Complications of Pregnancy

JOEL D. FEDERICO, RN,MAN

First Trimester Bleeding

Abortion
- The expulsion of the products of conception
before the age of viability ( fetus can survive
extra uterine life)
- Fetus is less than 20 weeks or less than 500
grams
 Induced
• Ipinalaglag / Induced/ Elective Termination/
• Therapeutic INTENTIONAL (sinadya)
• Planned

Abortion types
Spontaneous
• Nalaglag/ Spontaneous
• UNINTENTIONAL (di sinadya)
• Unplanned
• Other term: MISCARRIAGE
 Spontaneous Abortion
Threatened
• Possible loss of the
product of conception
• Consists of any vaginal
bleeding during early
pregnancy without
cervical dilatation or
change in cervical
consistency.
• All products of
Inevitable or Imminent
• Threatened abortion that
becomes inevitable because of
uterine contractions & cervical
dilatation so that the loss of
the products of conception
Completed cannot be halted.
conception expelled
within 24 to 48
hours
Spontaneous Abortion
Incomplete
• The expulsion of a part
( usually the fetus) of the
product of conception & the
retention of other parts in
utero.
• tissue, no fetal heart tone can be
Dilatation & Curettage
( D&C) or suction curettage
.
Missed
• The fetus dies in utero but the fetus
is not expelled
• Risk for developing disseminated
intravascular coagulopathy (DIC)
• S/sx: slight bleeding, no cramping,
closed cervical os, no passage of
auscultated, decrease in fundic
height,
• Mx: d & c ; cytotec to dilate the
cervix then oxytoxics to induce
contractions
 Spontaneous Abortion
Habitual or Recurrent Pregnancy Septic Abortion
Loss • Usually caused by an induced abortion
done by unskilled practitioners using a
non-sterile technique.
• Spontaneous abortion in • Typical causative organisms include
three or more successive Escherichia coli, Enterobacter aerogenes,
pregnancies usually due Proteus vulgaris, hemolytic streptococci,
to incompetent cervix, staphylococci, and some anaerobic
defective sperm, organisms (eg, Clostridium perfringens). One
deviations of the uterus, or more organisms may be involved.
infection • Symptoms and signs (e.g., chills, fever,
vaginal discharge, peritonitis, vaginal
. bleeding) typically appear within 24 to 48
hours after an abortion.
 Causes of Abortion

01 02
Abnormality in the Defect in the germ plasma
implantation process - Occurs when meiosis doesn’t happen
- Occurs during early fertilization normally, A fetus may have an extra
- Stage that the oocyte complete its chromosomes (trisomy), or Have a
first meiotic division
04 missing chromosome (monosomy)

03 Hormonal Imbalance
Trauma - Hormonal imbalances of prolactin, thyroid hormone or
- Termination of pregnancy by progesterone can result in miscarriage. Illnesses such as
an outside force diabetes mellitus or immune system abnormalities may
- Psychological orphysical increase the chance of miscarriage.
trauma
 Causes of Abortion
07
05 06 Presence of Venerial
Disease
Intake of Drugs Infectious Diseases - Patients with Chlamydia trachomatis
- Quinine, Aspirin infection, and bacterial vaginosis would
- German measles, PTB, Herpes
appear to be at increased risk, and detection
and treatment of these conditions can lower
this risk
08
Abnormality in the reproductiove
09
system Severe Malnutrition
- Certain uterine conditions or weak cervical tissues - by way of altering the germ cell morphology
(incompetent cervix) might increase the risk of miscarriage.
Nursing Intervention
1. Institute measures to alleviate fear and anxiety
2. Monitor and document amount and type bleeding
a. Save and count number of perineal pads
b. Distinguish between dark clotted blood and frank bleeding
(bright red)
3. Monitor vital signs for hypovolemia, shock, and infection
4. Monitor fundus for firmness after products of conception are
expelled
5. Check laboratory reports (e.g., CBC, hemoglobin,
hematocrit) in preparation for blood transfusion
6. Administer oxygen if necessary
Nursing Intervention

7. Maintain fluid and electrolyte balance

8. Administer RhoGAM if prescribed
9. Assist with grieving process
a. Discuss physiologic reality, but encourage to work
through feelings
b. Expect that grieving may continue for 24 months
c. Encourage participation with thanatology services and
bereavement/support groups when appropriate
10. Educate about necessity for follow-up
 Abortion risks
Pelvic infection Blood clots
PID can occur after a miscarriage, Abortions had double the risk Heavy bleeding
abortion, or any other procedure that opens for venous thromboembolism
the cervix or abdomen, allowing disease- of women who were not
causing germs easy entry to the pregnant
reproductive organs.

Perforation Incomplete loss