Risk Factors Associated with Pregnancy PDF

Risk Factors Associated with Pregnancy BLEEDING COMPLICATIONS IN PREGNANCY First Trimester Abortion ( 1-3 months) Ectopic Pregnancy Second Trimester Hydatidiform Mole ( 4-6 mos) Incompetent Cervix Third Trimester Abruptio/Ablatio Placenta ( 7-9 mos)...

Risk Factors Associated with Pregnancy BLEEDING COMPLICATIONS IN PREGNANCY First Trimester Abortion ( 1-3 months) Ectopic Pregnancy Second Trimester Hydatidiform Mole ( 4-6 mos) Incompetent Cervix Third Trimester Abruptio/Ablatio Placenta ( 7-9 mos) Placenta Previa Preterm Labor HYPERTENSIVE DISORDERS IN PREGNANCY Gestational Hypertension Chronic Hypertension Pregnancy Induced Hypertension Pre-eclampsia Eclampsia HeLLP Syndrome METABOLIC DISORDER IN PREGNANCY Gestational Diabetes Mellitus MEDICAL CONDITIONS COMPLICATING PREGNANCY  Risk Factors associated with Pregnancy Advanced age of 35 yrs and above is a high risk pregnancy Teenage pregnancy of 16 years and below is considered a high risk pregnancy Parity First pregnancy – is the period of highest risk Second / Third and Fourth pregnancy – the risk of death for the mother is at its lowest Fifth pregnancy – marked increase especially when the pregnant mother is over 40 years of age.  COMPLICATIONS OF PREGNANCY A.FIRST TRIMESTER BLEEDING: 1. ABORTION - THE EXPULSION OF THE PRODUCTS OF CONCEPTION BEFORE THE AGE OF VIABILITY ( FETUS CAN SURVIVE EXTRAUTERINE LIFE) - FETUS IS LESS THAN 20 WEEKS ( 24 weeks in the US) OR LESS THAN 500 GRAMS CAUSES OF ABORTION: 1. ABNORMALITY IN THE GERM PLASMA ( defective ovum/ congenital defects) 2.ABNORMALITY IN THE IMPLANTATION PROCESS 3. TRAUMA – PSYCHOLOGICAL, PHYSICAL 4. HORMONAL IMBALANCE ( LOW PROGESTERONE) 5. INTAKE OF DRUGS – CYTOTEC 6. INFECTIOUS DISEASES – GERMAN MEASLES, PTB, HERPES 7. PRESENCE OF VENEREAL DISEASES 8. ABNORMALITY IN THE REPRODUCTIVE SYSTEM 8. SEVERE MALNUTRITION EARLY ABORTION – HAPPENS BEFORE 16 WEEKS LATE ABORTION – HAPPENS BETWEEN 16 – 20 WEEKS Types of Abortion: SPONTANEOUS = UNINTENDED TERMINATION OF PREGNANCY AT ANY TIME BEFORE THE FETUS HAS ATTAINED VIABILITY. THREATENED – POSSIBLE LOSS OF THE PRODUCTS OF CONCEPTION S/SX: SLIGHT BLEEDING; MILD UTERINE CRAMPING BUT NO CERVICAL DILATATION ON VAGINAL EXAMINATION;NO PASSAGE OF TISSUE Mx: - Advise on complete bedrest for 24 to 48 hours Teach to save all blood clots passed & perineal pads used - Advise prompt reporting to the hospital if bleeding persists or increases Prevention of abortion: Avoid coitus or orgasm INEVITABLE OR IMMINENT ABORTION - is a loss of pregnancy that cannot be prevented. Clinical Manifestations: Moderate to profuse Bleeding Moderate to severe uterine cramping Cervix dilated Membranes rupture TYPES OF INEVITABLE ABORTION: 1) Complete – all products of conception are expelled. Sxs of complete abortion: Small negative bleeding Moderate cramping Close or partially open cervix Passage of complete placenta with fetus 2) Incomplete – not all products of conception are expelled from the uterus. Signs and Sxs: Profuse vaginal bleeding( bleeds the most) Severe uterine cramping Open cervix Passage of fetus or incomplete placental tissue Other products are retained Missed miscarriage Retention of all products of conception after the death of the fetus in the uterus S/Sx: - No FHT w/ ultrasound - Signs of pregnancy disappear Management: D&C Septic Abortion Abortion complicated by infection S/Sx: mild to severe bleeding, - Foul smelling vaginal discharge - Severe Uterine cramping - Presence of Fever Management: - Treat abortion - Antibiotics  HABITUAL OR RECURRENT PREGNANCY LOSS –SPONTANEOUS ABORTION IN THREE OR MORE SUCCESSIVE PREGNANCIES USUALLY DUE TO INCOMPETENT CERVIX. A. Induced Abortion – is an intentional loss of pregnancy through direct stimulation either by chemical or mechanical means. Types of induced abortion: 1) Therapeutic abortion – to preserve the life of the mother 2) Elective abortion – to end a pregnancy because of a woman’s choice not to have a child yet Reasons for Induced Abortion: Therapeutic – to end a pregnancy that is life threatening to the mother To end a pregnancy of a fetus found to have severe congenital abnormalities that may be incompatible with life To end an unwanted pregnancy that is a result of rape or incest 2. ECTOPIC PREGNANCY – “kyawa” - ANY PREGNANCY THAT OCCURS OUTSIDE THE UTERINE CAVITY. --- SECOND LEADING CAUSE OF BLEEDING IN EARLY PREGNANCY. TYPES: 1.AMPULAR- most common type 90 %- 95% 2. ABDOMINAL 3. OVARIAN 4. CERVICAL Predisposing causes: Salpingitis or Pelvic Inflammatory Disease Previous ectopic pregnancy Tumors that distort the tubes External migration of the ovum Intrauterine device (IUD) Adhesion of the fallopian tube from a previous infection Scars from tubal surgery Signs and Sxs: Vaginal spotting or bleeding Absence of amniotic sac Amenorrhea or abnormal menstruation -/ SPOTTING – most common sign Rectal pressure because of blood in the cul de sac Positive (+) pregnancy test in many women ( 50%) Signs of tubal rupture: Sudden ,Severe sharp knife like pain in the lower quadrant of the abdomen radiating to the shoulder ( Kehr’s sign ( referred shoulder pain) or neck pain Abdominal rigidity Nausea and vomiting Sharp localized pain in the cervix on internal examination ( wiggling sign)  Signs of hemorrhage: - Cullen’s sign – bluish discoloration of the umbilicus due to the presence of blood in the peritoneal cavity -Hard or rigid boardlike abdomen. Signs of hypovolemic shock: - Falling Hgb, Hct - Falling BP, rapid pulse , rapid RR ( HYPO, TACHY, TACHY) - Light headedness - Pallor - Cyanotic nail beds - Cold clammy skin  Diagnostic Aids Culdocentesis – aspiration of bloody fluid from Cul de sac of Douglas indicating intraperitoneal bleeding from tubal rupture Ultrasound reveals presence of the gestational sac outside of the uterine cavity Laparoscopy – visualization of tubal pregnancy Culdocentesis Treatment and management: If not yet ruptured: Salpingotomy – removal of a conceptus less than 2 cm located at the distal portion of the fallopian tube by performing a linear incision over the ectopic pregnancy. The conceptus will extrude from the incision & is removed manually.  If ruptured: Salpingectomy - removal of the ruptured tube because the presence of a scar if tube is repaired & left can lead to another tubal pregnancy Ectomy – removal NURSING CARE: Prevent and treat hemorrhage which is the main danger of ectopic pregnancy. Blood transfusion Place patient flat in bed with legs elevated Monitor Vital signs, I & O, & amount of blood Prevent loss infection as the woman who lost so much blood is susceptible to infection Contraception must be started upon discharge from hospital. Ovulation  Heterotopic pregnancy A tubal pregnancy with co-existing intrauterine pregnancy lgeblancomd maternal disorders 28