ANTENATAL

COMPLICATION
S

Kathleen Gail C. Guevarra, RN, MAN,

MSN
 A. Description
Spontaneous abortion is the expulsion of
the fetus and other product s of conception
from the uterus before the fetus is capable of
living outside of the uterus.
SPONTANEOUS
Types of spontaneous abortions.
ABORTION a.threatened abortion
b.imminent or inevitable abortion
c. incomplete abortion
d. complete abortion
e. missed abortion
f. recurrent or habitual abortion
B. Etiology. Spontaneous abortion may result from unidentified natural causes or from fetal,
placental or maternal factors.
1. Fetal factors
a. Defective embryonic development
b. Faulty ovum implantation
c. Rejection of the ovum by the endometrium
d. Chromosomal abnormalities
2. Placental factors
a. premature separation of the normally implanted placenta
b. abnormal placental implantation
c. abnormal placental function
3. Maternal factors
a. Infection
b. severe malnutrition
c. reproductive system abnormalities e.g. incompetent cervix
d. endocrine problems such as thyroid dysfunction
e. trauma
f. drug ingestion
C. Pathophysiology. The fetal or the placental defect or the maternal condition result in the
disruption of blood flow , containing oxygen and nutrients to the developing fetus. The fetus is
compromised and subsequently expelled from the uterus .

D. Assessment findings
1. Associated findings. The client and family may exhibit a grief reaction at the loss of
pregnancy , including :
a. crying c. sustained or prolonged social isolation
b. depression d. withdrawal
2. Clinical manifestations include common signs and symptoms of spontaneous abortion.
a. vaginal bleeding in the first 20 weeks of pregnancy
b. complaints of cramping in the lower abdomen
c. fever, malaise, or other symptoms of infection
3. Laboratory and diagnostic findings
a. serum beta hCG levels are quantitatively low .
b. ultrasounds reveals the absence of the viable fetus.
E. Implementations
1. Provide appropriate management and prevent complication
a. assess and record vital signs , bleeding, and cramping or pain.
b. measures and record intravenous fluids and laboratory results. In instances of heavy
vaginal bleeding: prepare for surgical interventions (D&C) if indicated
c. prepare for RhoGAM administration to an Rh-negative mother , as prescribed.
d. recommend iron supplements and increased dietary iron as indicated to prevent
anemia.

NOTE: Whenever the placenta is dislodged (birth, D&C, abruption) some of the fetal blood
may enter the circulation. If the woman is Rh-negative enough fetal Rh-positive blood cells
may enter the circulation to cause isoimmunization. The production of antibodies Rh-
positive blood thus endangering the well being of future pregnancies . Because the blood
type of the conceptus is not known, all women with Rh-negative blood should receive
RhoGAM after an abortion.
2. Provide client and family teaching
a. Offer anticipatory guidance relative to expected recovery , the need for rest ,
and delay of another pregnancy until the client fully recovers.
b. Suggest avoiding intercourse until after the next menses or using condoms when
engaging in intercourse .
c. Explain that in many cases, no cause for the spontaneous abortion is ever
identified.
3. Address emotional and psychosocial needs.
 A. Description
1. Hydatidiform mole is an alteration of early embryonic growth
causing placental disruption, rapid proliferation of abnormal
cells, and destruction of the embryo.
2. There are two distinct types of hydatidiform mole- complete
GESTATTIONAL and partial .
TROPHOBLASTIC a. In a complete mole , the chromosomes are either 46XX or
46XY but are contributed by only one parent and the
DISEASE chromosomes material are duplicated.
b. A partial mole has 69 chromosomes . There are three
(Hydatidiform chromosomes for every pair instead of two. This type of mole
rarely leads to choriocarcinoma.
Mole)
B. Etiology.
•The etiology of hyatidiform mole is unknown. Genetic, ovular or
nutritional abnormalities could possibly be responsible for
trophoblastic disease.
Two distinct types of hydatidiform moles are:
1. Complete (or classic): mole results from fertilization of egg with
lost or inactivated nucleus
2. Partial mole: result of two sperm fertilizing a normal ovum
 9 of
A. Chromosomal origin of 68

complete mole.
Single sperm (in color) A
fertilizes an “empty” ovum

B. Uterine rupture with

hydatidiform mole
1. Evacuation of mole through
cervix
2. Rupture of uterus and spillage
of mole into peritoneal cavity
(rare)

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Mosby, Inc.
C. Pathophysiology.
1. A hydatidiform mole is a placental tumor that develops after
pregnancy has occurred; it may be benign or malignant. The risk of
malignancy is greater with a complete mole.
2. The embryo dies, and the trophoblastic cell continues to grow forming
an invasive tumor.
3. It is characterized by proliferation of placental villi that becomes
edematous and for grapelike clusters. The fluid-filed vesicles grow
rapidly, causing the uterus to be larger than expected for the duration of
pregnancy.
4. Blood vessel are absent as are the fetus and the amniotic sac.
D. Assessment findings
1. Clinical manifestations
a. vaginal bleeding (may contain some of the edematous villi.)
b. uterus larger than expected for the duration pregnancy.
c. abdominal cramping for uterine distention.
d. signs and symptoms of uterine preeclampsia before 20
weeks of gestation.
e. severe nausea and vomiting.
2. Laboratory and diagnostic findings
a. hCG serum levels are abnormally high.
b. ultrasounds reveals characteristics appearance of the molar
growth.
E. Nursing management
1. ensure physical well being of the client through accurate
assessments and interventions.
a. review pertinent history and history of pregnancy.
b. prepare for suction curettage evacuation of the uterus (
induction of labor with oxytocic agents or prostaglandins is not
recommended because of the increased risk of hemorrhage.)
c. Administer intravenous fluids as prescribed.
2. Provide client and family teaching
3. Address emotional and psychosocial needs.
  Nursing Diagnosis  Expected Outcome
1. High risk for fluid Vital signs within
volume deficit normal limits
  Absent or minimal
  vaginal bleeding
•F. Nursing Diagnoses and Expected
Outcome 2. Grief Verbalize feelings of
  grief
 •HYPEREMESIS GRAVIDARUM
• Is a severe and excessive nausea and vomiting during pregnancy
which leads to electrolyte, metabolic and nutritional imbalance in
the absence of other medical problems.
HYPEREMESIS • Etiology:
• High levels of hCG
GRAVIDARUM • Metabolic or nutritional deficiencies
• More common in unmarried women and 1st pregnancies
• Ambivalence toward the pregnancy or family related stress
• Thyroid dysfunction
S/S:
 Unremitting nausea and vomiting
 Vomitus initially containing undigested food, bile and mucus, later
containing blood and materials that resembles coffee grounds.
 Pail, dry skin
 Rapid pulse
 Fetid, fruity breath odor from acidosis
 CNS effects such as confusion, delirium, headache, lethargy, stupor
and coma
Nursing Mngt:

• Promote resolution of the complication

• NPO until cessation of vomiting
• Administer IVF as prescribed
• Measure I and O
• Encourage small frequent meals once vomiting subsided
• Advise to eat dry crackers before arising in the morning
• Address emotional and psychosocial needs
Antiemetics and other meds.
Doxylamine/pyridoxine (Diclegis)
Promethazine (Phenergan)
Prochlorperazine (Compazine)
Metoclopramide (Reglan)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Meclizine (Antivert, Antrizine, Meni-D, Dramamine, Marezine)
Ondansetron (Zofran)
 •ECTOPIC PREGNANCY
• Implantation of products of conception in a site other than uterine
cavity such as fallopian tube, ovary, cervix or peritoneal cavity.

ECTOPIC
• Possible causes:
• Salpingitis
• Diverticula
PREGNANCY • Tumors
• Adhesions from previous pregnancy
• Transmigration of the ovum from one ovary to the opposite fallopian
tube.
But you are more likely to have an ectopic pregnancy if you
have any of the following:
•Pelvic inflammatory disease (PID)
•Sexually-transmitted diseases
•Scarring from previous pelvic surgeries
•History of ectopic pregnancy
•Unsuccessful tubal ligation or tubal ligation reversal
•Use of fertility drugs
•Infertility treatments such as in vitro fertilization (IVF)
Uterus- the only organ capable of containing and sustaining pregnancy.

S/S:
• Dizziness and syncope
• Sharp abdominal pain and referred shoulder pain
• Vaginal bleeding
• Adnexal mass and tenderness
• Ruptured fallopian tubes can produce life-threatening complications
such as hemorrhage, shock and peritonitis
 Diagnostic:
• Elevated serum quantitative beta hCG
• UTZ confirm extrauterine pregnancy
Medical treatment:
• Methotrexate
• Explorlap (exploratory laparotomy)

Nursing Mngt:
• assess VS, bleeding and pain
• monitor complications
• provide client and family teaching to relieve anxiety
• address emotional and psychosocial needs
 •Unruptured:
CLINICAL •Missed period
MANIFESTATION •Early symptoms of pregnancy
S
•Abdominal pain within 3-5 weeks of
missed period (may be generalized or one
sided)
•Vague discomfort
•Scant, dark brown vaginal bleeding
•Positive serum pregnancy
Tubal rupture:
• Syncope
• Abdominal cramping
• Shoulder pain (indicative of intraperitoneal bleeding that extends to
diaphragm and phrenic nerve)
• Signs and symptoms of hypovolemic shock:
• Hypotension
• Tachycardia
• Tachypnea
• Blue tinge around umbilicus called CULLEN’S SIGN
• Sudden sharp severe pain
 DIAGNOSIS
Serum progesterone

• Serial Quantitative HCG levels often are low and do not show the normal doubling every
2 days. However, some (10-15%) ectopic pregnancies do show a normal rise, and some
(10-15%) normal pregnancies don't show the normal doubling rate.
• Progesterone levels are sometimes very low (<5). Levels greater than 25 are usually seen
with normal intrauterine pregnancies, but this is a generalization.

Ultrasound ( transvaginal )

Culdocentesis

• A needle is inserted through the vaginal wall into the posterior culdesac.
 D&C
• Dilatation and curettage is sometimes done in
the presence of a clearly abnormal HCG pattern,
MEDICAL combined with abnormal ultrasound findings, to
confirm or rule out ectopic pregnancy.
MANAGEME
NT Salpingectomy with ectopic
pregnancy removed from the tube

Laparotomy
 INCOMPETENT CERVIX
• also called a cervical insufficiency
• Before pregnancy, your cervix — the lower part of
the uterus that connects to the vagina — is
normally closed and rigid. As pregnancy progresses
and you prepare to give birth, the cervix gradually
softens, decreases in length (effaces) and opens
INCOMPETENT (dilates).
•Premature dilatation of the cervix ; passive and painless
CERVIX without labor or contractions occurring during second or
early third trimester
• Is characterized by a painless dilation of the cervical os
without contraction of the uterus
• The connective tissue structure of the cervix is not
strong enough to maintain closure of the cervical os
during pregnancy
• Occurs at about 20 weeks AOG 
 Etiology:
• Hx of traumatic birth
• Repeated D and C
• Client’s mother treated with
diethylstilbestrol
• Congenitally short cervix
• Uterine anomalies
 S/S:
• appreciable cervical dilation with prolapse of the membranes through the cervix without
contraction.
 
Nursing Mngt:
• provide client and family teaching
• maintain an environment to preserve the integrity of the pregnancy
-restrict activity
-vaginal rest
• prepare for the birth if membranes are about to ruptured
• address emotional and psychosocial needs
An incompetent cervix poses risks for your
pregnancy — particularly during the second
trimester — including:
•Premature birth
•Pregnancy loss
•Transvaginal ultrasound - During this type of
ultrasound, a slender transducer is placed in your
vagina to send out sound waves and gather the
reflections of your cervix and lower uterus on a
monitor.
•Pelvic exam- Your health care provider will
examine your cervix to see if the amniotic sac has
begun to protrude through the opening
(prolapsed fetal membranes). If the fetal
membranes are in your cervical canal or vagina, DIAGNOSTICS
you have an incompetent cervix.
•Lab tests- If the fetal membranes are visible and
an ultrasound shows signs of inflammation, but
you don't have symptoms of an infection, your
health care provider might test a sample of
amniotic fluid (amniocentesis) to diagnose or rule
out an infection of the amniotic sac and fluid
(chorioamnionitis).
• Medical management
• Conservative management of bed rest, progesterone, anti-inflammatory drugs, and
antibiotics
• Shirodkar or McDonald procedure
• Prophylactic cerclage is placed at 11 to 15 weeks
of gestation
• Nursing care and home care