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Teach pt to watch for this after a D&C.
- Heavy bleeding,
- foul-smelling discharge,
- abdominal tenderness
Vaginal bleeding, cramping, backache,
Vaginal bleeding, cramping, dilatation of
the internal cervical os
Products of conception retained; usually
the placenta, cervical os open
All the products of conception are
expelled, cervical os may be closed
The fetus dies in utero but is not
Some causes of spontaneous abortion.
- chromosomal abnormalities
- abnormalities of the reproductive tract or placenta
- maternal diseases and infections
Treatment for ectopic pregnancy.
- 1. Assess appearance and amount of vaginal bleeding
- 2. Assess BP, pulse and respirations for signs of shock
- 3. Prepare the patient for emergency surgery if the ectopic has ruptured
- 4. Establish IV therapy and blood transfusion capability
- 5. Assess emotional needs of the couple and family and provide support
- 6. Some ectopics may be treated with methotrexate* and close monitoring (serial hCG levels)
- 7. Give Rh immune globulin to Rh negative woman
Methotrexate dosing for ectopic pregnancy.
1 mg/kg IM for 1-3 doses.
Develops from an anuclear ovum (“empty
Fertilized by a haploid sperm (23X) and duplicates to become 46XX of total paternal origin
No embryonic or fetal tissue are found
Normal ovum fertilized by two sperm
Results in triploid karyotype (69 chromosomes)
Identifiable fetal parts may be present
Similar to complete mole, but involves
Invasive, malignant trophoblastic disease
Metastatic, can be fatal
S/S of Gestational Trophoblastic Disese (molar pregnancy)
- Vaginal bleeding, often brownish (“prune
- Passage of hydropic vesicles
- Anemia (due to loss of blood)
- Uterine enlargement greater than expected
- Markedly elevated serum hCG levels
- Severe hyperemesis gravidarum
- Absence of fetal heart tones
What is hyperemesis gravidarum r/t?
- rising chorionic gonadotropin and
- estrogen levels
What is gestational HTN?
- HTN (BP >140/90) detected for the first time after mid-pregnancy (20 weeks) without
When is gestational HTN confirmed?
- If/when BP returns to normal by the 12th week
- *if does not rtn to normal, chronic HTN is diagnosed
Preeclampsia is a systemic disease characterized by?
- HTN (BP > 140/90),
- proteinuria > 300 mg/24 hours or 1+ dipstick after the 20th week of gestation
How is chronic HTN managed during pregnancy?
What is Chronic HTN with Superimposed Preeclampsia?
- New-onset proteinuria > 300 mg/24 hours in hypertensive women but NO proteinuria
- BEFORE 20 weeks gestation
- Sudden increase in proteinuria or hypertension in women with hypertension AND
- proteinuria BEFORE 20 weeks gestation
What can occur as a complication of severe eclampsia?
- HELLP syndrome:
- Eevated Liver enzymes
- Low Platelets
Symptoms of HELLP syndrome.
- epigastric pain
What are the 3 questions you should ask in a pregnant woman, especially with s/s of preeclampsia?
1) Do you have a headache?
2) Are you having any visual disturbances?
3) Are you having any right upper quadrant or epigastric pain?
S/S of preeclampsia.
- Persistant hypertension
- CNS symptoms:
- Visual disturbances
- Hyperreflexia and clonus
- Seizure (1/400 of mild preeclamptics; 2%
- of severe)
- Stroke (rare)
- Liver involvement manifested by:
- RUQ or epigastric pain
- Nausea and vomiting
- “I just don’t feel good”
- Dyspnea (related to pulmonary edema)
Antihypertensive therapy is usually initiated
when SBP is ≥______mmHg and/or DBP is ≥_______
Target goal: SBP _______; DBP
- 105 to 110
Delivery is recommended
for any patient with preeclampsia at least __ weeks gestation
If pt with preeclampsia is <37 weeks, what is the expected management?
- Restricted activity (although there is no evidence that supports that complete bedrest
- improves outcome)
- Daily fetal movement counts
- Nonstress test and/or biophysical profile
- Ultrasound to evaluate growth and AFI
- Umbilical artery flow study (if growth is a concern)
- Repeat laboratory evaluation once or twice weekly
- Platelet count, serum creatinine, serum AST
- Antenatal corticosteroids to promote fetal lung maturity in women less than 34 weeks gestation
Care during a seizure.
- Call for help
- Ensure airway and breathing
- Remain with patient
- Prevent injury
- Record time, length, type of seizure activity
After seizure care.
- IV access
- Administer MgSO4
- Assess maternal and fetal status
- Suction if needed
- Supplemental O2
- Patient will be stabilized then deliver
Hypertensive Disorders of Pregnancy: Fetal Risks.
- Growth Retardation
- Low birth weight
- Fetal intolerance to labor due to decreased placental perfusion
Why do pregnant women need to do the glucose test at 24-28 weeks?
- In the second half of pregnancy, the
- placental hormone hPL (human placental lactogen) causes maternal peripheral resistance to insulin
- This ensures that there is glucose for the developing fetus
- Mother metabolizes fat for energy and produces ketones as a result
Gestational diabetes is diagnosed if two or more of the following values are met or exceeded:
- Fasting = 95mg/dl
- 1 hour = 180 mg/dl
- 2 hour = 155 mg/dl
- 3 hour = 140 mg/dl
Goal for glucose monitioring.
- Fastings < or = 95
- 2 hour postprandials < or = 120
Medication for diabetes management.
- Glyburide (oral agent)
- Insulin (injectable)
- -Need for insulin will increase as pregnancy advances
Effects of pregnancy on woman with heart disease.
- Blood pressure drops during 2nd trimester in response to decreased systemic vascular resistance
- 30% to 50% increase in intravascular volume and cardiac output
- Increase of heart rate by 15-20 bpm
- Increased risk of thromboembolism
- Dramatic volume shifts occur after delivery
- Cardiac output may increase an additional 50% during labor