FERNANDEZ, JIAN MARCO N.

APRIL 26,2023

BSN 2J

PRELIM – MIDTERM ACTIVITY

NCM 109 (RLE)

1. Differentiate Placenta Previa and Abruptio Placenta

Placenta previa and placenta abruption (abruptio placentae), the two leading and major
causes of antepartum hemorrhage, result in substantial maternal and perinatal morbidity and
mortality. In their severe forms, both placenta previa and placenta abruption may have long-
term maternal and neonatal sequelae.

Placenta previa is the partial or complete implantation of placental tissue within the
lower region of the uterus after 20 weeks of gestation. The cervix may be partially or
completely covered by the improperly inserted placenta. There are four forms of placenta
previa: low-lying placenta previa, partial placenta previa, marginal placenta previa, and total
placenta previa. After 20 weeks of gestation, pregnancies complicated by placenta previa
frequently present with painless vaginal bleeding, which is then confirmed and classified on
obstetric ultrasonography. Placenta Previa is a concern because of a great risk of hemorrhage.
Bleeding often occurs as the lower part of the uterus thins during the third trimester of
pregnancy in preparation for labor. This causes the area of the placenta over the cervix to
bleed. The more of the placenta that covers the cervical os (the opening of the cervix), the
greater the risk for bleeding.

In contrary, Abruptio Placenta is defined as bleeding at the decidual-placental interface

of a properly implanted placenta, which results in partial or full placental detachment prior to
fetal delivery. The diagnosis is normally reserved for pregnancies that are more than 20 weeks
gestation. The most common clinical manifestations are vaginal bleeding and stomach pain,
which are frequently accompanied with hypertonic uterine contractions, uterine soreness, and
an unsettling fetal heart rate (FHR) pattern. Placental abruption is an uncommon yet serious
complication of pregnancy. The placenta develops in the uterus during pregnancy. It attaches to
the wall of the uterus and supplies the baby with nutrients and oxygen.

In the event of placenta abruptio, the placenta becomes totally or partially separated
from the uterine wall before to birth. In the instance of placenta previa, the placenta is
observed close or over the cervix in the lower region of the uterus. Patients with placenta
abruption usually experience severe contractions and bleeding, whereas those with placenta
previa experience painless bleeding.

2. What is the result of the following in Pregnant woman:

a. Poverty
b. Unemployment
c. Lack of Education
d. Victims of Abuse

During pregnancy, their moms are more likely to experience a variety of stressful life
events, such as lone-mother and teen pregnancies, unemployment, more crowded or polluted
physical settings, and considerably fewer resources to deal with these exposures. The early
child health impacts of poverty and pregnancy are numerous, and they frequently set a
newborn child on a life-long path of health inequities. Preterm birth, intrauterine growth
restriction, and neonatal or newborn death are all significantly increased risks. Poverty has
regularly been demonstrated to be a strong predictor of complications as a pregnant woman.

Poverty has been linked to higher rates of overall fertility, unwanted or teenage
pregnancy, and being a single mother. Youth living in poverty have a significantly increased risk
of adolescent pregnancy in nearly all developed countries. A recent study discovered that poor
female teenagers are five times more likely to become pregnant. When compared to higher-
income women, poor women were more likely to smoke, have poorer dietary habits, have
lower levels of education, and engage in higher-risk and health-detrimental behaviors. Lower
socioeconomic level is connected with lower prenatal care attendance elsewhere.

One of the most important elements influencing medical outcomes is socioeconomic

position. When SES is low, medical care is insufficient, which has been linked to negative
results. Unemployment can increase the risk of unfavorable pregnancy outcomes in pregnant
women. Previous research has linked poor socioeconomic status to pregnancy issues such as
abortion, premature delivery, preeclampsia, eclampsia, and gestational diabetes. Inadequate
prenatal care is linked to poor obstetric outcomes such as preterm birth, preeclampsia, and
stillbirth, and unemployed women are less likely to receive prenatal care. In fact, both
insufficient prenatal care and low socioeconomic status increase the risk of premature delivery,
preeclampsia, and gestational diabetes.

Lack of education compromises the ability of the woman to take care of her pregnancy.
Poor education tends to mislead the woman to certain things regarding the her pregnancy
which may impose a great risk for both maternal and child.

Abuse, whether emotional or physical, is never okay. Unfortunately, some women

experience abuse from a partner. Abuse crosses all racial, ethnic and economic lines. Abuse
often gets worse during pregnancy. During pregnancy, physical abuse can lead to miscarriage
and vaginal bleeding. It can cause your baby to be born too soon, have low birthweight or
physical injuries.

3. What is the cause of HIV/ AIDS among Pregnant Women and teen mothers?

The majority of the thirty-three million HIV-positive people live in the developing
countries, where HIV is prevalent. In some cases, infection during pregnancy has become the
most common medical complication of pregnancy. Over 70% of all HIV infections are caused by
heterosexual transmission, and 90% of childhood illnesses are transmitted from mother to kid.

Pregnancy does not have an adverse effect on the natural history of HIV infection in
women in most studies, although AIDS has become a leading cause of maternal mortality in
some areas, as the epidemic progresses. Adverse pregnancy outcomes that have been reported
in HIV positive women include increased rates of spontaneous early abortion, low birth weight
babies, and stillbirths, preterm labour, preterm rupture of membranes, other sexually
transmitted diseases, bacterial pneumonia, urinary tract infections and other infectious
complications. Although whether these are attributable to HIV infection is unknown.

HIV transmission from maternal to child ranges from 15% to 40% in the absence of
antiretroviral treatment and varies by country. Transmission can occur during pregnancy, labor
and delivery, or postpartum via breast milk. The majority of the transmission is assumed to take
place in late pregnancy and during labor. Viral factors such as viral load, genotype and
phenotype, strain variety, and viral resistance are associated with an increase in the likelihood
of transmission; maternal factors such as clinical and immunological state are also associated
with an increase in the risk of transmission.
obstetric factors such as duration of ruptured membranes, style of delivery, and intrapartum
haemorrhage; and infant factors, mostly related to the higher risk of transmission through
nursing.

4. Explain Hyperemesis Gravidarum, Causes, and Intervention.

The medical term for extreme nausea and vomiting during pregnancy is hyperemesis
gravidarum. The symptoms might be excruciatingly painful. You may vomit more than three
times a day, become dehydrated, feel dizzy and lightheaded all the time, and lose weight.
Fortunately, there are treatments available, including nausea medications. Hyperemesis
gravidarum is sometimes called severe morning sickness. You will vomit numerous times every
day if you have hyperemesis gravidarum. This can lead to weight loss and dehydration in the
long run. HG symptoms frequently continue longer than morning sickness. If you become
dehydrated, you may require hospitalization and IV fluids (fluids administered intravenously, or
through a vein).

Hyperemesis gravidarum typically develops during the first trimester of your pregnancy
(about six weeks). Symptoms can linger for weeks, months, or even until the baby is born. They
can be incapacitating, preventing you from carrying out your daily activities.
The following are the most prevalent symptoms of hyperemesis gravidarum: Severe nausea,
vomiting more than three times per day, losing more than 5% of your pre-pregnancy weight,
inability to keep food or beverages down, dehydration, feeling dizzy or lightheaded, peeing less
than normal, extreme exhaustion, fainting, headaches are all signs of pre-term labor.

It is most likely caused by rising hormone levels. Specifically, HCG (human chorionic
gonadotropin), which your body produces in large amounts during pregnancy. HCG levels peak
at 10 weeks of pregnancy, which is when most women report the most severe symptoms.
Estrogen, another hormone that rises during pregnancy, may potentially play a role in nausea
and vomiting.

Nursing care for patients with hyperemesis gravidarum focuses on determining the intensity of
nausea and vomiting, the degree of dehydration, and the level of weight loss. Nurses administer
drugs to reduce nausea and vomiting, as well as IV fluids and electrolyte replacement in severe
cases. Patient education aids in the prevention of problems and the management of discomfort
at home.

5. Explain Ectopic Pregnancy

Normal pregnancies develop inside your uterus after a fertilized egg travels through
your fallopian tube and attaches to your uterine lining. Ectopic pregnancy occurs when a
fertilized egg attaches elsewhere in your body, most commonly in your fallopian tube — hence
the term "tubal pregnancy."

Ectopic pregnancies can also occur on your ovary or elsewhere in your abdomen.
Ectopic pregnancies are uncommon, occurring in roughly 2 out of every 100 pregnancies. They
are, nevertheless, quite hazardous if not addressed. Fallopian tubes can rupture if they are
overstressed by the expanding fetus; this is known as a ruptured ectopic pregnancy. This can
result in internal bleeding, infection, and, in severe circumstances, death. An Ectopic Pregnancy
is fatal to the infant. It's vital to highlight that the fertilized egg in an ectopic pregnancy is not
"viable," which means it can't survive and grow into a baby that can live within or outside of
your body. It will always result in a miscarriage. This is because the egg cannot receive the
blood flow and support it requires to develop outside of the uterus.

You may not notice any symptoms of an early ectopic pregnancy at first. They may
appear to be very similar to those of a typical pregnancy. You may miss your period and
experience abdominal discomfort and breast tenderness. Only about half of women who have
an ectopic pregnancy will have all three main symptoms: a missed period, vaginal bleeding, and
abdominal pain. Upset stomach and vomiting, sharp tummy cramps, pain on one side of your
body, dizziness or weakness, pain in your shoulder, neck, or rectum are all early indicators of an
ectopic pregnancy.

An ectopic pregnancy can rupture or collapse your fallopian tube. Major pain, with or
without substantial bleeding, is one of the emergency symptoms. If you experience significant
vaginal bleeding with lightheadedness, fainting, or shoulder discomfort, or if you have severe
abdomen pain, especially on one side, call your doctor straight once.

6. Give 5 Risks of Pregnancy aside from the ones mentioned above and explain them.

A high-risk pregnancy can sometimes be the outcome of a pre-existing medical issue. In

other circumstances, a medical problem that arises during pregnancy that affects either you or
your baby makes the pregnancy high risk. The following are some risk of pregnancy aside from
previously listed risks.

Advanced maternal age. When the birth parent is 35 or older, the pregnancy is at a higher risk
of certain difficulties. Some of these risks include greater miscarriage rates, genetic diseases,
and pregnancy difficulties such as high blood pressure or gestational diabetes.

Pregnancy Complications. Various complications that arise during pregnancy can be dangerous.
An atypical placenta position, fetal development less than the 10th percentile for gestational
age (fetal growth restriction), and rhesus (Rh) sensitization — a potentially fatal condition that
can arise when your blood group is Rh negative and your baby's blood group is Rh positive —
are among examples.

Pregnancy History. A history of pregnancy-related hypertension disorders, such as

preeclampsia, increases the likelihood of being diagnosed with this condition during the next
pregnancy. If you had a premature birth in your previous pregnancy or have had several
premature births, you are more likely to have another premature birth in your future
pregnancy. Discuss your entire obstetric history with your health care physician.

Multiple pregnancies. Women who are expecting multiple pregnancies are more than twice as
likely to develop excessive blood pressure during pregnancy. This health issue frequently begins
earlier and worsens than in a single-baby pregnancy. It can also increase the likelihood of
premature placental detachment (placental abruption).

Lifestyle choices. Evidence suggests that smoking, excessive alcohol and caffeine consumption,
diet, obesity, and malnutrition may cause genetic, cellular, metabolic, and physiological changes
in the developing baby that have long-term consequences in adulthood and increase the child's
lifetime risk of cardiovascular complications.