11/19/23, 9:22 AM 3. CH 19, 20 - High Risk Pregnancy
1
OB Exam 1 Study Guide Susset H. Alcover
CH 19 - Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
High Risk Pregnancy
• Jeopardy to mother, fetus, or both
• Condition due to pregnancy or result of condition present before pregnancy
• Higher morbidity and mortality
• Risk assessment with first antepartal visit; ongoing
• Diverse factors
Pregnancy complications
• Bleeding during pregnancy
• Hyperemesis gravidarum
• Gestational hypertension
• HELLP syndrome
• Gestational diabetes
• Blood incompatibility
• Amniotic fluid imbalances
• Multiple gestation
• Premature rupture of membranes
Conditions Associated with Early Bleeding During Pregnancy
• Spontaneous abortion
• Ectopic pregnancy
• Gestational trophoblastic disease
• Cervical insufficiency
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,11/19/23, 9:22 AM 3. CH 19, 20 - High Risk Pregnancy
2
OB Exam 1 Study Guide Susset H. Alcover
Spontaneous Abortion
• Cause unknown and highly variable
– First trimester commonly due to fetal genetic abnormalities
– Second trimester more likely related to maternal conditions
• Most common complication of early pregnancy
• Abortion: Loss of an early pregnancy, usually before week 20th of gestation. Can be spontaneous (loss of
fetus d/t natural causes) or induced.
• Nursing assessment
– Vaginal bleeding à women complaining of vaginal bleeding must be seen immediately to determine
the cause/reason why she’s bleeding
– ask about color of bleeding (bright red is significant), amount (saturating a pad/hr. is significant),
and any passage of clots or tissue
– assess pain level, cramping or contractions
– Vital signs, pain level
– Client’s understanding
• Types of Spontaneous Abortion
– Threatened: The cervix is not dilated, and the placenta is still attached to the uterine wall, but
some bleeding occurs, not passage of fetal tissue
– Inevitable: The placenta has separated from the uterine wall, the cervix has
dilated, and the amount of bleeding has increased, possible passage of products
– Incomplete: The embryo or fetus has passed out of the uterus, but the placenta
remains inside
– Complete: embryo or fetus and placenta are out
– Missed: non-viable embryo retained in uterus for at least 6 weeks,
without s/s (in other words when mom doesn’t know the fetus is
dead inside)
– Habitual: > 3 consecutives spontaneous abortions
• Nursing Management:
– Continued monitoring: vaginal bleeding, pad count
– Observe for passage of products of conception
– Pain level and management of pain to address cramping discomfort
– Preparation for procedures (most of the time after abortion, a D&C is done)
– If spontaneous abortion happened out of the hospital, and passage of products of conception
occurred, pt. should bring everything to the hospital with her
– Medications
§ meds such as misoprostol or PGE2 (intravaginal suppository) to empty the uterus or retained
tissue or fragments that were not completely passed in the abortion w/o surgical intervention
§ If mother Rh negative and abortion occurs, administer RhoGAM within 72 hrs.
– Support: physical and emotional support; emphasis that the woman is not the cause of the loss;
verbalization of feelings, grief support, referral to community support group
!
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, 11/19/23, 9:22 AM 3. CH 19, 20 - High Risk Pregnancy
3
OB Exam 1 Study Guide Susset H. Alcover
!
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1
OB Exam 1 Study Guide Susset H. Alcover
CH 19 - Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
High Risk Pregnancy
• Jeopardy to mother, fetus, or both
• Condition due to pregnancy or result of condition present before pregnancy
• Higher morbidity and mortality
• Risk assessment with first antepartal visit; ongoing
• Diverse factors
Pregnancy complications
• Bleeding during pregnancy
• Hyperemesis gravidarum
• Gestational hypertension
• HELLP syndrome
• Gestational diabetes
• Blood incompatibility
• Amniotic fluid imbalances
• Multiple gestation
• Premature rupture of membranes
Conditions Associated with Early Bleeding During Pregnancy
• Spontaneous abortion
• Ectopic pregnancy
• Gestational trophoblastic disease
• Cervical insufficiency
!
about:blank 1/20
,11/19/23, 9:22 AM 3. CH 19, 20 - High Risk Pregnancy
2
OB Exam 1 Study Guide Susset H. Alcover
Spontaneous Abortion
• Cause unknown and highly variable
– First trimester commonly due to fetal genetic abnormalities
– Second trimester more likely related to maternal conditions
• Most common complication of early pregnancy
• Abortion: Loss of an early pregnancy, usually before week 20th of gestation. Can be spontaneous (loss of
fetus d/t natural causes) or induced.
• Nursing assessment
– Vaginal bleeding à women complaining of vaginal bleeding must be seen immediately to determine
the cause/reason why she’s bleeding
– ask about color of bleeding (bright red is significant), amount (saturating a pad/hr. is significant),
and any passage of clots or tissue
– assess pain level, cramping or contractions
– Vital signs, pain level
– Client’s understanding
• Types of Spontaneous Abortion
– Threatened: The cervix is not dilated, and the placenta is still attached to the uterine wall, but
some bleeding occurs, not passage of fetal tissue
– Inevitable: The placenta has separated from the uterine wall, the cervix has
dilated, and the amount of bleeding has increased, possible passage of products
– Incomplete: The embryo or fetus has passed out of the uterus, but the placenta
remains inside
– Complete: embryo or fetus and placenta are out
– Missed: non-viable embryo retained in uterus for at least 6 weeks,
without s/s (in other words when mom doesn’t know the fetus is
dead inside)
– Habitual: > 3 consecutives spontaneous abortions
• Nursing Management:
– Continued monitoring: vaginal bleeding, pad count
– Observe for passage of products of conception
– Pain level and management of pain to address cramping discomfort
– Preparation for procedures (most of the time after abortion, a D&C is done)
– If spontaneous abortion happened out of the hospital, and passage of products of conception
occurred, pt. should bring everything to the hospital with her
– Medications
§ meds such as misoprostol or PGE2 (intravaginal suppository) to empty the uterus or retained
tissue or fragments that were not completely passed in the abortion w/o surgical intervention
§ If mother Rh negative and abortion occurs, administer RhoGAM within 72 hrs.
– Support: physical and emotional support; emphasis that the woman is not the cause of the loss;
verbalization of feelings, grief support, referral to community support group
!
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, 11/19/23, 9:22 AM 3. CH 19, 20 - High Risk Pregnancy
3
OB Exam 1 Study Guide Susset H. Alcover
!
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