Complications
What are some high risk pregnancies?
Age related (<18yo - >35yo)
Pre-existing conditions (cardiac disorders, blood disorders, diabetes, weight, drug use)
Multiple gestations (after 35, greater chance of twins)
Infections (STIs, COVID, HIV/AIDS)
Multiple Gestations Considerations
nursing considerations
increased risk of fetal hypoxia
traumatic or cesarean birth
increased nutritional needs
increased discomforts as pregnancy progresses
more frequent antepartum visits and fetal monitoring
increased emotional and financial stress
transportation needs to be available 24/7
What are the different types of abortion/miscarriages? Define each one (5 types)
threatened (have fetal heart rate, closed cervical os, vaginal bleeding)
inevitable (vaginal bleeding, dilated cervical os, products of conception may still be seen or felt at or above cervical os)
incomplete (vaginal bleeding, dilated cervical os, some products of conception expelled and some remaining)
complete (vaginal bleeding, closed cervical os, products of conception completely expelled)
missed (diagnosed with no bleeding, body has not recognized loss of pregnancy, bleeding form a miscarriage can take a few days or weeks to begins, ultrasounds taken to detect/confirm miscarriage)
Ectopic Pregnancy s/sx
Prior to rupture, s/sx may be vague. intermittent dull ache in the abdomen, some spotting a few weeks after the last menstrual cycle period. They will a positive pregnancy test.
What are some acute s/sx?
sudden, severe adnominal pain, often unilateral
nausea
anxious
sharp or stabbing pain referred to shoulder, scapula, or chest
syncope, shock
vaginal bleeding
Placental previa:
Nursing considerations
NO vaginal exams
patient might need bedrest for the rest of pregnancy
pelvic rest
frequent checks on maternal/fetal well being
Age Related Complications:
Teenage Pregnancy nursing considerations
Infections:
Name some viral infections
COVID
west nile
rubella
herpes simplex
varicella-zoster
hepatitis
HIV (no breast feeding and must be c-section)
CMV (spread through daycare's & small children, no prevention because its hard to detect)
What are some nursing considerations for miscarriages?
monitor for bleeding/infection
pelvic rest
serum hCG levels (serial)
ultrasound
expectant management
medical
surgical - D&C or D&E
comfort measures
hydration, nutrition, PNV
patient education
Rh immune globulin (if Rh negative and ABS negative)
grief support/ counseling
follow-up physical exam and possible labs (hCG,H&H)
family planning
Ectopic pregnancy care and treatment
*goal is to preserve the falloian tube*
ultrasound
lab work
nursing assessment
medical - methotrexate protocol single dose injection
surgical
grief support and effects on future childbearing
conception and family planning
Placental Previa:
can lead to....
PROM
placental abruptions
PTL and birth
IUGR
fetal distress
anemia
placenta accreta
hemorrhage
sepsis
embolism
Age related complications:
geriatric complication nursing considerations
fertility issues to get pregnant
increased risk of miscarriage
increase in hypertensive conditions
preterm labor or complicated delivery
placental abnormalities
desire to have "ideal" pregnancy
Infections:
Name some parasites
toxoplasmosis
What is an ectopic pregnancy?
implantation outside of the uterus
usually in the fallopian tube, but may occur in uterus, ovaries, cervix, abdomen
leading cause of pregnancy related first trimester deaths
increased incidence related to risk factors and fertility treatment
What is gestational trophoblastic disease/molar pregnancy?
a pregnancy that has the potential to turn into a malignancy
cells from conception rapidly divide and form "moles"
ultrasounds will look like a snowstorm or a cluster of grapes
rare 1:1000
treatment - evacuation of the pregnancy
follow up care after evacuation to include evaluation for malignant cells
What is placenta accreta spectrum (PAS)?
where the placenta grows too deeply into the uterine wall
What are some pre-existing complications?
Type 1 or 2 diabetes
congenital heart disease
obesity or anorexia
paraplegic
cognitive or developmentally delayed
Infections:
Name some bacterial infections
group beta strep (GBS) (swab to test, if positive, either c-section or antibiotics 48 hrs)
listeriosis (infection of blood or brain of baby, birth defects, avoid unpasteurized dairy, no brie, careful of hotdogs/deli meats, undercooked meats, wash produce)
What are some risk factors associated with ectopic pregnancy?
history of ectopic pregnancy
history of and/or current (often related to STI)
tubal anomalies
altered tubal motility
tubal surgery
endometriosis
multiple abortions
ART (assisted reproductive technology)
advanced maternal age (>35 yo)
Placental previa is when the placenta completely or partially covers the the opening of the uterus
what are the four types of previa and how do you determine which is which?
low lying: implantation low in uterus
marginal: 3cm from the internal cervical os, even at full dilation
partial: partially covers the cervial os
complete: placenta completely covers the cervical os
*absolutely NO vaginal exams in partial or complete previa*
Placenta Accreta Spectrum:
what are differences between accreta, increta, and percreta?
increta: chorionic villi invade the uterine myometrium
percreta: chorionic villi invade the uterine myometrium and serosa; may also invade adjacent organs (i.e. bladder, etc.)
Multiple Gestations Considerations
Increase incidence of...
gestational diabetes
anemia
pre-eclampsia
abruption
preterm labor
dysfunctional labor
abnormal presentation of one or more fetuses
What are some conditions or scenarios where the patient will experience hemorrhage?
miscarriage/abortion
ectopic pregnancy
gestational trophoblastic disease (GTD)
placental previa
premature separation of placenta (abruptio placenta)
DIC (not important right now)
Ectopic Pregnancy s/sx
Prior to rupture, s/sx may be vague. intermittent dull ache in the abdomen, some spotting a few weeks after the last menstrual cycle period. They will a positive pregnancy test.
What are some chronic s/sx?
often gradual and subtle
low abdominal pain (intermittent) and pelvic pressure
dark red or pink vaginal spotting or bleeding
fatigue
increased WBCs and decreased H&H
Placental Previa
what are the s/sx?
may not have bleeding episodes in pregnancy if only a low lying placenta
classic sign is sudden onset of painless uterine bleeding in the second half of the pregnancy
bleeding may be scanty or profuse
the uterus is soft upon palpation
bleeding may cease spontaneously and reoccur or be continuous
A patient diagnosed with placental accreta spectrum may need to have a __________.
hysterectomy