Download Pregnancy Related Complications

Pregnancy
Related
Complications
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Hyperemesis Gravidarum
A disorder of early pregnancy that is
characterized by severe (excessive)
nausea and vomiting
Most often appears between 8 and 12
weeks gestation – resolves by 16 weeks
Associated with high levels of human
chorionic gonadotropin (hCG) or estrogen
Increases with multiple pregnancies,
molar pregnancies and stress
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Hyperemesis Gravidarum
Not “morning sickness”
More severe and results in dehydration,
weight loss and electrolyte imbalances
Emergency Tx is correct fluid, electrolyte
and acid-base imbalances
Hospitalization is needed with IV fluid
administration with dextrose added to
prevent protein breakdown and
antiemetics
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Hyperemesis Gravidarum
Pt. is kept NPO for the first 24 hours
Ginger, and herbal remedy can
significantly reduce nausea
Pyridoxine (makes up vitamin B6)
supplementation may be ordered because
a deficiency in the B vitamin is associated
with hyperemesis
Encourage small frequent meals to
decrease nausea
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Ectopic Pregnancy
Ectopic refers to an object that is located
away from the expected site or position
An ectopic pregnancy occurs outside of
the uterus
Adhesions, scarring and narrowing of the
tubal lumen may block the zygote’s
progress to the uterus
Symptoms appear at 4 to 8 weeks after
LMP
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Ectopic Pregnancy
The most common symptoms are pelvic pain
and/or vaginal spotting
If the tube ruptures, hemorrhage occurs into the
abdominal cavity, which can lead to hypovolemic
shock
S/S of shock – rapid, thready pulse; rising
respiratory rate; shallow, irregular respirations;
falling BP; decreased/absent urine output; pale,
cold, clammy skin; faintness; thirst
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Ectopic Pregnancy
Diagnosis not apparent
A serum pregnancy test is done to detect the
presence of hCG.
Transvaginal ultrasound is used to locate
gestational sac – may be diagnostic
Surgery may be needed to remove the ectopic
pregnancy
Methotrexate (chemo drug) targets pregnancy
for destruction, may avoid surgery
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Early Pregnancy Loss
Is the most common complication of
pregnancy
Occurs in approximately 75% of women
who are trying to conceive
Spontaneous abortion (miscarriage) – loss
before 20 weeks gestation, early before
12 weeks, late between 12 and 20 weeks
Most common cause is fetal chromosomal
defects
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Early Pregnancy Loss
Treatment is conservative “wait and see”
If pregnancy is lost, a D&C may be
needed to clear uterus of products of
conception, and may need pitocin or
Methergine to prevent excessive bleeding
If Rh negative, needs RhoGam
Emotional response varies
Needs ongoing grief support after
discharge – make referrals at discharge
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Incompetent Cervix
Painless dilation occurs with bulging of
fetal membranes and parts through the
external os
Usually results in the loss of the
pregnancy
Tx is placing a purse string type suture in
the cervix to keep it from dilating =
cerclage, done between 14 and 26 weeks
Suture removed when term or in labor
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Hydatidiform Mole
Molar pregnancy is characterized by a
benign growth of placental tissue
Molar pregnancies have some features of
a malignancy in that trophoblastic tissue
proliferates out of control
20% of women with complete molar
pregnancies develop choriocarcinoma
malignancy of the uterine lining within 6
months to 1 year after a molar pregnancy
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Hydatidiform Mole
Continuous follow-up for 1 year is
extremely important
Return every 1 to 2 weeks to have hCG
levels drawn
Follow-up to detect choriocarcinoma
which is highly treatable when caught
early
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Placenta Previa
When the placenta is implanted close to or
over the cervical os
May be caused by scarring which causes
the embryo to implant in a more favorable
area
Classified to the degree of which it covers
the cervix
Marginal, partial, or complete
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Placenta Previa
Strong indications of placenta previa is
painless, bright red bleeding that begin
with no warning, may be light or severe
Presentation with painless bleeding = a
digital exam is not done until placenta
previa is ruled out – fingers could
penetrate the placental tissue and cause
massive hemorrhage
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Placenta Previa
Most require cesarean delivery
Marginal placenta previas may deliver
vaginally
May require an emergency cesarean
delivery if bleeding is excessive and the
fetus and mother are compromised
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Abruptio Placentae
Placental abruption is the premature
separation of a normally implanted
placenta
Risk factors – HTN, preeclampsia,
advanced maternal age, multiparity,
trauma, smoking, use of cocaine,
premature rupture of membranes
Bleeding is concealed or apparent
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Abruptio Placentae
Massive hemorrhage may occur
Maternal complications include DIC,
hemorrhagic shock, uterine rupture, renal
failure and death
Fetal complications include hypoxia,
anemia, growth retardation and death
Classic signs are pain, dark red vaginal
bleeding, tender/rigid abdomen, blood y
amniotic fluid
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Abruptio Placentae
Requires careful monitoring
Large bore IV and IV fluid infusion
Blood products immediately available
Emergency cesarean delivery
Strict I&O after delivery
DIC may still develop after delivery
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Gestational Hypertension
Formerly called pregnancy induced
hypertension
Indicated when BP is greater than or
equal to 140/90, develops for the first time
in pregnancy, and is without the presence
of protein in the urine
May develop in to more severe
preeclampsia-eclampsia
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Preeclampsia-Eclampsia
A serious condition of pregnancy
Diagnosed when BP rises to 140/90 or
higher and in accompanied by proteinuria
Develops after 20 weeks
The underlying cause of the disorder is
unknown
Risk factors – African-American,
nulliparity, systemic lupus erythematosus,
renal disease, diabetes
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Preeclampsia-Eclampsia
Underlying development os generalized
vasospasm, which affects every organ of
the body
Vasospasm leads to endothelial damage
which causes abnormal clotting
CNS irritability results in hyperactive deep
tendon reflexes and clonus
May include HA, visual disturbances,
elevated liver enzymes, low platelets
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Preeclampsia-Eclampsia
Advances to full blown eclampsia when
there is seizure activity or coma
Cerebral hemorrhage and stroke are
complications of seizures in eclampsia
HELLP syndrome is a severe form of
preeclampsia-eclampsia (hemolysis,
elevated liver enzymes and low platelets
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Preeclampsia-Eclampsia
Tx – includes activity restriction (bedrest,
visitor restriction, stimulation restriction),
IV magnesium sulfate infusion
Magnesium infusion requires careful
monitoring of VS, I&O, maternal ling
sounds, FHR, and deep tendon reflexes
Therapeutic magnesium level is 4 to 8
Calcium gluconate is magnesium sulfate
antidote if toxicity occurs
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Blood Incompatibilities
Rh incompatibility
Rh factor is an protein that is found on the
surface of blood cells
If the factor is present = Rh positive
If the factor is missing = Rh negative
Isoimmunization is when an Rh negative
women’s body has produced antibodies to
the Rh factor and she is sensitized to Rh
positive blood
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Blood incompatibilities
If a pregnant Rh negative women who has
been sensitized and produced antibodies
to Rh positive blood, and she then carries
a fetus who is Rh positive, the antibodies
cross the placenta and attack the fetus’
blood cells, resulting in hemolytic anemia
This hemolytic anemia often requires
exchange transfusions in utero or after
birth
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Blood Incompatibilities
Now, Rh negative women are given RhoGam at
28 weeks and 72 hours after the delivery of an
Rh positive baby
It is critical for a woman who is Rh negative to
receive RhoGam after childbirth, miscarriage or
abortion, ectopic pregnancy, or any invasive
procedures
If the baby is also Rh negative, no RhoGam is
needed – only when they are Rh positive
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Blood Incompatibilities
ABO Incompatibility is another hemolytic
disease of the newborn
Arises when the woman’s blood type is O
and the fetus is A, B, or AB
O has naturally occurring antibodies to the
other blood types, but these antibodies
are large and don’t cross the placenta
Only occurs if fetal blood leaks into
maternal circulation
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Blood Incompatibilities
The woman’s immune system then
produces antibodies to the fetal blood that
can cross the placenta and work to
destroy the fetal blood
This incompatibility is much less severe
The neonate may, but rarely needs an
exchange transfusion
Most likely will have problems with
jaundice
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