NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
Adolescent Pregnancy
• Consequences:
o Less likely to complete high school
o Dependence on welfare
o Single parenthood
o More likely to abuse or neglect the child
Physical Consequences
• Poor nutritional intake
• Preeclampsia
• CPD
• Anemia
• Drugs
• STIs
• Fetal death
• LBW (low birth weight)
• - need to eat 2800 calories for baby and mom to grow
• - preeclampsia is higher is adolescents
• - #1 reason for cesarean is cephalopelvic disproportion (CPD) -head is too big to go
through the pelvis
• - high risk behaviors include drugs and STIs
Nursing Objectives
• Provide support system
• Education
• Assessment of complications
• Provide options for consideration.
• - Options- adoption, abortion (YEET), or keeping the kid
Abortion
• Any interruption of pregnancy before viability.
o Early
o Late
• Causes
• - Not necessarily an induced abortion, can be natural (miscarriage)
• - Viability depends where you live
• - Early is prior to 16 weeks late is after 16 weeks
• - Causes- incompetent cervix, genetic anomalies (nature's way), poor implant to the
uterine wall
,NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
• - what should you say- nothing
Threatened Abortion
• Bright red vaginal bleeding
• No cramping
• No dilation
• Interventions:
o Hcg and progesterone levels
o Limit activity
o Pelvic rest
• - just spotting blood
• - Why progesterone- stops the uterus from ending the pregnancy, dropping is not a
good sign
• - Pelvic rest- no sex, no inserting anything
• - if she is rh negative- give Rhogam
Imminent (Inevitable) Abortion
• Bright red vaginal bleeding
• Contractions
• Dilation
• Possible passage of tissue fragments.
• Intervention
o Save fragments
o D&C
• - Is going to happen
• - has cramping and dilation with some tissue fragments that passes, save anything that
comes out, scrape the lining of the uterus after abortion so she can be ready for the next
one
Incomplete Abortion
• Moderate bright red vaginal bleeding.
• Contractions
• Dilation
• Spontaneous expulsion of partial contents of conception (usually fetus only)
• Save fragments, D & C
• - the fetus came out but the placenta is still inside
Complete Abortion
• Moderate bright red vaginal bleeding
• Contractions
• Dilation
• Spontaneous expulsion of entire contents of conception.
,NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
• - Everything came out, completely empty when you do an ultrasound, no reason to do a D
and C, needs a lot of support
Clinical Interruption of Pregnancy
• Elective
• Therapeutic
• Procedures:
o Mifepristone/
▪ misoprostol
o Vacuum
aspiration
o Dilation and evacuation.
• - Induced abortion
• - Why do people have abortions- not ready for a baby, medical conditions (danger to
the mom), rape, incest, baby has multiple anomalies
• - mifepristone- pill that blocks progesterone, estrogen takes over and the uterine lining is
shed, taken at docs office when the go home they take the misoprostol which expels the
pregnancy itself, will cause cramping and pain, have to be under 8 weeks pregnant to take
the pills, do an ultrasound to make sure the pregnancy is ended
• - Saline induction- introduce saline into the uterus and then put laminaria (sterile
seaweed) into the cervix to dilate it
Nursing Implications
• Watch for potential complications.
• Follow-up
• Rhogam
• Psychosocial support
• Education re:
o Complications
o Side effects
• - watch for infection and hemorrhage
• - when she goes home, look for fever, abnormal discharge, excessive bleeding
(all complications)
Ectopic Pregnancy
• Fertilized ovum is implanted in any tissue other than uterine wall
• Mostly fallopian
• 2% outside of tubes.
• 1% occurrence overall
• - Pregnancies where they shouldn’t be
• - 98% are in the fallopian tube because the cilia might not be functioning or can get stuck
Causes
, NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
• Cilia damage and Tube occlusion
• PID
• Tubal surgery
• Excessive estrogen and progesterone
• Advancing age
• Smoking
• Vaginal douching
• - Infection that goes into the upper reproductive tract (PID)
• - Birth control pills- excessive estrogen and progesterone
• - advanced maternal age is above 35
Symptoms
• Pain
• Vaginal bleeding
• Low serum hematocrit
• Elevated HCG
• Diagnosis made
o Ultrasound
o Laparoscopy
• - This can burst the fallopian tube, cause major hemorrhage, and can die from shock
• - a lot of pain where the side is, referred shoulder pain, if she says she has abdominal and
shoulder pain it is this
• - look for signs of shock, elevated HCG, bluish color around belly button (cullen’s
sign) Treatment
• Nonsurgical: methotrexate
• Surgical:
o laparoscopy or laparotomy
o Salpingectomy
• Future pregnancies?
o 30% difficulty conceiving again
o If tube spared, 60% future success.
o Repeat tubal pregnancy = 15%
• - methotrexate is chemo so it stops the cells from growing and kills the fetus, point of this
is to maintain the tubes
• - laparotomy takes the tubes out on the side where it is happening
• - salpingectomy- removal of the tubes, either one or both of them
• - If you take the tubes out you need to opt for IVF
Gestational Trophoblastic Disease (mole)
• Hydatidiform mole
o Abnormal placenta
OF PREGNANCY 2022
Adolescent Pregnancy
• Consequences:
o Less likely to complete high school
o Dependence on welfare
o Single parenthood
o More likely to abuse or neglect the child
Physical Consequences
• Poor nutritional intake
• Preeclampsia
• CPD
• Anemia
• Drugs
• STIs
• Fetal death
• LBW (low birth weight)
• - need to eat 2800 calories for baby and mom to grow
• - preeclampsia is higher is adolescents
• - #1 reason for cesarean is cephalopelvic disproportion (CPD) -head is too big to go
through the pelvis
• - high risk behaviors include drugs and STIs
Nursing Objectives
• Provide support system
• Education
• Assessment of complications
• Provide options for consideration.
• - Options- adoption, abortion (YEET), or keeping the kid
Abortion
• Any interruption of pregnancy before viability.
o Early
o Late
• Causes
• - Not necessarily an induced abortion, can be natural (miscarriage)
• - Viability depends where you live
• - Early is prior to 16 weeks late is after 16 weeks
• - Causes- incompetent cervix, genetic anomalies (nature's way), poor implant to the
uterine wall
,NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
• - what should you say- nothing
Threatened Abortion
• Bright red vaginal bleeding
• No cramping
• No dilation
• Interventions:
o Hcg and progesterone levels
o Limit activity
o Pelvic rest
• - just spotting blood
• - Why progesterone- stops the uterus from ending the pregnancy, dropping is not a
good sign
• - Pelvic rest- no sex, no inserting anything
• - if she is rh negative- give Rhogam
Imminent (Inevitable) Abortion
• Bright red vaginal bleeding
• Contractions
• Dilation
• Possible passage of tissue fragments.
• Intervention
o Save fragments
o D&C
• - Is going to happen
• - has cramping and dilation with some tissue fragments that passes, save anything that
comes out, scrape the lining of the uterus after abortion so she can be ready for the next
one
Incomplete Abortion
• Moderate bright red vaginal bleeding.
• Contractions
• Dilation
• Spontaneous expulsion of partial contents of conception (usually fetus only)
• Save fragments, D & C
• - the fetus came out but the placenta is still inside
Complete Abortion
• Moderate bright red vaginal bleeding
• Contractions
• Dilation
• Spontaneous expulsion of entire contents of conception.
,NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
• - Everything came out, completely empty when you do an ultrasound, no reason to do a D
and C, needs a lot of support
Clinical Interruption of Pregnancy
• Elective
• Therapeutic
• Procedures:
o Mifepristone/
▪ misoprostol
o Vacuum
aspiration
o Dilation and evacuation.
• - Induced abortion
• - Why do people have abortions- not ready for a baby, medical conditions (danger to
the mom), rape, incest, baby has multiple anomalies
• - mifepristone- pill that blocks progesterone, estrogen takes over and the uterine lining is
shed, taken at docs office when the go home they take the misoprostol which expels the
pregnancy itself, will cause cramping and pain, have to be under 8 weeks pregnant to take
the pills, do an ultrasound to make sure the pregnancy is ended
• - Saline induction- introduce saline into the uterus and then put laminaria (sterile
seaweed) into the cervix to dilate it
Nursing Implications
• Watch for potential complications.
• Follow-up
• Rhogam
• Psychosocial support
• Education re:
o Complications
o Side effects
• - watch for infection and hemorrhage
• - when she goes home, look for fever, abnormal discharge, excessive bleeding
(all complications)
Ectopic Pregnancy
• Fertilized ovum is implanted in any tissue other than uterine wall
• Mostly fallopian
• 2% outside of tubes.
• 1% occurrence overall
• - Pregnancies where they shouldn’t be
• - 98% are in the fallopian tube because the cilia might not be functioning or can get stuck
Causes
, NURS 3590 FINAL EXAM STUDY GUIDE-COMPLICATIONS
OF PREGNANCY 2022
• Cilia damage and Tube occlusion
• PID
• Tubal surgery
• Excessive estrogen and progesterone
• Advancing age
• Smoking
• Vaginal douching
• - Infection that goes into the upper reproductive tract (PID)
• - Birth control pills- excessive estrogen and progesterone
• - advanced maternal age is above 35
Symptoms
• Pain
• Vaginal bleeding
• Low serum hematocrit
• Elevated HCG
• Diagnosis made
o Ultrasound
o Laparoscopy
• - This can burst the fallopian tube, cause major hemorrhage, and can die from shock
• - a lot of pain where the side is, referred shoulder pain, if she says she has abdominal and
shoulder pain it is this
• - look for signs of shock, elevated HCG, bluish color around belly button (cullen’s
sign) Treatment
• Nonsurgical: methotrexate
• Surgical:
o laparoscopy or laparotomy
o Salpingectomy
• Future pregnancies?
o 30% difficulty conceiving again
o If tube spared, 60% future success.
o Repeat tubal pregnancy = 15%
• - methotrexate is chemo so it stops the cells from growing and kills the fetus, point of this
is to maintain the tubes
• - laparotomy takes the tubes out on the side where it is happening
• - salpingectomy- removal of the tubes, either one or both of them
• - If you take the tubes out you need to opt for IVF
Gestational Trophoblastic Disease (mole)
• Hydatidiform mole
o Abnormal placenta
