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Care for women with pregnancy complications
This brain map deeply explores the care content for women with complications during pregnancy, sorting out detailed learning points to help you become familiar with the key points of knowledge and enhance your memory. Students in need can save it.
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Care for women with pregnancy complications
- Reproductive system
This template shows the structure and function of the reproductive system in the form of a mind map. It introduces the various components of the internal and external genitals, and sorts out the knowledge clearly to help you become familiar with the key points of knowledge.
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Care for women with pregnancy complications
spontaneous abortion
Abortion: Any pregnancy terminated before 28 weeks and the fetal weight is less than 1000g
Early miscarriage: Miscarriage occurs before 12 weeks of pregnancy
Late miscarriage: occurs between 12 weeks and less than 28 weeks of pregnancy
Cause
Embryonic factors: Chromosomal abnormalities are the most common cause of spontaneous abortion
maternal factors
systemic disease
immune factors
Reproductive organ abnormalities
other
Placental factors: Insufficiency of development and function of trophoblast cells is an important cause of early embryonic death.
Environmental factors: chemical substances (lead, DDT) and physical factors (radioactive substances, noise, high temperature, etc.)
clinical manifestations
Menopause, abdominal pain and vaginal bleeding are the main clinical symptoms of miscarriage
Clinical classification
threatened abortion
Symptoms include a small amount of vaginal bleeding after menopause, which is less than menstrual flow, sometimes accompanied by slight lower abdominal pain, low back pain, and lumbar spine pain. The cervix is not dilated, the fetal membranes are not ruptured, and no products of pregnancy are discharged. If the bleeding stops or the abdominal pain disappears, the pregnancy is sustainable.
Miscarriage is inevitable
Miscarriage is inevitable, vaginal bleeding has increased, paroxysmal abdominal pain has worsened, the size of the uterus is consistent with or slightly smaller than the number of weeks after menopause, and the cervix has been dilated.
incomplete abortion
The bleeding does not stop, the abdominal pain is relieved, the products of pregnancy are partially discharged, and the uterus is smaller than the number of weeks after menopause.
complete miscarriage
All the products of pregnancy have been expelled from the body, vaginal bleeding has gradually stopped, abdominal pain has gradually disappeared, the cervix has been closed, and the uterus is close to normal size.
missed abortion
recurrent miscarriage
Three or more spontaneous miscarriages in a row with the same partner
Miscarriage complicated by infection: uterine evacuation as soon as possible
ectopic pregnancy
When a fertilized egg implants and develops outside the uterine cavity, it is called an ectopic pregnancy. The fallopian tube (ampullary region) is more common, followed by the isthmus
Cause
Fallopian tube inflammation (most common)
Fallopian tube dysplasia or abnormal function
Fertilized egg swims
assisted reproductive technology
Others: endocrine disorders
pathology
Fallopian tube pregnancy miscarriage: more common in the ampulla
Fallopian tube pregnancy rupture: more common in the isthmus
old ectopic pregnancy
secondary abdominal pregnancy
persistent ectopic pregnancy
clinical manifestations
Menopause, abdominal pain, vaginal bleeding
Fainting and shock
abdominal mass
nursing assessment
health history
Physical condition: When the patient has a lot of intra-abdominal bleeding, he or she will appear anemic. Severe cases may have shock symptoms such as pale complexion, clammy limbs, fast, thin, weak pulse, and decreased blood pressure.
Abdominal examination: Patients with fallopian tube pregnancy miscarriage or rupture will have obvious tenderness and rebound pain in the lower abdomen, mainly on the affected side; when bleeding is prolonged, there will be shifting dullness to percussion.
Pelvic examination: Cervical lifting pain or swinging pain is one of the main signs of fallopian tube pregnancy; when intra-abdominal bleeding is prolonged, the uterus will appear to be floating when examined
psychosocial condition
Diagnostic points
Posterior vaginal fornix puncture: the simplest and most reliable
Pregnancy test: Dynamic observation of changes in blood hCG is extremely important for diagnosing ectopic pregnancy
Ultrasound: B-mode ultrasound imaging helps diagnose ectopic pregnancy
Laparoscopy: suitable for early-stage patients whose fallopian tube pregnancy has not yet miscarried or ruptured and for patients who have difficulty in diagnosis. Do not do this if you have massive intra-abdominal bleeding or are in shock.
Endometrial pathology examination
Treatment points: The main treatment principle is surgical treatment, followed by drug treatment.
surgical treatment
Those with unstable vital signs or signs of intra-abdominal bleeding
Those with progressive ectopic pregnancy (blood hCG>3000U)/L or continuously elevated, with fetal heartbeat and large mass in the adnexal area
Those with unreliable follow-up
Those with contraindications or ineffectiveness of drug treatment
Persistent ectopic pregnancy
Medical Treatment: Early Ectopic Pregnancy in Young Patients Requiring Preservation of Fertility
Methotrexate: inhibits trophoblast proliferation, destroys villi, and causes embryonic tissue necrosis, shedding, and absorption.
premature birth
Those who gave birth between 28 weeks and less than 37 weeks of pregnancy
The most common causes: premature rupture of membranes, chorionic villitis
clinical manifestations
Threatened premature labor
Regular uterine contractions occur, accompanied by progressive shortening of the cervical canal, and the cervix has not yet dilated.
premature labor
There are regular uterine contractions, progressive changes in the cervix, and dilation of the cervix.
Nursing measures
Prevent premature birth
Medical care (the main treatment for threatened preterm labor is to suppress uterine contractions)
Beta-adrenoceptor agonists: ritodrine, albuterol
Magnesium sulfate: Patients should be closely observed for signs of poisoning
Calcium channel blockers: Those who have taken magnesium sulfate should be used with caution to prevent a sharp drop in blood pressure.
prostaglandin synthase inhibitor
Hypertensive disorders of pregnancy
It is a disease specific to pregnancy, including gestational hypertension, preeclampsia, eclampsia, chronic hypertension complicated by preeclampsia, and pregnancy complicated by chronic hypertension.
Predisposing factors
primipara
Young pregnant women (age ≤18 years old) or elderly pregnant women (age ≥35 years old)
Those who are overly stressed or stimulated, causing central nervous system dysfunction
Pregnant women with a history of chronic hypertension, chronic nephritis, diabetes, etc.
Malnutrition, such as anemia and hypoalbuminemia
Those with body mass index (BMI) ≥28kg/m² at the first prenatal check-up
Uterine hypertonia (such as polyhydramnios, twins with gestational diabetes, macrosomia)
There is a history of hypertension in the family, especially if the mother of a pregnant woman has a history of severe gestational hypertension.
Pathophysiology
Basic disease: systemic arteriolar spasm
Clinical manifestations: proteinuria, edema, hypertension
Hypertension during pregnancy: first hypertension after 20 weeks of pregnancy, systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg, returning to normal within 12 weeks after delivery; proteinuria (-)
preeclampsia
Mild
After 20 weeks of pregnancy, BP ≥ 140/90mmHg, urine protein ≥ 0.3g/24h or urine protein/creatinine ratio ≥ 0.3 or random urine protein ≥ ( )
Severe
BP ≥ 160/110mmHg; urine protein ≥ 2.0g/24h or random urine protein ≥ ( ); serum creatinine > 106 μmol/L, platelets < 100x109/L
Eclampsia: convulsive seizures or coma in addition to preeclampsia
It first manifests as fixed eyeballs, dilated pupils, head turned to one side, trismus, followed by trembling of the corners of the mouth and facial muscles for a few seconds, and then the muscles of the whole body and limbs become rigid (the dorsal side is stronger than the ventral side). The hands are clenched and the arms are straightened, and a strong seizure occurs. twitch. During convulsions, breathing pauses and the face turns blue. The twitching lasts for about a minute, the intensity weakens, and the muscles all over the body relax, and then they stretch and inhale to resume breathing. During convulsions, the patient loses consciousness. When the condition becomes milder, the number of convulsions decreases, and the convulsions wake up quickly. However, sometimes the convulsions are frequent and last for a long time, and the patient can fall into a deep coma. During the convulsions, various traumas such as lip and tongue bites, falls, and even fractures are prone to occur. Vomiting occurs during coma. Can cause suffocation or aspiration pneumonia.
Chronic hypertension complicated by preeclampsia
Pregnant women with high blood pressure have no proteinuria before 20 weeks of pregnancy. If urine protein ≥0.3g/24h or random urine protein ≥ ( ) appears after 20 weeks of pregnancy; or if urine protein suddenly increases after 20 weeks of pregnancy, blood pressure further rises, or Thrombocytopenia (<100x109/L).
Pregnancy complicated by chronic hypertension
Blood pressure ≥140/90mmHg before pregnancy or before 20 weeks of pregnancy, but not significantly aggravated during pregnancy; or hypertension is first diagnosed after 20 weeks of pregnancy and continues beyond 12 weeks postpartum
nursing assessment
health history
Physical condition: Typical patient symptoms include hypertension, edema, and proteinuria after 20 weeks postpartum.
If your blood pressure is elevated during the initial measurement, you need to rest for an hour before taking the measurement again to accurately reflect your blood pressure. Turn over test (ROT): Measure the blood pressure while the pregnant woman is lying on her left side. After the blood pressure stabilizes, turn over to the supine position for 5 minutes and then measure the blood pressure. If the diastolic blood pressure in the supine position is ≥20 mmHg compared with the left lateral position, it indicates a tendency to develop preeclampsia, and its positive predictive rate is 33%.
Collect 24-hour urine for urine protein detection. If the 24-hour urine protein quantity is ≥0.3g, it is abnormal.
Edema in late pregnancy Edema is not obvious, but the body weight increases by more than 0.5kg within a week. Hidden edema
Headache, dizziness, chest tightness, nausea, vomiting
Convulsions and coma are the most serious manifestations
psychosocial status
Diagnostic points
Fundus examination: The degree of spasm of retinal arterioles can directly reflect the severity of the disease.
Treatment points: The treatment principles are sedation, antispasmodic, antihypertensive and diuretic
Suitable for terminating pregnancy: an important means to thoroughly treat hypertensive disease during pregnancy
Patients with gestational hypertension and preeclampsia can expect treatment until pregnancy termination at 37 weeks
For patients with severe preeclampsia whose pregnancy is <24 weeks, and those whose condition is unstable after treatment, it is recommended to terminate the pregnancy between 24 and 28 weeks of gestation. The decision on whether to receive expectant treatment will be based on the condition of the mother and child, as well as local medical conditions and medical standards.
Nursing measures
general care
Ensure rest: It is advisable to lie on the left side, which can reduce the pressure of the uterus on the abdominal aorta and inferior vena cava, increase the return blood flow and improve the blood supply of the uterus and placenta. Lying on the left side for 24 hours can reduce diastolic blood pressure by 10mmHg
Adjust your diet: Salt does not need to be strictly restricted, but pregnant women with generalized edema should limit their salt intake.
Closely monitor mother and child status
Intermittent oxygen inhalation
Medication care: Magnesium sulfate is currently the preferred antispasmodic drug for the treatment of preeclampsia and eclampsia.
toxic reactions
The infusion rate of magnesium sulfate is preferably 1g/h and does not exceed 2g/h. The daily dosage is 25~30 grams. The first manifestation is a weakening or disappearance of the knee reflex, which may appear as the concentration increases. General hypotonia and respiratory depression, and in severe cases, the heartbeat may suddenly stop
Things to note
Knee tendon reflexes must be present
Breath no less than 16 times/min
Urine output is not less than 400ml every 24 hours, or not less than 17ml per hour
Monitor blood magnesium concentration and kidney function. In case of poisoning, immediately intravenously inject 10 ml of 10% calcium gluconate.
Care of patients with eclampsia
Assist doctors in controlling convulsions
Once a patient develops convulsions, magnesium sulfate should be controlled as soon as possible and magnesium sulfate is the drug of choice.
Dedicated care to prevent injuries
First, keep the airway open and give oxygen immediately. Place a tongue depressor to prevent the tongue from falling back. Do not give food, drink or oral medication when unconscious or unconscious to prevent aspiration pneumonia from accidentally entering the respiratory tract.
Reduce stimulation to avoid triggering convulsions
Place in a single cue and keep absolutely quiet to avoid sound and light stimulation. Activities and operations should be as gentle and focused as possible to avoid disturbing the patient
Close supervision
Monitor vital signs, urine output and output
Be prepared to terminate your pregnancy
Intrapartum and postpartum care for pregnant women with gestational hypertension
health education
Intrahepatic cholestasis of pregnancy (ICP)
It is an important pregnancy complication characterized by skin itching and jaundice during pregnancy, which mainly harms the fetus. Increased perinatal morbidity, mortality and premature birth rates.
clinical manifestations
Skin itching: generally starts from the palms and soles of the feet and gradually extends to the proximal ends of the limbs, and can even develop to the face
jaundice
Diagnostic points
Serum cholic acid measurement (most important) uninduced skin itching and serum TBA > 10 μmol/L
Liver function test
Pathological examination
Treatment points
Relieve itching symptoms, restore liver function, reduce blood bile acid levels, and strengthen monitoring of fetal intrauterine conditions to improve pregnancy outcomes.
triad