REVIEW OF

PATHOLOGIC
OBSTETRICS
KRISJOHN PAUL D. FLORES, RN
 COMPLICATIONS
DURING PREGNANCY
BLEEDING
BLEEDING
DEFINITION
• First Trimester 1. THREATENED

2. IMMINENT /
• Abortion INEVITABLE
3. COMPLETE
• Ectopic Pregnancy 4. INCOMPLETE

5. MISSED
6. RECURRENT
BLEEDING
• Second Trimester

• Gestational Trophoblastic Disease

• Incompetent Cervix
BLEEDING
• Third Trimester

• Placenta Previa

• Abruptio Placenta
HYPERTENSION
HYPERTENSION
• Gestational Hypertension

• Mild pre-eclampsia

• Severe Pre-eclampsia

• eclampsia
HYPERTENSION
• HELLP SYNDROME
HYDRAMNIOS
HYDRAMNIOS
• Polyhydramnios

• Oligohydramnios
ISOIMMUNIZATION
ISOIMMUNIZATION
ISOIMMUNIZATION
COOMB’S TEST

• INDIRECT

• DIRECT
HYPEREMESIS
GRAVIDARUM
HYPEREMESIS GRAVIDARUM
• Excess nausea and vomiting

• severe reaction to HCG

• Management?
CARDIAC CONDITIONS
CARDIAC CONDITIONS
• Classification

• Pre-natal

• Intra-partal

• Post-Partal
 GESTATIONAL
DIABETES MELLITUS
GESTATIONAL DIABETES MELLITUS
• Significance

• Assessment Findings

• Interventions/Management
MULTIFETAL GESTATION
MULTIFETAL GESTATION
• Mechanism

• Risk Factors

• Diagnosis

• Complications

• Delivery
INFECTIONS
INFECTIONS
• Urinary Tract Infection

• TORCH Infection

• HIV/AIDS

• Hepatitis B
ADOLESCENT
PREGNANCY
ADOLESCENT PREGNANCY
• Serious complications:
1. Toxemia
2. Low birth weight infants
3. Anemia
 DISSEMINATED
INTRAVASCULAR
COAGULOPATHY
DISSEMINATED INTRAVASCULAR
COAGULOPATHY
• Mechanism

• Management

• A diffuse, pathologic form of clotting occurring most often during?

SUBSTANCE ABUSE
SUBSTANCE ABUSE
• Alcohol

• Cocaine

• Opiates
DANGER SIGNS
 SIGN POSSIBLE IMPORTANCE
vaginal bleeding low implanted placenta, premature separation of
placenta, premature birth
persistent vomiting systemic infection, hyperemesis of pregnancy

chills, fever intrauterine infection

sudden escape of fluid from vagina premature rupture of membranes
abdominal or chest pain ectopic pregnancy, premature separation of
placenta, uterine rupture, pulmonary embolus

swelling of face or fingers hypertension of pregnancy

vision changes, flashes of light, diplopia, dimness hypertension of pregnancy
or blurring of vision
severe, continuous headache hypertension of pregnancy
increase or decrease in intensity or frequency of fetal distress
fetal movements
 COMPLICATIONS
DURING LABOR AND
DELIVERY
PREMATURE OR PRE-TERM LABOR
• Assessment Findings

• Causes

• Prevention

• Management
POST-MATURE OR PROLONGED PREGNANCY
POST-MATURE OR PROLONGED PREGNANCY
POST-MATURE OR PROLONGED PREGNANCY
• Dystocia

• IUGR

• EDD
PROLAPSED UMBILICAL CORD
• Intervention
PREMATURE RUPTURE OF MEMBRANES
PRECIPITOUS LABOR AND DELIVERY
• Assessment Findings

• Intervention
AMNIOTIC FLUID EMBOLISM
• Etiology

• Risk Factors

• Pathophysiology

• Clinical Presentation

• Management
 POSTPARTUM
COMPLICATIONS
POSTPARTUM HEMORRHAGE
• 1. UTERINE ATONY
• 2. LACERATION OF BIRTH CANAL
• 3. RETAINED PLACENTAL FRAGMENTS
• 4. PLACENTA ACCRETA

• Other Possible Causes

• Assessment Findings
THROMBOPHLEBITIS
• Assessment Findings

• Management
SUBINVOLUTION
• Causes

• Assessment Findings

• Management
POSTPARTUM INFECTION
• a. endometritis

• b. perineal infection

• c. urinary tract infection

POSTPARTUM INFECTION
• Assessment Findings

• Interventions
MASTITIS
• Assessment Findings

• Management

• Prevention
EMOTIONAL COMPLICATIONS
 
postpartum blues postpartum depression postpartum psychosis

onset

symptom

incidence

etiology

therapy

HCW role 
ANCILLARY TOPICS
BREASTFEEDING
Breastfeeding
Infant Health Benefits
• COLOSTRUM
• Small amount for the immature digestive system
• ‘paints’ the digestive tract
• Low fat for easy digestion
• Contains mothers antibodies which boost infants’ immune system
• Acts as a laxative to ease passage of meconium
Breastfeeding
Infant Health Benefits
• The milk comes in
• Transitional milk for up to 2 weeks
• May still have yellow appearance
• Amounts increase quickly as infant hungers and digestive system matures
• Mother's" milk making” changes from endocrine to autocrine system
• Mature milk
• Supply/demand system engorgement decreases
• Properties of fore milk and hind milk present
Breastfeeding
Infant Health Benefits
• Lower risk of
• Diarrhea
• Constipation
• Infections
• Ear, respiratory, meningitis, urinary tract
• SIDS
• Allergic diseases
• Chronic digestive diseases
• Juvenile onset diabetes
• Acute leukemia
• Adult obesity
Breastfeeding
Infant Health Benefits
• Provides immunologic protection while the infant’s immune system is maturing
• Antimicrobial agents
• Anti-inflammatory agents
• Immunomodulating agents
Breastfeeding
Infant Health Benefits
• Preterm Infants
• Decreased necrotizing enterocolitis
• Decreased ROP
• Decreased infection rates
• Better able to tolerate feedings
• Increased IQ rates
• Contains long chain polyunsaturated fatty acids that help the infant’s
brain develop – these are normally provided by the mother in late
pregnancy, therefore preterm infants miss this
Breastfeeding
Mother Health Benefits
• Less postpartum bleeding
• More rapid uterine involution
• Weight loss
• Decreased premenopausal breast cancer rates
• Decreased ovarian cancer rates
• Lactational amenorrhea
• Should still use progesterone only contraceptives
• Combined contraceptives dry up milk
Breastfeeding
Parent Benefits
• Saves money
• Saves time
• Babies love it
Lactation
Anatomy and Physiology
• Breast enlargement
• During pregnancy and lactation indicates the mammary glands are becoming functional
• Breast size before pregnancy does not determine the amount of milk a woman will
produce
Lactation
Anatomy and Physiology
• Hormones during pregnancy
• Estrogen stimulates the ductile systems to grow, then estrogen levels
drop after birth
• Progesterone increases the size of alveoli and lobes
• Prolactin contributes to increasing the breast tissue during pregnancy
Lactation
Anatomy and Physiology
• Alveoli secrete milk and contract when stimulated
• Oxytocin stimulates milk secretion and is released during the ‘let down’ or milk
ejection reflex
• After let down, milk travels into the ductules, then to the larger – lactiferous or
mammary ducts
Lactation
Anatomy and Physiology
• Hormones during breastfeeding
• Prolactin levels rise with nipple stimulation
• Alveolar cells make milk in response to prolactin when the baby sucks
• Oxytocin causes the alveoli to squeeze the newly produced milk into the duct system
Lactation
Anatomy and Latch
Physiology
On and sucking

Oxytocin Release

Releases Milk

Infant Empties Breast

Production Increases

Milk Production Occurs

Interference with this cycle decreases the milk supply.

Breastfeeding
Barriers
• Early breastfeeding failures deprive infants of the benefits, and leave many
mothers disappointed
• It is a natural process, but many mothers need a lot of help
Breastfeeding
Barriers
•
Must educate mothers regarding:
• Positioning the baby
• Latching on
• Normal nipple soreness
• Cramping with breastfeeding
• How often to feed the baby
• Need to wake the baby
• Alerting techniques
• Rooting
• Sucking
• Listening for swallows
• Preventing engorgement
• Nutrition
• Supply and demand
• Infant cues
Breastfeeding
Barriers
• Breast Pathology
• Flat/inverted nipples, breast reduction surgery that severed milk ducts,
previous breast abscess, extremely sore nipples (cracked, bleeding,
blisters, abrasions)
• Hormonal pathology
• Failure of lactogenesis, hypothyroidism
• Overall health
• Smoking, anemia, poor nutrition, depression
• Psychosocial
• Restrictive feeding schedules, mother without support system, not
rooming in with baby, bottle supplementing when not medically
required
• Other
• Previous breastfed infant who failed to gain weight well, perinatal
complication (hemorrhage, htn, infection
Breastfeeding
Teaching methods
• With infant in mother’s arms

• Consistent information

• Repeat information in a variety of ways

• Watch the mother feed the baby and help

• Let the mother know she may have difficulties at first

• Remind mom that baby is learning with her

• Praise the mother’s progress, help build confidence

• Provide discharge support

Breastfeeding
The Results
• Baby gains weight
• No more than 7% weight loss
• Back to birth weight in 2 weeks
• 1oz per day weight gain for the first three months

• Mother is comfortable and satisfied

• If baby is still loosing weight on the 4th day of life:

• Get feeding evaluation
• Remember to:
• 1. fed the baby
• 2. maintain the milk supply
• 3. continue breastfeeding
Breastfeeding
Complications
•
Infants at risk for poor weight gain
• Premature (less than 38 weeks)
• Difficulty latching on
• Ineffective or unsustained sucking
• Oral anatomic abnormalities (cleft lip/palate, short frenulum, receding chin)
• Multiples
• Jaundice
• Cystic fibrosis
• Infection
• Cardiac disorders
• Neurologic problems – downs, hypo or hypertonia
• Poor apgars
• Long labor
• Sleepy, nondemanding, passive temperament
• Separation from mother early after delivery
• Infants less than 5 lbs
Breastfeeding
Hospital Discharge Support
• Mother breastfeed longer if they:
• Are confident at hospital discharge
• Have a good support system after discharge
• Receive follow up after discharge
• Upon discharge
• Give written information
• Recommend mom to keep breastfeeding record
• Give mom phone number for a telephone helpline
• Lactation consultant follow-up
Breastfeeding
Hospital discharge support
• Support the mothers breastfeeding efforts
• Provide accurate current breastfeeding information
Breastfeeding
Resources for Mothers
• Books:
• The Womanly Art of Breastfeeding – LeLeche League
• So that’s what they’re for! Breastfeeding Basic by Janet Tamaro
• The Breastfeeding Book by Martha and William Sears
• Nursing Mother Companion - Huggins Howard Common Press
• The Breastfeeding Answer Book – LeLeche Legue
• Medication and Mothers Milk – Thomas Gele PhD., a manual of lactational pharmacology 9 th Ed.
• Breastfeeding and Human Lacation – 2nd Ed. Jan Rioden and Kathleen G. Auerbach
• Breastfeeding Triage Tool - Sanie Jollay and Ellen Phillips-Angeles, M.S. Ches 4 th Ed.

• Websites
• LeLecheLeague.org
• Medela.com
• Parents.com
• CBI@illi.org

• Groups
• LeLeche League
• WIC – Public Health Department
• Carle’s Breast Feeding Clinic
• Twin clubs
LAWS
• EO 51

• RA 10354

• RA 7600
COVID-19 During Pregnancy
• Vaccination

• Management

• Maternal Complications

• Fetal Complications
CESARIAN DELIVERY
• Indications • Techniques

• Maternal • Prior Cesarean Delivery

• Maternal Fetal

• Fetal
FETAL DEMISE
• Risk Factors

• Diagnosis

• Treatment
THANK YOU!