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What type of abortion occurs in the first trimester of pregnancy?
  • Spontaneous abortion
  • Ectopic pregnancy
Define Ectopic Pregnancy
Implantation fo fertilized ovum in area outside the uterine cavity

- 98% in the fallopian tube which causes rupture and can be fatal
Define Spontaneous Abortion
Pregnancy that is terminated before 20 weeks of gestation
Sing and symptoms of Spontaneous Abortion
  • Vaginal Bleeding
  • Uterine Cramping
  • Partial or complete expulsion of products of conception
In the second trimester what is the  two causes that most likely to cause bleeding during pregnancy?
  • Gestational Trophoblastic disease
  • Incompetent Cervix
This disease is caused by peripheral cell that attache the fertillized ovum to the urtine wall, which causes it to grow abnoral. Proliferation and edema of chorionic villi gives a grapelike cluster apperance of the placenta.
Gestational Trophoblastic disease

aka Hydatifiform Moles
Does the plenta develop a fetus in Gestational Trophoblastic disease?
No it does not, it may or may not have fetal tissue
What is the clinical manifestations of Gestational Trophoblastic disease
  • Strongly positive and elevated hCG
  • No fetus or heartsound on ultra sounds
  • Larger than expected uterus
  • Vaginal bleeding- dark brown prune juice  looking blood
  • Excessive N/V
  • Preclampsia prior to 20 weeks gestation
Gestational Trophoblastic disease is the pre-cursor to what
Choriocarcinoma
In Gestational Trophoblastic disease if hCG should continue to increase after evacuation of products of conception what can that indicate
Choriocarcinoma
How often should hCG levels be drawn after Gestational Trophoblastic disease
  • 1-2 weeks until level are normal
  • every 2-4 weeks for 6 months
  • every 2 months for 1 year
What should the nursing assessment of Gestational Trophoblastic disease include?
  • Measuring fundal height (lrger than usual)
  • Vaginal bleed and discharge (drk brown blood)
  • Gestational status and appetite (risk factor low protien)
  • Vital signs (PIH)
  • Assessing extremities and face for edema  (PIH)
Painless bleeding with cervical dialation leading to fetal expulsion
Incompetent Cervix
What medication is used to inhibit cell division and enlargment of the embryo, and can also prevent rupture of fallopian tube in ectopic pregnancy?
Methotrexate

the pt should avoid alcohol and folic acid to avoid toxic effects
What is the risk factors for Ectopic pregnancy?
  • PID
  • IUD
factors that comprimise tubal pregnancy
What is the usual sign and symptoms of Ectopic pregnancy
  • unilateral stabbing pain in the lower abdominal quadrant
  • referred shoulder pain
What should the nurse assess for when suspecting ectopic pregnancy?
  • Unilateral pain
  • vaginal bleeding (scant dr. red if tubal rupture)
When does expulsion of the products of conception usually occur in incompetent cervix
- around the 20th week (2nd trimester)
What is the most common signs and symptoms of Incompetent cervix
  • Pink stained vaginal discharge
  • Pelvic pressure
Verbalize some interventions for incompetent cervix
  • Cervical Cerclage
  • Activity restriction/ bed rest
  • hydration
  • administering  tocolytic ( inhibit uterine contractions)
What should the nurse teach the client about Incompetent Cervix
Refraim from
  • Intercourse
  • prolong standing for more than 30 minutes
  • Heavy lifting
What is the 3 primary cause of bleeding in the third trimester?
  • Placenta Previa
  • Abruptio placenta
  • Perm Labor
This occur when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus.
Placenta Previs
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