Maternity - Pregnancy, part 7: Complications: Miscarriage, Hydatidiform Mole, Ectopic Pregnancy

by Meris Shuwarger September 09, 2021 Updated: September 14, 2021

Full Transcript

Hi, I'm Meris, 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 flashcards. These are available on our website, 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, hydatidiform 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 patient. 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.

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. But 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 that the pregnancy is lost.

Now, the treatment for miscarriage varies wildly based on what type of miscarriage it was and how far along the pregnancy was, and those sorts of things. So I'm going to tell you a personal story, 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. 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. However, that's not always the case. In two cases, I had to have what's called a D and C, dilation and curettage. And what this means is that the cervix is dilated to allow instruments to be passed through to it, and curettage refers to kind of a scraping motion. So this is where 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, like a Valium, or in one case, I did get Versed. The cervix is numbed with Lidocaine, and this helps to prevent discomfort. But your patient will likely experience cramping, heavier bleeding, passage of clots, those sorts of things. Now, the D and C does mean that the provider may be able to send samples of the products of conception to the lab to see what happened. 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 easier passage of the pregnancy contents. So all of this is going to 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 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 friend to come pick you up? Those sorts of things. Do not say anything that starts with the words, "At least." There is no at least. My baby still died. So 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 hydatidiform 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. There's just nonsense in the uterus. It is just black and white craziness. Some other places will describe it differently like it will look like grape-like clusters. And maybe it does. But 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 this may be described as a prune juice consistency or color. So it's kind of that dark brown purplish color. That should be making you think this might be a molar pregnancy. 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 too high of a rate. And that is very classic for molar pregnancies.

So we can diagnose this on ultrasound. Like I said, there's a very classic look to it, and unfortunately, the treatment for this is D and C. This pregnancy is abnormal and cannot ever be normal, and it needs to be removed from the uterus entirely. Not just that, but then your patient needs to have each HCG monitoring to ensure that their levels return to zero, that it goes back down to normal. For six months after the D and C, they're actually going to have that HCG monitoring, and then you're going to teach your patient that they need to avoid pregnancy for one whole year because the pregnancy and HCG levels rising would make it difficult to monitor for something called a Chorriocarcinoma. So Chorrio referring to the chorion, 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 Chorriocarcinoma, 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 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 pregnancy to grow in the fallopian tubes, any portion thereof, or outside of the uterus entirely where it's actually growing in the abdomen or the pelvis. This is a rare complication of pregnancy 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 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 the 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 five to nine weeks. If you have a patient ever, regardless of their pregnancy status, if you have 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 patient can have surgery to remove the pregnancy, 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.

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 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 ways that you might remember these difficult concepts. If you want to leave me a comment below, I promise I will read it, and I do hope that you subscribe to the channels that you can be the first to know when our next video comes out.

Here's an ectopic story though. I was an in-vitro fertilization baby, and my parents tried for five years to conceive, and I was finally born. They were very excited, 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. 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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