Obstetrics and Pregnancy Complications

Bleeding Disorders of Pregnancy

• Bleeding during pregnancy is a danger sign requiring immediate attention
• A bloody show is an exception, indicating true labor as cervix dilates
• A bloody show presents as a small amount of blood-tinged mucus discharged from the vagina, indicating the cervix's dilation and onset of labor

First Trimester (Weeks 1-12)

• Abortion refers to the loss of pregnancy during the first trimester
• Ectopic pregnancy occurs when the fertilized egg implants outside the uterine cavity, commonly in the fallopian tube
• Signs: Sharp, unilateral abdominal pain, vaginal bleeding; If ruptured, severe internal bleeding leads to shock

Second Trimester (Weeks 13-27)

• Abortion before viability: Loss of pregnancy before 20 weeks is classified as abortion
• Viability is when the fetus can survive outside the womb, typically 20 weeks or more
• Causes of abortion include infections, uterine abnormalities, or chromosomal defects
• Hydatidiform Mole (H. Mole) is a type of gestational trophoblastic disease caused by abnormal fertilization
• Instead of forming a normal placenta and fetus, a cluster of grape-like vesicles forms
• H. mole does not lead to a viable pregnancy or premature labor
• Symptoms: Excessive nausea, uterine enlargement disproportionate to gestational age, and vaginal bleeding
• Incompetent Cervix is a structural weakness of the cervix leads to premature dilation and thinning, often without pain or contractions
• This can cause second-trimester pregnancy loss or preterm birth
• Management includes cervical cerclage to close the cervix
• H. Mole and Incompetent Cervix commonly occur around 5 1/2 months (approximately 22 weeks), complicating pregnancy

Third Trimester (Weeks 28-40)

• Placenta Previa: Placenta implants in the lower uterine segment, partially or completely covering the cervix
• Symptoms: Painless, bright red vaginal bleeding, often occurring late in pregnancy
• Management involves monitoring, bed rest, or cesarean section for severe bleeding
• Abruptio Placenta: Placenta separates from the uterine wall before delivery, causing painful vaginal bleeding, uterine tenderness, and contractions
• It is a medical emergency , endangering both the mother and fetus
• Risk factors: Hypertension, trauma, smoking, or previous history of abruptio placenta

Primary Question To The Mother

• Age of gestation is a key primary question
• Months of pregnancy is another key question

Gestational Age Classifications

• Preterm Pregnancy: Spans from 20 to 36 weeks
• Full-Term Pregnancy: Spans from 37 to 42 weeks
• Post-Term Pregnancy: Pregnancies extending beyond 42 weeks

Abortion

• Abortion is the termination of pregnancy before the fetus is viable, typically before 20 weeks or a fetal weight under 500 grams
• Spontaneous abortion (nalaglag) is a miscarriage that occurs unintentionally

Types of Spontaneous Abortion

• Threatened Abortion is the only type where the pregnancy is still viable

• Pregnancy at risk but may be saved through medical intervention, possibly with tocolytic drugs

• Cervix remains closed and undilated

• BOW is intact

• Presenting signs: Abdominal cramping, and spotting or light bleeding

• Management includes tocolytics (drugs to suppress uterine contractions), sedation, complete bed rest, and avoiding internal examinations

• Sanitary Pad Inspection: Used pads are saved to inspect for tissues or abnormal bleeding

• Imminent or Inevitable Abortion cannot be prevented once it starts

• Patient requires immediate hospitalization

• Cervix is open and dilated

• BOW is ruptured

• Products of Conception (POC) have been expelled in a complete Abortion

• Confirmed as the final diagnosis; Requires routine check-ups to ensure complete expulsion

• Administer oxytoxic to promote uterine contraction and reduce hemorrhage risk

• Provide antibiotics to prevent infection and analgesics for pain relief

• Perform vital signs monitoring and maintain meticulous perineal care

• Some Products of Conception (POC), often the placenta in an Incomplete Abortion, remain in the uterus, leading to complications: Requires immediate hospitalization Requires Dilation and Curettage (D&C) to remove any retained POC

• Cervix is Open and dilated

• BOW is Ruptured

• Administer oxytoxic to promote uterine contraction and reduce hemorrhage

• Provide antibiotics to prevent infection and analgesics for pain relief.

• Initial diagnosis should be "incomplete abortion" to avoid self-incrimination due to retained products of conception

• Missed Abortion is a type where intrauterine fetal demise or death (IUFD) occurs, but the fetus and Products of Conception remain in the uterus up to 1 month without infection

• The pregnancy can persist for 4-6 weeks without visible infection signs

• Diagnostic Procedures: urinary Pregnancy test to confirm pregnancy, Leopold’s maneuver to check for fetal outline and size, Doppler to detect suspicion via absence of fetal heart rate and finally, Ultrasound for definitive confirmation of IUFD and absence of fetal activity via visualization

• Patient remains pregnant but shows no fetal signs via intact state of cervix and BOW and no sign of uterine contraction, bleeding or POC intact.

• Missed abortion is identified around the 4th month, when the baby is about 16 cm in length and has a more human-like form

• Management

• If IUFD's confirmed: Remove POC to prevent infection by starting oxytoxic IV incorporation for uterine contractions/ POC expulsion, follow with D&C to ensure removal and finally, administer antibiotics, analgesics, and anti-inflammatory medications.

Bartholomew's Rule

• At 4 months of pregnancy, the uterus is palpable midway between the symphysis pubis and the umbilicus.
• At 5 months, it reaches the level of the umbilicus.

Haase's Rule (Fetal Length Estimation)

• For months 1–5, fetal length is approximately the month of pregnancy squared
• E.g., 4 months = 16 cm.
• For months 6–9, multiply the month by 5
• A fetus at 16 cm is 6.3 inches long (16 ÷ 2.54 cm/inch).

Septic Abortion

• Septic abortion (SA) is a serious infection that occurs due to retained POC following incomplete or missed abortion

• Open and dilated Cervix with Ruptured BOW

• Strong Uterine Contraction and Bleeding

• Foul smelling Baby and/or Placenta.

• Discharge is foul-smelling vaginal discharge, a hallmark sign along with fever.

• Management includes immediate hospitalization

• administer oxytoxics to contract the uterus

• remove POC through D&C to prevent further infection

• prescribe antibiotics, analgesics, and antipyretics to manage infection, pain, and fever

• ensure meticulous perineal care to prevent secondary infections

Habitual or Recurrent Abortion

• Habitual abortion is defined as three or more consecutive spontaneous abortions (naturally caused miscarriage, nalaglag)

Cause

The number one cause is incompetent cervix, where the cervix cannot remain closed during pregnancy.

• occurs in the second trimester, during the 4th month
• presents as painless vaginal bleeding without uterine contractions

Outcomes

• If pregnancy is less than 5 months, abortion occurs
• If pregnancy is more than 5 months but less than 9 months, preterm labor ensues

Management

• Kegel exercises when urinating, strengthen floor muscles while also helping maintain cervical closure
• Cerclage technique can be used to prevent cervical opening such as McDonald's Cerclage for term stitch/ labor occurrence by week 37 without true signs allows NSD

More Lochia During NSD

• Lochia is consist of vaginal discharge that appears during childbirth includes of blood, mucus and uterine tissue
• the discharge is heavier in NSD body expels uterine lining
• Increased lochia is common for the first few days post partum amount is decreased over time

Chromic 20 Suture

• A type of absorbable suture that's surgical and commonly used for procedures like episiotomies or C-sections.
• "Chromic" refers to treatment with acid suture makes tissues more durable and slower for better healing.
• "20" shows thickness of suture.

Before Closing the Endometrium, Give Wet Gauze or Sponge (Not Dripping), Wipe to Remove Remnants of Decidua

• wipe to clear residual tissues like the inner uterine lining postpartum
• wet gauze helps clean clear out possible risks and infections to promote healing

Blood Transfusion Post-Abortion

• Before Transfusion: 1. Type-Determines compatibility. 2. Match-adverse reactions donor/ recipient. 3. CBC-Monitors blood. 4. Checks data
• Methods: 1.Transfer directly donor to recipient and 2. Process Blood

Nasogastric Tube (NGT) Placement

• Measure insertion length at the tip of the nose, extend to the earlobe, then finish at the xiphoid process

Catheterization

• Indwelling Catheter: 2-way Foley for urine drainage. 3-way Foley to lavage for post-surgical) such as in bleeding cases

• Non-Indwelling Catheter 1-way straight catheter is single-use, orange, clients who temporarily bladder drainage

DRUGS

• Oxytocics (Uterotonic)

• drugs stimulate contractions, usually used for Labor or postpartum

• Synto/Pito for synethic Oxytocin IV to stimulte contractions

• Oxytocin administered IM to mom, min to help release contractions

• Methergine released in IM. administerd, can cause retained

Tocolytic (Tanggal Hilab or Uterine Relaxants)

• used to prevent labor
• such like duvadilan or magniesum to early contractions

INTENTIONAL or INDUCED ABORTION

• Therapeutic: is legal or performed it in attempt save mom and medic comp like Ectopic pregnant of gravid cardiac Patients who could faint too cardiac
• Nontheapeutic: want for preg. Is illegal. Divorce was passed before it.

Who perform ABORTION?

• Hilot: born into the traditional profession.

Role Of nurses in ABORTION?

• use the drug called cytotec. orally or inserting followed by sex may to lead the disturbance microbical growth in a abortion

Method to abort

• Wire bleeding= involves mechanics
• Saline infusion=used irritates and for abortion

ECTOPIC PREGNANCY

• pregnancy grown outside of the uterus, ex: fallopian tube and other locations

• inflammatory increase the scarring and risk Risk increases

• Device intrauterine increase risk

• Inflammation in the tube in orection of the fertilization

Four Sites

• 1. Tubal: common and in ampulla may require aparotomy Preg in ampulla and vaginal in
• 2. Ovarian: managed by laparotomy
• 3. Abdomen: is type very dangerous and may exploratory laparotomy
• 4. Cerivcal: the rarest may require

• Rupture occcurs between 10-20 weeks

• Signs

• Absence and period:

• Test presence, though on use

• Ul trasound: detects the complication

• Sighs of Rupture

• 1. Kehr sharp stebbing

2. Cullen dis
3. shock

• BP low

Treatment -exlap and can remove part or use General Asthesia

• Sur Toolis

• Kel Clam helps control bld

• Sutlig- Tools used in site.

• Tied a long suture

Consideration

= potential or overies are able to pregnancy still

HYDATIDFROM mole

• form a disease from abnormal fertilization.

• Normal Fertilization : SPERM egg creates zygote will turns then a blastyst. the part outer forms sac of the eggs

• prefactors

• faulty fertilization

• low social status : Protein : lack protein cell in the body

• physiogy : detaches causeing ABort

• HCG evelations Signs 2nd TRI : bigger than the normal use BArtholormuels rules assess normal levels 5th month its at belly and 9th is near

• Abn HCG HIGH 1=2 m level

• absecne development : pasage V

Syptoms

• no period= not expeected : vomiting= hcg leads too hypermeiss

• urinaruy and frequent

• US to determine high HCG While HG with High HCG it doesn't asso with mole

• if Linked to H linked to high hGC is influenced

Complication

: Rupture may need treat and surgery

_ Management_ D&C and curettes / forcep and remover

_Sucton: can used to abnornal and cathetoer help low damage

_monitor

= after measure need to prevent tissue =low level shows #avoid pregnancy in years or Methsoreasate to help cancer grows

_ PREVIA : condition plac located lower instead top portion and lead comp _ sym _ no cervix all bright =no uterine _ not known the actual of plac how it got

detect 1 trimeser during early _ or till 3rd

Managent: : early it may revsolve but if presesnt need cearean

#BRupto; permatuley detach form UTERANIAL and effects M/F

SYM :Baby disstrss Bleeds, cause of the damage which compromise the the ability to supply nutriets

INcompatibility

• abdmoem / long

Factors

:Hypertention _ short cable chord _ Double coil _ Trauma =Lown Ourshment ; not known when till acctuly show

Managent

if preterm daxa is able be helpped CS= if needed

Medical Condition

:H blood is caused during preg

_Cause : unknown/factors or vessel press

_Gonne and D : cause of all baby press blood

• Family HT there increrase likely

Signs

: protien urine damage _ Swealing duing poor cric : Htn press over 140.90 that can lead and the other that hgih risk

:types

Htn preg PrEE presense is edema 30.ml protien may visual disturb

_ Edma= siezeres

_Chornic 149,90 before Indicates pregnancy.

Requires monotor

#mild pre #140.9 lesss then _ Protien 1.2 #EDma= swollen has

SERVI

: 1. 60 with urine test and high

#Edml ; face and high

Eclpas

1 60 HTN and pro 3 EDMS Seizures can cause from the problem and emergency 31. factors Horomna= new hormone press _Renal blld

Losing protine= protein in urine

#hepatic

:decreased blood flwo leads ti hepta +ceberal Rduced oxygen leads ti brian Fetal issues and distress :Uterplacental

2 type

#Chronic = chornichtn Acute= devlops TRIAD :

= persitiHTN _ Protien losss = Endma = all the increasing

MENET :HTRaline helps diolate _ mGSO4 seisure Admin Lodginf

#ACTION

Desrase= reduces irritability to prevent the sure

Monitor

Dtr= reduce the hyperref

==Rr=holldd the drug in under1212

Out put min

• to doid toxic Calcu to hekp Helpful to keep safe labor Monittoring

Diets ; protine/ LOW :

3_Fettl kick: #avg=10 mv

#Less more signla distress and fhr that ccan indxiute

GRAVICE Cardiac

RHD rheumatic

• PATH*infection ; 5 Joens:cardirts. chorea. poly. ermary
• Minor History fever arth

1 2 confirms

• Treat With pencilit monthly

;delays treat ment may lea

Mitrat parts open

_ BCD fl flows increace

= To inrcreas power

: Lf the blood at the u ; pulm is hard and not getting

Ddecerse out is sympto

• Class all _ Pain == Useful for presene motor continue, but Use forceps or dila

_ Forceps in corm or under.

_ Activy: useful to perment

• digitalis when wtiting for daliver
• Useul improve for the haert and valve
• DECREASE heart and rate
• KEY EFFECT

Ren per-is sign working

• increate that kidney enchanees funct

_heart rate

DIGIX in the heart rates so

== prevemt to help sooth. To precent damage

= menage dental precent sysy

_ early allow

• gest diabetes - Hormone cause

Human placent lactogen is primay

• block action action of insulin , high maternal glucose

. type : absolute

==insulin is essenit

_ diet and exercise

types: hormonal cagne durn preg

= DIET is first

effect. : :Role to bld cells .

= actions - Human blocks

__glocuese

+fliod is attract LEADS . cells and shrinke with thirst

• Alternate: muscle loss / fast bld down leading into ketosidos and brain daamge. - Poor control leading increase risk, permanent damage

• screen at 24-8

• test = to ddo testing needed to help. if high proceed confirm test

#oral: conifrm #no fast at last 2 dayss

_ sugaar and is taken normally bellow Dring sllution Blood is draw times normal vaulues below

_if is conrifmed

REpeeat To help. and ne

== -DIET

Excerse morning and pieces to helpp hyp Insolin : regulare used before immeridate : mixing always = short/ fast help quick fast

• _ long for mianence

Regular timing

Helps with admisteration on timing _ peask tiime the effect.

Rheum : and messur

: Asot meause specific antti diese and inrespoesse

, Noraml 150 / 250 Units

; 253 .4 indecare Super permenrt damage heart leading "ESR blood that and inrease and high

CFH if the red blood cells are high

_ CPp roein produces bbbby . If high .antiboisis levels in days .

_problem is sysmtem . Pain with polyathitir

====

• INsulin the to avoid hypd

subQ Is adminerd and used

:common. Thigh

Asepies . inportant in

_ mornitonr

A

What A4a

5 kick : what well

what is

==== :the abiliy ro rupture lab

• normal : 2 36th

• Purpose =to ratal uteutibe in conntrctoion that helpped == That test is to see fetal labor "Is possitive

• the thees may may . Atest helps _ thees are not the test so

_ Fetal can helpped _ If high, then a

Amniocentis:

Is visualtion or baby

=== is for low week or low fluid

Is for small and the if is help

• loctate babies and size baby for

. test

To help

That helo 5 14 .test may be conrtadicated

This quiz focuses on obstetrical complications, including VBAC contraindications, abruptio placentae management, gestational hypertension, and abortion types. It covers critical clinical decision-making for maternal and fetal well-being during pregnancy and delivery.