Midterm Exam
Antepartum Complications
Abortion: loss of pregnancy b4 20 wks
• Spontaneous – miscarriage
• Therapeutic – to preserve health of mother, prevent birth of infant w/ severe birth
defects, to end pregnancy caused by rape or incest
• Elective – voluntary method of ending pregnancy
Spontaneous abortions
Incidence
• 50-70% occur in 1st trimester
• Increases w/ maternal age
Causes
• Severe congenital abnormalities
• Chromosomal abnormalities (50-60%)
• Blighted ovum (anembryonic)
• Maternal infection, disease, disorder, substance use
Types
• Threatened – vaginal bleeding
• Inevitable – membranes rupture & cervix dilates
• Incomplete – some products of conception have been expelled but some remain
Sings & symptoms
• Vaginal bleeding
• Cramping
• Persistent backache
• Pelvis pressure
Interventions
• Detailed history
• Ultrasound
• Labs: serum beta-hCG/progesterone level
• D&C/vacuum curettage
• Monitor for PPH/shock
• Administer Rhogam for all Rh negative clients
• Psychological support
Ectopic Pregnancy: implantation of fertilized ovum in area outside of uterine cavity
Incidence
• 97% occur in Fallopian tube
• 2nd most frequent cause of bleeding
• Leading cause of infertility
Risk Factors
• History of STI
• Assisted reproductive technology (ART)
, • Intrauterine device (IUD)
• Tubal surgery
Symptoms
• Missed menstrual period
• Positive pregnancy test
• Abdominal pain: abrupt unilateral lower quadrant pain
• Vaginal spotting
• Referred shoulder pain
• Shock (hypotension, tachycardia, pallor)
Diagnosis
• Transvaginal ultrasound
• Elevated hCG levels (but lower than expected)
• Laparoscopy: diagnose ruptured ectopic pregnancy
Treatment
• IV fluid replacement
• Methotrexate: inhibits cell division. 90% effective
• Surgery
o Linear salpingostomy (removal of pregnancy from tube)
o Salpingectomy (removal of tube)
• Psychological support
Hydatidiform Mole / Molar Pregnancy / Gestational Trophoblastic Disease
Often benign abnormal growth of chorionic villi. Appears as transparent grapelike clusters. May
develop choriocarcinoma (rare)
Risk Factors
• Age extremes (teens or over 40)
• Previous use of ovulation-stimulation drugs
• History of spontaneous abortions
• Poor nutrition
• Unknown etiology
Types
• Complete: paternal contribution, no fetal parts
• Incomplete: maternal/paternal contribution abnormal chromosomal composition &
fetal parts
Symptoms
• Vaginal bleeding, brown grapelike clusters
• Anemia
• Rapid uterine growth
• Cramping
• Extreme nausea
• Hyperthyroidism
• Preeclampsia prior to 24 wks
, Diagnosis
• Ultrasound
• Persistent high hCG levels
Treatment
• Evacuate trophoblastic tissue of mole
o Vacuum aspiration & curettage
o Oxytocin to contract uterus
• Continuous follow-up to check for malignancy
o Monitor hCG levels after delivery up to 1 yr post delivery
o Avoid pregnancy for 1 yr to allow hCG to normalize
Placenta previa & abruptio placentae
Separation of normally implanted placenta before fetus is born (after 20 wks)
Risk Factors
• Maternal HTN
• Blunt trauma
• Multiparity/multiple gestation
• Cocaine use
• Previous history
• PROM (Premature rupture of membranes)
• Cigarettes
Placenta Previa
When placental abnormally implants into lower segment of uterus near or over cervical os
rather than attaching to the fundus
Types
• Complete/total: placenta completely covers the ox
• Incomplete/partial: cervical os is only partially covered by the placenta
• Marginal/low-lying: placenta is attached to lower uterine segment but does not reach
the cervical os
Risk Factors
• Previous previa, smoking
• Uterine scarring (previous C section, curettage, endometritis)
• Maternal age >35 yr
• Multifetal gestation, closely spaced pregnancies
Symptoms
• Painless, bright red bleeding during 2-3 trimester
• Uterus soft, nontender, relaxed, w/ normal tone
• Fundal height greater than usually expected
• Fetus in oblique, breech, or transverse position
• Reassuring FHR
• Vital signs WNL
• Decreasing output may indicate blood loss
Antepartum Complications
Abortion: loss of pregnancy b4 20 wks
• Spontaneous – miscarriage
• Therapeutic – to preserve health of mother, prevent birth of infant w/ severe birth
defects, to end pregnancy caused by rape or incest
• Elective – voluntary method of ending pregnancy
Spontaneous abortions
Incidence
• 50-70% occur in 1st trimester
• Increases w/ maternal age
Causes
• Severe congenital abnormalities
• Chromosomal abnormalities (50-60%)
• Blighted ovum (anembryonic)
• Maternal infection, disease, disorder, substance use
Types
• Threatened – vaginal bleeding
• Inevitable – membranes rupture & cervix dilates
• Incomplete – some products of conception have been expelled but some remain
Sings & symptoms
• Vaginal bleeding
• Cramping
• Persistent backache
• Pelvis pressure
Interventions
• Detailed history
• Ultrasound
• Labs: serum beta-hCG/progesterone level
• D&C/vacuum curettage
• Monitor for PPH/shock
• Administer Rhogam for all Rh negative clients
• Psychological support
Ectopic Pregnancy: implantation of fertilized ovum in area outside of uterine cavity
Incidence
• 97% occur in Fallopian tube
• 2nd most frequent cause of bleeding
• Leading cause of infertility
Risk Factors
• History of STI
• Assisted reproductive technology (ART)
, • Intrauterine device (IUD)
• Tubal surgery
Symptoms
• Missed menstrual period
• Positive pregnancy test
• Abdominal pain: abrupt unilateral lower quadrant pain
• Vaginal spotting
• Referred shoulder pain
• Shock (hypotension, tachycardia, pallor)
Diagnosis
• Transvaginal ultrasound
• Elevated hCG levels (but lower than expected)
• Laparoscopy: diagnose ruptured ectopic pregnancy
Treatment
• IV fluid replacement
• Methotrexate: inhibits cell division. 90% effective
• Surgery
o Linear salpingostomy (removal of pregnancy from tube)
o Salpingectomy (removal of tube)
• Psychological support
Hydatidiform Mole / Molar Pregnancy / Gestational Trophoblastic Disease
Often benign abnormal growth of chorionic villi. Appears as transparent grapelike clusters. May
develop choriocarcinoma (rare)
Risk Factors
• Age extremes (teens or over 40)
• Previous use of ovulation-stimulation drugs
• History of spontaneous abortions
• Poor nutrition
• Unknown etiology
Types
• Complete: paternal contribution, no fetal parts
• Incomplete: maternal/paternal contribution abnormal chromosomal composition &
fetal parts
Symptoms
• Vaginal bleeding, brown grapelike clusters
• Anemia
• Rapid uterine growth
• Cramping
• Extreme nausea
• Hyperthyroidism
• Preeclampsia prior to 24 wks
, Diagnosis
• Ultrasound
• Persistent high hCG levels
Treatment
• Evacuate trophoblastic tissue of mole
o Vacuum aspiration & curettage
o Oxytocin to contract uterus
• Continuous follow-up to check for malignancy
o Monitor hCG levels after delivery up to 1 yr post delivery
o Avoid pregnancy for 1 yr to allow hCG to normalize
Placenta previa & abruptio placentae
Separation of normally implanted placenta before fetus is born (after 20 wks)
Risk Factors
• Maternal HTN
• Blunt trauma
• Multiparity/multiple gestation
• Cocaine use
• Previous history
• PROM (Premature rupture of membranes)
• Cigarettes
Placenta Previa
When placental abnormally implants into lower segment of uterus near or over cervical os
rather than attaching to the fundus
Types
• Complete/total: placenta completely covers the ox
• Incomplete/partial: cervical os is only partially covered by the placenta
• Marginal/low-lying: placenta is attached to lower uterine segment but does not reach
the cervical os
Risk Factors
• Previous previa, smoking
• Uterine scarring (previous C section, curettage, endometritis)
• Maternal age >35 yr
• Multifetal gestation, closely spaced pregnancies
Symptoms
• Painless, bright red bleeding during 2-3 trimester
• Uterus soft, nontender, relaxed, w/ normal tone
• Fundal height greater than usually expected
• Fetus in oblique, breech, or transverse position
• Reassuring FHR
• Vital signs WNL
• Decreasing output may indicate blood loss
