• Interruption of pregnancy before the age of VIABILITY (20 weeks)
Spontaneous Abortion
  • Causes
    • Abnormal fetal formation
    • Low progesterone levels
    • Implantation abnormalities
    • Infection
    • Teratogens
  • Signs and Symptoms
Threatened Abortion
  • Unexplained scant bright red vaginal bleeding
  • No cervical dilatation
  • Most common cause of 1st trimester bleeding
  • Nursing Care
    • Avoid strenuous activity
    • No coitus for 2 weeks
Imminent/Inevitable Abortion
  • Bleeding with cervical dilation and uterine contractions
  • Treatment
    • Save any tissue fragments discharged for later examination
    • If no FHT is detected, D&C is performed to remove conceptus
Complete Abortion
  • All of conceptus is expelled without any assistance; profuse bleeding which stops after a few days
  • Treatment
    • Go directly to hospital for assistance
    • Fragments of conceptus may be checked to prevent further bleeding
    • Oxytocin or methergine to stop bleeding
Incomplete Abortion
  • Part of the conceptus is expelled, usually the fetus, and the placenta and membranes are left
  • Treatment
    • Dilatation and Curettage (D&C)
    • Make sure the woman knows that the pregnancy is already lost
Missed Abortion
  • The fetus dies but is not expelled
  • Treatment
    • Dilatation and Curettage (D&C)
    • Make sure the woman knows that the pregnancy is already lost
    • MISOPROSTOL (Cytotec) - to dilate cervix and stop bleeding
Habitual Abortion
  • Also known as Recurrent Pregnancy Loss; 3 spontaneous miscarriages at roughly the same gestational age
  • Causes
    • Defective sperm or ova
    • Endocrine disorders
    • Uterine defects
    • Infections
    • Autoimmune disorders
Induced Abortion
  • Artificial induction of abortion via mechanical or chemical means
Ectopic Pregnancy
  • Implantation of the zygote outside the uterine cavity; most commonly on the ampullar region of the Fallopian tube
  • Causes
    • Salpingitis - may cause scarring of Fallopian tube and subsequent blockage
    • PID
    • Use of IUD
    • Smokers
    • Uterine tumors
  • Signs and Symptoms
    • Bleeding during 6-12 weeks
    • CULLEN’S SIGN – bluish tinge on the umbilicus
    • Falling hCG
    • Shock
  • Treatment
    • Ligation of bleeding vessels
    • Unilateral salpingectomy
    • METHOTREXATE FOLLOWED BY LEUCOVORIN - to destroy remaining tissue
    • Mifepristone - to induce labor
Abdominal Pregnancy (Ectopic)
  • Growth of the fetus outside of the uterus
  • Signs and Symptoms
    • Fetal outline easily palpable directly below the abdominal wall and not inside the uterus
Hydatidiform Mole / Gestational Trophoblastic Disease
  • the abnormal proliferation and degeneration of trophoblastic villi
  • Most common cause of 2nd trimester bleeding
    • Complete Mole - trophoblastic villi swell and become cystic, “empty ovum” was fertilized; usually lead to choriocarcinoma
    • Partial Mole - some of the trophoblastic villi form normally but is swollen and misshapen, has 69 chromosomes; usually doesn’t lead to choriocarcinoma
  • Causes
    • Asians
    • Low protein intake
    • Older than 35 years of age
  • Signs and Symptoms
    • Elevated hCG
    • High weight gain for gestational age
    • No FHT
    • Discharge of clear fluid filled vesicles
  • Treatment
    • No pregnancy for 12 months
    • Let mother express concerns, feelings and emotions
    • METHOTREXATE FOLLOWED BY LEUCOVORIN - to destroy remaining tissue
    • Dactinomycin - alternative to methotrexate
Hyperemesis Gravidarum
  • Projectile vomiting during pregnancy
  • Causes
    • Increased levels of hCG
  • Treatment
    • Monitor I&O
    • TPN
    • IV fluid replacement
    • Soft diet
    • Antiemetics – METOCLOPRAMIDE (Plasil, Reglan)

Hyperemesis Gravidarum
Morning Sickness
Skin Color
yellow, jaundiced
Exceeds 1st trimester
1st-2nd trimester
Skin Turgor

Incompetent Cervix
  • Also known as Premature Cervical Dilation
  • Signs and Symptoms
    • Pink show
    • Painless dilation
  • Treatment
    • Modified Trendelenburg position

Placenta Previa & Abruptio Placenta
  • Types of Placenta Previa
    • Low - placenta is in close proximity to the cervical os
    • Partial - placenta covers a portion of the cervical os
    • Total - placenta completely covers cervical os
  • Degrees of Separation (Abruptio Placenta)
    • - no separation
    • - minimal separation, no fetal distress, vaginal bleeding
    • - moderate separation, fetal distress, uterus is tense and painful
    • - extreme separation, no immediate intervention, shock, death
  • Treatment
    • Amniocentesis to assess fetal lung maturity
    • BETAMETHASONE – to improve lecithin:sphingomyelin ratio of lung surfactants

Abruptio Placenta
Placenta Previa
Skin Color
Blood Color
bright red
Amount of Bleeding
board-like, rigid, tender
soft, boggy, not tender

Pregnancy-Induced Hypertension (PIH)
  • Signs and Symptoms
    • EDEMA
  • Treatment
    • Bed rest
    • Nutritious Diet
  • Care During Seizures
    • Place pillow under head
    • Raise side rails
    • Side-lying position
    • No sudden stimuli
    • NPO

Mild Preeclampsia (PIH)
  • Signs and Symptoms
    • BP 140/90
    • Proteinuria +1 to +2
    • Edema on face and upper extremities
Severe Preeclampsia (PIH)
  • Signs and Symptoms
    • BP 160/110
    • Proteinuria +3 to +4
    • Extreme edema on face and hands
    • Hyperreflexia and ankle clonus
Eclampsia (PIH)
  • Signs and Symptoms
    • Seizures
    • Signs and symptoms of preeclampsia
  • Stages of Tonic-Clonic Seizures
    • Tonus – muscles of the body contract and stiffen
    • Clonus – muscles contract and relax repeatedly and limbs flail wildly
    • Post-ictal state – in a semicomatose state
  • Drug of Choice

HELLP Syndrome
  • Hemolysis, Elevated Liver enzymes, Low Platelet
  • Signs and Symptoms
    • Nausea
    • Epigastric pain
    • General malaise
    • Right upper quadrant tenderness
    • Thrombocytopenia
  • Treatment
    • Platelet transfusion
    • IV Dextrose

  • Signs and Symptoms
    • Elevated alpha-fetoprotein
    • Faster rate of increase in size of uterus
    • Multiple FHT
  • Nursing Care
    • Bed rest
    • Cesarean section upon delivery
Fetal Death
  • No FHT
  • MISOPROSTOL w/ OXYTOCIN - to induce labor and stop bleeding

  • Amniotic fluid more than 2000mL
  • Normal amount: 500-1000mL
  • Signs and Symptoms
    • Unusual rapid enlargement of uterus
    • Shortness of breath
    • Weight gain
    • Varicosities
  • Tx
    • Bed rest
    • Stool softeners
    • Amniocentesis

Post Term Pregnancy
  • Exceeds 42 weeks of gestation
  • Treatment
    • Cesarean section
    • Assessment of maturity
    • Labor induction
  • Treatment
    • MISOPROSTOL - induces labor
    • PROSTAGLANDIN E1 - induces labor
    • Oxytocin - induces labor

Preterm Labor
  • Labor before the 37th week of gestation
  • Causes
    • Chorioamnionitis
    • Other infections
    • Incompetent cervix
  • Signs and Symptoms
    • Early uterine contractions
  • Rx
    • Tocolytics - MAGNESIUM SULFATE - halts contractions
    • BETAMETHASONE IM q24h 12mg - improves lung surfactant ratio
    • DEXAMETHASONE IM q12h 6mg - improves lung surfactant ratio
    • β-sympathomimetic drugs - TERBUTALINE & RITODRINE - halts contractions
TORCH Complex
  • Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, Herpes Simplex
  • Vaccination, Antibiotics, and Cesarean Section
PROM (Premature Rupture of Membranes)
  • Rupture of fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks
  • Signs and Symptoms
    • Blue Nitrazine test result
    • Sudden gush of clear fluid
  • Treatment
    • FIBRIN-BASED SEALANT - glues membranes
    • AMNIOINFUSION - infusion of fluid into amniotic sac
    • Bed rest - reduces fluid loss
    • Antibiotics - prophylactic measure for infection
Rh Incompatibility
  • Also known as Isoimmunization
  • Develops when Rh- mother with Rh+ baby
  • Baby may develop erythroblastosis fetalis - maternal antibodies destroy the Rh+ fetal RBC
  • The destruction of red blood cells from erythroblastosis fetalis releases large amounts of unconjugated bilirubin leading to a condition known as kernicterus, wherein the unconjugated bilirubin is deposited in the brain and damages it
  • Caused when the father is Rh+
  • Appears as Coombs’ Test Negative
  • Treated with RhoGam
DIC (Disseminated Intravascular Coagulation)

  • Fibrinogen levels fall below effective limits
  • Extreme bleeding at one site because most of the fibrin and platelets rush to another area; not enough is left for the rest of the body especially at the site of implantation
  • Signs and Symptoms
    • Easily bruised
  • Treatment


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