Emergency Conditions by Trimester

Common Complications of Pregnancy

First Trimester Complications

1. Complications affecting fluid-gas transport: hemorrhagic disorders
   • General aspects
     1. Assessment:
        • Vital signs, output, general status.
        • Evidence of internal/external bleeding (pad count).
        • Pain.
        • Emotional response.
        • Perineal pads saturated and number.
        • Speculum examination.
     2. Analysis/nursing diagnosis:
        • Knowledge deficit related to diagnosis, prognosis, treatment, sequelae.
        • Anxiety/fear related to loss of pregnancy, surgery.
        • Fluid volume deficit, potential/actual, related to excessive blood loss.
        • Pain.
        • Ineffective coping, individual/family, related to knowledge deficit and fear.
        • Anticipatory/dysfunctional grieving, related to loss of pregnancy.
        • Disturbance in self-esteem, body image, role performance, related to threat to selfimage as woman and childbearer.
     3. Nursing care plan/implementation:
        • Goal: minimize blood loss, stabilize physiological status.
          1. Facilitate prompt medical management.
          2. Administer IV fluids, blood, as ordered.
          3. Administer analgesics, as needed.
        • Goal: prevent infection. Strict aseptic technique.
        • Goal: emotional support.
          1. Encourage verbalization of anxiety, fears, concerns.
          2. Supportive care for grief reaction.
     4. Evaluation/outcome criteria:
        • Blood loss minimized; physiological status stable.
        • Copes effectively with loss of pregnancy.
   • Spontaneous abortion: before viable age of 20-22 wk
     1. Etiology:
        • Defective products of conception.
        • Insufficient production of progesterone.
        • Acute infections.
        • Reproductive system abnormalities, e.g., incompetent cervical os.
        • Trauma (physical or emotional).
        • Rh incompatibility.
     2. Assessment: types
        • Threatened - mild bleeding, spotting, cramping; cervix closed.
        • Inevitable - moderate bleeding, painful cramping; cervix dilated, positive Ni ¡[ trazine test (membranes ruptured).
        • Imminent - profuse   bleeding, severe cramping, urge to bear down.
        • Incomplete - fetal parts or fetus expelled; placenta and membranes retained.
        • Complete - all products of conception expelled; minimal vaginal bleeding.
        • Habitual/recurrent - history of spontaneous loss of three or more successive pregnancies.
        • Missed - fetal death with no spontaneous expulsion within 4 weeks.
          1. Anorexia, malaise, headache.
          2. Fundal height - inconsistent with gestational estimate.
          3. Laboratory - prolonged clotting time, due to resultant concurrent hypofibrinogenemia (disseminated intravascular coagulation [DIC], a major threat to mother).
        • Elective abortions (intentionally introduced loss of pregnancy).
     3. Analysis/nursing diagnosis:
        • Altered family processes related to pregnancy, circumstances surrounding abortion.
        • Sexual dysfunction related to compromised self-image, altered interpersonal relationship, guilt feelings.
     4. Nursing care plan/implementation:
        • Threatened—Goal: health teaching. Suggest: avoid coitus and orgasm, especially around normal time for menstrual period.
        • Incomplete, inevitable, imminent.
          1. Goal: safeguard status.
             • Save all pads, clots, tissue for expert diagnosis.
             • Report immediately any change in status, excessive bleeding, signs of infection, shock.
             • Prepare for surgery.
          2. Goal: comfort measures.
             • Administer analgesics, as necessary
             • Bed rest, quiet diversional activities.
          3. Goal: emotional support.
             • Encourage verbalization of fear, concerns.
             • Reduce anxiety, as possible.
             • If pregnancy terminates, facilitate grieving process; assist in working through guilt feelings.
             • Supportive care for grief reaction.
          4. Goal: prevent isoimmunization.
          5. Medical management:
             • Laboratory - blood type and Rh factor, indirect Coombs, platelets, serum fibrinogen, clotting time.
             • Replace blood loss; maintain fluid levels with IV.
             • Dilation and curettage or dilation and evacuation.
             • Habitual - determine etiology.
     5. Evaluation/outcome criteria:
        • Threatened - responds to medical/nurs-ing regimen; abortion avoided, successfully carries pregnancy to term.
        • Spontaneous abortion - after uterus emptied.
          1. Her bleeding is controlled.
          2. Her vital signs are stable.
          3. Copes effectively with loss of pregnancy.
          4. Expresses satisfaction with care.
        • Habitual abortion - cause identified and corrected; carries subsequent pregnancy to successful termination.