hi i'm maris and in this video i'm going
to be talking to you about some of the
complications of pregnancy i'm going to
be following along using our maternity
flash cards these are available on our
website
leveluprn.com if you want to get a set
for yourself and if you have a set for
yourself already i would invite you to
follow along with me before we start i
do want to just give you a trigger
warning here that we are going to be
talking about some different types of
pregnancy loss including miscarriage
heidiform mole and ectopic pregnancy so
this is a video that you may not want to
watch if you have personal experience
with these or if this is a very
triggering subject for you so with all
of that said let's go ahead and get
started
so first and foremost we're going to be
talking about spontaneous abortion which
is also known as miscarriage now
i need you to understand that an
abortion means a termination of
pregnancy for any reason
when you hear the word abortion you may
be thinking of an induced or therapeutic
abortion such as a surgical or medical
abortion that a patient may choose to
have that's not what we're talking about
in this case in this case we are talking
about spontaneous abortion which means
that the pregnancy was lost for some
reason through no fault of the patients
no there was no conscious decision made
it just happened spontaneously now that
is what the medical term abortion means
but i want you to remember that your
patients are very likely not medically
literate they don't know that abortion
means any sort of loss of a pregnancy
for any reason so it's very important to
use the correct terminology in your
charting or anything like that however
when you talk to your patients i would
very highly encourage you to use
simple english layman's terms such as
miscarriage instead um so a spontaneous
abortion is a miscarriage and you'll see
here that on this card we have a chart
that tells you about the different types
you can have a threatened inevitable
incomplete complete or missed abortion
and all of those are things that you may
see as diagnostic codes
for billing purposes for insurance
purposes as well
so you can look and see what all of
these different ones mean um but the the
important thing to understand here is
that this is the loss of a pregnancy
before 20 weeks before 20 weeks of
gestation this is called a miscarriage
for whatever reason uh the the pregnancy
is lost now the treatment for
miscarriage
varies
wildly based on what type of
miscarriage it was and how far along the
the pregnancy was and those sorts of
things so i'm going to tell you a
personal story um which is that i have
had eight miscarriages so i have a
genetic condition called familial
mediterranean fever and
one of the complications of my condition
is for unknown reasons it causes a
recurrent miscarriage so i have been
pregnant 10 times and i only have two
living children
now
most of my miscarriages were
very early on
and they required no treatment the only
treatment that i had was continuing to
see my doctor and she would draw my
blood levels to make sure that my
pregnancy hormone was returning to zero
um however that's not always the case in
two cases i had to have what's called a
d and c
dilation and curatage and what this
means is that the cervix is dilated to
allow instruments to be passed through
to it and curettage refers to um like
kind of a scraping motion so this is
where um the uterus actually needs to be
physically
cleaned basically of the pregnancy for
one reason or another
and for both of these instances i was
given some very light medication um you
know like a valium or uh in one case i
did get ver said um
the cervix is numbed with lidocaine and
this helps to prevent
discomfort but your patient will likely
experiencing cramping um heavier
bleeding passage of clots those sorts of
things now dnc does mean that the
provider may be able to send samples of
the products of conception to the lab to
see what happened um was there a
genetic abnormality with the fetus all
of these kinds of questions can help to
be answered in this instance there's
other ways that a miscarriage may be
handled as well such as with medications
like misoprostol which allow the cervix
to soften and dilate on its own to allow
for um easier passage of the pregnancy
contents so all of this is going to uh
depend on
the exact circumstance for your patient
i would very very very strongly
recommend that any time you have a
patient who experiences a miscarriage
that you be prepared to offer thorough
therapeutic communication
working as an emergency room nurse i
have had experiences
seeing patients have miscarriages where
they were not treated with the full
therapeutic
experience that they should have
received
and i myself have had that experience
and it is very traumatizing so um be
sure to ask your patient how best you
can support them
what you can do for them do you need me
to call your partner do you need me to
call a family member or a friend to come
pick you up those sorts of things
do
not
do not say anything that starts with the
words at least
there is no at least my baby still died
so i just that's just a personal thing a
soapbox of mine is you really need to
watch what you say to patients who have
just been told that they are
experiencing the loss of their pregnancy
okay so let's move on to hide a tida4
mole
from here on out i'm going to call it a
molar pregnancy because that's a
mouthful and i don't want to keep saying
it but a molar pregnancy is very rare
but a serious complication so this is
abnormal growth of the trophoblastic
villi in the placenta which prevents
normal embryo maturity so when we see
this on ultrasound i always say that it
looks like tv static it just there's
just nonsense in the uterus it is just
um just black and white craziness um
some some other uh places will describe
it differently like um
uh it will look like grape like clusters
uh and and maybe it does but that's
that's always what it looks like to me
is like tv snow or tv static on the
ultrasound
now your patient may have a dark
vaginal bleeding and in this may be
described as a prune juice consistency
or color so it's kind of that like dark
brown purplish color um that should be
making you think this might be a molar
pregnancy uh your patients if they maybe
they were undergoing artificial
reproductive therapy or something like
that and they might have been having hcg
levels you likely would have seen that
those pregnancy hormone levels were
growing at a at too high of a rate
and that is very classic for molar
pregnancies um so we can diagnose this
on ultrasound like i said there's a very
classic look to it um and unfortunately
the treatment for this is dnc um the
this pregnancy is abnormal and cannot
ever be normal um and it needs to be
removed from the uterus entirely not
just that but then your patient needs to
have hcg monitoring to ensure that their
levels return to zero that it goes back
down to normal
for six months after the dnc they're
actually going to have that hcg
monitoring and then you're gonna teach
your patient that they need to avoid
pregnancy for one whole year um because
the pregnancy and hcg levels rising
would make it difficult to monitor for
something called a choreocarcinoma
so choreo referring to the chorion that
that part of that developing placenta
and carcinoma is cancer so if your
patient has a molar pregnancy they are
at risk for developing a choriocarcinoma
which means that we need to monitor
those hcg levels and a pregnancy within
that year would make it impossible for
us to monitor those appropriately so
this is a rare complication but a very
important one to understand
okay lastly in this video we're going to
be talking about ectopic pregnancy now
ectopic means like outside of this means
a pregnancy that is not growing in the
correct place and the only correct place
for a pregnancy to grow is in the
uterine cavity so it is not okay for a
pregnancy to grow in the fallopian tubes
any portion thereof um or outside of of
the uterus entirely where it's actually
growing in the abdomen or the pelvis um
this is a rare complication of of
pregnancy um to have it grow completely
outside of the reproductive organs but
it does happen and it can happen so if i
have a pregnancy that's growing in the
wrong place it's not going to be in this
organ that allows it to stretch and grow
normally
this is going to be something that
cannot um be brought to life right this
pregnancy will not develop normally and
also puts the patient at significant
risk for complications including
hemorrhage and death so what does a
patient look like if they have this well
first of all hopefully they came in
early for their pregnancy their first
pregnancy visit and we could see it on
ultrasound
if not your patient is going to likely
report
unilateral
one-sided
stabbing pain in early pregnancy
somewhere between that like five to nine
weeks
if you have a patient ever regardless of
their pregnancy status if you have a a
woman of reproductive
age of childbearing age who presents
with unilateral stabbing pain you need
to think ectopic pregnancy until proven
otherwise this is a deadly complication
of pregnancy and it is very important to
catch it as soon as possible
so there are a couple of ways that this
can be treated one is methotrexate
methotrexate is a medication that can be
given to the patient that will actually
cause the pregnancy to end and for the
body to absorb it
the other is surgery
the the patient can have surgery to
remove the pregnancy um especially if
they already ruptured that tube or they
are about to rupture that fallopian tube
this is very very dangerous for this
patient so we have to just we can't wait
for the methotrexate basically we need
to get that pregnancy away from the tube
so that our patient does not hemorrhage
go into shock and die um so these are
some very scary complications of
pregnancy but it's very important that
you be aware of them so that you
understand what can happen to your
patient and understand uh what to look
for in those cases i hope this review
was helpful if it was please like this
video i would love to hear any sort of
you know ways that you might remember
these difficult concepts if you want to
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[Laughter]
here's an ectopic story though um my mom
actually i was um an in vitro
fertilization baby and my parents tried
for five years to conceive and i was
finally born they were very excited um
and my mom when i was two years old was
in the grocery store with me and she
said that she all of a sudden felt
stabbing pain and she abandoned her
shopping cart grabbed my hand and took
me to the neighbor's house and then
drove herself to the hospital um and
sure enough she had actually conceived
naturally but unfortunately had an
ectopic pregnancy but that's how sudden
and severe her pain was that she
literally just abandoned her full
shopping cart in the middle of the
grocery store i'm very glad that she was
okay and she was able to have that
surgery and survive
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