Episode Details

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Hemorrhagic Disorders (Bleeding in Pregnancy) Obstetric hemorrhage is a leading cause of worldwide maternal mortality.

• Ectopic Pregnancy: The fertilized ovum implants outside the uterine cavity, most often in the fallopian tubes. The hallmark presentation is abdominal pain accompanied by spotting. A ruptured ectopic pregnancy causes massive internal hemorrhage. Unruptured cases are often treated with Methotrexate, a folic acid antagonist that stops embryonic cell division.
• Placenta Previa: The placenta implants abnormally in the lower uterine segment, partially or completely covering the cervical os. It presents characteristically as painless, bright red vaginal bleeding. A critical nursing rule is to strictly avoid vaginal examinations, as they can disrupt the placenta and cause catastrophic hemorrhage.
• Placental Abruption: The premature separation of a normally implanted placenta from the uterine wall. Unlike previa, it presents with sudden and severe abdominal pain, dark red bleeding, and a firm, rigid, or board-like abdomen. It poses an extreme risk for fetal hypoxia and maternal Disseminated Intravascular Coagulation (DIC), typically requiring immediate emergency delivery.

Hypertensive Disorders Hypertensive disorders complicate up to 16% of pregnancies and exist on a progressive spectrum.

• Preeclampsia: Characterized by new-onset hypertension (≥140/90 mmHg) combined with maternal organ dysfunction (most often proteinuria) after 20 weeks' gestation. Severe features include BP ≥160/110, severe headache, visual disturbances, and hyperreflexia.
• Eclampsia: The severe progression of preeclampsia defined by the onset of generalized, tonic-clonic seizures.
• HELLP Syndrome: A life-threatening variant of severe preeclampsia defined by Hemolysis, Elevated Liver enzymes, and Low Platelet count.
• Medical Management: Magnesium Sulfate is the gold-standard therapy, administered intravenously to prevent and treat eclamptic seizures by depressing the central nervous system and blocking neuromuscular transmission. Nurses must strictly monitor for magnesium toxicity (indicated by respiratory depression and absent deep tendon reflexes); calcium gluconate must be readily available as the emergency antidote.

Endocrine and Metabolic Complications

• Diabetes (Pregestational and Gestational): Pregnancy hormones inherently increase insulin resistance, especially in the second and third trimesters. Poor glucose control significantly increases the risk for fetal macrosomia (large for gestational age), congenital malformations, and neonatal hypoglycemia.
• Hyperemesis Gravidarum: Severe, uncontrollable nausea and vomiting that causes dehydration, electrolyte imbalances, ketosis, and greater than 5% prepregnancy weight loss. The priority treatment is halting oral intake temporarily and restoring hydration with IV fluids and antiemetics.

Blood Incompatibility and Amniotic Fluid Imbalances

• Rh Incompatibility: Develops exclusively when an Rh-negative pregnant person is exposed to Rh-positive fetal blood. Rho(D) immune globulin (RhoGAM) is administered routinely to prevent the mother's immune system from creating antibodies that would attack...