1. Pregnancy at Risk: Gestational Conditions
Chapter 14
Pregnancy at Risk: Gestational Conditions

2. Gestational Conditions
Disorders that did not exist before pregnancy
Occurrence puts woman and fetus at risk
Hypertension in pregnancy
Hyperemesis gravidarum
Hemorrhagic complications
Surgery during pregnancy
Trauma
Sexually transmitted infections

3. Hemorrhagic Disorders
Hemorrhagic disorders in pregnancy are medical emergencies
Maternal blood loss decreases oxygen-carrying capacity
Increased risk for hypovolemia, anemia, infection, preterm labor, and preterm birth
Adversely affects oxygen delivery to fetus
Fetal risks include blood loss or anemia, hypoxemia, hypoxia, anoxia, and preterm birth

4. Early Pregnancy Bleeding
Miscarriage (spontaneous abortion)
Incidence and etiology
Types
Clinical manifestations
Care management
Assessment
Plan of care and implementation
Medical-surgical management

5. Fig. 14-7. Miscarriage. A, Threatened. B, Inevitable. C, Incomplete
Fig Miscarriage. A, Threatened. B, Inevitable. C, Incomplete. D, Complete. E, Missed.

6. Late Pregnancy Bleeding
Placenta previa
Placenta implanted in lower uterine segment near or over internal cervical os
Classification based on degree internal cervical os is covered by placenta
Complete placenta previa
Partial placenta previa
Marginal placenta previa

7. Late Pregnancy Bleeding—cont’d
Placenta previa
Incidence and etiology
Clinical manifestations
Maternal and fetal outcomes
Maternal morbidity and mortality
Complications
Fetal risks include malpresentation and congenital anomalies
Preterm birth

8. Fig. 14-13. Types of placenta previa
Fig Types of placenta previa. A, Low-lying placenta in second trimester.
B, Placenta previa. C, Marginal placenta previa.

9. Late Pregnancy Bleeding—cont’d
Placenta previa
Diagnosis and medical management
Standard diagnosis is transabdominal ultrasound examination
Accurate 93% to 97%
Management includes:
Expectant management: observation and bed rest
Cesarean birth
Hospital and home care

10. Late Pregnancy Bleeding—cont’d
Placental abruption (premature separation of placenta)
Incidence and etiology
Classification systems
Grades: 1 (mild), 2 (moderate), 3 (severe)
Clinical manifestations

11. Fig. 14-14. Abruptio placentae
Fig Abruptio placentae. Premature separation of normally implanted placenta.

12. Late Pregnancy Bleeding—cont’d
Premature separation of placenta
Maternal, fetal, and neonatal outcomes
Collaborative care
Hospital care
Home care