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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
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
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
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
MULTIPLE GESTATION
• DIAGNOSTIC: UTZ
• MANAGEMENT
IMMEDIATE CARE MEASURES
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
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
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
4% - 12% PIH
MATERNAL MORTALITY
INFANT MORTALITY
HELLP SYNDROME
SYMPTOMS
NAUSEA
EPIGASTRICPAIN
GENERAL MALAISE
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
INFECTIONS
ASSESSMENT
ABSENT FETAL MOV’T
MANAGEMENT
PROSTAGLANDIN GEL