Medical Document: Pregnancy Complications & Management PDF

## ASSESSMENT FINDINGS * Positive pregnancy test * Excessive nausea and vomiting due to excessive HCG (1-2 million IU/24hrs) * Abdominal cramping from uterine distention * UTZ reveals grapelike growth or snowflake pattern * (-) viable fetus, (-) EHT, (-) Fetal parts moving ## DIAGNOSIS - TRIAD SI...

## ASSESSMENT FINDINGS * Positive pregnancy test * Excessive nausea and vomiting due to excessive HCG (1-2 million IU/24hrs) * Abdominal cramping from uterine distention * UTZ reveals grapelike growth or snowflake pattern * (-) viable fetus, (-) EHT, (-) Fetal parts moving ## DIAGNOSIS - TRIAD SIGNS: 1. Rapid uterine enlargement 2. Vaginal bleeding: brownish and intermittent 3. HCG level of 1-2 million IU ## LABORATORY AND DIAGNOSTIC STUDY - FINDINGS * HCG serum levels are abnormally high * Ultrasound reveals characteristic appearance of molar growth ## TREATMENT 1. Evacuation by suction curettage 2. Hysterectomy if not treated early (surgical removal of uterus) 3. HCG titer monitoring for one year 4. Medical/treatment/replacement: blood, fluid plasma 5. Chemotherapy for malignancy 6. Chest X-ray to detect early lung metastasis ## COMPLICATIONS > * Choriocarcinoma > * Hemorrhage > * Uterine perforation > * Infection ## NURSING MANAGEMENT 1. Advise bedrest 2. Monitor VS, blood loss, molar tissue passage, I&O 3. Maintain fluid and electrolyte balance, plasma and blood volume through replacements as ordered 4. Prepare for DC, or hysterectomy 5. Reinforce instructions on NO PREGNANCY FOR 1 YEAR 6. Woman should use reliable contraceptives 7. Emphasize the need for follow-up. HCG titer determination for 1 year ## AOG DETERMINATION USING BARTHOLOMEW'S RULE * Estimation of AOG by the position of the fundus in the abdominal cavity * Due to process of lightening ## HCG LEVELS IN WEEKS (GESTATIONAL AGE) | Weeks LMP | mIU/mL | |---|---| | 3 | 5-50 | | 4 | 50-126 | | 5 | 18-7,340 | | 6 | 1,080-56,500 | | 7 | 7,050-229,000 | | 9-12 | 25,700-288,000 | | 13-14 | 13,000-254,000 | | 17-24 | 4,040-145,000 | | 25-40 | 3,440-111,000 | | Non-pregnant females | 25.0 | | Post menopausal females | 29.5 | ## INCOMPETENT CERVIX * A mechanical defect in the cervix causing cervical effacement and dilation * Cervix that dilates prematurely * Occurs in about 1% of women even before the term * Approximately 20th week of pregnancy ## INCIDENCE ## ETIOLOGY Unknown ## RISK FACTORS * Increased maternal age * History of traumatic birth, cervical trauma – Precipitate labor * Repeated dilation & curettage (D&C) within 1st stage of labor * Treatment with diethylstilbestrol (DES) – Miscarriage prevention * Uterine anomalies * Congenitally short cervix * Synthetic non-steroidal estrogen prevents miscarriage ## ASSESSMENT FINDINGS 1. Painless cervical dilation 2. Pink-stained vaginal discharge 3. Increased pelvic pressure 4. Ovarian contractions may begin showing 5. Uterine contractions may begin showing ## SURGICAL MANAGEMENT * Cervical cerclage – Done 12th-14th Week AOG * Purse-string sutures are placed in the cervix by the vaginal route under regional anesthesia * Strengthen the cervix; prevent dilation until the end of pregnancy ## MCDONALD PROCEDURE * Nylon sutures placed horizontally and vertically across the cervix and pulled tight to reduce cervical canal to a few millimeters in diameter ## SHIROPKAR PROCEDURE * Sterile tape is threaded in a purse string manner under the submucous layer of the cervix and sutured in place to achieve a closed cervix ## POST CERCLAGE SURGERY 1. Bedrest modified Trendelenburg position for a few days 2. Sutures are removed at 37th-38th weeks so fetus can be born vaginally ## NURSING MANAGEMENT & INTERVENTIONS * Assess intense pressure on women’s pelvis * Determine the labor contractions – painful, constant * Inspect and save pads * Assessment for signs of labor, infection or PROM. * Monitor maternal vital signs, PHR and fetal growth * Routine prenatal care * Instruct client to report promptly signs of labor * Prepare the client for cervical cerclage as indicated * Instruct the client for signs and symptoms of labor * Maintain bed rest after surgery as ordered * Encourage follow-up to evaluate progress of pregnancy. * Provide psychological support * Advise the woman that the sutures will be removed around the 37-39 weeks of pregnancy. * In labor, prepare STITCH REMOVAL SET in addition to delivery set ## ECTOPIC PREGNANCY * Fertilized ovum implants outside the uterine cavity ## TYPES 1. Tubal – Most common type * Found in 90-95% of cases 2. Cervical ## RISK FACTORS 1. Previous infection 2. Scars from a tubal surgery 3. Congenital malformations 4. Uterine tumors. 5. Use of intrauterine devices 6. Smoking 7. Previous ectopic pregnancy ## ASSESSMENT FINDINGS * Sharp abdominal pain * Vaginal spotting or bleeding * Amenorrhea or abnormal menstrual period * Nausea and vomiting * Severe unilateral pelvic-abdominal pain (one side only) ## TUBAL RUPTURE SIGNS: * Bluish navel (CULLEN'S SIGN) because of blood in the peritoneal cavity * Sudden, acute stabbing and sharp low abdominal pain radiating to the shoulder (KEHR’S SIGN) – referred shoulder pain or neck pain ## LABORATORY FINDINGS 1. Low hemoglobin and hematocrit. 2. Low HCG 3. Elevated WBC ## DIAGNOSTIC TEST * AT THE BACK