Complication Of Pregnancy

COMPLICATIONS OF PREGNANCY

FIRST TRIMESTER BLEEDING  SPONTANEOUS o

ABORTION o

o

o

INTERRUPTION OF PREGNANCY BEFORE FETUS IS VIABLE MEDICALLY OR SURGICALLY INTERRUPTED

MISCARRIAGE o

o

MISCARRIAGE

INTERRUPTION OCCURS SPONTANEOUSLY

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  ENTIRE

MISCARRIAGE

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  COMMON

LABOR SYMPTOMS

 PERSISTENT,

DULL, LOW BACKACHE  VAGINAL SPOTTING  ABDOMINAL PRESSURE OR TIGHTENING  UTERINE CONTRACTION  THERAPEUTIC  TOCOLYTIC

MANAGEMENT

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  VAGINAL

WITH

INFECTION

 THERAPEUTIC  ANBIOTICS

MANAGEMENT

 PREGNANCY-INDUCED  VASOPASM

HPN

DURING PREGNACY

 SIGNS

OF HPN  PROTEINURIA  EDEMA  5%

-10%  CAUSE: UNKNOWN  <20 YEARS OLD & > 30 YEARS OLD

 PREGNANCY-INDUCED  CLASSIFIED

INTO

 GESTATIONAL

HPN  MILD PREECCLAMPSIA  SEVERE PREECLAMPSIA  ECLAMPSIA

HP

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 ECLAMPSIA

SYMPTOMS CONVULSION OR COMA + SIGNS OF SEVERE PREECCLAMPSIA

 NURSING  BED

INTERVENTION

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  EPIGASTRIC

PAIN  GENERAL MALAISE  R UPPER QUADRANT TENDERNESS  LAB

TEST

 HEMOLYSIS

OF RBC  <100,000/mm3 PLATELET COUNT

 HELLP  LAB

SYNDROME

TEST

 ELEVATED  

LIVER ENZYMES

ALANINE AMINOTRANSFERASE SERUM ASPARTATE AMINOTRANSFERASE

 MANAGEMENT  FRESH

FROZEN PLASMA OR PLATELETS

 MULTIPLE

PREGNANCY

 2%

OF PREGNANCIES  TYPES  MONZYGOTIC  DIZYGOTIC

 ASSESSMENT  INC

IN 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  PROM

MALPRESENTATION

 ASSESSMENT:

ENLARGEMENT OF

UTERUS  DIAGNOSTICS: UTZ  MANAGEMENT  BED

REST  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