D, HEALTH PROBLEMS THAT ARISE DURING

CARE OF MOTHER AND CHILD AT RISK OF

WITH PROBLEMS (ACUTE & CHRONIC) PREGNANCY
1. Includes: PIH, Anemia, Hyperemesis
Gravidarum, Hemorrhage, Gestational
Framework for Maternal and Child Health Diabetes
Nursing (MCN) Focusing on At-Risk, High Risk, 2. Occur as a result of ineffective adaptation to
and Sick Clients the changes that occur with pregnancy
3. More likely to occur among women who are
A. National Health Situation on MCN
already at risk
B. Statistics on MCN
C. Genetics and Genetic Counseling E, OBSTETRICAL-GYNECOLOGICAL FACTORS
A, NURSING CARE OF THE PREGNANT CLIENT 1. Number of pregnancies (gravid) and birth
(para)
Identifying a High-Risk Pregnancy:
2. Pelvic and uterine malformation and
High-risk pregnancy abonormalities
3. History of STDs and pelvic inflammatory
Is one in which a concurrent disorder, disease (PID)
pregnancy-related complication, or external 4. History of complications with previous
factor jeopardizes the health of the pregnant
pregnancies (abortion, hemorrhage)
person, the fetus, or both. 5. History of infertility
In most instances, more than one factor 6. Exposure to DES (diethylstilbestrol) as a
contributes to the classification of a fetus
pregnancy as high risk.
F, PSYCHOSOCIAL RISK FACTORS
FACTORS
1. Instability of family relationship
1. Age <18 and >40 years old 2. Inadequate economic resources
2. Nutritional habits and status 3. Limited access to nearby culturally sensitive
3. Abuse of tobacco, alcohol and drugs
prenatal care or a high-risk pregnancy
4. Presence of a disability or trauma, or center
substance abuse (hyperglycemia)
4. Minority status in terms of race-ethnicity-
B. FACTORS ARISING FROM THE HEALTH experience higher rates of maternal-infant
STATUS AND LIFESTYLE OF THE FATHER OF morbidity as well as low birth weight (LBW)
THE BABY 5. History of mental health disorders including
depression and psychosis
1. Abuse of drugs, alcohol and tobacco
2. Harmful sexual practices (multiple sex 1. DIAGNOSTIC TESTS AND LABORATORY
partners) EXAMS
3. Exposure to environmental hazards
1. Complete Blood Count
C, PRE-EXISTING HEALTH PROBLEMS Hemoglobin, Hematocrit, and Red Cell
Index – determine the presence of anemia
1. Health problems present prior to the onset 2. HGB – 120-180 G/L
of pregnancy 3. HCT – 0.37-0.54
2. Pregnancy effects the health problem and WBC count – to determine infection
the health problem effects the pregnancy 4. WBC – 4.5-11x10/L
3. Preconception care and counseling is Platelet count – to estimate clotting ability
critical 5. PLT CT – 150-450x10/L
Sickle cell anemia screen – detect fickle cell
trait or disease
2. VDRL – VENEREAL DISEASE RESEARCH A PREGNANCT PATIENT WITH CARDIAC
LABORATORY - screening test for syphilis DISEASE – cardiac disease can affect pregnancy
in different ways depending on whether it involves
3. BLOOD TYPING (RH FACTOR) - to determine the left or the right side of the heart.
blood type and Rh status of mother
CLASSIFICATION OF HEART DISEASE
4. MsAFP (MATERNAL SERUM ALFA FETO
PROTEIN) - to screen for open neural tube defects
5. INDIRECTS COOMB’S TEST - the indirect
Coombs test looks for free-flowing anitbodies
against certain red blood cells. It is most often done
to determine if you may have a reaction to blood
transfusion.
6. RUBELLA TITER – verify that all pregnant
women and those planning to become pregnant
have a sufficient amount (titer) of rubella antibodies
to protect them from infection.
A PREGNANT PATIENT WITH LEFT-SIDED
7. HEPATITIS B SURFACE ANTIGEN (HbsAG) – HEART FAILURE
to screen for hepatitis B infection (non-reactive)
8. HIV TEST – to screen for HIV Mitral Stenosis (obstruction to left ventricular flow)

General recommendations for screening includes Mitral Insufficiency

women who:
A. Have used or are using IV drugs Aortic Coarctation
B. Have engaged in sex with multiple partners
The left ventricle cannot move the large volume of
C. Have sexual partners who are infected or at
blood forward that it has received by the left atrium
risk
from the pulmonary circulation. This causes back
D. Received a blood transfusion between 1977
pressure- the left side of the heart becomes
and 1985
distended, systemic BP decreases in the face of
9. ORAL GLUCOSE TOLERANCE TEST (OGTT) lowered cardiac output, and pulmonary
– to screen for gestational diabetes hypertension occurs. Due to limited oxygen
exchange, those with left-sided heart failure are at
10. URINALYSIS – to determine the presence of an extremely high risk for spontaneous miscarriage,
bacteria, albumin and glucose in the urine preterm labor, or even death.
11. TUBERCULIN SKIN TEST/PURIFIED
PROTEIN DERIVATIVE TEST – to screen for
tuberculosis
12. ULTRASONOGRAPHY – to confirm the
pregnancy length or document healthy fetal growth
13. PAP SMEAR – to screen for the presence of
atypical cells
14. TESTING OF CERVICAL AND VAGINAL
SECRETIONS – to screen for reproductive tract
infection
CARDIAC DISEASE IN PREGNANCY –
pregnancy places stress to the cardiovascular
system as a result of plasma volume expansion
which increases cardiac output and workload.
SIGNS AND SYMPTOMS 5. Most women with gestational diabetes
return to euglycemic state after delivery,
Fatigue
however, these individuals have an
Cough
increased risk of developing DM in their
Tachycardia
lifetimes.
Increased RR
Poor fetal heart tone variability PREDISPOSING CONDITIONS TO
Decreased amniotic fluid GESTATIONAL DIABETES
Edema
1. Older then 35 years
MANAGEMENT: 2. Obesity
3. Multiple gestation
ANTEPARTAL PERIOD
4. Family history of diabetes mellitus
Adequate nutrition ASSESSMENT:
Promotion of rest
Protection from infection Excessive thirst
Drug therapy Hunger
Restriction of activity Weight loss
Continuous monitoring of pregnancy Frequent urination
Psychological support Blurred vision
Recurrent UTI and vaginal yeast infection
INTRAPARTAL PERIOD
Glycosuria and ketonuria
Continuous monitoring of vital signs Signs of gestational hypertension
Assessment of pulmonary function Polyhydramnios
Proper positioning (left-side lying) Large fetus for gestational age
Supportive therapie
INTERVENTIONS
Assistance during delivery
Psychological support 1. Emply, diet, insulin (if diet cannot control
blood glucose levels), exercise, and blood
POSTPARTAL PERIOD
glucose determinations to maintain blood
Assessment of post delivery heart status glucose levels between 65 mg/dL and 130
Proper positioning mg/dL
Planning of scheduled activity 2. Observe for signs of hyperglycemia,
Psychologocal support glycosuria and ketonuria, and hypoglycemia
Education and assistance of mother in 3. Monitor weight
infant care 4. Increase calorie intake as prescribed, with
Preparation for discharge adequate insulin therapy so that glucose
moves into the cells.
GESTATIONAL DIABETES 5. Assess for signs of maternal complications
1. Occurs in pregnancy (during the second or such as preeclampsia (hypertension,
third trimester) in clients not previously proteinuria, and edema)
diagnosed as diabetic and occurs when the 6. Monitor for signs of infection
pancreas cannot respond to the demand for 7. Instruct the client to report burning and pain
more insulin on urination, vaginal discharge or itching, or
2. Pregnant women should be screened for any other signs of infection to the health
gestational diabetes between 24 to 28 care provider
weeks of pregnancy 8. Assess the fetal status and monitor for signs
3. A 3-hour OGTT is performed to confirm of fetal compromise
gestational diabetes mellitus
4. Gestational diabetes frequently can be
treated by diet alone, however some clients
may need insulin
 Marijuana and Hashish – are obtained from the
hemp plant, cannabis
Substance abuser – is one who uses drug for
pleasure
Drug dependent - someone who craves a Tachychardia
particular drug for psychological and physical well- Sense of well-being
being. Loss of short term memory
Increase respiratory infection
Reduce milk production
Woman is in the youngest age group
They may have less traditional lifestyle than
others Learning deficits
They may come late for prenatal care
They may have difficulty following prenatal
instructions The woman with CANDIDIASIS
Signs and Symptoms:
1. Anticipatory guidance and nursing support Thich, cream cheese like vaginal discharge
during pregnancy Extreme pruritus
2. Interdisciplinary team approach Vagina appears red and irritated
3. Discouraged breastfeeding (drug is
secreted in breastmilk) CANDIDIASIS – causes vaginal infection spread by
the fungus Candida
Risk Factors:
Cocaine – derived from erythrxylon coca, a plant
grown almost exclusively in South America Women being treated with an anitbiotic for
another infection
Alkaloidal cocaine - a concentrated mixture, Women with gestational diabetes
produces an even more rapid and intense ‘high’ Women with HIV
when it is inhaled

Vasoconstriction
Increased respiratory and cardiac rate
Increased blood pressure
Severely compromise placental circulation

Management:
Intracranial hemorrhage
Withdrawals syndrome of tremulousness, 1. Treat the infection durign pregnancy
irritability and muscle rigidity 2. Local application of an antifungal cream:
Learning deficits Miconazole (Monistat) or Clotrimazole
(Gyne-Lotrimin)
Amphetamines – has a pharmacologic effect similar
3. Caution the women to telephone their
to cocaine. It is a drug easily and cheaply
primary health care provider before using
manufactured
over the counter preparation for candidiasis.
The woman with TRICHOMONIASIS
Signs of jitteriness
Trichomonias vaginalis – is a single-cell protozoan
Poor feeding at birth
spread by coitus
Signs and Symptoms Management:
Yellow-gray frothy vaginal discharge 1. Administration of erythromycin or amoxicillin
The woman with SYPHILIS
Syphilis – is a systemic disease caused by the
Spirochete Treponema Pallidum
Signs and Symptoms:
Painless ulcer (chancre) on the vulva or
vagina
Management: placenta appears imprevious to the distance
1. Assess for the presence of trichomoniasis organism before 18 weeks of pregnancy
infections Management:
2. Administer medication Metronidazole
(Flagyl), topical Clotrimazole 1. infection of Benzathine Penicillin G is the
drug of choice for the treatment of Syphilis
The woman with BACTERIAL VAGINOSIS during pregnancy. After therapy, the woman
Bacterial vaginosis - is a local infection of the may experience a sudden episode of
vagina by the invasion, most commonly of hypotension, fever, tachychardia and
Gardnerella organisms muscle aches, this is called JARISCH
HERXHEIMER reaction.
Signs and Symptoms
Gray and fish-like odor discharges
Intense pruritus

The woman with HERPES INFECTION

Genital Herpes Infection – is a sexually transmitted
disease caused by the Herpes Simplex Virus
Management:
(HSV) type 2
1. Application of vaginal topical cream
Signs and Symptoms
The woman with CHLAMYDIA TRACHOMATIS
Painful, small, pinpoint vesicles surrounded
Chlamydia infection – is one of the most common by erythema on the vulva or in the vagina 3
type of vaginal infections seen during pregnancy. It to 7 days after exposure.
is caused by gram-negative intracellular paraiste.
Management:
Signs and Symptoms
1. Hot Sitz bath
Heavy gray-white vaginal discharge 2. Application of warm, moist tea bags to the
lesions
3. Administration of acyclovir (Zovirax) in an
ointment or oral form
4. Women with active lesions from a primary
infection may be scheduled for a ceasarean
 birth. If no lesion are present, a vaginal birth
is preferable.

Management:
1. Application of trichloroacetic acid (TCA) or
bichloroacetic acid (BCA) to the lesions
weekly
2. Large lesions may be removed by laser
The woman with GONORRHEA
therapy, cryocautery or knife excision
Gonorrhea – is a sexually transmitted disease 3. Hot sitz bath and application of lidocaine
caused by the gram-negative coccus Neisseria cream maybe soothing during the postpartal
gonorrhoeae period
4. Caesarean delivery maybe performed when
Signs and Symptoms vulvar lesion is present at the time of birth
Yellow-green vaginal discharge 5. Women who have had one episode of
infection should be conscientious about
having a yearly papsmear for the rest of
their lives.
The woman with a GROUP B STREPTOCOCCI
INFECTION
Streptoccocus B infection perhaps occurs
during at a higher incidence during pregnancy
than herpes type 2 or gonorrhea. Infection
develops within the cervix or vagina and the
mother usually experiences no symptoms.
Consequences and intra-amniotic infection.
Management:
Management:
1. Traditionally been treated with amoxicillin
and probenecid, the incidence of 1. Women are screened for the infection at 35
penicillnase-producing strains has made to 38 weeks of pregnancy by a vaginal
this traditional therapy ineffective. culture and treated with broad spectrum
2. Oral cefixime and Ceftriaxone sodium IM penicillin such as ampicillin.
are now the drug of choice 2. Women who experience rupture of
3. Sexual partner should be treated as well to membranes at less than 37 weeks of
prevent infection. pregnancy are treated with Intravenous IV
ampicillin.
The woman with HUMAN PAPILLOMA VIRUS
INFECTION The woman with HUMAN
IMMUNODEFICIENCY VIRUS INFECTION
Human Papilloma Virus – causes fibrous tissue
overgrowth on the external vulva (condyloma A. Description
acuminatum) 1. HIV is the causative agent of AIDS
2. Women infected with HIV may first show
Signs and Symptoms symptoms at the time of pregnancy or
Lesion appear as discrete papillary structure possibly develop life-threatening
Large cauliflower-like lesions infections because normal pregnancy
 involves suppression of the maternal clients may experience outbreak of herpes
immune system. zooster (shingles)
3. Zidovudine (Retrovir) is recommended client may experience transient
for the prevention of maternal-to-fetal thrombocytopenia
HIV transmission and is administered
STAGE 3:
orally beginning after 14 weeks
gestation, intravenously during labor, client is symptomatic
and in the form of syrup to the newborn immune dysfunction is evident
for 6 weeks after birth. all body systems can show signs of immune
dysfunction
B, TRANSMISSION
ntegumentary and gynecological problems
1. Sexual exposure to genital secretions of an are common
infected person
STAGE 4:
2. Parenteral exposure to infected blood and
tissue advanced infection
3. Perinatal exposure of an infant to infected client vulnerable to common bacterial
maternal secretions through birth or infections development of opportunistic
breastfeeding infections
serious immune compromise
C, RISK TO THE MOTHER; a mother with HIV is
managed as high-risk because she is vulnerable to INTERVENTIONS
infections
prevent opportunistic infections
D, DIAGNOSIS avoid procedures that increase the risk of
perinatal transmission, such as
1. Test used to determine the presence of
amniocentesis and fetal scalp sampling
antibodies to HIV include enzyme-linked
if the fetus has not been exposed to HIV in
immunosorbent assay (ELISA), western blot
utero, the highest risk exist during delivery
and immunofluorecence assay (IFA)
through the birth canal
2. A single reactive ELISA test by itself cannot
be used to diagnose HIV and the test THE NEWBORN AND HIV
should be repeated with the same blood
sample, if the result is again reactive, follow Neonates born to HIV positive clients may test
up tests using Western blot or IFA should be positive because antibodies received from the
done. mother may persist for 18 months after birth, all
3. Positive western bot or IFA is considered neonates acquire maternal antibody to HIV
confirmatory for HIV infection, but not all acquire infection.
4. 4. A positive ELISA that fails to be confirmed INTERVENTIONS:
by western blot or IFA should not be
considered negative and repeat negative bath the baby carefully before any invasive
and repeat testing should be done in 3 to 6 procedure, such as the administration of
months. vitamin K, heel sticks, or venipunctures,
clean the umbilical cord stump meticulously
STAGE 1: every day until healed
Fever the newborn can room with the mother
Headache administer zidovudine to the newborn as
Lymphadenopathy prescribed for the first 6 weeks of life
Myalgia RH INCOMPATIBILITY
STAGE 2: The Rh factor (ie, Rhesus factor) is a red blood cell
infection is active but asymptomatic and surface antigen that was named after the monkeys
may remain so far years in which it was first discovered. Rh incompatibility,
also known as Rh disease, is a condition that
occurs when a woman with Rh-negative blood type RISK FACTORS:
is exposed to Rh-positive blood cells, leading to the
1. multiple pregnancies
development of Rh antibodies.
2. women with a secondary hemolytic disease
The most common cause of Rh incompatibility is 3. women who are taking hydantoin- drug that
exposure from an Rh-negative mother by Rh- interferes with folic acid absorption
positive fetal blood during pregnancy or delivery. As
COMPLICATIONS
a consequence, blood from the fetal circulation may
leak into the maternal circulation, and, after a 1. early abortion
significant exposure, sensitization occurs leading to 2. abruption placenta
maternal antibody production against the foreign
Rh antigen. MANAGEMENT

Once produced, maternal Rh immunoglobulin G 1. take a supplement of 400ug of folic acid

(IgG) antibodies may cross freely from the placenta daily
to the fetal circulation, where they form antigen- 2. eat foods rich in folic acid
antibody complexes with Rh-positive fetal Sickle cell anemia- is a recessively inherited
erythrocytes and eventually are destroyed, resulting hemolytic anemia caused by an abnormal amino
in a fetal alloimmune-induced hemolytic acid in the beta chain of hemoglobin.
anemia. Although the Rh blood group systems
consist of several antigens (eg, D, C, c, E, e), the D SIGNS AND SYMPTOMS:
antigen is the most immunogenic; therefore, it most
RBC’s are irregular or sickle shape
commonly is involved in Rh incompatibility.
hemoglobin level of 6-8 mg/100 mL
ANEMIA IN PREGNANCY increase indirect bilirubin
asymptomatic bacteriuria
Iron deficiency anemia - is characteristically a
microcytic and hypochromic anemia COMPLICATIONS:

CAUSES: 1. direct fetal compromise with low birth weight

2. death
1. diet low in iron
2. heavy menstrual period MANAGEMENT:
3. hort period between pregnancies
1. MIO
4. women from low socio-economic status
2. proper positioning
SIGNS AND SYMPTOMS 3. exchange transfusion periodically
4. administer IVF
1. Pica-eating non nutritious food results to low 5. administer folic acid supplement, avoid iron
fetal birth weight and preterm birth supplement
2. extreme fatigue 6. administer oxygen
3. poor exercise tolerance 7. administration of meds (acetaminophen,
4. Decreased hemoglobin (below 11 mg/dL) NSAIDS, narcotics)
MANAGEMENT GESTATIONAL CONDITION
1. take 120 to 180 mg of elemental iron per Hyperemesis gravidarum - is nausea and vomiting
day of pregnancy that is prolonged past 12 weeks of
2. eat foods high in iron pregnancy
3. increase roughage in diet
CAUSATIVE FACTORS:
Folic deficiency anemia - deficiency in folic acid
which is necessary for both the normal formation of 1. Hormonal factors
RBC’s in the mother and has been associated with 2. gastrointestinal factors
a decrease in neural tube defects in the fetus. 3. psychological-emotional factor
4.
SIGNS AND SYMPTOMS: (+) Cullen’s sign
excruciating pain of cervix if moved on IE
weight loss
signs of shock
fluid volume deficit
acid base imbalance Cullen’s sign - umbilicus may develop a bluish
nutritional deficit tinged if blood is slowly seeping into the peritoneal
electrolyte deficit cavity
activity intolerance, fatigue, weakness
MANAGEMENT:
fear
hypoxia and intrauterine growth 1. careful history taking
MANAGEMENT 2. record amount of blood discharge
3. monitor v/s
1. hospitalization-monitor IO and blood 4. position patient for shock
chemistry and prevent dehydration 5. pelvic exam
2. rest gastrointestinal tract 6. Culdocentesis
3. restore ability to take and retain oral fluids 7. Laparatomy
and food 8. Ultrasonography
4. maintain integrity of oral cavity 9. Salpingotomy
5. promote rest and relaxation 10. Salphingectomy
6. prepare for discharge 11. Blood transfusion
Ectopic pregnancy - pregnancy in which Pelvic exam - to check for the size of uterus and
implantation occurs outside uterine cavity feel for growth and tenderness
CAUSES:
Culdocentesis - involves passing a needle through
1. adhesion of the fallopian tube from previous the cul-de-sac of Douglas to aspirate fluids from the
infection (chronic salpingitis or PID) peritoneal cavity
2. congenital malformation
Laparotomy - to ligate bleeding vessels and to
3. scars from tubal surgery or a uterine tumor
remove or repair damaged fallopian tube
4. use of IUD
5. Progestin-only oral contraceptives,
Ultrasonography - to visualize the peritoneal cavity
postconceptual or ovarian induction drugs for an ectopic implanted pregnancy
6. Smoking
Salpingotomy - surgical incision of uterine tube
CLINICAL CLASSIFICATION:
1. tubal pregnancy Salpingectomy - surgical excision of uterine tube
2. abdominal pregnancy
3. ovarian pregnancy blood transfusion - to replace blood loss
4. cervical pregnancy
Gestational Trophoblastic disease/Hydatidiform
SIGNS AND SYMPTOMS: mole - is a proliferation and degeneration of the
tropoblastic villi as the cells degenerate, they
amenorrhea degenerate, they become fluid filled with fluid,
nausea and vomiting appearing as fluid, appearing as fluid-filled, grape
+pregnancy test for HCG sized vesicles
breast tenderness
fatigue Etiology: UNKNOWN
increase urination TYPES OF MOLAR PREGNANCY:
severe unilateral pelvic pain often referred
to the shoulder 1. Partial mole
severe sharp-like stabbing pain either right vesicular degeneration of the chorionic villi
or left lower quadrant affects only parts of the placenta
rigid abdomen
 fetal parts and normal placenta are present ETIOLOGY:
along with abnormal trophoblastic tissue
1. increase maternal age
low risk of subsequent development of
2. trauma to cervix (repeated D and C)
malignancy
SIGNS AND SYMPTOMS
2. Complete mole
no normal placenta presence of show
bulky mass which can fill the uterine cavity increase pelvic pressure
no fetal parts or normal placenta villi rupture of membranes
low risk of subsequent development of discharged of amniotic fluid
malignancy uterine contraction-fetus is born

SIGNS AND SYMPTOMS: MANAGEMENT:

(+) pregnancy test 1. Cervical cerclage-purse string sutures are

vaginal bleeding (brownish, prune juice) placed in the cervix by a vaginal route
containing grapelike tissue A. McDonald
uterine enlargement, fundal height greater B. Shirodhar bacter
than expected for length of pregnancy 2. Emergent cerclage - suture are placed in
nausea and vomiting the cervix as prophylaxis preterm birth
symptoms of PIH earlier than 24 weeks of Abortion - is defined as any interruption of a
gestation pregnancy before the fetus is viable
absence of fetal heart tones/activity
absence of fetal part upon palpation or TYPES OF ABORTION:
radiologic exam
A. Spontaneous abortion-also called
LABORATORY TEST miscarriage, happens in 15% to 30% of all
pregnancies and occurs from natural
routine urinalysis causes
blood values/exam
a. hematocrit, hemoglobin, rbc CAUSES:
b. HCG titers are elevated up to 12M in 24
1. abnormal fetal formation
hours
2. implantation abnormalities
c. ultrasonography
3. corpus luteum fails to produce enough
MANAGEMENT: progesterone
4. infections in the woman
1. Induced abortion followed by D and C in a
few days TYPES OF SPONTANEOUS ABORTION
2. Hysterectomy
1. threatened abortion- characterized by
3. Follow-up supervision for 1 year
spotting and bleeding in the 1st trimester of
4. HCG titer-once a week until results are
pregnancy
negative for 3 consecutive weeks
once a month for 6 months SIGNS AND SYMPTOMS
every 2 months for 6 months
every 6 months spotting, scant bleeding
bleeding, bright red in color
B. Chest x-ray- done every month until HCG titer is slight cramping, backache
negative, then every 2 months for 1 year no cervical dilatation
C. oral contraceptives to prevent pregnancies
D. pregnancy is not advised until 1 year test are MANAGEMENT:
negative 1. limiting activity to no strenous activity for 24-
Incompetent cervi x- is a cervix that dilates 48 hours
prematurely and therefore cannot hold a fetus until 2. convey concerned reassurance
term. The dilatation is usually painless 3. coitus is restricted for 2 weeks
 2. Imminent (Inevitable) abortion-pregnancy no tissue passed
cannot be saved cervix closed
signs of pregnancy subside, pregnancy test
SIGNS AND SYMPTOMS:
becomes negative
moderate bleeding MANAGEMENT:
moderate uterine cramping, backache
cervix dilation 1. sonogram to establish death of the fetus
2. D and C
MANAGEMENT:
3. Provide emotional support
1. prompt termination of pregnancy through D
6. Habitual abortion - women who have 3 or more
and C consecutive spontaneous abortion
2. tissue fragment should be saved for
examination for abnormality (H-mole) CAUSES:
3. Complete abortion - the entire products of
conception are expelled spontaneously 1. defective spermatozoa or ova
2. endocrine factors
SIGNS AND SYMPTOMS: 3. deviation of the uterus
4. infection
slight bleeding
5. autoimmune disorders
mild uterine cramping
tissue is passed-complete products of B, INDUCED ABORTION - Is one which is
conception artificially brought about or pregnancy may be
cervix closed interrupted for medical or for social reason
MANAGEMENT: Social reason: unwanted pregnancy due to rape or
incest, want to maintain body figure
1. No medical intervention is required if:
- bleeding and cramping subside after TYPES OF INDUCED ABORTION:
passage
1. Therapeutic abortion - termination of
- tissue passed is evaluated to be complete
pregnancy with legal justification due to
- infection does not occur
2. Provide emotional support some maternal disease which extremely
endanger the fetus and mother
4. Incomplete abortion - part of the fetus is 2. Criminal abortion - done illegally outside of
expelled, but membrane or placenta is retained in the hospital or without proper medical
the uterus supervision
SIGNS AND SYMPTOMS: COMPLICATIONS OF ABORTION:
heavy bleeding associated with retained 1. Hemorrhage- excessive bleeding (a rule of
placenta thumb is more than 1 sanitary napkin per
moderate to severe uterine cramping hour)
tissue is passed with the bleeding
Management:
cervix is open and dilated
MANAGEMENT: 1. Position patient flat on bed and massage
fundus of the uterus to aid contraction
1. D and C
2. Emotional support
2. Provide emotional support
3. Monitor v/s every 15 minutes
5. Missed abortion- fetus dies but products of
conception are not passed or aborted 4. D and C (to empty uterus that is preventing
it from contracting and achieving
SIGNS AND SYMPTOMS:
hemostasis)
slight bleeding, brownish discharge
5. Blood transfusion
no uterine cramping
 6. Direct replacement of fibrinogen (to aid Management:
coagulation
1. Provide emotional support
7. Oral medication (methergin) to aid with
contraction Placenta Previa - the placenta is implanted in the
lower uterine segment instead of a the upper third
2. infection - the organism responsible for infection of the uterus
after abortion is usually E. coli
CLASSIFICATION:
Management
1. Low lying placenta- implantation in the lower
1. Observe the woman closely for signs of rather than in the upper portion of the uterus
infection such as fever, abdominal pain or 2. Marginal implantation-placenta edge
tenderness, foul vaginal discharge approaches that of the cervical os
3. Partial placenta previa- implantation that
2. Administer antibiotics as ordered
partially occludes cervical os
3. Proper perineal care 4. Total placenta previa- implantation that
totally obstruct cervical os
4. Caution mother not to use tampons
CAUSES:
3. Septic abortion - abortion that is complicated by
infection 1. increased parity
2. advanced maternal age
- usually happens after spontaneous abortion 3. past ceasarean section
especially those who have tried to self-abort using 4. past uterine curettage
a non-sterile environment 5. multiple gestation
- if left untreated it can lead to toxic shock SIGNS AND SYMPTOMS:
syndrome, septicemia, kidney failure and death
abrupt painless bleeding and bright red in
SIGNS AND SYMPTOMS: color
Fever bleeding after sexual intercourse and
Crampy abdominal pain vaginal exam
Uterus feels tender to palpation premature labor

MANAGEMENT: IMMEDIATE NURSING CARE:

1. D and C- removal of all infected/ necrotic tissue 1. complete bedrest

from uterus 2. assess the following
- duration of pregnancy
2. Antibiotics usually broad spectrum is used - time bleeding begins
- estimation of amount of blood
3. Tetanus toxoid or tetanus immune globulin IM
- whether there was accompanying pain
4. Isoimmunization - whenever a placenta is - color of blood
dislodge either by spontaneous birth or by D and C - What she had done for the bleeding?
at any point in pregnancy, some blood from - whether there were previous bleedings?
placental villi enter maternal circulation - whether she had prior cervical surgery?
3. Monitor vital signs
MANAGEMENT: 4. Stat laboratory to be done- (CBC, typing,
All women with Rh negative blood should receive prothrombin time, to establish baseline and
Rh (D antigen) immune globulin (RHIG) in the detect a possibility of clotting disorder)
event the conceptus is Rh positive 5. Begin IVF stat/doctors order (to replace fluid
loss)
5. powerlessness - a feeling of sadness and grief 6. prepare oxygen and blood transfusion
over the loss or that they have lost control of their
lives is to be expected.
CONTINUING CARE: placenta allowing blood to escape from the
uterus cavity. Bleeding is internal
1. bed rest and close watch
2. if bleeding stops-home care SIGNS AND SYMPTOMS:
3. careful assessment of FHR and laboratory
sharp stabbing pain high in the uterine
test
fundus (as the initial separation occurs)
4. reassurance
5. inform mother of a possible CS delivery heavy bleeding (usually accompanies
premature separation of the placenta)
Abruptio placenta - premature separation of a hard board-like uterus (results if separation
normally implanted placenta occurs from the center rather than the
margin)
Etiology: unknown
signs of shock
PREDISPOSING FACTOR:
MANAGEMENT:
1. high parity
1. hospitalization
2. chronic hypertension disease
2. Combat blood shock and blood loss
3. hypertension of pregnancy or toxemia
large gauge IV catheter inserted for fluid
4. direct trauma
replacement and oxygen by mask to limit
5. vasoconstriction from cocaine use
fetal anoxia
6. Cigarette smoking
monitor vital signs of mother and FHR every
7. Acute emotional stress
5-15 minutes
8. Strenuous physical activity
fibrinogen determination and CBC
9. nutritional deficiency
if it occurs in active labor-rupturing of
DEGREES OF SEPARATION: membranes and augmenting labor with IV
oxytocin maybe method of choice
Grade 0 - no symptoms of separation were if delivery is not imminent-CS is the delivery
apparent from maternal or fetal signs. The method of choice
diagnosis that a slight separation did occur is made
after delivery when the placenta shows a recent COMPLICATIONS:
adherent clot on the maternal surface
1. hypovolemic shock
Grade 1 - Minimal separation, but enough to cause 2. fetal hypoxia
marginal bleeding and changes in the maternal vital 3. Couvelaire uterus- is a life-threatening
signs, no fetal distress or hemorrhagic shock condition in which loosening of the placenta
occurs (abruptio placentae) causes bleeding that
penetrates into the
Grade 2 - Moderate separation, there is no uterine myometrium forcing its way into
evidence of fetal distress, the uterus is tense and the peritoneal cavity.
painful on palpation 4. infections
Grade 3 - Extreme separation, without immediate Spontaneous rupture of the membrane before the
intervention maternal death and fetal death will onset of labor
occur
TYPES:
TYPES OF ABRUPTIO PLACENTA:
premature rupture of the membranes
1. covert/central abruptio placenta-separation (PROM) - rupture of membranes after the
begins at the center of placenta completion of the 37th week of gestation
attachment resulting in blodd being trapped with labor usually beginning with 12 to 24
behind the placenta, bleeding, then is hours
internal and not obvious preterm premature rupture of the
2. Overt or marginal abruptio placenta- membranes (PPROM)-rupture of
separation begins at the edges of the membranes before the 38th week of
gestation
Etiology: unknown blood clots
CONTRIBUTING FACTORS: drop in blood pressure
reproductive tract infections DIAGNOSTIC TEST:
increased intrauterine pressure
examination of a blood sample under a
lifestyle habits
fetal anomalies and malpresentations microscope
fibrin degradation products
SIGNS AND SYMPTOMS: partial thromboplastin time (PTT)
platelet count
sudden gush of clear fluid from the vagina
prothrombin time
vaginal pooling of fluid
serum fibrinogen
COMPLICATIONS:
MANAGEMENT:
risk for infection
1. treat the initiating cause
fetal hypoxia as a result of cord
2. IV administration of heparin
compression
3. blood transfusion
prolapse of the cord 4. delivery of the fetus and placenta
decreased amounts of amniotic fluid to
cushion cord Pregnancy induced hypertension - is a form of high
development of a Potter-like syndrome of blood pressure in pregnancy
distorted facial features and pulmonary
also called toxemia or preeclampsia. It
hypoplasia from pressure
occurs most often in young women with a
MANAGEMENT: first pregnancy.
1. Determine WHO IS AFFECTED BY PIH
A. exact time of rupture Pregnancy - induced hypertension (PIH) affects
B. characteristics of fluid-amount, approximately one out of every 14 pregnant
color, and odor, confirm that fluid is amniotic women. Although PIH more commonly occurs
by performing during first pregnancies, it can also occur in
a.1 Nitrazine test-alkaline reaction subsequent pregnancies. PIH is also more common
a. 2 Fern test- ferning pattern appears when in pregnant teens and in women over age 40. Many
fluid dries on a glass slide times, PIH develops during the second half of
a.3 Sonogram- to assess amniotic fluid pregnancy, usually after the 20th week, but it can
index also develop at the time of delivery or right after
C. gestational age of the pregnancy delivery.
Disseminated intravascular coagulation - is an WHO IS AT RISK OF DEVELOPING PIH:
acquired disorder of blood clotting A woman is more likely to develop PIH if she:

RISK FACTORS: Is under age 20 or over age 35

Has a history of chronic hypertension
1. premature separation of placenta Has a previous history of PIH
2. hypertension of pregnancy Has a female relative with a history of PIH
3. Amniotic fluid embolism Is underweight or overweight
4. Placental retention Has diabetes before becoming pregnant
5. Septic abortion Has an immune system disorder, such as
6. retention of a dead fetus lupus or rheumatoid arthritis
7. saline abortion Has kidney disease
Has a history of alcohol, drug, or tobacco
SIGNS AND SYMPTOMS:
use
-early bruising Is expecting twins or triplets

- bleeding, possibly from multiple sites in the body

WHAT ARE THE SYMPTOMS OF PIH? HOW HELLP IS DIAGNOSED:
- Rapid or sudden weight gain, high blood pressure,
protein in the urine, and swelling (in the hands, and • Hemolysis - Red blood cells
face) are all signs of PIH. Abnormal peripheral smear
- Other symptoms of PIH include abdominal pain, Lacatate dehydrogenase >600 U/L
severe headaches, a change in reflexes, spots Bilirubin > 1.2 mg/dl
before your eyes, reduced output of urine or no • Elevated liver Enzyme levels
urine, blood in the urine, dizziness, or excessive Serum aspartate amniotransferase >70 U/L
vomiting and nausea Lacatate dehydrogenase >600 U/L
• Low Platelets
- During routine prenatal tests, your weight gain, Platelet count
blood pressure and urine protein are monitored.
If PIH is suspected, a non-stress test may be TREATMENT’S THAT MAY BE USED TO
performed to monitor the baby. During the non- MANAGE HELLP UNTIL BABY IS DELIVERED
stress test, an ultrasound transducer records the INCLUDE:
baby's heart rate, and a pressure transducer (called • Bed rest and admission into a medical
the toco transducer) records uterine activity. facility to be monitored closely
MANAGEMENT: • Corticosteroid ( to help babies lungs
develop more rapidly)
Rest • Magnesium Sulfate ( to help prevent
Lying on your left side to take the weight of seizures)
the baby off your major blood vessels. Blood transfusion if platelet count gets too
Increase prenatal checkups. low
Consume less salt. • Blood pressure medication
Drink 8 glasses of water a day.
• Fetal monitoring and tests including
HELLP SYNDROME: biophysical tests, sonograms, non stress
tests and fetal movement evaluation
HELLP Syndrome is a series of symptoms that
make up a syndrome that can affect pregnant A multiple birth occurs when more than
women. HELLP syndrome is thought to be a variant one fetus is carried to term in a single pregnancy.
of preeclampsia, but it may be an entity all on its The preceding pregnancy is called a multiple
own. There are still many questions about the pregnancy.
serious condition of HELLP syndrome. The cause
CAUSES:
is still unclear to many doctors and often HELLP
syndrome is misdiagnosed. o Heredity (family history)
HELLP STANDS FOR: o Older age (women over 30 y.o)
H- hemolysis ( breakdown of red blood cells)
o High parity
EL- elevated liver enzymes (liver function)
LP- low platelets counts (platelets help the blood o Race (African American have more twins
clot) than Asian and Native American

MOST COMMON SYMPTOMS OF HELLP o Ovulation (Clomiphene Citrate and FSH

help produce many eggs, if fertilized can
Headaches result to multiple birth)
Nausea and vomiting that continue to get
worse (this may also feel like a serious case o Assisted reproductive technologies (In vitro
fertilization)
of the flu.)
Upper right abdominal pain or tenderness CLASSIFICATIONS:
Fatigue or malaise
1. MONOZYGOTIC – When a single ovum is
fertilized but in the process of fusion or in
one of the first cell divisions, the zygote
divides into 2 identical individual
 Always of the same sex Rest period
1 placenta, 2 umbilical cord, 1 chorion and 2
amnion Anticipatory guidance and support

2. DIZYGOTIC - Two separate ova fertilized by

2 different sperms.
They are actually siblings growing at the
same time in the uterus
May or may not be of the same sex
2 placentas, 2 umbilical cord, 2 chorions, 2
amnions
SIGNS AND SYMPTOMS:
▪ Uterine size is greater than expected
▪ On quickening there are several flurries of
action in different portion of abdomen
▪ On auscultation, 2 sets of fetal heart tone
are heard
▪ There is marked weight gain, not due to
toxemia or obesity
COMPLICATIONS:
▪ Premature delivery (the higher the number
of fetus, the greater risk for early birth)
▪ Postpartum hemorrhage (due to abnormal
uterine stretching
▪ Hypertensive disorders (pre-eclampsia,
eclampsia)
▪ Hydramnios
▪ Maternal anemia
▪ Nausea and vomiting throughout pregnancy
▪ Dyspnea (due to the pressure in the
diaphragm
▪ Pedal edema (Na retention)
▪ Abruptio placenta/ placenta previa
▪ Ceasarean delivery
Twin to twin transfusion syndrome - is a condition of
the placenta that develops only with identical twins
that share placenta connect with in the placenta
and divert blood from one fetus to the other.
Recipient fetus receives too much blood which lead
to cardiovascular overload. Donor fetus, does not
get enough blood and decrease amount of amniotic
fluid.
MANAGEMENT:
Prenatal care
Balanced diet