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AntepartalComplication

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First Trimester Second Trimester Third Trimester

1. Spontaneous

Miscarriage2. Ectopic Pregnancy

1. Gestational

Trophoblastic Disease(H-Mole)

2. Premature CervicalDilatation

1. Placenta Previa

2. Abruptio Placenta3. Preterm Labor

Bleeding

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Miscarriage

Threatened

Vaginal bleeding withNO CERVICALDILATATION

What to do?

Limit activity for 24hours

Inevitable

Uterine contractions WITH CERVICALDILATATION andsubsequent loss of

products of conception What to do?Sonogram; thenD&C

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Miscarriage

Complete

ALL PRODUCTS OFCONCEPTION areexpelled spontaneouslywithout assistance

Incomplete

Product of conceptionare expelled butmembranes mayberetained.

What to do?D&C or suctioncurettage is done

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CBR w/o BRPAssess pt: vaginal bleeding odor, color, amount

Place pt. in T-positionGive analgesics & oxytocin as orderedv/s q4 for 24 hrsMonitor Urine outputProvide pericareExplain all procedures and treatments; answerquestions of pt.

Other nursing

intervention

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Implantation that occurs outside the uterine cavity

Ectopic Pregnancy

Mostcommon siteis in theFALLOPIANTUBE!

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Gestational Trophoblastic

Diseaseaka: H-Mole/Molarpregnancy

Rapid deterioration oftrophoblastic villi cells;the cells becomeedematous appearing asgrapelike clusters ofvesicles.Assessment: Large uterus,bleeding, grapelikevesicles, no FHT, highHCG levels

What to do?v/s

Observe forcomplicationsExplain to pt. that sheneeds to takecontraceptives for atleast a year until hCGlevels return to normal

How it is treated?Dilatation and suctioncurettage

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Dilatation of cervix prematurely and cannot hold afetus to term

Treatment:Cerclage : McDonalds or Shirodkar

Incompetent Cervix

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Placenta Previa

Low implantation of theplacentaAssessment:

Abrupt painless andbright red vaginal bleeding

Management:Side-lying positionNo internal examinationv/sBed rest for 48 hrsIf bleeding stops pt. issent home with areferral for bed rest andhome care

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Abruptio placenta

Premature separationof the placenta with a

normal implantation;occurs late in thepregnancyAssessment: sharpstabbing pain in thefundusHeavy bleeding notreadily apparent

Management:IV fluids

O2Monitor: FHT & V/SLeft lateral positionNo I.E. or enemaDelivery: C/S

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Vasospasm during pregnancy that produces signs ofhypertension, proteinuria and edema

AssessmentManagement

Pregnancy Induced

Hypertension

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Hemolysis, Elevated Liver enzymes, and LowPlatelet

A category of PIH that involves changes in bloodcomponents and liver functionAssessmentManagement

HELLP Syndrome

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Condition which the pregnant woman is Rh-negativebut her fetus is Rh-positive

AssessmentManagement

Isoimmunization (Rh

incompatibility)

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Diabetes that occurs during pregnancy and fadeagain at completion of pregnancy

Risk FactorAssessmentManagement

Gestational Diabetes

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Pregnant woman with preexisting cardiac diseaseAssessmentManagement

Cardiac disease of

Pregnancy

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Intrapartum Conditions

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Preterm Labor

Labor that occursbefore the end of 37

weeks of gestationAssessment:

Vaginal spottingAbdominal tightening

Menstrual-like crampsUterine contractionsLow back ache

ManagementIntervention:

Continuous monitoringSide lying positionReport: Maternaltachycardia,contractions, rapture ofmembrane and inc.vaginal bleeding

Medication:Terbutaline

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Rapture of fetal membranes with loss of amnioticfluid during pregnancy

AssessmentManagement

Premature Rapture of

Membrane

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Stress on the uterine muscle exceeds its ability tostretch

AssessmentManagement

Uterine Rapture

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is the escape of amniotic fluid containing debris suchas meconium, lanugo and vernix caseosa into the

maternal circulation, usually resulting in depositionof fluid or debris in the pulmonary arterioles.AssessmentManagement

Amniotic Fluid Embolism

(Anaphylactic Syndrome of Pregnancy)

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Cord descents before the presenting partAssessmentManagement

Cord Prolapse

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Post PartumComplications

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Loss of 500ml of blood or more during the first 24 hrsof postpartum in vaginal birth; 1000ml in cesarean

section.AssessmentManagement

Postpartum Hemorrhage

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Bacterial invasion of birth canal or a localizedinfection of the lining of the uterus

AssessmentManagement

Postpartum Infection

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Usually occurs within 2 weeks postpartumAssessmentManagement

Postpartum

Depression/Psychosis

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End