Bulacan State University

City of Malolos Bulacan

COLLEGE OF NURSING

CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS

NCM 109-A Hand- out No: 2

NURSING CARE OF A FAMILY EXPERIENCING A SUDDEN PREGNANCY COMPLICATION

FIRST TRIMESTER BLEEDING

I. ABORTION
 Any pregnancy that terminates before the age of viability (before it is capable of living outside
the uterus)
 A fetus who is less than 24 weeks’ gestation or weighing less than 600 grams is not viable

Causes:
 Usually associated with embryonic or thropoblastic defect

Types:
 Induced
 Spontaneous

A. INDUCED ABORTION

1. LEGAL
 With medical reason or therapeutic purpose/s
2. ILLEGAL
 Intentional abortion
 No medical reason

B. SPONTANEOUS ABORTION

1. THREATENED ABORTION
 Bleeding, cramping and softening of uterus with CLOSED CERVIX
 Management: bed rest, avoid coitus for 2 weeks, and monitor bleeding
2. INEVITABLE ABORTION
 Unpreventable cervical dilation with persistent hemorrhage and severe cramping with
OPENING OF CERVIX
 Management: save and count pads, monitor hemorrhage, emotional support, and IV
oxytocin
3. INCOMPLETE ABORTION
 Expulsion of some parts of conception.
 Massage bleeding since placental fragments are retained
 Management: Dilation and curettage, oxytocin, IVF, and blood transfusion
4. COMPLETE ABORTION
 Entire product of conception is expelled with minimal bleeding
  Management: Observe and may be given oxytocin
5. MISSED ABORTION
 Fetus died in the utero and has not been expelled since the cervix may be closed and
presents with intermittent bleeding. There is no increase in fundal height
 Management: Dilation and curettage\, and monitor for infection and DIC
(Disseminated Intravascular Coagulation)
6. HABITUAL ABORTION
 History of three or more abortions, commonly due to incomplete cervical os
 Management: Cervical Cerclage (encircling cervix with suture): Shirodkar and Mc
Donald

II. ECTOPIC PREGNANCY

 Gestation is located outside the uterus
 2nd most frequent cause of bleeding early in pregnancy
 Occurs frequently in smokers

SECOND TRIMESTER BLEEDING

I. HYDATIDIFORM MOLE
 Gestational Trophoblastic Disease
 Development (degenerative) anomaly of the placenta converting chorionic villi into the
mass of clear vesicles

II. INCOMPETENT CERVIX

 Premature Cervical Dilation
 Inability of the cervix to remain closed enough during pregnancy for the fetus to survive
 Associated with increased maternal age, congenital structure defects, and cervical trauma

THIRD TRIMESTER BLEEDING

I. PLACENTA PREVIA
 Inevitable Hemorrhage
 Development of the placenta in the lower uterine segment, partially or completely
covering the internal cervical os. Assessed through routine sonograms
 Asian and African ethnicity is high risk
 Smoking and cocaine use is also associated
 Endometritis is also common as placental site is close to cervix (portal of entry)
 Apt or Kleihauer- Betke test (test strip procedure to determine if blood is fetal or
maternal in origin)

II. ABRUPTIO PLACENTA

 Placental Abruption/ Accidental Hemorrhage
 Premature separation of a normally implanted placenta either partial/ marginal or
complete/ total
 Common among women with hypertension, high parity, advanced maternal age, short
umbilical cord, direct trauma, and alcohol use
  Occurs after 20-24 weeks of pregnancy

III. PREMATURE LABOR

 Labor occurring after 20 weeks and before the end of 37 weeks of gestation
 Contraction are less than 10 min apart, leading to progressive cervical changes and
cervical dilatation of 2 cm or effacement of 75%

PREMATURE RUPTURE OF MEMBRANE (PROM)

 Rupture and loss of amniotic fluid that occurs before labor begins
 If associated with premature labor, PROM poses risk of immature birth
 Gush of clear fluid from the vagina

PREGNANCY INDUCED HYPERTENSION (PIH)

 Originally called toxemia

Pathophysiologic:
 Basis is vascular spasm leading to hypertension, edema and proteinuria

MILD PREECLAMPSIA
 BP: 140/90 (increase of 30/15)
 1+ to 2+ proteinuria on random
 Weight gain of 2 lbs per week (2nd trimester) and 1 lb per week (3rd trimester)
 Slight edema in upper extremities and face
 May be managed at home

SEVERE PREECLAMPSIA
 BP: 160/110
 3+ or 4+ proteinuria
 Oliguria (less than 500ml/24hrs)
 Cerebral or visual disturbances
 Epigastric pain
 Pulmonary edema
 Peripheral edema
 Hepatic dysfunction

ECLAMPSIA
 Hypertension
 Proteinuria
 Convulsion
 Coma
 Death is from cerebral hemorrhage, circulatory collapse, or renal failure
 Obstetric emergency
PREECLAMPSIA
 Assess BP in sitting and left lateral position; protein level in urine; changes in level of
consciousness, weight, FHT, and vagina bleeding
 Bedrest
 Left Lateral recumbent
 High Protein diet
 Seizure precautions

ECLAMPSIA
 Maintain IV line
 Keep oxygen and airway equipment available at bedside
 Avoid placing a tongue blade between the teeth
 Minimize stimuli
 Turn to the side to drain secretions
 Administer medications as ordered: Magnesium sulfate, Valium, and hypotensive drugs such as
hydralazine (Apresoline) or labetalol (Normodyne)
 Raise padded side rails

POLYHYDRAMIOS
 Excessive aminiotic fluid of 2000ml or amniotic index above 24 cm, exceeding the normal
volume of 500 to 1000 ml

OLIGOHYDRAMIOS
 Refers to a pregnancy with less than the average amount of amniotic fluid

HELLP SYNDROME
 Variation of the gestational hypertension process named for the common symptoms that occur:
o H- hemolysis leads to anemia
o E- elevated Liver enzymes lead to epigastric pain
o L- low Platelets lead to abnormal bleeding/ clotting

POST TERM PREGNANCY

 A term pregnancy is 38-42 weeks long. A pregnancy that exceeds these limits is prolonged

ISOIMMUNIZATION (Rh INCOMPATIBILITY)

 Occurs when Rh-negative mother carries a fetus with an Rh-positive blood type.