in gushes, or
continuous.
2. Uterus remains soft.
3. FHR usually stable unless maternal shock present.
Diagnosis
1. Ultrasound to locate placenta.
Treatment
1. Hospitalization initially
2. Send home if bleeding ceases and pregnancy to be
maintained
Nursing Interventions
1. Bedrest side-lying or Trendelenburg position for at least
72 hrs.
2. No vaginal, rectal exam unless delivery would not be a
problem. Maintain sterile conditions for any invasive
procedures.
3. Monitor maternal/fetal v/s
4. Daily Hgh and Hct.
5. 2 units cross of cross-matched blood available
6. Monitor amount of blood loss
7. Amniocentesis for lung maturity of the fetus.
8. Make provision for double set-up procedure.
9. Provide Physical and psychological comfort
Abruptio Placentae
( Separation of Placenta from part or all of normal
implantation site.
Predisposing Factors
1. Seen frequently in women with hypertension,
previous abruptio placentae, late pregnancies, and
multigravidas, but cause is essentially unknown.
2. Short umbilical cord
3. Trauma
4. Advance age
Š50% of cases results as a consequence of convulsion in
eclampsia
Types
1. Concealed/covert/central
1. Placenta separates at the center-causing blood the
accumulate behind the placenta.
2. Bleeding not evident
3. Signs of shock not proportional to the amount of external
bleeding
2. Marginal/overt/external bleeding type
1. Placental separates at the margins
2. Bleeding is external.
Signs/Assessment
3. Painful vaginal bleeding
4. Abdomen (uterus) is tender boardlike, painful, tense
5. Usually occurs after the 20th week of pregnancy
6. Slow or absent FHT
5. Watch out for signs of shock
6. If in labor; absent alternating contraction and
relaxation of the uterus.
Diagnosis
1. Clinical Diagnosis is by means of the s/s
2. Ultrasound can detect the retroplacental clot.
3. Clotting studies: DIC ± disseminated intravascular
coagulation.
1. Complications:CVA, Couvelaire uterus (segment
of uterus may not contract well ± hysterectomy),
hypofibrinogemia.
Nursing Interventions
1. Ensure bedrest
2. Careful monitoring
1. Maternal v/s
2. FHR
3. Labor onset/progress
4. Uterine pain
5. Bleeding
6. I & O (oliguria/anuria)
3. Administer fluid, plasma, & blood replacement as
ordered.
4. Prepare for emergency surgery as indicated
5. Provide psychological support; explain what is
happening
6. Observe for associated problems after
delivery.
1. Poorly contracting uterus (Couvelaire)
2. DIC
3. Neonatal distress