A 3.1 Sudden Pregnancy Complications PDF

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Sudden Pregnancy
Complications
Sudden Pregnancy complications
> Bleeding During Pregnancy
> 1 Spontaneous Miscarriage
> 1 Ectopic Pregnancy
> 2 Gestational Trophoblastic Disease (H – mole)
> 2 Cervical Insufficiency
>3 Placenta Previa
>3 Abruptio Placenta
>3 Pre term Labor
>3 Premature Rupture of Membranes
> Gestational Disorders in Pregnancy
> Fetal Death
Bleeding During Pregnancy
Spontaneous Miscarriage
Spontaneous Miscarriage (Spontaneous Abortion) –

- one of the most common cause of bleeding
- The expulsion of the fetus and other
products of conception from the uterus
before the fetus is capable of living
outside of the uterus.
Abortion – any form of interruption of pregnancy before
the fetus if viable.
Viable fetus – is 20-24 weeks gestation or at least 500 grams.
Elective abortion – a planned medical termination of pregnancy.
Causes of Spontaneous Miscarriage
1. Fetal factors (Abnormal fetal formation) – is either due to:
- teratogenic factor or to a chromosomal aberration
- immunologic factors or rejection of the
embryo through an immune response.
2. Placental factors (Implantation abnormalities) – with

inadequate implantation, the placental circulation
cannot function adequately causing inadequate
fetal nutrition.
Causes of Spontaneous Miscarriage
3. Maternal factors - Failure of the corpus luteum to

produce enough progesterone to maintain
the decidua basalis (nearest part of the
endometrium that lies directly under the embryo).
4. Infections – like TORCH, UTI increases the incidence

of miscarriage.
5. Ingestion of teratogenic drugs and/or alcohol.

Types of Spontaneous Abortion
1. Threatened abortion
2. Imminent abortion
or Inevitable abortion
3. Complete abortion
4. Incomplete abortion
5. Missed abortion
6. Recurrent abortion
1. Threatened abortion
Threatened abortion – characterized by scanty
vaginal bleeding with cramping but with
NO cervical dilatation
- usually lasts for 24 to 48 hrs.
Management:
- avoid strenuous activities
- complete bed rest is usually recommended
- reduce stress
- strictly NO coitus for 2 weeks
- If bleeding persist, proceed to the hospital
- Ultrasound (to assess fetal viability)
2. Imminent abortion or Inevitable abortion
- There is a loss of the products of conception
if there is uterine contraction and cervical
dilatation during threatened abortion.
Characteristics:
- vaginal bleeding (tissue fragments to be
saved)
- cramping (severe uterine contraction)
- cervical dilatation
- NO fetal heart sounds
Management: (Imminent abortion or Inevitable abortion)
- Assess status of vaginal bleeding

- Dilatation and Curettage (D & C) evacuation to ensure
all products of conception are removed & uterus cleaned.
3. Complete abortion
Complete abortion – the entire products of conception (fetus,

membranes & placenta) are expelled spontaneously
without any assistance. The bleeding usually slows within
2 hrs., then stops within a few days after passage of the
products of conception.
4. Incomplete abortion
Incomplete abortion - characterized by expulsion of

only part of the products of conception
(usually the fetus) but the membranes
or the placenta is retained in the uterus.
Maternal hemorrhage – usually occur as long as part

of the conceptus is retained in the uterus
because the uterus cannot contract
effectively with retained products of conception
 Management: (Incomplete abortion)
- Dilatation and Curettage (D & C) or suction
curettage to evacuate the remains of
conception
- Make sure the woman is aware that
pregnancy is already lost and that D &C
is done to prevent further bleeding and
infection.
- Antibiotics
- Complete uterine evacuation
5. Missed abortion
Missed abortion – characterized by early
intrauterine fetal death without
expulsion of the products of conception.
Characteristics:
- no increase in fundal height during
prenatal check up
- no fetal heart sound hears
- had previous experience of threatened abortion
- sonogram result will reveal a dead fetus
 Management: (Missed abortion)
- Dilatation and Evacuation if the embryo is 4 to 6 weeks
age of gestation.
- Induction of labor if fetus is over 14 weeks
A.) Prostaglandin supp. or Misoprostol (Cytotec) – are the
drug of choice used to dilate the cervix
B.) Start Oxytocin drip to stimulate uterine contraction
and actively terminate pregnancy.
 Complication: Disseminated Intravascular Coagulation – a

coagulation defect may develop if the dead fetus
remains too long in utero.
6. Recurrent Abortion
6. Recurrent Abortion or Recurrent Pregnancy Loss or
Habitual Abortion - a spontaneous abortion of 3 or
more consecutive pregnancies.
Possible Causes:
- defective spermatozoa or ova
- deviations of the uterus
- endocrine factors (low protein bound iodine,
poor thyroid function or luteal phase defect)
- autoimmune defects
- infections
Common Signs & Symptoms of
Spontaneous Abortion
1. Vaginal bleeding in the first 20
weeks of pregnancy
2. Cramping in the lower abdomen
due to uterine contractions
3. Body malaise or other signs of
infections.
4. Ultrasound reveals the absence of
a viable fetus.
Nursing Management of Spontaneous Abortion
1. Assess and record vital signs, amount of bleeding, frequency

and intensity of cramping or pain.
2. Prepare patient for surgical intervention (D & C) if indicated
in case of severe vaginal bleeding.
3. Provide health teachings to the patient like
- The need to delay the next pregnancy until she fully
recovers
- Use of reproductive life planning methods
- Avoid coitus until after the next menses
4. Address emotional and psychological needs.
Complications of Miscarriage/ Abortion
1. Hemorrhage – major hemorrhages usually happen to a
woman who develop abortions especially with
accompanying coagulation defect (DIC).
bleeding indicator – 1 sanitary pad fully soaked per hour
2. Infection – tends to occur when women who have lost

appreciable amount of blood due to severe blood loss.
Escherichia coli – organism responsible for infection after
miscarriage (it is spread from the rectum to the
vagina)
Complications of Miscarriage (con’t)
Endomitritis – infection of the endometrial lining
- the most common infection after miscarriage.
3. Septic Abortion – an abortion that is complicated
by infection
Incidence:
- happens after a spontaneous abortion to
women who tried to self abort or were
aborted illegally using a
non-sterile instrument
Symptoms:
- fever
- crampy abdominal pain
- uterus is tender on palpation
Management: (same with the usual miscarriage cases)

1. Blood laboratories – CBC, Electrolytes, Creatinine,
Blood typing and Crossmatching
2. Cervical, vaginal and urine cultures
3. Intravenous fluid to restore fluid volume loss
4. Broad spectrum antibiotic therapy
5. Tetanus toxoid for prophylaxis against Tetanus
Ectopic Pregnancy
 Ectopic Pregnancy – 2nd most frequent cause of
bleeding during the 1st trimester
- pregnancy in which implantation occurs outside
the uterine cavity.
Sites where Ectopic pregnancy occurs:
1. ovary
2. fallopian tube (most common)
80% - in the ampulla
12% - isthmus
8% - fimbriae
3. abdominal cavity or intestine (rare)
4. cervix (very rare)
Vaginal
spotting
after the
Incidence:
pain

1. Woman with history of PID which leads to tubal
scarring.
2. Woman who smoke which cause the constriction of
the reproductive organ
3. Use of IUD as a contraception which causes the
slow transport of the zygote.
4. In vitro fertilization
Assessment: (signs and Symptoms)
1. Positive HCG result
2. nausea & vomiting (morning sickness) – at early pregnancy
3. Sharp, stabbing pain in one of the lower abdominal
quadrants at the time of rupture
4. Scanty vaginal spotting after the pain
5. Signs of shock, (lightheadedness, rapid pulse & resp, falling BP)
6. Leukocytosis is present due to trauma
7. Ultrasound (TVS) reveals ruptured fallopian tube & blood in the
peritoneum – bluish tinge color on the woman’s umbilicus
8. A tender mass is palpable in Douglas’ cul-de-sac on vag’l exam
Management:
 Early Stage: (before the rupture of the tube) which can be
diagnosed by ultrasound
1. Methotrexate (an oral drug), a folic acid antagonist
chemotherapeutic agent, attacks and destroys
fast growing cells.
- Hysterosalpingography, also known as uterosalpingography,
is a radiologic procedure to investigate the shape
of the uterine cavity and the shape and patency
of the fallopian tubes. This means it is a special x-ray
using dye to look at the womb and Fallopian tubes.
2. Mifepristone – an abortifacient drug; also effective
at causing sloughing of the tubal implantation site.
- It keeps the tube intact with no surgical scarring.
3. If ectopic pregnancy ruptures – it is an emergency situation.
Therapy: LAPAROSCOPY – the ligation of bleeding vessels
and to remove or repair the damaged fallopian tube. ,
Nursing Management:
1. Monitor vital signs, intensity of pain and
bleeding
2. Ensure appropriate physical, psychological
and emotional needs are attended to
3. Prepare the client for emergency
operation if needed.
 Incidence
> 1: 1,500 pregnancies
> common to women who have a low protein intake
> common to women older than 35 yrs age.
> more to women of Asian heritage
2 Types of H – Mole identified by Chromosomal Analysis
1. Complete – all trophoblastic villi swell & become cystic.
- karyotype is 46XX or 46XY component only which
means the father is the one contributing the
chromosomes, the ovum is empty.
2. Partial H mole – the syncytiotrophoblastic layer of villi is swollen & mishapen.
- Fetal blood and the macerated embryo is present.
- has 69 chromosomes(a triploid formation) in which there are
3 chromosomes instead of 2 in every pair; meaning 1 ovum is being
fertilized by 2 sperms or 1 ovum is fertilized by 1 sperm who did not
undergo meiosis
Assessment:
1. Strongly positive pregnancy test ( by serum or urine)
2. NO fetal heart sounds
3. Nausea & vomiting at early pregnancy period
4. 16 weeks pregnancy > vaginal spotting of dark brown blood
or as a profuse fresh flow.
5. Discharge of clear fluid- filled vesicles which confirms the
diagnosis of H-Mole.
Management:
1. Suction curettage to evacuate the mole.

2. Monitor the hCG levels for 12 months (every 4 wks)
- if remains high for 3 times; instruct to use an
oral contraceptive for 12 months.
- avoid getting pregnant for at least a year
3. Methotrexate – drug of choice for
choriocarcinoma as a
prophylactic course.
Cervical Insufficiency
 Cervical insufficiency (formerly called cervical incompetence)
- is painless cervical dilation resulting in delivery of a live
fetus during the 2nd trimester.
- refers to presumed weakness of cervical tissue that
contributes to or causes premature delivery not
explained by another abnormality.
- Estimated incidence varies greatly (1/100 to 1/2000).
Factors Associated with Premature Cervical
Dilatation:
 increased maternal age
 congenital structural defects
 trauma to the cervix (repeated D & C)
 Incidence:
- commonly occurs at approximately 20th week of
pregnancy when the fetus is still too immature.
MANAGEMENT:
 The most common treatment
for incompetent cervix is a
procedure called a cerclage.
Your doctor will sew a stitch
around the weakened cervix to
make it stronger. This
reinforcement may help your
pregnancy last longer. Doctors
usually perform a cerclage at
12 to 14 weeks of pregnancy.
 Transvaginal – McDonald’s
- Shirodkar
 Shirodkar Technique – sterile tape is
threaded in a purse string manner
under the sub mucous layer of
the cervix and suture in place to
achieve a closed cervix.
 McDonald’s Procedure – nylon sutures are

placed horizontally and vertically
across the cervix and pulled tight
to reduce the cervical canal to a
few millimeters.
Nursing Management:

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FAIR USE NOTICE AND

Spontaneous Miscarriage (Spontaneous Abortion) –

2. Placental factors (Implantation abnormalities) – with

3. Maternal factors - Failure of the corpus luteum to

4. Infections – like TORCH, UTI increases the incidence

5. Ingestion of teratogenic drugs and/or alcohol.

- Assess status of vaginal bleeding

Complete abortion – the entire products of conception (fetus,

Incomplete abortion - characterized by expulsion of

Maternal hemorrhage – usually occur as long as part

 Complication: Disseminated Intravascular Coagulation – a

1. Assess and record vital signs, amount of bleeding, frequency

2. Infection – tends to occur when women who have lost

Management: (same with the usual miscarriage cases)

1. Suction curettage to evacuate the mole.

 McDonald’s Procedure – nylon sutures are

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