Pregnancy Complications Some patients report severe epigastric pain and nausea or

I. Pregnancy Induced Hypertension vomiting.

 Pulmonary edema has developed.
GESTATIONAL HYPERTENSION (Pregnancy Induced  Several edema has occurred.
Hypertension) Symptoms
 Formerly known as pregnancy-induced hypertension or  Blood pressure is 160/110 mmHg
PIH.  proteinuria 3+ to 4+ on a random sample and 5 g on a 24-
 Gestational hypertension is a condition in which hour sample
vasospasm occurs in both small and large arteries during  oliguria (500 ml or less in 24 hours or altered renal function
pregnancy, causing increase blood pressure. tests
The condition tends to occur most frequently in patients who meet
 elevated serum creatinine more than 1.2 mg/dl)
any of the following criteria:
 Being a person of color   cerebral or visual disturbances (headache, blurred vision);
pulmonary or cardiac involvement
 Experiencing multiple pregnancy 
 extensive peripheral edema
 Being primiparous younger than 20 years or older than 40
 hepatic dysfunction; thrombocytopenia; epigastric pain
years
Nursing Interventions:
 Having come from a low socioeconomic background which
 Support bed rest.
may lead to a history of poor nutrition
 Monitor well-being
 Having a status of gravida five or more  Monitor Fetal Well-Being
 Experiencing polyhydramnios  Support a Nutritious Intake
 Having an underlying disease such as heart disease diabetes  Administer medications as ordered by the physician to
with vessel or renal involvement and essential hypertension prevent eclampsia
Symptoms of Gestational Hypertension:
 Blood pressure is 140/90 mmHg or systolic pressure III. ECLAMPSIA
elevated 30 mmHg or diastolic pressure elevated 15 mmHg Eclampsia is the most severe classification of pregnancy
above pre pregnancy level related hypertensive disorders.
 no proteinuria or edema  With eclampsia, the mortality rate for pregnant individuals
 blood pressure returns to normal after birth  can be as high as 20% in resource-poor areas due to
cerebral hemorrhage circulatory collapse or renal failure.
II. PREECLAMPSIA  The fetal prognosis with eclampsia is also poor because of
Preeclampsia is a pregnancy related disease process hypoxia, possibly caused by the seizure, with consequent
evidence by increased blood pressure and proteinuria. fetal acidosis.
a) Preeclampsia without severe features Symptoms:
b) Preeclampsia with severe features  Either seizure or coma accompanied by signs and
A. Preeclampsia without severe features symptoms of preeclampsia are present. 
 Proteinuria- 1+ on urine dip or 300 mg in 24 hour urine Nursing Interventions:
protein collection or 0.3 or higher on urine protein-  The priority care for a woman with a tonic–clonic seizure is
creatinine ratio to maintain a patent airway.
 Blood pressure- rise to 140/90 mmHg, taken on two  If the fetus has reached a point of viability, a decision about
occasions at least 4 hours apart. birth will be made as soon as a woman’s condition
Symptoms: stabilizes, usually 12 to 24 hours after the seizure.
 Blood pressure is 140/90 mmHg or systolic pressure
elevated 30 mmHg or diastolic pressure elevated 15 mmHg IV. Abortion
above prepregnancy level Abortion is described as the expulsion of products of conception
 proteinuria of 1+ to 2+ on a random sample before the embryo or fetus is viable.
Assessment:
 weight gain over 2 lb/week in second trimester and 1 The presenting symptom of spontaneous miscarriage is almost always
lb/week in third trimester
vaginal spotting. At the first indication of this, a woman should
 mild edema in upper extremities or face contact her healthcare provider and describe how much spotting she
Nursing Interventions: is having and its appearance
 Monitor antiplatelet therapy
 Promote Bed Rest
 Promote Good Nutrition Factors to assess:
 Provide emotional support Confirmation of pregnancy Blood type
Pregnancy length Action
B. Preeclampsia with severe features Duration Associated symptoms
 A patient has passed to preeclampsia with severe features Intensity Frequency
when blood pressure rises to 160 mmHg systolic and 110 Description
mmHg diastolic or above on at least two occasions 4 hours
apart at bed rest (the position in which blood pressure is Diagnosis:
lowest) or diastolic pressure is 30 mmhg above their Threatened miscarriage
pregnancy level.
 
threatened miscarriage is a condition that indicates the
potential for a miscarriage or early pregnancy loss
 Symptoms of a threatened miscarriage begin as vaginal
bleeding, initially only scant 1173 and usually bright red. A
woman may notice slight cramping, but no cervical
dilatation is present on vaginal examination.
 Common Causes: Small falls, injuries, stress during the
first trimester of pregnancy
Imminent (inevitable) miscarriage
 A threatened miscarriage becomes an imminent (i.e.,
inevitable) miscarriage if uterine contractions and cervical
dilation occur as, with cervical dilation, the loss of the
products of conception cannot be halted
 it is the appearance of symptoms that signal the impending
loss of the products of conception.   Smoking
Complete miscarriage
 Is when the entire products of conception ( fetus,
membranes, and placenta)  are expelled spontaneously
without any assistance.
Incomplete miscarriage
 Incomplete miscarriage is when a miscarriage begins, but
some pregnancy tissue stays in the womb.
Missed Miscarriage
 A missed miscarriage, also known as a missed abortion or a
silent miscarriage, occurs when a fetus is no longer alive,
but the body does not recognize the pregnancy loss or expel
the pregnancy tissue.  prevents it from rupturing). The pregnancy tissue is then
Recurrent pregnancy loss
 In the past, women who had three spontaneous miscarriages
that occurred at the same gestational age were called
“habitual aborters.” Today, the term recurrent pregnancy
loss is used to describe this miscarriage pattern
Complications of miscarriage
 Hemorrhage
 Infection
Septic abortion
 is an abortion complicated by infection. And septic abortion
refers to any abortion, spontaneous or induced, that is
complicated by uterine infection, including endometritis.
 A septic abortion is an abortion complicated by infection.
Infection can occur after a spontaneous miscarriage, but
more frequently, it occurs in women who have tried to self-
abort or whose pregnancy was aborted illegally using a
nonsterile instrument such as a knitting needle.
 The woman will have symptoms of fever and crampy
abdominal pain; her uterus will feel tender to palpation.
 Isoimmunization
 Powerlessness or Anxiety
V. Ectopic Pregnancy
 An ectopic pregnancy is one in which implantation
occurred outside the uterine cavity.
 The most common site (in approximately 95% of such
pregnancies) is in the fallopian tube
Causes:
 Fallopian tube inflammation and scarring brought on by a
past medical illness, infection, or surgery.
 pelvic inflammatory disease, which can lead to tubal
scarring
 Medical conditions
 Genetic Abnormalities/ Congenital Abnormalities
 Using an intrauterine device (IUD) for contraception 
 Risk Factors:
Maternal Age
 History of pelvic surgery or abdominal surgery 
 History of multiple abortions
 History of pelvic inflammatory disease
 History of ectopic pregnancy
 History of sexually transmitted disease
 Signs and Symptoms
Nausea and breast soreness (common
Following signs and symptoms indicate medical emergency
 Sharp waves of pain in the abdomen, pelvis, shoulder, or
neck
 Severe pain that occurs on one side of the abdomen
 Light to heavy vaginal spotting or bleeding
 Dizziness or fainting
 Rectal pressure
Therapeutic Management
 Methotrexate
It blocks the enzymes in the body that maintain the
pregnancy. It stops the tissue from growing bigger and
gradually reabsorbed by the body
Surgical Management
Salpingectomy
 It is used to manage an ectopic pregnancy. Salpingectomy
is used to remove all or part of the affected fallopian tube.
Salpingostomy
 This procedure is typically used to remove a small
unruptured pregnancy that is usually <2 cm in length and
located in the distal third of the fallopian tube. It is the
creation of an opening into the fallopian tube without
removing the tube itself.
 used in patients who have an ectopic pregnancy that has not
ruptured
VI. H. Mole
 It’s a rare mass growth that form inside the womb (uterus)
atthe beginning of a pregnancy.
 It is also known as molar pregnancy or vesicular mole. And
1 in every 2000 pregnancies.
 Aka gestational trophoblastic disease is abnormal
proliferation and then degeneration of the trophoblastic
villi. Asthe cells degenerate, they become filled with fluid
and appear as clear fluid-filled, grape sized vesicles.
Types of H. Moles:
1. Complete Hydatidiform mole
 all throphoblastic villi swell and become cystic.There also
no formation of fetal tissue.
 Fetus absent, uterine size more than the date.
2. Incomplete or Partial Hydatidiform mole Ultrasonography
 some of the villi form normally. The syncitiotrophoblastic  Ultrasonography is done to be sure that the growth is a
layer of villi, however, is swollen and misshapen. hydatidiform mole and not a fetus or amniotic sac (which
 There also be formation of fetus but the fetus is not able to contains the fetus and fluid around it).
survive
 Fetus present, uterine size less than the date. Treatment
 A molar pregnancy can’t be allowed to continue. To
Etiology prevent complications, the affected placental tissue must be
removed
 Maternal Age  Treatment usually consists of one or more of the following
 Previous molar pregnancy steps:
 Nutrition/ Diet 
1. Dilation and curettage (D&C)
 Cytogenic abnormality
This procedure removes the molar tissue from the uterus. You lie on a
table on your back with your legs in stirrups. You receive medicine to
Signs and Symptoms
numb you or put you to sleep.
 Vaginal bleeding in the first trimester - prune juice
discharge may occur
 Severe nausea and vomiting (Hyperemesis Gravidarum)
 Passage of vaginal tissue - ”Grape –Like Clusters Or
Vesicles”
 Hyperthyroidism - including tachycardia and tremors
 Pre-eclampsia
 Lower abdominal pain 
Complications
 Hemorrhage and shock
 Sepsis
 Perforation of uterus
 Ovarian cysts 
 Breathlessness – when it spreads to the lungs 
 Gestational choriocarcinoma
Diagnostic Test
Transvaginal ultrasound
 A health care provider who suspects a molar pregnancy is
likely to order blood tests and an ultrasound. During early
pregnancy, a sonogram might involve a wandlike device
placed in the vagina.
 As early as eight or nine weeks of pregnancy, an ultrasound
of a complete molar pregnancy might show:
o No embryo or fetus
o No amniotic fluid
o Ovarian cysts

 An ultrasound of a partial molar pregnancy might show:

 A fetus that’s smaller than expected
 Low amniotic fluid
 Placenta that appears unusual
 After finding a molar pregnancy, a health care provider
might check for other medical issues, including:
 Preeclampsia
 Hyperthyroidism
 Anemia
Blood tests
 Blood tests to measure the level of human chorionic
gonadotropin (hCG—a hormone normally produced early
in pregnancy) are done. If a molar pregnancy or another
type of gestational trophoblastic disease is present, the level
is usually very high because these tumors produce a large
amount of this hormone.