MATERNITY NURSINGABORTIONDifferent types of abortionsThreatened AbortionSlide 5Inevitable AbortionComplete AbortionMissed AbortionSlide 9Slide 10Habitual AbortionTherapeutic AbortionTherapeutic “early” abortion“Term Abortion”“Term” or “Partial Birth” AbortionIllegal AbortionSlide 17Slide 18Diagnostic toolsTreatmentNursing InterventionsDIC Disseminated Intravascular CoagulopathyDISSEMINATED INTRAVASCULAR COAGULATION (DIC)Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29ECTOPIC PREGNANCYEctopic PregnancySlide 32Slide 33Slide 34Slide 35Slide 36Slide 37HYDATIDIFORM MOLEHydatiform MoleSlide 40Slide 41Slide 42HEMORRHAGIC COMPLICATIONSMay include:Types of PLACENTA PREVIAPLACENTA PREVIA (marginal & low-lying are similar)Placenta previa with fetusPlacenta PreviaPlacenta Previa: AssessmentPlacenta Previa: InterventionsPlacenta Previa: In-Hospital InterventionsPlacenta Previa: Home InterventionsSlide 53ABRUPTIO PLACENTA Placenta Abruptio Premature separation of placentaABRUPTIO PLACENTA Covert OvertAbruptio PlacentaAbruptio Placenta: 3 typesAbruptio Placenta: 5 classic S/SAbruptio Placenta: Other S/SSlide 60FETAL DEATHPregnancy Induced HypertensionPREGNANCY-INDUCED HYPERTENSIONClassifications of BP: National Heart, Lung & Blood InstituteSlide 65PIH: 3 Classic SymptomsPRE-ECLAMPSIAPre-eclampsia: S/SPre-eclampsia: ComplicationsECLAMPSIAPRE-ECLAMPSIA & ECLAMPSIA IMPLEMENTATIONLABSMEDICATIONSWhen the patient is on Magnesium SulfateNursing Assessment r/t Magnesium SulfateASSESSMENT OF REFLEXESSlide 77Slide 78Slide 79HELLP SyndromeSlide 81HELLP Syndrome = Microangiopathic AnemiaTHE END!!!!MATERNITY NURSINGMATERNITY NURSINGRISK CONDITIONS RELATED RISK CONDITIONS RELATED TO PREGNANCYTO PREGNANCYProfessor Unn HidleProfessor Unn HidleUpdated Spring 2010Updated Spring 2010ABORTIONABORTIONDescription (legal medical definition)Description (legal medical definition) Termination of pregnancy before Termination of pregnancy before the fetus is viable (20 weeks) or a the fetus is viable (20 weeks) or a weight of 500 gweight of 500 gDifferent types of abortionsDifferent types of abortionsThreatened abortionThreatened abortionInevitable abortionInevitable abortionIncomplete abortionIncomplete abortionComplete abortionComplete abortionMissed abortionMissed abortionHabitual abortionHabitual abortionTherapeutic abortionTherapeutic abortion““Term Abortion”Term Abortion”Illegal abortionIllegal abortionThreatened AbortionThreatened AbortionFetus is jeapardized by unexplained Fetus is jeapardized by unexplained bleeding, cramping and backachebleeding, cramping and backacheCervix is closedCervix is closedBleeding may persist for days and may be Bleeding may persist for days and may be followed by partial or complete expulsionfollowed by partial or complete expulsionTreatment:Treatment:Bedrest!Bedrest!Monitor bleedingMonitor bleedingInevitable AbortionInevitable AbortionBleeding and cramping increasesBleeding and cramping increasesInternal os dilatesInternal os dilatesMembranes may ruptureMembranes may ruptureComplete AbortionComplete AbortionWhen When ALLALL the products of the the products of the embryo/fetus are expelledembryo/fetus are expelledUterine contractions and bleeding stopsUterine contractions and bleeding stopsCervix closesCervix closesMissed AbortionMissed AbortionFetus dies in utero during the first 1/2 of the pregnancy (before Fetus dies in utero during the first 1/2 of the pregnancy (before 20 weeks gestation)20 weeks gestation)Fetal matter is retained in the uterusFetal matter is retained in the uterusEarly s/s of pregnancy (N/V, urinary frequency & breast Early s/s of pregnancy (N/V, urinary frequency & breast tenderness) tenderness) disappearsdisappearsDiagnosisDiagnosis::Based on history, pelvic exam and negative pregnancy testBased on history, pelvic exam and negative pregnancy testConfirmed with ultrasoundConfirmed with ultrasoundTreatmentTreatment::D&CD&CProstaglandin may be necessary during 2nd trimesterProstaglandin may be necessary during 2nd trimesterPossible complicationsPossible complications::DIC: Disseminated Intravascular CoagulationInfectionMissed AbortionMissed AbortionHabitual AbortionHabitual AbortionThree consecutive abortionsRecurrent spontaneous abortions / miscarriagesRecurrent spontaneous abortions / miscarriagesPrimary causePrimary cause::Genetic/chromosomalGenetic/chromosomalAnomalies of the female reproductive tract (i.e. Anomalies of the female reproductive tract (i.e. incompetent cervix)incompetent cervix)Hormonal such as insufficient secretions of Hormonal such as insufficient secretions of progesteronprogesteronTreat the causeTreat the causeTherapeutic AbortionTherapeutic Abortion““Planned” abortion performed Planned” abortion performed under licensed medical under licensed medical supervisionsupervisionTherapeutic “early” abortionTherapeutic “early” abortion““Term Abortion”Term Abortion”Abortion performed after 20 Abortion performed after 20 weeks gestationweeks gestationAlso referred to as “partial birth Also referred to as “partial birth abortions”abortions”““Term” or “Partial Birth” Term” or “Partial Birth” AbortionAbortionIllegal AbortionIllegal AbortionNo medical supervisionNo medical supervisionHistorically: Historically: DirtyDirtyIn back-allyIn back-allyKnitting needlesKnitting needlesOther “instruments”Other “instruments”BleechBleechIllegal AbortionIllegal AbortionABORTIONABORTIONOverall AssessmentOverall AssessmentSpontaneous vaginal bleedingSpontaneous vaginal bleedingPassage of clotsPassage of clotsPassage of tissue through vaginaPassage of tissue through vaginaLow uterine crampingLow uterine crampingBackacheBackacheContractionsContractionsHemorrhage and shockHemorrhage and shockDiagnostic toolsDiagnostic toolsUltrasoundUltrasound::May see gestational sac or fetusMay see gestational sac or fetusHcG levelsHcG levels::Usually Usually NOTNOT helpful as HcG levels fall slowly helpful as HcG levels fall slowly after fetal deathafter fetal deathCBCCBC::Hgb/Hct used to assess blood lossHgb/Hct used to assess blood lossTreatmentTreatmentD&C (dilitation and curettage):D&C (dilitation and curettage):1st trimester: D&C w/suction1st trimester: D&C w/suctionIf > 12 weeks: