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Pregnancy Related Complications
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Ricci Chapter 19
ATI Chapters 7 & 9
NUR 212
•Dr. Baker Stein DNP, RN, CNE
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Healthy People 2030 Objectives
• Reduce severe maternal complications of pregnancy identified during labor and
delivery hospitalizations.
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• Reduce preterm births.
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Common Causes of Hemorrhage
1st half of Pregnancy
• Abortion
• Ectopic Pregnancy
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• Gestational Trophoblastic
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Abortion
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Spontaneous Abortion
1 • “Miscarriage”
• SAB
• Most occur before 12 weeks
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2 Causes:
• Congenital Abnormalities
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• Maternal Infection
• Maternal Endocrine Disorders
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• Defects in cervix or uterus
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Types of Abortions
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Dilation & Vacuum Curettage (D & C )
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Dilation & Evacuation
2 (D & E)
Ectopic Pregnancy
(out of place)
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Ectopic Pregnancy
(out of place)
• I in every 50 pregnancies
• 2% of all pregnancies
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• Risk Factors?
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Gestational Trophoblastic Disease
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“Hydatidiform Mole” “Choriocarcinoma”
• Abnormal cell growth ~ placenta develops but not the fetus
• 110-120 / 100,000 pregnancies
• Management
• Evacuation of molar pregnancy
• Regular follow-up for 1 year to detect malignant changes
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Cervical Insufficiency
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• Premature dilation of cervix
• Cause unknown; possibly due to cervical damage
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Therapeutic Management
• Bed rest, pelvic rest, avoidance of heavy lifting
• Cervical Cerclage
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Hemorrhagic Conditions of Late Pregnancy
• Placenta Previa
• Abruptio Placentae
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Placenta Previa
Implantation of the placenta in the lower uterus
Stats:
• 1st pregnancy: 1:400
• After PCB: 1:160
• After 2nd RCB: 1:60
• After 3rd RCB: 1:30
• After 4th RCB: 1:10
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Classifications of Placenta Previa
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Classifications of Placenta Previa
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Placenta Previa
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Vaginal bleeding (painless, bright red in second or third trimester, spontaneous
cessation then recurrence)
Placenta Previa
Monitoring of maternal–fetal status
• Vaginal bleeding; pad count
• Avoidance of vaginal exams
• FHR
Support and education: fetal movement counts, effects of prolonged bed rest (if
necessary); signs and symptoms to report
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Risk factors
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• AMA
• Prior Previa
• Smoking
• Cocaine use
• HTN, DM
• Multiparity
• RCB
• Previous Myomectomy
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Marginal “Low – lying”
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• Placenta implanted in lower uterus
• Appears to move ~ drawn upward as myometrium beneath it develops with
pregnancy
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Total Previa
Delivery?
Abruptio Placentae
• Separation of a normally implanted placenta before the fetus is born
• Bleeding and formation of a hematoma on the maternal side of the placenta
• Bleeding may be visible or concealed.
• 10% of preterm births
• 10-20% of perinatal deaths
• Abruptio placentae is accompanied by pain, uterine tenderness, and uterine
hyperactivity.
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• Abruptio placentae is accompanied by pain, uterine tenderness, and uterine
hyperactivity.
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5 Classic Signs
Risk Factors
Risk Factors
Intrapartum Emergencies
Placental abnormalities
• Placenta accreta
• Placenta increta
• Placenta percreta
Placenta Abnormalities
All or part of the placenta attaches abnormally to the myometrium Three grades
defined according to the depth of invasion
Accreta – chorionic villi attach to the myometrium, rather than being restricted within
the decidua basalis.
Increta – chorionic villi invade into the myometrium.
Percreta – chorionic villi invade through the perimetrium (uterine serosa).
Hyperemesis Gravidarum
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• Severe form of nausea and vomiting
• Symptoms usually resolve by week 20
• Weight loss >5% of prepregnancy body weight
• Dehydration, metabolic acidosis, alkalosis, and hypokalemia
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Laboratory and Diagnostics
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• Liver enzymes r/o Hepatitis, Pancreatitis, Cholestasis
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• CBC r/o dehydration(increase RBC & hematocrit)
• Electrolytes (decrease K, Na) *vomiting loss of hydrochloric acid
• Ultrasound r/o “molar” pregnancy
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Therapeutic Management
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Therapeutic Management
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Weight Loss or Electrolyte Imbalance
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Hypertension During Pregnancy
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Gestational Hypertension (PIH)
• Blood pressure elevation after 20 weeks of pregnancy
• Not accompanied by proteinuria
• Resolves 12 weeks PP
• If it persists chronic hypertension may be diagnosed
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Preeclampsia
• Generalized vasospasm decreases circulation to ALL organs of the body including the
placenta.
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• Hypertension with proteinuria (*current research)
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• Systolic greater than 140 mm Hg
• Diastolic greater than 90 mm Hg
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____________
•Cure???
PreEclampsia
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Symptoms / Diagnostics / Assessments
• Cardiovascular
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• Central Nervous System
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• Renal
• Hepatic
• Placenta
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Eclampsia
Progression of preeclampsia to generalized seizures
• Facial twitching …. Rigid body
Med to prevent seizure?
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Med to prevent seizure?
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Magnesium Sulfate
• Action?
• How does patient “feel” with this med?
• Adverse Reactions?
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• Antidote: Calcium gluconate (slow IVP)
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HELLP Syndrome
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• Hemolysis ~ fragmentation and distortion of erythrocytes during passage through
damaged blood vessels.
• Liver enzyme levels increase ~ hepatic blood flow is obstructed by fibrin deposits.
• Low platelet levels ~ vascular damage resulting from vasospasm.
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Disseminated intravascular coagulation (DIC)
• Pro-coagulation and anti-coagulation factors are simultaneously activated.
• Thromboplastin activates widespread clotting
• “Uses up” other clotting factors ~ platelets
• in clotting factors &
anticoagulants = BLEEDING
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Progression
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Incompatibility Between Maternal and Fetal Blood
• Rh incompatibility (reviewed with PP)
• Rh– woman conceives an Rh+ child
• Maternal antibodies may then develop after exposure to fetal Rh+ blood
• Administration of RhoGAM
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ABO incompatibility
• Mother: O blood type
• Fetus: A, B, AB (antigens not present in O)
• May cause hemolysis of fetal RBC
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• May result in hyperbilirubinemia of the infant
• Direct Coombs test
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Polyhydramnios
• Amniotic fluid >2,000 mL 32-36 weeks
• 2% of all pregnancies
• Fetal anomalies ~ upper GI, neural tube, impaired swallowing
• 18% w/maternal DM,
• increased cesarean delivery, low 5-minute APGAR
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Oligohydramnios
Amniotic fluid <500 mL
• US
• NST
• Amnioinfusion
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