GESTATIONAL

CONDITIONS
by:

Maricris D. Banquilay, R.N.,M.A.N.

HYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUM
- AKA Pernicious vomiting
- persistent vomiting
- a complication of nausea and vomiting in
pregnancy
• N&V beyond the 1st trimester
• Etiology: Unknown
? Elevated HCG/ Estrogen
? Psychogenic causes
? Hydatidiform mole
- some will experience severe
symptoms until they give birth to
their baby, and sometimes even after
giving birth
 NURSING INTERVENTIONS
1.Taking a dry piece of toast or a
cracker ( dry carbohydrate foods ) a
half hour before getting out of bed may
produce relief.
2. Sips hot water ( plain or lemon juice),
hot tea, clear coffee, hot milk.
3. Discourage intake of greasy foods.
4. Advise small frequent feedings of 5-6
times a day.
5. Sweet lemonade, about half a lemon to

a pint of water sweetened with sugar

6. Advise a high-protein meals (cheese,
eggs, meat),fruit, fruit juices
 ECTOPIC PREGNANCY
- Pregnancy in which implantation occurs
outside the uterus (most frequent site is
middle portion of fallopian tube, other
sites are abdomen, ovaries or cervix)
- the most common site (in approx 95% of
such pregnancies) is in a fallopian tube
– approx 80% occur in the ampular
portion, 12% occur in the isthmus, and
8% are interstitial or fimbrial
- fertilization occurs as usual in the distal
third portion of the fallopian tube.
Immediately after the union of ovum and
spermatozoon, the zygote begins to
divide and grow normally but because of
the obstruction, the zygote cannot travel
the length of the tube but rather lodges at
the strictured site along the tube and
implants there instead of in the uterus
- causes: adhesion of the fallopian tube from a
previous infection (chorionic salphingitis or pelvic
inflammatory dse), congenital malformations,
scars from tubal surgery, or a uterine tumor
pressing on the proximal end of the tube
- early signs and symptoms are usually concealed;
may be diagnosed by ultrasonography
 Risk Factors
- those who had pelvic inflammatory
disease(PID)
- those who are using IUDs
- women who smokes
- women who douche
 Signs and Symptoms:
- spotting may occur after one or two
missed menstrual periods,
- sharp lower right or left abdominal pain

radiating to shoulder develops

- concealed bleeding from site of
rupture leads to sudden shock
 THERAPEUTIC
INTERVENTIONS
• Diagnosis confirmed by ultrasound
examination , laparoscopy or
culdocentesis
• Immediate blood replacement if blood
loss is severe
• Surgical repair or removal of ruptured
fallopian tube maybe attempted
 HYDATIDIFORM MOLE OR
TROPHOBLASTIC DISEASE
(H MOLE)
- an abnormal pregnancy in which there is
a growth of the chorion or abnormal
proliferation of the throphoblastic villi
- spontaneous expulsion usually occurs
between the 16th and 18th weeks of
pregnancy
- uterus is generally larger for the period of
gestation and fetal parts are not palpable
- Symptoms of pregnancy-induced
hypertension are common
- Potential for uterine perforation
 THERAPEUTIC INTERVENTION
1. If spontaneous evacuation does not occur,
evacuation by delicate curretage or hysterectomy
is performed
2. Continued follow up of serum gonadotrophin
levels is imperative for 1 year to rule out
metastasis from chorionic carcinoma (increased
gonadotropin levels require chemotheraphy)
3. Preventing a new pregnancy is
essential for 1 year
 INCOMPETENT CERVIX
- Cervical effacement and dilation in early
second semester resulting in expulsion of
products of conception
- Usually results from previous forceful
dilation and curettage, difficult birth, or
congenitally short cervix
S/Sx : painless contractions in
midtrimester, birth of dead or
nonviable fetus
THERAPEUTIC INTERVENTIONS
1. Cervical Cerclage procedure during
14th to 16th week of gestation; suture or
ribbon placed beneath cervical mucosa
to close cervix (Mc Donald or Shirodkar
procedure)
2. At the end of pregnancy cesarean birth
or cutting of suture for vaginal birth
 ABORTION
-an interruption of pregnancy in which
there is complete expulsion or partial
expulsion (incomplete) of the products
of conception before the period of
viability
-may be sudden, spontaneous, or
induced by external mechanical force
or trauma (for planned abortion)
 TYPES OF ABORTION
THREATENED ABORTION
- cervix is closed, but bleeding,
cramping and backache are present

IMMINENT OR INEVETABLE ABORTION

- bleeding and cramping become more
severe, cervix dilates, and products of
conception are expelled
COMPLETE ABORTION - all products of
conception are expelled within
24 to 48 hours

INCOMPLETE ABORTION- all the products

of conception are not expelled

MISSED ABORTION - fetus dies in utero

but not expelled , must be
monitored for DIC
THERAPEUTIC INTERVENTIONS
1. Complete bed rest
2. Diagnostic/therapeutic blood studies:
CBC, blood typing, Rh incompatibility,
and cross-matching with availabilty of
blood
3. Dilation and Curettage or vacuum
aspiration performed if the products of
conception are retained
 PLACENTA PREVIA
- low implantation of the placenta
- or implantation of the placenta in the
lower uterine segment
- 5 per 1000 pregnancies
- Causes : increased parity, advanced
maternal age, past cesarian birth, past
uterine curretage, multiple gestation,
and perhaps a male fetus
 4 TYPES :
1. Low-lying placenta –implantation in
the lower portion
2. Marginal implantation- the placental edge
approaches that of the cervical os
3. Partial placenta previa – implantation
that includes a portion of the cervical
os
4. Total placenta previa – implantation that
totally obstructs the cervical os
 Signs and Symptoms:
- painless bright-red vaginal bleeding;
hemorrhage
- soft uterus in the latter part of
pregnancy
- signs of infection may be present
 THERAPEUTIC INTEVENTIONS
1. Ultrasonography to confirm the
presence of placenta previa
2. Depends on the location of placenta,
amount of bleeding and status of the
fetus
3. Control bleeding
4. Replace blood loss if excessive
5. Cesarian birth may be performed
 ABRUPTIO PLACENTA
-premature separation of the placenta
- Occur in 10% of pregnancies and is the
most frequent cause of perinatal death
- Cause is unknown but pre disposing
factors could be : high parity, advanced
maternal age, a short umbilical cord,
chorionic hypertensive disease, PIH,
direct trauma (as from an automobile
accident or intimate partner abuse) ,
 Signs and Symptoms:
1. A sharp stabbing pain high in the
uterine fundus as the initial separation
occurs
2. Concealed bleeding if center of the
placenta separates and margins are
intact
3. Dark red blood may or may not be
evident with partially detached placenta
at margins
4. Moderate to agonizing abdominal pain
5. Persistent uterine contraction; normal
to boardlike abdomen
6. Hyperactivity and cessation of fetal
movements
7. Frequently associate with PIH, essential
hypertension, maternal crack use, and
previous history of abruptio placenta
8. Predisposes client to hemorrhage, DIC,
and fibrinogenemia
 PREMATURE RUPTURE OF
MEMBRANES
- is rupture of membranes with loss of
amniotic fluid during pregnancy before
37 weeks
- Cause is unknown but is associated
with infections of the membranes
(Chorioamnionitis)
-occurs in 5 to 10% of pregnancies
 Signs and Symptoms
-prolapsed cord
-FHR decelerations caused by cord
compression from lack of amniotic fluid
-sepsis from ascending infections
THERAPEUTIC INTERVENTIONS
1. Hospitalization with bed rest after 37
weeks of gestation
2. Amnioinfusion of isotonic saline in
some cases to allow for fetal
movement and lessen danger of cord
compression
3. Prophylactic antibiotics
 PREGNANCY-INDUCED
HYPERTENSION (PIH)
- is a condition in which vasospasm
occurs during pregnancy in both small
and large arteries
- Characterized by triad of symptoms:
edema, hypertension and proteinuris
occuring after the 20th to 24th week of
gestation and disappearing 6 weeks
after birth
GESTATIONAL HYPERTENSION
- when a pregnant woman develops an
elevated blood pressure (140/90
mmHG) but has no proteinuria or
edema)
- If just simple, no drug therapy is needed
 MILD PRE ECLAMPSIA
MILD :
- systolic pressure increased 30 mmHg
or more above normal
- diastolic pressure increased 15mmHg
or more above normal
- proteinuria 1+ or 2+ on a reagent test
strip
- edema manifested by excessive weekly
weight gain and upper body edema
 MILD PRE ECLAMPSIA
SEVERE :
- BP is 160/110 or above on two
readings taken 6 hours apart after bed
rest
- proteinuria 3+ to 4+
- extensive edema (puffiness of hands
and face)
- hyperreflexia
 ECLAMPSIA
- seizure and or coma associated with
hypertension, proteinuria and edema
- 20% mortality rate from cause such as
cerebral hemorrhage, circulatory
collapse, or renal failure
 NURSING INTERVENTIONS :
MILD PIH
1. Promote bed rest
- lateral recumbent position to
excrete sodium faster
2. Promote good nutrition
3. Provide emotional support
 NURSING INTERVENTIONS :
SEVERE PIH
1. Support bed rest – darken the room if
possible because a bright light
can trigger seizures
2. Monitor maternal well-being – doppler
auscultation every hours interval
- maintain adequate oxygen
administration
3. Support a nutritious diet
4. Administer medications to prevent
Eclampsia
- Hydralazine (Apresoline) – an
antihypertensive (peripheral
vasodilator) used to decrease
hypertension
- Magnesium Sulfate (MgSO4) – a
muscle relaxant to prevent seizures
“Since we find ourselves fashioned
into all these excellently formed
and marvelously functioning of
Christ’s body, lets just go ahead
and be what we were made to be.”
Romans 12:5
Thank you!