Assignment 2.​ 2nd Trimester 3.

​ 3rd Trimester
1.​ 1st Trimester a.​ ✓Incompet a.​ ✔Placenta
a.​ ✓ ent Cervix Previa
Spontaneou b.​ ✓Gestation b.​ ✓ Abruptio
s Abortion al Placenta
b.​ ✓Ectopic Trophoblast c.​ ✔Hyperem
Pregnancy ic Disease esis
c.​ ✓PROM Gravidarum
d.​ ✓PIH

Lubrica, Nathalia Kelly R.

MCN Assignment

1st TRIMESTER

SPONTANEOUS PREGNANCY

○​ Infections (e.g., varicella

Definition: The natural termination of a during the first trimester).
pregnancy before 20 weeks of gestation or a ○​ Genetic factors or uterine
fetal weight of less than 500 g. Using abnormalities.
"miscarriage" instead of "abortion" is more ○​ Unknown or multifactorial
sensitive, as "abortion" can have negative causes.
connotations for grieving families.
NOTE: Infections are not a common cause
●​ Etiology: of early miscarriage (Cunningham et al.),
○​ Chromosomal abnormalities but there is an increased risk for a
(most common cause, spontaneous abortion with varicella infection
especially in the first in the first trimester (Gilbert, 2011).
trimester).Endocrine
imbalances (e.g., · Risk Factors:
hypothyroidism, luteal phase
1. First-trimester risks:
defects, uncontrolled
diabetes). a. Chromosomal
○​ Immune disorders (e.g., abnormalities,
antiphospholipid syndrome). maternal endocrine
○​ Systemic diseases (e.g., lupus disorders, and
erythematosus). infections.
 2. Second-trimester risks: ○​ Incomplete: Heavy bleeding,
expulsion of fetus, retained
a. Maternal age placenta.
(extremes), previous ○​ Complete: Minimal bleeding,
pregnancy closed cervix after fetal tissue
complications, poor expelled.
prenatal care, morbid ○​ Missed: Fetus dies, but
obesity, heavy products remain in utero, no
alcohol/caffeine use, symptoms or minimal
severe dietary spotting.
deficiencies, and ○​ Septic: Malodorous
infections. discharge, fever, tenderness.
3. General risks: Note: Recurrent (habitual) early miscarriage
is three or more spontaneous pregnancy
a. Bleeding during
losses before 20 weeks of gestation
pregnancy, history of
recurrent ●​ Significant Laboratory Findings
miscarriages, uterine ○​ hCG levels: May decrease or
abnormalities. fail to rise appropriately.
○​ Progesterone levels: Low
· Assessment/Signs and Symptoms
levels may indicate
○​ General symptoms: Uterine non-viability.
bleeding, uterine cramping, ○​ Hemoglobin/Hematocrit:
abdominal pain. Assess for anemia due to
○​ Early miscarriage (<6 bleeding.
weeks): Heavy ○​ WBC count: Elevated in
menstrual-like flow. septic miscarriage.
○​ Miscarriage at 6–12 weeks: ○​ Clotting factors: Monitored
Moderate discomfort, to detect disseminated
moderate blood loss. intravascular coagulation
○​ Miscarriage after 12 weeks: (DIC).
Severe pain, heavy bleeding ●​ Complications:
(similar to labor). ○​ Hemorrhage.
●​ Types and Specific symptoms: ○​ Infection (septic
○​ Threatened: Spotting, mild miscarriage).
cramping, closed cervix. ○​ Disseminated intravascular
○​ Inevitable: Moderate coagulation (DIC).
bleeding, open cervix, ROM ○​ Psychological impact
possible. (depression, PTSD, anxiety).
●​ Medical Management:
 ○​ Threatened miscarriage:
Monitoring with ultrasounds
and blood tests; bed rest often
recommended (though not
proven effective).
○​ Inevitable/Incomplete
miscarriage: Surgical
intervention: Dilation and
curettage (D&C) or suction
curettage.
■​ Medications:
Misoprostol (to
induce expulsion).
ECTOPIC PREGNANCY
○​ Complete miscarriage: No
further treatment unless · Definition: A pregnancy where the
infection or bleeding persists. fertilized ovum implants outside the uterine
○​ Missed miscarriage: cavity. Ectopic pregnancies are often called
Surgical removal, tubal pregnancies because at least 90% are
misoprostol, or expectant located in the uterine tube (American
management if spontaneous Society for Reproductive Medicine [ASRM],
expulsion is anticipated. 2013).
■​ Monitor clotting
factors to prevent
DIC.
○​ Septic miscarriage:
Termination of pregnancy.
Broad-spectrum antibiotics
(e.g., ampicillin).
■​ Treatment for septic
shock if necessary.

o Recurrent miscarriage
Prophylactic cerclage for
cervical insufficiency.

■​ Karyotyping,
placental assessment,
uterine cavity
evaluation.

· Nursing Management/Interventions
 o​ History of ectopic
pregnancy (increased risk
due to bilateral scarring).
· Etiology: o​ Tubal surgery or
o Fertilization occurs in the trauma causing adhesions or
fallopian tube but an scarring.
obstruction prevents the
o​ Smoking (may impair
zygote from traveling to the
uterus. tubal function).

o Common causes of o​ Congenital

obstruction include: anomalies (e.g., fibrous
bands or webbing blocking
§ Adhesions from fallopian tubes).
prior pelvic infections
(e.g., chronic o​ Oral contraceptives
salpingitis or pelvic used before pregnancy
inflammatory (notably associated with
disease).
reduced risk).
■​ Congenital
· Assessment/ Signs and Symptoms:
malformations of the
fallopian tube. o Initial symptoms may be
■​ Scarring from nonspecific: absence of
previous tubal menstruation, nausea, and
surgery. positive hCG test.
■​ Pressure from uterine o Diagnosed by early
tumors. ultrasound or MRI;
confirmed with transvaginal
· Risk Factors
ultrasound or laparoscopy.
o​ Previous pelvic o Symptoms of rupture:
infections (e.g., pelvic
o Sharp, stabbing lower
inflammatory disease leading
to tubal scarring). abdominal pain.

o​ In vitro fertilization o Scant vaginal spotting

(due to underlying tubal or bleeding.
damage).
o Signs of hypovolemic
shock: light-headedness,
rapid pulse, hypotension.
 o Cullen sign (bluish
umbilicus) and shoulder
pain from peritoneal
blood irritation.

o Abdominal rigidity and

tender mass in Douglas
cul-de-sac.

· Significant Laboratory
Findings:

o Quantitative β-hCG:

§ Levels
>1500–2000
mIU/mL with no
intrauterine
pregnancy seen on
transvaginal
ultrasound
suggests ectopic
pregnancy.

o Progesterone levels:

§ <5 ng/mL
suggests ectopic
or abnormal
intrauterine
pregnancy.

§ 25 ng/mL rules
out ectopic
pregnancy.

o Hematocrit may be low

if significant bleeding has
occurred.

· Complications: