Pregnancy sites

Although pregnancy, labor, and delivery are normal physiologic processes, complications can arise at any time, with serious consequences for the woman and fetus. The birth attendant may order an amniocentesis when he or she suspects intrauterine growth restriction (IUGR), which generally results in an infant who is small for gestational age (SGA).IUGR can begin at any time during pregnancy and is linked to inadequate amounts of oxygen and nutrients necessary for fetal growth. Maternal serum a-fetoprotein (MSAFP) levels are increasingly used as a screening tool to detect the presence of fetal neural tube defects and open abdominal wall defects early in pregnancy. Pregnancy may be interrupted due to abortion, premature cervical dilation, ectopic pregnancy, or hydatidiform mole. Abortion (AB) describes the natural or artificial (through medical intervention) termination of a pregnancy.
It is estimated that approximately 10% to 20% of all pregnancies end in spontaneous abortion.
Some habitual and spontaneous abortions are the result of premature cervical dilation, during the second or early third trimester of pregnancy. Minor surgical procedures are often used for the pregnant woman with an incompetent cervix. For inevitable, incomplete, and missed abortions occurring between 16 and 20 weeks of pregnancy, a drug called dinoprostone (Prostin E2) may be administered to the mother. A therapeutic abortion may be recommended for a woman whose life is in jeopardy due to the stress of pregnancy.
The word ectopic means outside; therefore, an ectopic pregnancy is one that implants outside the uterus (Fig. Factors predisposing to ectopic pregnancy are tubal occlusion, an intrauterine contraceptive device, tumors, pelvic infections, endocrine imbalances, and abnormal tubal development. The symptoms of an ectopic pregnancy begin with spotting or bleeding 2 to 3 weeks after a missed menstrual period.

NCLEX Alert Common questions may include situations that need immediate nursing actions, such as with ectopic pregnancy. Discuss the nursing implications related to the pregnant woman with an existing cardiac disorder or who has a chemical dependency.
The term high-risk pregnancy (or at-risk pregnancy) is used when physiologic or psychological factors could significantly increase the chances of mortality or morbidity of the woman or fetus. Causes related to maternal conditions include diabetes (gestational or long-standing), placental growth or functioning, intrauterine infection, or pregnancy-induced hypertension. It can identify multiple pregnancies, and in some cases, it can also determine the sex of the fetus. The loss or termination of a pregnancy has physical, psychological, and emotional consequences for the woman. This condition exists any time bleeding or cramping occurs in the first 20 weeks of pregnancy without major cervical dilation. A therapeutic abortion is the legal termination of pregnancy under a physician’s direction. If the woman has rubella (German measles) during pregnancy, especially during the first trimester, the likelihood of fetal defects is strong, and an abortion may be performed.
An intervention in pregnancy without medical or legal justification is a criminal or illegal abortion. Many birth attendants will not take extreme measures to save such a pregnancy because a spontaneous abortion is often nature’s way of disposing of a malformed fetus. This suture holds the cervix closed during the remainder of the pregnancy; when the woman begins labor, the suture or ring is removed.
If the fetus is not expelled spontaneously within 1 month, the pregnancy will be terminated and a D&C performed.

A tubal pregnancy requires surgical removal of part or all of the affected tube to prevent rupture, a dangerous complication. The examiner confirms the fetal position by palpation, cleanses the area, and anesthetizes the skin site.
Because nonmedical people normally carry out illegal abortions in unsterile environments, the risks to the pregnant woman are great.
An untreated ectopic pregnancy can be rapidly fatal due to shock from blood loss after tubal rupture.
PUBS has also become the preferred method of intrauterine blood transfusion for Rh-sensitized fetuses because it can be done early in the pregnancy.
Roman Catholic hospitals, for example, may not perform abortions unless specific criteria are met, such as a life-threatening situation for the mother. He or she then withdraws approximately 20 mL of fluid, removes the needle, and covers the insertion site with a bandage. Referred to in the past as habitual abortion, this term means that a woman has spontaneously lost three or more successive pregnancies. In such a case, the birth attendant usually makes every possible effort to save the pregnancy. Attempts are made to determine the cause of the recurrent abortions and to correct the situation if possible.

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