ANTEPARTUM COMPLICATIONS

 This may occur at any time during pregnancy and can result from pre-existing maternal
medical problems or from the pregnancy itself.

Significant complications of pregnancy includes:

 Spontaneous abortion
 Gestational trophoblastic disease (hydatidiform mole)
 Ectopic pregnancy
 Incompetent cervix
 Hyperemesis gravidarum
 Anemia
 Placenta previa
 Abruptio placenta
 Preeclampsia and eclampsia
 Gestational diabetes
 Hemolytic disease of the fetus and newborn
 Infections

Maternal conditions that significantly affect the fetus or the progress of pregnancy:

 Diabetes Mellitus
 Cardiac disease
 Hypertensive disease
 Hematologic disorders
 Infections
 Sexually transmitted diseases
 Smoking
 Substance abuse

Cardinal signs and symptoms

 Dizziness
 Nausea and vomiting
 Headache
 Fatigue
 Abdominal pain and cramping
 Uterine labor contractions before the estimated date of delivery

Physical Examination

 Measure weight for excessive loss and gain

 Measure for increased blood pressure
 Measure for rapid pulse
 Measure for increased temperature.
 Assess for vaginal bleeding
 Inspect for premature rupture of the membranes (PROM)
  Assess the skin for rash, pale, dry kin, or edema
 Inspect the oral cavity for overall dental health and signs of poor nutrition
 Palpate the uterus to determine whether it is abnormally soft or hard and whether it is
abnormally soft or smaller than expected for gestational age.
 Palpate the cervix to detect preterm cervical dilation.
 Auscultate the fetal heart rate (FHR) to detect abnormally fast or slow rates

Laboratory studies and diagnostic tests

 Complete blood count (CBC)

 Pregnancy test
 Serum alpha-fetoprotein measurement
 Ultrasound
 Blood glucose and glycosylated hemoglobin
 Indirect cooms test
 Amniocentesis
 Serologic tests
 Cultures

Nursing Management

 Ensure that appropriate physical needs are addressed and monitor for additional
complications.
 Address emotional ad psychosocial needs.
 Provide client and family teaching
 Promote compliance

SPONTANEOUS ABORTION

 The expulsion of the fetus and other products of conception from the uterus before the fetus
are capable of living outside of the uterus.

 Abortion - any interruption of a pregnancy before a fetus is viable

 Viable fetus - 20 to 24 weeks of gestation or weighs at least 500 g.

 Miscarriage or premature or immature birth ---------- 15% to 30%

 Early miscarriage - before week 16 --------- late miscarriage - between weeks 16 and 20

 Weeks 6 and 12 - lead to the most severe, even life-threatening bleeding.

 Abnormal fetal development - frequent cause of first trimester due to teratogenic factor or
to a chromosomal aberration.

 Implantation abnormalities (another cause) – zygotes, never implant securely because of

inadequate endometrial formation

 Corpus luteum (cause) - fails to produce enough progesterone to maintain the decidua
basalis. --- Progesterone therapy
  Assessment - almost always vaginal spotting

4 Tyoes of Spontaneous Abortion

1. Threatened Abortion - is characterized by cramping and vaginal bleeding in early pregnancy

with no cervical dilation. It may subside or an incomplete abortion may follow.

- Symptoms - vaginal bleeding, initially only scant and usually bright red.
- Intervention - strenuous activity for 24 to 48 hours
- Complete bed – not necessary, appear to stop the vaginal bleeding but only because
blood pools vaginally.

2. Imminent or Inevitable Abortion - is characterized by bleeding, cramping, and cervical

dilation. Termination cannot be prevented.

- Dilatation and Curettage (D&C) or a Dilation and Evacuation (D&E)

3. Complete abortion - is characterized by complete expulsion of all products of conception.

- Products of conception (fetus, membranes, and placenta)

4. Incomplete abortion -is characterized by expulsion of only part of the products of

conception. Bleeding occurs with cervical dilation.

- Part of the conceptus (usually the fetus) is expelled, but the membranes or placenta are
retained in the uterus. -------- hemorrhage and infection

5. Missed abortion - is characterized by early fetal intrauterine death without expulsion of the
products of conception. The cervix is closed, and the client may report dark brown vaginal
discharge. Pregnancy test findings are negative. ---------- misleading

- Also known as early pregnancy failure ------- fetus dies in utero but is not expelled.
- discovered at a prenatal examination when the fundal height is measured and no
increase in size
- labor - can be induced by a prostaglandin suppository or misoprostol (Cytotec)
- Oxytocin stimulation or administration of mifepristone techniques - used for elective
termination of pregnancy, which cause contractions and birth.
- Disseminated Intravascular Coagulation (DIC) - a coagulation defect, may
develop if the nonviable (and possibly toxic) fetus remains too long in utero.

Recurrent Pregnancy Loss (1%)

 Habitual aborters - women who had three spontaneous miscarriages that occurred at the
same gestational age.
 Possible causes include
- Defective spermatozoa or ova
- Endocrine factors such as lowered levels of protein-bound iodine (PBI), butanol
extractable iodine (BEI), and globulin-bound iodine (GBI); poor thyroid function; or a
luteal phase defect
 - Deviations of the uterus, such as septate or bicornuate uterus
- Resistance to uterine artery blood flow --------------- Chorioamnionitis or uterine infection
- Autoimmune disorders such as those involving lupus anticoagulant and antiphospholipid
antibodies

Complications of Miscarriage (after)

1. Hemorrhage
 Disseminated Intravascular Coagulation (DIC) - major hemorrhage
 Excessive vaginal bleeding - position a woman flat and massage the uterine fundus
to try to aid contraction.
 Pneumatic antishock garments – apply to help maintain blood pressure

2. Infection
 Often a reason for excessive blood loss.
 Danger signs
- Fever higher than 100.4°F (38.0°C)
- Abdominal pain or tenderness ------------- Foul-smelling vaginal discharge.
 Escherichia coli - organisms responsible for infection - spread from the rectum
forward into the vagina --------- group A streptococcus
 Tampons - stasis of any body fluid increases the risk of infection

Septic Abortion

 an abortion complicated by infection

Isoimmunization

 the production of antibodies against Rh-positive blood.

Etiology

 may result from unidentified natural causes or from fetal, placental, or maternal factors

Fetal factors

 Defective embryonic development

 Faulty ovum implantation
 Rejection of the ovum by the endometrium
 Chromosomal abnormalities

Placental factors

 Premature separation of the normally implanted placenta

 Abnormal placental implantation
 Abnormal placental function

Maternal factors
  Infection
 Severe malnutrition
 Reproductive system abnormalities
 Endocrine problems
 Trauma
 Drug ingestion

Clinical Manifestations

 Vaginal bleeding in the first 20 weeks of pregnancy

 Complaints of cramping in the lower abdomen
 Fever, malaise, or other symptoms of infection

Diagnostic Procedure

 Serum beta hCG levels are quantitatively low

 Ultrasound reveals the absence of a viable fetus

Nursing management

 Provide appropriate management and prevent complications

 Provide client and family teaching
 Address emotional and psychosocial needs