Chapter 36 Prenatal Problems

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Conception and Pregnancy  Abdominal Pain in Women of Childbearing Age  Sexual Assault  Complications of Pregnancy  Blunt Abdominal Trauma

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Conception and Pregnancy  Ovary releases an egg  It travels through the fallopian tube where it may be fertilized if sperm is present  The fertilized egg travels into the uterus where it implants in the uterine wall

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5 Conception and Pregnancy  Changes of pregnancy: First trimester –Implantation occurs –Organs begin to develop in fetus –Blood flow increases to uterus –Blood volume increases 30-35% –Heart rate increases –Blood pressure drops

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Conception and Pregnancy  Changes of pregnancy: Second trimester –Rapid growth and development of fetus –Uterus expands and presses on diaphragm –Breathing becomes more difficult

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Conception and Pregnancy  Changes of pregnancy: Third trimester –Fetus completes development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Abdominal Pain in Women of Childbearing Age  Ectopic pregnancy –Ovum fails to descend into the uterus and it implants in the fallopian tubes –Rupture of the fallopian tube can cause severe bleeding, leading to shock

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Abdominal Pain in Women of Childbearing Age  Ectopic pregnancy –Lower abdominal pain, scant vaginal bleeding, tachycardia, tachypnea, pallor –Treat for hypoperfusion

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Stop and Review  How does the body change with pregnancy?  What can you do to care for a patient with abdominal pain?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Sexual Assault  Psychological as well as physical trauma  Treat life threats during the initial assessment  Maintain the patient’s privacy and the right to refuse physical examination  Never perform a genital exam unless significant bleeding is present

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Complications of Pregnancy  Spontaneous abortion –Termination before 20 weeks is termed abortion –Usually due to a defect in the fetus or conditions within the uterus –Usually occurs between the 6th and 12th weeks –Treat as you would an ectopic pregnancy

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Complications of Pregnancy  Placental abruption –Premature detachment of the placenta from the uterine wall –Decreased blood flow to the fetus and increased blood loss of mother

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Complications of Pregnancy  Placenta previa –Placenta grows over the opening of the uterus –Results in severe bleeding, which can rapidly progress to hemorrhagic shock

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Complications of Pregnancy  Toxemia –Meaning “poisoned pregnancy”; known as eclampsia today –Can lead to coma and death

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Complications of Pregnancy  Toxemia –Pre-eclampsia presents as hypertension and edema –Eclampsia presents as seizure

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Blunt Abdominal Trauma  Amniotic fluid surrounds the fetus and acts as a shock absorber  In the third trimester, the abdomen protrudes outside the bony protective structures of the pelvis  Severe blunt force trauma can rupture the uterus

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Blunt Abdominal Trauma  Falls –Additional weight shifts the woman’s center of gravity, making the pregnancy woman more prone to falling  Intentional trauma –Some pregnant women may become victims of spousal abuse

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Blunt Abdominal Trauma  Motor vehicle collisions –The bulging abdomen can become the area of first contact

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Stop and Review  How do you care for the pregnant patient with vaginal bleeding?  How do you care for the patient experiencing pre-eclampsia or eclampsia?  What protects the fetus from blunt abdominal trauma?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23