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COMPLICATIONS OF

PREGNANCY
FIRST TRIMESTER BLEEDING

 SPONTANEOUS MISCARRIAGE
o ABORTION
o INTERRUPTION OF PREGNANCY BEFORE FETUS
IS VIABLE
o MEDICALLY OR SURGICALLY INTERRUPTED
o MISCARRIAGE
o INTERRUPTION OCCURS SPONTANEOUSLY
o NONVIABLE FETUS : 20 – 24 WEEKS
AOG 500 g or less
FIRST TRIMESTER BLEEDING

 SPONTANEOUS MISCARRIAGE
 15 % - 30 %
 CAUSES:
 ABNORMAL FETAL FORMATION
 IMMUNOLOGIC FACTORS

 IMPLANTATION ABNORMALITIES

 INFECTION

 TERATOGENIC DRUGS
FIRST TRIMESTER BLEEDING

 SPONTANEOUS MISCARRIAGE
 PRESENTING SYMPTOM: VAGINAL

SPOTTING
 MANAGEMENT

 DEPENDS ON THE SYMPTOMS


FIRST TRIMESTER BLEEDING

TYPES OF SPONTANEOUS ABORTION


 THREATENED MISCARRIAGE
 MANIFESTED BY VAGINAL BLEEDING,
SLIGHT CRAMPING
 NO CERVICAL DILATATION

 MANAGEMENT
 NO STRENOUS ACTIVITY (24-48 HOURS)
FIRST TRIMESTER BLEEDING

 IMMINENT
(INEVITABLE)
MISCARRIAGE
 PRESENCE OF UTERINE
CONTRACTION & CERVICAL DILATION
 SIGNS & SYMPTOM
 MANAGEMENT:
 DILATATION & CURETTAGE
FIRST TRIMESTER BLEEDING

 COMPLETE MISCARRIAGE

 ENTIRE
PRODUCTS OF
CONCEPTION ARE EXPELLED
SPONTANEOUSLY
FIRST TRIMESTER BLEEDING

 INCOMPLET MISCARRIAGE
• PART OF THE CONCEPTUS IS
EXPELLED, MEMBRANES OR PLACENTA
IS RETAINED IN THE UTERUS
• MATERNAL HEMORRHAGE
• MANAGEMENT
 DILATION & CURETTAGE
FIRST TRIMESTER BLEEDING

 MISSED MISCARRIAGE
• EARLY PREGNANCY FAILURE
• FETUS DIES IN UTERO BUT IS NOT
EXPELLED
• SIGNS
 NO INCREASE IN FUNDAL HEIGHT
 NO FETAL MOVEMENT

• DIAGNOSTIC: ULTRASOUND
FIRST TRIMESTER BLEEDING

 MISSED MISCARRIAGE
• MANAGEMENT
> 14 WEEKS: INDUCE LABOR
FIRST TRIMESTER BLEEDING
 RECURRENT PREGNANCY LOSS
• THREE SPONTANEOUS MISCARRIAGE
THAT OCCURRED AT THE SAME
GESTATIONAL AGE
• 1%
• POSSIBLE CAUSES:
 DEFECTIVE SPERMATOZOA OR OVA
 ENDOCRINE FACTORS

 DEVIATION OF UTERUS

 INFECTION

 AUTOIMMUNE DISORDERS
FIRST TRIMESTER BLEEDING

 ECTOPIC PREGNANCY
• IMPLANTATION OCCURS OUTSIDE THE
UTERINE CAVITY
• 2% OF PREGNANCIES
• MOST COMMON SITE: FALLOPIAN TUBE
 AMPULLAR PORTION : 80%
 ISTHMUS: 12%

 INTERSTIAL OR FRIMBRIAE: 8%
FIRST TRIMESTER BLEEDING

 ECTOPIC PREGNANCY
• CAUSES
ADHESION OF FALLOPIAN TUBE

FROM
• PREVIOUS INFECTION

CONGENITAL MALFORMATION

UTERINE TUMORS
FIRST TRIMESTER BLEEDING

 ECTOPIC PREGNANCY
• ASSESSMENT
ABDOMINAL PAIN

VAGINAL SPOTTING

• MANAGEMENT
LAPAROSCOPY
2nd TRIMESTER BLEEDING

 GESTATIONAL TROPHOBLASTIC
DISEASE
 HYDATIDIFORM MOLE
 PROLIFERATION AND DEGENERATION
OF TROPHOBLASTIC VILLI
 ASSOCIATED WITH CHORIOCARCINOMA

 1 IN 2,000 PREGNANCIES
2nd TRIMESTER BLEEDING

 GESTATIONAL TROPHOBLASTIC
DISEASE
• RISK FACTORS
LOW PROTEIN INTAKE

< 18 YEARS OLD

> 35 YEARS OF AGE

ASIAN
2nd TRIMESTER BLEEDING
2nd TRIMESTER BLEEDING

 GESTATIONAL TROPHOBLASTIC
DISEASE
• ASSESSMENT
 UTERUS LARGER THAN USUAL
 NO FETAK HEART SOUNDS

• DIAGNOSTICS:
 UTZ– SNOWFLAKE PATTERN
 HCG - INCREASE
2nd TRIMESTER BLEEDING

 GESTATIONAL TROPHOBLASTIC
DISEASE
• MANAGEMENT
SUCTION CURETTAGE
2nd TRIMESTER BLEEDING
 PREMATURE CERVICAL DILATATION
• INCOMPLETE CERVIX
• CERVIX THAT DILATES PREMATURELY
• SIGNS & SYMPTOMS:
 PINK-STAINED VAGINAL DISCHARGE

RUPTURE OF MEMBRANES

DISCHARGE OF AMNIOTIC FLUID

• COMMONLY OCCURS AT 20 WKS AOG


2nd TRIMESTER BLEEDING
 PREMATURE CERVICAL DILATATION
• ASSOCIATED WITH
INC. MATERNAL AGE

CONGENITAL STRUCTURAL
DEFECT
TRAUMA TO CERVIX

• MANAGEMENT
CERVICAL CERCLAGE
CERVICAL CERCLAGE
3RD TRIMESTER BLEEDING

 PLACENTA PREVIA
• LOW IMPLANTATION OF THE PLACENTA
• FOUR DEGREES
1. LOW-LYING PLACECNTA

2. MARGINAL IMPLANTATION

3. PARTIAL PLACENTA PREVIA

4. TOTAL PLACENTA PREVIA


3RD TRIMESTER BLEEDING
 PLACENTA PREVIA
• ASSOCIATED WITH
INCREASED PARITY

ADVANCED MATERNAL AGE

PAST CEASARIAN BIRTHS

PAST UTERINE CYRETTAGE

MULTIPLE GESTATION

• 5 PER 1,000 PREGNANCIES


3RD TRIMESTER BLEEDING
 PLACENTA PREVIA
• ASSESSMENT
ABRUPT, PAINLESS BLEEDING

• DIAGNOSTIC: UTZ
• MANAGEMENT
IMMEDIATE CARE MEASURES

• BED REST IN SIDE-LYING

POSITION
ABRUPTIO PALCENTAE
BIRTH

 ABRUPTIO PALCENTAE
• PREMATURE SEPARATION OF
MEMENBRANES
• 10% OF PREGNANCIES
• MOST FREQUENT CAUSE OF
PERINATAL DEATH
• CAUSE: UNKNOWN
ABRUPTIO PALCENTAE
PREDISPOSING FACTORS
HIGH PARITY

HYPERTENSION

DIRECT TRAUMA

COCAINE USE
BIRTH

 ABRUPTIO PLACENTAE
• ASSESSMENT
SHARP, STABBING PAIN

HEAVY BLEEDING

• THERAPEUTIC MANAGEMENT
FLUID REPLACEMENT

OXYGEN
 PRETERM LABOR
 LABOR OCCURS BEFORE 37 WEEKS
 9% - 10% OF PREGNANCIES

 CAUSE : UNKNOWN

 ASSOCIATED WITH
 CHORIOAMNIONITIS

 DEHYDRATION

 UTI
 PRETERM LABOR
 COMMON SYMPTOMS
 PERSISTENT,DULL, LOW BACKACHE
 VAGINAL SPOTTING

 ABDOMINAL PRESSURE OR TIGHTENING

 UTERINE CONTRACTION

 THERAPEUTIC MANAGEMENT
 TOCOLYTIC AGENTS
 PRETERM
RUPTURE OF
MEMBRANES
 RUPTURE OF FEYAL MEMBRANE WITH
LOSS OF AMNIOTIC FLUID
 CAUSE; UNKNOWN

 2 % TO 18%

 ASSESSMENT
 SUDDEN GUSH OF CLEAR FLUID
 PRETERM
RUPTURE OF
MEMBRANES
 ASSOCIATED WITH
 VAGINAL INFECTION
 THERAPEUTIC MANAGEMENT
 ANBIOTICS
 PREGNANCY-INDUCED HPN
 VASOPASM DURING PREGNACY
 SIGNS OF HPN
 PROTEINURIA

 EDEMA

 5% -10%
 CAUSE: UNKNOWN

 <20 YEARS OLD & > 30 YEARS OLD


 PREGNANCY-INDUCED HP
 CLASSIFIED INTO
 GESTATIONAL HPN
 MILD PREECCLAMPSIA

 SEVERE PREECLAMPSIA

 ECLAMPSIA
TYPE SYMPTOMS
GESTATIONAL BP 140/90
HPN 30 mmHg Systolic
15mmHg Diastolic
NO PROTEINURIA OR EDEMA
BP RETURNS TO NORMAL
AFTER DELIVERY
TYPE SYMPTOMS
MILD BP 140/90
PREECCLAMPSIA 30 mmHg Systolic
15mmHg Diastolic
PROTEINURIA 1-2+
WEIGHT GAIN > 2 LBS/WK
MILD EDEMA
(UPPER EXTREMITIES OR
FACE)
TYPE SYMPTOMS
SEVERE BP 160/110
PREECCLAMPSIA PROTEINURIA 3-4
OLIGURIA
CEREBRAL OR VISUAL
DISTURBANCES
EXTENSIVE PERIPHERAL
EDEMA
TYPE SYMPTOMS
ECLAMPSIA CONVULSION OR COMA
+ SIGNS OF SEVERE
PREECCLAMPSIA
 NURSING INTERVENTION
 BED REST
 MONITOR FETAL WELL-BEING

 NUTITRIOUS DIET

 ADMINISTER MEDS
 HELLP SYNDROME
 HEMOLYSIS

 ELEVATED LIVER ENZYMES


 LOW PLATELETS

 4% - 12% PIH

 MATERNAL MORTALITY

 INFANT MORTALITY
 HELLP SYNDROME
 SYMPTOMS
 NAUSEA

 EPIGASTRICPAIN
 GENERAL MALAISE

 R UPPER QUADRANT TENDERNESS

 LAB TEST
 HEMOLYSIS OF RBC
 <100,000/mm3 PLATELET COUNT
 HELLP SYNDROME
 LAB TEST
 ELEVATED LIVER ENZYMES
 ALANINE AMINOTRANSFERASE
 SERUM ASPARTATE AMINOTRANSFERASE
 MANAGEMENT
 FRESH FROZEN PLASMA OR PLATELETS
 MULTIPLE PREGNANCY
 2% OF PREGNANCIES
 TYPES
 MONZYGOTIC

 DIZYGOTIC

 ASSESSMENT
 INCIN SIZE AT A RATE FASTER THAN
USUAL
 ALPHA FETOPROTEIN LEVEL ELEVATED
 MULTIPLE PREGNANCY
 DIAGNOSTICS ; UTZ
 MANAGEMENT
 CLOSER PRENATAL SUPERVISION
 HYDRAMNIOS
 EXCESSIVE AMNIOTIC FLUID
FORMATION
 NORMALLY 500-1,000 ML

 > 2,000 ml

 CAN CAUSE
 FETAL MALPRESENTATION
 PROM
 ASSESSMENT: ENLARGEMENT OF
UTERUS
 DIAGNOSTICS: UTZ
 MANAGEMENT
 BEDREST
 AMNIOCENTESIS
 POST-TERM PREGNANCY
 38– 42 WEEKS LONG
 3% - 12% OF PREGNANCIES

 ASSOCIATED WITH
 SALICYLATE
INTAKE
 MYOMETRIAL QUIESCENCE

 MANAGEMENT: INDUCTION OF LABOR


 ISOIMMUNIZATION
 RH - MOTHER CARRIES A RH POSITIVE
FETUS
 HEMOLYTIC DISEASE OF THE NWBORN
OR ERYTHROBLASTOSIS FETALIS
 MANAGEMENT
 Rh Immune Globulin
 FETAL DEATH
 CAUSES
 CHROMOSOMAL ABNORMALITIES
 CONGENITAL MALFORMATION

 INFECTIONS

 COMPICATION OF MATERNAL DISEASE

 ASSESSMENT
 ABSENT FETAL MOV’T
 MANAGEMENT
 PROSTAGLANDIN GEL