Early Pregnancy Complications

Question 1

Spontaneous Abortion (miscarriage)

Answer 1

• Pregnancy that ends prior to the 20th week of gestation
• Embryo or fetus <500 g
• Incidence: 10- 20% of identified pregnancies
• Most common etiology of early SAB is chromosomal abnormalities
• Risk factors age, hx SAB, lifestyle, disease, infections, structural uterine anomalies
• Sx: vaginal bleeding, low back pain, abdominal cramping, passing POC, cervical dilation

Question 2

Types of Spontaneous miscarriages

Answer 2

• Threatened: Spotting, cramping but fetus viable
• Inevitable: Bleeding, cramping, ROM, non-viable
• Incomplete: Expulsion of fetus with retention of placenta
• Missed: Fetus has died but products of conception retained
• Complete: All products of conception expelled

Question 3

Diagnosis of client experiencing a miscarriage

Answer 3

• H&P, ultrasound
• hCG and CBC, progesterone, T&S

Question 4

Medical Management of client experiencing a miscarriage

Answer 4

Misoprostol (Helps with ulcers -> causes cramping)
Prostaglandins

Question 5

Surgical Management of client experiencing a miscarriage

Answer 5

• Dilation and Curettage (D&C)
• Dilation and Evacuation (D&E)

Question 6

Nursing Care of client experiencing a miscarriage

Answer 6

• Assess fluid volume status
• Prevent infection
• Manage pain
• Provide emotional support
• Patient/Family Education
• Discharge teaching:

> Will have scant vaginal bleeding/discharge for several days
Pain medication for cramping
Pelvic rest until follow
Call if severe vaginal bleeding, abdominal pain, fever, foul smelling discharge, or severe sadness/thoughts of harm

Question 7

Ectopic Pregnancy

Answer 7

• Fertilized ovum implanted outside the uterine cavity
• 95% are in the fallopian tube
• Risk factors: tobacco use, hx PID, IVF, IUD, hx of ectopic
• Sx: Early signs of pregnancy, Abdominal/unilateral lower quadrant pain, vaginal bleeding/spotting, shoulder pain, and low back pain.

Question 8

Diagnosis of a client experiencing an ectopic pregnancy

Answer 8

• H&P, ultrasound
• CBC, βHCG, T&S

Question 9

Surgical Management of client experiencing an ectopic pregnancy

Answer 9

Salpingectomy vs Salpingostomy

Question 10

Medical Management of client experiencing an ectopic pregnancy

Answer 10

Methotrexate

Question 11

Nursing Care of client experiencing an ectopic pregnancy

Answer 11

• Assess for s/sx: Tubal rupture, Internal hemorrhage, Hypovolemic shock
• Provide emotional support
• Patient/family education: Methotrexate care and follow up (Off label use to get rid of folic acid)
• S/Sx surgical complications (Salpingostomy and Salpingectomy)