COMPLICATIONS of

PREGNANCY

Complications of Pregnancy:
1. Abortion termination or expulsion of
pregnancy from the uterus of fetus or
embryo prior to viability

Types of Abortion:
1. Induced pregnancy intentionally aborted
1.1 Therapeutic abortion when performed to
save the life of the pregnant woman,
prevent harm to the womans physical or
mental health, if the child will have
increased chance of prematurity ,or
disabled.

1.2 Elective or voluntary abortion- when

performed at the request of the woman or
non-medical reasons.
2. Spontaneous also known as miscarriage is
untentional expulsion of an embryo or fetus
before the 20th or 22th week of gestation.

Complications of Pregnancy:
2. Ectopic pregnancy
- abnormal pregnancy
that occurs outside the uterus
- embryo implants outside the uterine cavity
Sites of ectopic pregnancy:
2.1 tubal pregnancy occurs in the fallopian
tube
2.2 non tubal pregnancy ovary, cervix,
intraabdominal

Signs & symptoms of ectopic pregnancy:

1.Pain in the lower abdomen, inflammation
( pain maybe with strong stomach pain, may
also like a strong cramp pain
2. Pain while urinating
3. Mild pain & discomfort
4. Mild abnormal vaginal bleeding
5. Low back pain

6. Mild cramping pain on one side of the pelvis

7. Nausea
8. Pain in the lower abdomen or pelvic area
Ectopic pregnancy is often caused by a
condition that blocks or slows the movement
of a fertilized egg through the fallopian tube
to the uterus. This can be caused by a
physical blockage in the tube or by hormonal
factors .

Cause is unknown
Most cases are caused by:
1. Smoking
2. Alcohol drinking
3. Past ectopic pregnancy
4. Past infection on of the fallopian tube
5. Surgery of the fallopian tubes

50% of women with ectopic pregnancy:

1. Birth defects in the fallopian tubes
2. Complications of ruptured appendix
3. Endometriosis occurs when cells from the
lining of the uterus grow in other areas of
the body
4. Scarring caused by previous pelvic surgery

Risk factors of ectopic pregnancy:

1. Age over 35
2. Having had many sexual partners
3. Invitrofetilization

Diagnostic tests:
1. Culdocentesis procedure that check
abnormal fluid in the space just behind the
vagina (cul-de-sac)

Diagnostic tets
2. Hematocrit
3. Pregnancy tets
4. Serum progesterone level
5. White blood count
6. Transvaginal ultrasound or pregnancy
ultrasound
7. Qunatitative HCG blood test

Other tests to confirm ectopic pregnancy:

1. D & C
2. Laparoscopy look directly at the contents of
a patients abdomen or pelvis, fallopian
tubes, ovaries, uterus, small bowel, large
bowel, appendix, liver & gallbladder
3. Laparotomy abdominal surgery to examine
the contents of the abdomen

Management:
1. Blod transfusion
2. IVF administration
3. Oxygen
4. Warm
5. Raising the legs

If there is a rupture, surgery is done:

1. Confirm an ectopic pregnancy
2. Remove the abdominal pregnancy
3. Repair any tissue damage
4. Most cases remove the fallopian tube

Prevention:
1. Avoid risk factors for pelvic inflammatory
disease sexual partners, sex with out
condom, getting STD
2. Early diagnosis & treatment of STDs
3. Stopping smoking

Complication of Pregnancy
3. H-Mole/Hydatidiform mole abnormal form of
pregnancy wherein a non viable fertilized egg
implants in the uterus characterized by
hydatidiform (hydatid mole)
Rare mass or growth that forms inside the
uterus at the beginning of pregnancy
Type of gestational trophoblastic disease

Trophoblastic disease group of abnormalities

in which tumor grow inside a womans uterus.
- The abnormal cells wil start in the tissue that
would normally become the placenta, the
organ that develops during pregnancy

Cause of H-mole results over production of the

tissue that is supposed to develop into the
placenta . The placenta feeds a fetus during
the pregnancy . In this condition, the tissues
develop into an abnormal growth called a
mass.

Types of H-mole:
1. Partial molar H-mole there is an abnormal
placenta & some fetal development
2. Complete molar pregnancy abnormal
placenta but no fetus
Both forms are due to problems during
fertilizaton.
Exact cause of fertilization problems still
unknown

Symptoms of H-mole:
1. Abnormal growth of the womb (uterus)excessive growth
2. Nausea & vomiting that maybe severe
3. Vaginal bleeding during pregnancy frist 3
months of pregnancy
4. Hyperthyroidism: heat intolerance, loose
stools, rapid heart rate, nervousness,
trembling hands, unexpected weight loss

Signs of H-mole
5. Symptoms similar to eclampsia: 1st or nearly
2nd trimester almost always a sign of H-mole
because pre eclampsia is rare this early in the
normal pregnancy : hypertension & swllin gin
feet, ankles & feet

Exams & Tests:

1. Pelvic exam may show sign of normal
pregnancy but the size of the womb maybe
abnormal
2. Pregnancy ultrasound will show an
abnormal placenta without some
development of a baby
3. Chest x ray

Exams & tests:

4. MRI of the abdomen or CT scan
5. Blood clotting tetst
6. Kidney & liver function tests
7. HCG blood test (human chorionic
gonadotropin) - will check if there is HCG in
the blood. HCG is normally produced during
pregnancy

Treatment:
1. If suspect of H-mole suction curettage is
done
- surgical abortion done that ends pregnancy
by removing the fetus & placenta from the
mothers womb
2. Hysterectomy

After treatment serum HCG will be followed

It is important to avoid pregnancy & use a
reliable contraceptive for 6-12 months after
treatment for a molar pregnancy-to allow
correct testing to be sure that the abnormal
tissue does not return
Women who got pregnant too soon after a
molar pregnancy have a greater risk of having
another one.

Prognosis:
More than 80% of H-mole are benign
The outcome after treatment is usually
excellent
After treatment use very effective
contraception for at least 6-12 months
In some cases, H-moles may develop into
invasive moles which may grow far into the
uterine wall that may cause bleeding

Prognosis:
Few cases, H-mole may develop into
choriocarcinoma fast growing form of
gestational gestational trophoblastic form
Choriocarcinoma- fast growing cancer in a
womans uterus ,abnormal cells start in the
uterus that would normally become the
placenta the organ that develops placenta

Possible Complications:
1. Pre eclampsia
2. Thyroid problems

Complications of Pregnancy
4. Incompetent Cervix medical condition in
which a pregnant womans cervix begins to
dilate & efface (thin) before pregnancy has
reached its term. This may cause miscarriage
or preterm birth.
During pregnancy as the babys grows & gets
heavier presses on the cervix, this pressure
cause the cervix to start to open.

Causes of incompetent or weakened cervix:

1. Previuos surgery on the cervix
2. Damage during a difficult birth
3. Malformed cervix or uterus from a birth
defect
4. Previous trauma to the cervix such as D & C
from a termination or a miscarriage
5. DES exposure - Dietheylstilbestrol

Women can be evaluated before pregnancy or

in early pregnancy through pelvic exam
Ultrasound should be used to measure the
cervical opening or the length of the cervix
How often an incompetent cervix happenIt happens in about 1-2& of pregnancies .
Almost 25% or babies miscarried in the 2nd
trimester are due to incompetent cervix

Treatment:
1.Cervical cerclage surgical procedure in
which the cervix is sewn during pregnancy.The
cervix is the lowest part of the uterus &
extends into the vagina.
WHY IS CERVICAL CERCLAGE IS USED: IF A
WOMANS CERVIX IS AT RISK OF OPENING
UNDER THE PRESSURE OF THE GROWING
PREGNANCY.

When is cervical used: best time is the 3 rd

month (12-14 weeks) of pregnancy
However there are women may need cervical
cerclage later in pregnancy ( emergent
cerclage)
A WEAK CERVIX MAYBE THERESULT OF:
1. History of 2nd trimester miscariage
2. Previuos cone biopsy
3. Damaged cervix by pregnancy termination

Benefits of the cerclage:

1. Prevents miscarriage
2. Prevents premature labor casued by cervical
incompetence
What to do before the cerclage:
3. Medical history
4. Th0rough exam of the cervix
General anesthesia, spinal or epidural
anesthesia

Nursing care after the procedure:

1. Advise to stay in the hospital for a few hours
or overnight
2. Inform that immediately after he procedure
may experience light bleeding & mild
cramping which stop after a few days.
3. Explain that there will be an increased thick
vaginal discharge

4. For 2-3 days plan to relax at home avoid

unnecessary physical activity
5. Abstinence from sex for one week before & at
least one week after the procedure.
POSSIBLE RISKS OF CERVIAL CERCLAGE:
1.Premature contractions
2. Cervical dystocia- inability of the cervix to
dilate normally in the course of labor

3. Rupture of membranes
4. Cervical laceration if labor happens before
the cerclage is removed
5. Some risks associated with general
anesthesia include vomiting & nausea

Signs to look for after cerclage:

1. Contractions or cramping
2. Lower abdominal or back pain that comes
and goes like labor pain
3. Vaginal bleeding
4. A fever over 37.8 or chills
5. Nausea & vomiting
6. Foul smell vaginal discharge
7. Bag of water breaking or leaking

Complication of Pregnancy:
5. Placenta previa placenta grows in the
lowest part of the uterus & covers all or part
of the opening to the cervix.
Previa placenta partly or completely covers
the cervix

Types of Placenta previa:

1. Marginal placenta is next to the cervix but
does not cover the opening
2. Partial placenta covers the part of the
cervical opening
3. Complete placenta covers all the cervical
opening

Placenta Previa is common in women who have:

1. Abnormally develop uterus
2. Large or abnormal placenta
3. Many previous pregnancies
4. Multiple pregnancies
5. Scarring on the lining of the uterus due to
surgery, c-section, previous pregnancy,
aboriton

Women at risk: smokes, have children at older

age
Symptoms:
1. Sudden bleeding from the vagina.cramps,
bleeding may start near the end of the 2 nd
trimester or beginning of the 3rd trmester
2. Severe bleeding on & off
3. Labor starts after several days of severe
bleeding

Treatment depends on :
1. The amount of bleeding
2. Wether the baby is developed enough to
survive if delivered
3. How much of the cervix is covered
4. The babys position
5. The number of previous births
6. Wether the woman is in labor

If the lpacenta is near or covering a part of the

cervix, the doctor will recommend:
1. Reducing the activities
2. Bed rest
3. Pelvic rest no sex, no tampons & no
douching
4. Nothing should be placed in the vagina

Treatment:
1. Blood transfusion if lots of blood is lost
2. Medicines to prevent early labor
3. Medcines to help pregnancy to continue to at
least 36 weeks
4. Shot of special medicine Rhogam if blood
type Rh negative
5. Steroids shots to help the babys lungs to
mature

6. After 36 weeks delivery of the baby maybe

the best treatment
7. Emergency c- section maybe done if there is
severe bleeding
Risks to the mother:
1. Major bleeding
2. Shock
3. death

Other risks include: blood clots, infection, need

for blood transfusion
Risks to the baby: blood loss in the baby, death
MOST INFANT DEATH DUE TO PLACENTA PREVIA
OCCUR WHEN THE BABY DELIVERED BEFORE
36 WEEKS OF PREGNANCY

Complication of pregnancy:
6. Abruptio Placenta - premature separation of
the placenta from the uterus.
-also called placental abruption, typically
present with bleeding, uterine contractions,
and fetal
-placental abruption must be considered
whenever bleeding is encountered in the
second half of pregnancy.

Complications:
1. Hemorrhage into the decidua basalis occurs
as the placenta separates from the uterus.
2. Hematoma formation further separates the
placenta from the uterine wall, causing
compression of these structures and
compromise of blood supply to the fetus.

Classification of placental abruption is based on

extent of separation (ie, partial vs complete)
and location of separation (ie, marginal vs
central). (See Clinical.) Clinical classification is
as follows:
1. Class 0 Asymptomatic
2. Class 1 - Mild (represents approximately 48%
of all cases

3. Class 2 - Moderate (represents approximately

27% of all cases)
4. Class 3 - Severe (represents approximately
24% of all cases)

Class 1 characteristics include the following:

No vaginal bleeding to mild vaginal bleeding
Slightly tender uterus
Normal maternal BP and heart rate
No coagulopathy
No fetal distress

Class 2 characteristics include the following:

No vaginal bleeding to moderate vaginal

bleeding
Moderate to severe uterine tenderness with
possible tetanic contractions
Maternal tachycardia with orthostatic changes
in BP and heart rate
Fetal distress
Hypofibrinogenemia (ie, 50-250 mg/dL)

Class 3 characteristics include the following:

No vaginal bleeding to heavy vaginal bleeding
Very painful tetanic uterus
Maternal shock
Hypofibrinogenemia (ie, < 150 mg/dL)
Coagulopathy
Fetal death

Risk factors in abruptio placentae include the

following:
Maternal hypertension - Most common cause
of abruption, occurring in approximately 44%
of all cases
Maternal trauma (eg, motor vehicle collision
[MVC], assaults, falls) - Causes 1.5-9.4% of all
cases
Cigarette smoking
Alcohol consumption

Cocaine use
Short umbilical cord
Sudden decompression of the uterus (eg,

premature rupture of membranes, delivery of

first twin)
Retroplacental fibromyoma
Retroplacental bleeding from needle puncture
(ie, postamniocentesis)
Idiopathic (proba

Previous placental abruption

Chorioamnionitis
Prolonged rupture of membranes (24 h or

longer)
Maternal age 35 years or older
Maternal age younger than 20 years
Male fetal sex
Low socioeconomic status

An increased risk of placental abruption has

been demonstrated in patients younger than

20 years and those older than 35 years
Placental abruption is more common in

African American women than in white or

Latin American women. However, whether this
is the result of socioeconomic, genetic, or
combined factors remains unclear.

Prognosis
If the bleeding continues, fetal and maternal
distress may develop. Fetal and maternal
death may occur if appropriate interventions
are not undertaken.
The severity of fetal distress correlates with
the degree of placental separation. In nearcomplete or complete abruption, fetal death is
inevitable unless an immediate caesarian
delivery is performed.

Maternal morbidity may include the following:

Transfusion-related morbidity
Classic cesarean delivery with need for repeat

cesarean deliveries
Hysterectomy

Maternal and fetal complications include

issues related to (1) cesarean delivery, (2)

hemorrhage/coagulopathy, and (3) prema
Patient Education
Educate patients about reversible risk factors,
especially smoking, before further
pregnancies.
Question the patient regarding possible
trauma from abuse.