3-Complications of pregnancy
Ant partum Hemorrhage
1.Early Pregnancy Bleeding
2. late Pregnancy Bleeding
Introduction:
Pregnancy is one of the most profound times in a woman’s life. It is marked
by a variety of physical changes, as well as by thoughts and feelings that
sometimes overwhelm the mother-to-be. Though pregnancy is generally a
time of joy and well-being, complications can occur that cloud the
experience and put the woman and her unborn child at risk. The following
complication or high risk condition are the most common ones seen in
pregnancy:
Ant partum Hemorrhage
Bleeding in pregnancy may jeopardize maternal and fetal well-being. The
following conditions may cause abnormal bleeding in pregnancy:
Early Pregnancy Bleeding and nursing care
1.Miscarriage (Spontaneous Abortion)
Abortion is the delivery of a fetus before the 20th week of gestation.
Signs and symptoms: Typically, bleeding occurs followed by abdominal
cramping pain.
Types of spontaneous abortion
o Threatened: first-trimester bleeding in the absence of fluid or tissue
loss
o Inevitable: cervical dilation in the setting of rupture of membranes
most often followed by contractions and the expulsion of placental or
fetal tissue or both
o Incomplete: characterized by bleeding through a dilated internal
cervical os; placental or fetal tissue or both, either completely or
partially remain in utero and may need to be extracted by ring forceps
or evacuated by suction and curettage
o Complete: placental or fetal tissue or both is completely and
spontaneously delivered
o Missed: retained placental or fetal tissue, or both, from a failed
, intrauterine pregnancy
o Induced abortion: an elective medical or surgical termination of a
pregnancy before viability.
Medical management:
if bleeding and infection are not present. Prostaglandin medications
(e.g., misoprostol [Cytotec]) may be given orally or vaginally and are
usually effective in completing the miscarriage within 7 days.
If the products of conception are not passed completely, the woman
may be prepared for manual or surgical evacuation of the uterus
(dilation and curettage (D&C))
Nursing care:
Special care may be needed for management of side effects of
prostaglandin such as nausea, vomiting, and diarrhea.
Before a surgical procedure: The nurse reinforces explanations,
answers any questions or concerns, and prepares the woman for
surgery.
After evacuation After evacuation of the uterus,
oxytocin is often given to prevent hemorrhage
Antibiotics are given as necessary
Analgesics such as antiprostaglandin agents may decrease discomfort from
cramping
The woman who is Rh negative and is not isoimmunized is given RhO(D)
immunoglobulin
Follow-up Care. The woman will likely be discharged home within a
few hours after a D&C or as soon as her vital signs are stable, vaginal
bleeding remains minimal, and she has recovered from anesthesia.
Discharge teaching emphasizes the need for rest. If significant blood
loss has occurred, iron supplementation may be ordered.
Teaching includes:
information about normal physical findings such as cramping,
type and amount of bleeding
resumption of sexual activity
family planning
2.Molar pregnancy (Gestational trophoblastic disease):
Molar pregnancy (Gestational trophoblastic disease) GTD, also known as
hydatidiform mole is a benign proliferative growth of the placental
, trophoblast in which the chorionic villi develop into edematous, cystic,
avascular transparent vesicles that hang in a grapelike cluster, figure (1).
Symptoms:
Dark brown to bright red vaginal bleeding during the first trimester
Severe nausea and vomiting
Sometimes vaginal passage of grapelike cysts
Pelvic pressure or pain
Risks for the Woman
Increased risk of choriocarcinoma
Diagnosis
diagnosis of molar pregnancy is much earlier than before because
the routine use of ultrasound in early pregnancy detects the molar
pregnancy earlier.
hCG and transvaginal ultrasound
Medical Management:
immediate evacuation of mole with aspiration/suction D&C
Follow-up of hCG levels for at least 6 months to detect trophoblastic
neoplasia. After hCG levels fall to normal for 6 months, pregnancy
can be considered.
figure (1).Formation of gestational trophoblastic disease (hydatidiform mole).
Ant partum Hemorrhage
1.Early Pregnancy Bleeding
2. late Pregnancy Bleeding
Introduction:
Pregnancy is one of the most profound times in a woman’s life. It is marked
by a variety of physical changes, as well as by thoughts and feelings that
sometimes overwhelm the mother-to-be. Though pregnancy is generally a
time of joy and well-being, complications can occur that cloud the
experience and put the woman and her unborn child at risk. The following
complication or high risk condition are the most common ones seen in
pregnancy:
Ant partum Hemorrhage
Bleeding in pregnancy may jeopardize maternal and fetal well-being. The
following conditions may cause abnormal bleeding in pregnancy:
Early Pregnancy Bleeding and nursing care
1.Miscarriage (Spontaneous Abortion)
Abortion is the delivery of a fetus before the 20th week of gestation.
Signs and symptoms: Typically, bleeding occurs followed by abdominal
cramping pain.
Types of spontaneous abortion
o Threatened: first-trimester bleeding in the absence of fluid or tissue
loss
o Inevitable: cervical dilation in the setting of rupture of membranes
most often followed by contractions and the expulsion of placental or
fetal tissue or both
o Incomplete: characterized by bleeding through a dilated internal
cervical os; placental or fetal tissue or both, either completely or
partially remain in utero and may need to be extracted by ring forceps
or evacuated by suction and curettage
o Complete: placental or fetal tissue or both is completely and
spontaneously delivered
o Missed: retained placental or fetal tissue, or both, from a failed
, intrauterine pregnancy
o Induced abortion: an elective medical or surgical termination of a
pregnancy before viability.
Medical management:
if bleeding and infection are not present. Prostaglandin medications
(e.g., misoprostol [Cytotec]) may be given orally or vaginally and are
usually effective in completing the miscarriage within 7 days.
If the products of conception are not passed completely, the woman
may be prepared for manual or surgical evacuation of the uterus
(dilation and curettage (D&C))
Nursing care:
Special care may be needed for management of side effects of
prostaglandin such as nausea, vomiting, and diarrhea.
Before a surgical procedure: The nurse reinforces explanations,
answers any questions or concerns, and prepares the woman for
surgery.
After evacuation After evacuation of the uterus,
oxytocin is often given to prevent hemorrhage
Antibiotics are given as necessary
Analgesics such as antiprostaglandin agents may decrease discomfort from
cramping
The woman who is Rh negative and is not isoimmunized is given RhO(D)
immunoglobulin
Follow-up Care. The woman will likely be discharged home within a
few hours after a D&C or as soon as her vital signs are stable, vaginal
bleeding remains minimal, and she has recovered from anesthesia.
Discharge teaching emphasizes the need for rest. If significant blood
loss has occurred, iron supplementation may be ordered.
Teaching includes:
information about normal physical findings such as cramping,
type and amount of bleeding
resumption of sexual activity
family planning
2.Molar pregnancy (Gestational trophoblastic disease):
Molar pregnancy (Gestational trophoblastic disease) GTD, also known as
hydatidiform mole is a benign proliferative growth of the placental
, trophoblast in which the chorionic villi develop into edematous, cystic,
avascular transparent vesicles that hang in a grapelike cluster, figure (1).
Symptoms:
Dark brown to bright red vaginal bleeding during the first trimester
Severe nausea and vomiting
Sometimes vaginal passage of grapelike cysts
Pelvic pressure or pain
Risks for the Woman
Increased risk of choriocarcinoma
Diagnosis
diagnosis of molar pregnancy is much earlier than before because
the routine use of ultrasound in early pregnancy detects the molar
pregnancy earlier.
hCG and transvaginal ultrasound
Medical Management:
immediate evacuation of mole with aspiration/suction D&C
Follow-up of hCG levels for at least 6 months to detect trophoblastic
neoplasia. After hCG levels fall to normal for 6 months, pregnancy
can be considered.
figure (1).Formation of gestational trophoblastic disease (hydatidiform mole).
