Nursing Care of the Client during Labor and Delivery

OUTLINE ELECTIVE ABORTION

- medical termination of a pregnancy
I. HYPEREMES GRAVIDARUM
II. SPONTANEOUS MISCARRIAGE
MISCARRIAGE
A. Causes of Spontaneous Miscarriage
- spontaneous interruption of a pregnancy
B. Classifications of Spontaneous
Abortions/Miscarriages
Early miscarriage
C. Complications of miscarriage
- occurs before week 16 &late miscarriage
III. INCOMPETENT CERVIX or PREMATURE CERVICAL
between weeks 16 & 24
DILATATION
A. McDONALD’s cerclage
l Causes of Spontaneous Miscarriage
B. SHIRODKAR PROCEDURE
IV. ECTOPIC PREGNANCY
⚫ Abnormal fetal formation
V. GESTATIONAL TROPHOBLASTIC
⚫ Immunologic factors: Rh/ABO incompatibility
DISEASE/MOLAR PREGNANCY
⚫ Implantation abnormalities
(HYDATIDIFORM MOLE)
⚫ Corpus luteum fails to produce enough P to maintain
A. 2 Types of H Mole
the d. basalis (P therapy may be attempted)
VI. PLACENTA PREVIA
⚫ Infection (rubella, syphilis, poliomyelitis, CMV,
A. 4 Types of Placenta Previa
toxoplasmosis, UTI)- fetus fails to grow, P & E decline
B. BETAMETHASONE
causing sloughing off of the endometrium
VII. PREMATURE SEPARATION OF THE
⚫ Trauma
PLACENTA (ABRUPTIO PLACENTAE)
⚫ Incompetent cervix
A. Types of AP
⚫ Maternal systemic diseases: DM, thyroid problems,
B. COUVELAIRE uterus
severe anemia
(UTEROPLACENTAL APOPLEXY)-
VIII. HYPERTENSIVE DISORDERS OF
PREGNANCY/PREGNANCY-INDUCED HYPERTENSION Assessment:
(PIH) 1. Vaginal spotting
A. Classifications of PIH 2. Cramping
B. TONIC-CLONIC
C. STAGES OF A SEIZURE: Classifications of Spontaneous Abortions/Miscarriages
D. CLONIC PHASE
E. (POST-ICTAL STAGE HELLP SYNDROME
1. Threatened Miscarriage
I. HYPEREMES GRAVIDARUM Symptoms:
1. vaginal bleeding- scant, usually bright red
Description & Etiology: 2. Slight cramping or backache
1. PERNICIOUS or PERSISTENT VOMITING OF 3. No cervical dilatation
PREGNANCY
2. extreme N/V that is prolonged past week 12 of Threatened Abortion
3. pregnancy or is so severe(DHN, ketonuria, Management:
weightloss ) within the 1st 12 weeks AOG ⚫ Assess fetal viability via UTZ; FHT
4. associated with H. pylori ⚫ Assess amount of bleeding
⚫ Monitor VS; assess for impending shock
Assessment: ⚫ Provide emotional support hCG titer at start of
⚫ N/V is so severe that nutrition cannot be maintained bleeding & after 24h (if viable, hCG doubles)
and weight loss is severe ⚫ avoid strenuous activity, CBR for 24 to 48 h
⚫ Elevated hct due to hemoconcentration ⚫ Avoid stress
⚫ Reduced Na, K Cl and hypokalemic alkalosis may occur ⚫ coitus is restricted for 2 weeks after bleeding to
polyneuritis dt deficiency in Vitamin B avoid bleeding & infection
⚫ Urine may be (+) for ketones due to breakdown of
protein & fat for cell growth 2. Imminent or Inevitable Miscarriage
⚫ IUGR or preterm birth Symptoms:
⚫ In history taking ask frequency/quantity of vomiting, 1. + cramping or uterine contractions
how much she eats in a typical day 2. + Vaginal bleeding
3. Cervix dilates & membranes rupture
Management:
Management:
⚫ 24hHosp.(I & O, blood chemistries & rehydration) ⚫ assess bleeding;
⚫ NPO; IVF ( 3L Ringer’s lactated solution+ vitB)to ⚫ save any tissue fragments passed
control vomiting ⚫ initiate IVT with an 18-gauge needle
⚫ If no vomiting after the 1st 24h, sips of clear ⚫ If (-) FHT & UTZ reveals empty uterus or
fluid,gradually advanced to a soft, then normal,diet. nonviable
⚫ If vomiting returns, TPN or enteral nutrition may be ⚫ fetus, D&E after D & E monitor bleeding
prescribed ( saturating > pad/hour is heavy bleeding)
⚫ RhOGAM as necessary
II. SPONTANEOUS MISCARRIAGE ⚫ Provide psychological support

ABORTION 3. Complete Miscarriage

- any interruption of a pregnancy before a fetus is Symptoms:
viable (> 20 to 24 weeks & weighs at least 500 g) 1. the entire products of conception (fetus, placenta,
membranes) are expelled
 Nursing Care of the Client during Labor and Delivery
2. Bleeding, cramping & expulsion of conceptus - Administer RhOGAM or RhIg to all women with
3. Bleeding slows within 2 hours then stops within a Rh (-) blood to prevent buildup of antibodies in case the
few fetus is Rh (+)
days after passage of conceptus - Powerlessness or Anxiety
4. The cervix is closed & the uterus contracts
INCOMPETENT CERVIX or PREMATURE CERVICAL
4. Incomplete Miscarriage DILATATION
Symptoms:
1. Bleeding, cramping & part of the conceptus (usually the Description & Etiology
fetus) is expelled but the rest are retained; cervix is dilated ⚫ cervix that dilates prematurely and cannot hold a
2. danger of hemorrhage because the uterus cannot fetus until term cause of habitual abortion
contract effectively ⚫ it usually at week 20 when the fetus is still too
immature to survive.
Management: ⚫ associated with maternal age, congenital
⚫ D & C or suction curettage structural
defects & trauma to the cervix (cone biopsy, repeated D &
5. Missed Miscarriage/ Early Pregnancy Failure C)
Symptoms:
1. the fetus dies in utero but is not expelled & the Description cont’d
client experiences decreasing signs of ⚫ the dilatation is usually painless 1st symptom
Pregnancy usually SHOW, or increased pelvic pressure, which may be
2. Cervix is closed followed by rupture of membranes & discharge of AF
3. Dark brown vaginal discharge ⚫ - uterine contractions begin & after a short labor,
4. Pregnancy test (-) the fetus is born
5. Fundal height does not increase in size
Diagnosis
Management: - may be diagnosed by early UTZ before symptoms
⚫ UTZ to establish fetal death occur
⚫ D&E
⚫ If > 14 wks AOG, Pg suppository of misoprostol Management
(Cytotec) to dilate the cervix, followed by ⚫ UTZ to confirm that the fetus is healthy weeks
oxytocin or 12
⚫ mifepristone ⚫ To 14, purse-string sutures are placed in the
⚫ Miscarriage usually occurs spontaneously within cervix by the vaginal route under regional anesthesia
2 weeks (CERVICALCERCLAGE).
⚫ If conceptus remains in the uterus > 5 weeks, risk ⚫ Sutures strengthen the cervix & prevents it
for DIC and sepsis from dilating.

[Link] Pregnancy Loss/Habitual Abortion McDONALD’s Cerclage

⚫ Three Spontaneous miscarriage that occurred at - nylon sutures are placed horizontally & vertically
the same gestational age across the cervix & pulled tight to reduce the cervical canal
⚫ Causes to a few millimeters in diameter
⚫ Defective spermatozoa or ova - usually temporary
⚫ Poor Thyroid Function
⚫ Septate or Bicornuate Uterus
⚫ Resistance to uterine artery blood flow
⚫ Chorioamnionitis or uterine infection
⚫ Autoimmune disorders such as Lupus
⚫ Anticoagulant and Anti Phospholipid Antibodies \

Complications of Miscarriage

1. Hemorrhage
⚫ Monitor SHIRODKAR PROCEDURE
⚫ Position flat on bed
⚫ Blood replacement if necessary - sterile tape is threaded in a purse-string manner
⚫ D&C under the submucous layer of the cervix & sutured in place
to achieve a closed cervix
2. Infection - may be permanent
⚫ fever higher than 100.4°F (38.0°C)
⚫ abdominal pain or tenderness
⚫ foul-smelling vaginal discharge

3. Septic Abortion

4. Isoimmunization
- whenever the placenta is dislodged some blood
from the placental villi may enter the maternal circulation.
If the fetus is Rh (+) & the woman is Rh (-), the mother may
- After surgery, bed rest (in slight or modified
produce antibodies against Rh (+) blood & would attempt
Trendelenberg position) for a few days to decrease
to destroy RBC of the next infant while it is in utero
pressure n the new sutures
 Nursing Care of the Client during Labor and Delivery
- Sutures are then removed at weeks 37 to 38 so
that the fetus can be born vaginally. RISK FACTORS
⚫ Increased or decreased maternal age
⚫ Low socioeconomic status; low protein diet
ECTOPIC PREGNANCY ⚫ History of abortion and Clomiphene therapy

Definition:
⚫ It is the implantation of a fertilized ovum
outside of the uterus
⚫ Sites:ovary, cervix, peritoneal cavity,
fallopian tube (most common)

Etiology
⚫ Salpingitis, tumors, adhesions, or scarring,
IUD use, narrowed oviducts

2 Types of H Mole

1. Complete Mole
- All trophoblastic villi swell & become cystic;
embryo dies early
- Chromosomes are normal, 44xy or 44xx but are
contributed by only by the father or an empty ovum was
fertilized & the chromosome material from the sperm
was duplicated
Assessment - May lead to choriocarcinoma
⚫ Missed period, usual signs of pregnancy
(N/V,
positive pregnancy test, etc)
⚫ Spotting, bleeding (dark red or brownish),
possible signs of hypovolemic shock
⚫ If at the FP, by 6 to 12 weeks AOG, slowly
increasing
or sudden sharp, stabbing pain in LLQ or RLQ (due to 2. Partial Mole
rupture of FP), followed by bleeding, - Some of the villi form
⚫ abdominal rigidity normally
⚫ referred shoulder pain(KEHR’S SIGN) due to - Syncytiotrophoblast
blood in the peritoneum irritating the phrenic nerve layer is swollen & misshapen
- severe left shoulder pain - It has 69 chromosomes (3 chromosomes instead
- splenic rupture, ectopic pregnancy of 2 for every pair) resulting from 2 sperms fertilizing an
rupture ovum
- Rarely leads to choriocarcinoma
CULLEN’S SIGN
- ecchymotic blueness around the umbilicus
indicating blood pooling in the peritoneum
⚫ Dizziness, syncope
⚫ UTZ confirms extrauterine pregnancy
Rupture

Complications
⚫ Hemorrhage, Assessment
⚫ Shock ⚫ Uterus expands faster than normal
⚫ Peritonitis ⚫ No fetal heart sounds
⚫ hCG test is strongly positive (1 to 2 million IU) dt
Management overgrowing trophoblast cells & remains positive after the
⚫ Before rupture, oral administration of 100th day of gestation
METHOTREXATE (folic acid antagonist which destroys fast- ⚫ Marked N/V due to high hCG levels ( 1-2 M
growing cells) followed by LEUCOVORIN; treated until hCG IU/24hrs)
is (-); hysterosalpingogram to assess patency of the tube ⚫ Positive pregnancy test
⚫ Abdominal pain
GESTATIONAL TROPHOBLASTIC DISEASE/MOLAR ⚫ Signs of Pregnancy induced HPN (HPN,
PREGNANCY (HYDATIDIFORM MOLE) proteinuria,
edema) present before week 20 of pregnancy
⚫ It is the abnormal proliferation ⚫ UTZ shows dense growth (snowflake pattern) but
& degeneration of the trophoblastic chorionic villi. As the no
cells degenerate, they become filled with fluid & appear as fetal growth
clear, fluid-filled, grape-sized vesicles & the embryo fails to ⚫ Vaginal bleeding in the 1st trimester, may be
develop brown like
 Nursing Care of the Client during Labor and Delivery
prune juice & may contain grapelike vesicles - the placenta edge approaches that of the cervical
⚫ Very low msAFP levels os; 2 to 3 cm from the internal os & does not cover it
⚫ Expulsion of molar cyst by 16th-18th week
3. PARTIAL PLACENTA PREVIA
Diagnosis - placenta occludes a portion of the cervical os
⚫ Passage of vesicles- 1st sign
⚫ TRIAD SIGNS; 4. TOTAL or COMPLETE PLACENTA PREVIA
⚫ Big uterus - placenta completely covers the cervical os
⚫ Vaginal bleeding: brownish, intermittent
⚫ HCG > 1 M(NV: 400,000 IU/24hrs)
⚫ Ultrasound: no fetal sac, no fetal parts
⚫ XRAY: no fetal skeleton

Management
⚫ Monitor for signs of hemorrhage, PIH, or other
complications
⚫ Suction & curettage to evacuate the mole
⚫ After extraction, chest xray, pelvic examination,
serum
test for ß subunit of hCG Etiology
⚫ hCG is analyzed every 2 weeks until levels are ⚫ Increased parity
normal. ⚫ advanced maternal age
Afterwards, q 4 weeks for 6 to 12 months ( increase ⚫ past CS births
suggests malignancy) ⚫ past D & C
⚫ should not get pregnant within 1 year of ⚫ multiple gestation
diagnosis because signs of pregnancy can mask ⚫ male fetus (?)
⚫ signs of choriocarcinoma
⚫ Chest X-ray to detect early lung metastasis Assessment
⚫ if malignant, methotrexate is the DOC ⚫ Uterus soft, non-tender
⚫ Provide RhOGAM if Rh(-) ⚫ UTZ identification of placenta location
⚫ Address emotional & psychosocial needs. ⚫ Bleeding that is abrupt, painless, dark red

Diagnosis
⚫ Ultrasonography
- 95% accurate, detects site of implantation

Management
⚫ Bed rest in a side-lying position
⚫ Assess VS, bleeding (1 cup = 240 ml, 1 Tbsp = 15
ml), pain, shock, contractions, FHR
⚫ Monitor hgb, hct, platelet, PT, PTT; do blood
typing & cross-matching
⚫ Never perform vaginal or pelvic exam
PLACENTA PREVIA ⚫ Vaginal exams are done only in a double set- up
to allow
Description emergency CS
⚫ It is the low implantation of the placenta in the ⚫ Begin IVT & prepare for possible BT
uterus;
⚫ as the cervix softens & begins to efface & dilate, Double set-up: room is set up for vaginal delivery and
placental sinuses are opened causing progressive emergency CS
hemorrhages
Management cont’d
⚫ If labor has begun, bleeding is continuous or
fetus is
compromised, birth must be accomplished
⚫ If bleeding stops, FHT & maternal VS are of good
quality
hospital observation for 48h, sent on bed res at home

⚫ BETAMETHASONE,
- a steroid that hastens lung maturity may be given
if fetus is < 36 weeks

PREMATURE SEPARATION OF THE PLACENTA

4 Types of Placenta Previa (ABRUPTIO PLACENTAE)
1. LOW-LYING PLACENTA Description
- implantation in the lower rather than in the ⚫ It is the premature separation of the normally
upper portion of the uterus Implanted placenta after the 20th week of pregnancy,
typically with severe hemorrhage
2. MARGINAL PLACENTA PREVIA
 Nursing Care of the Client during Labor and Delivery
⚫ Fetal outcome depends on the degree of
separation
Diagnosis
⚫ Clinical diagnosis- symptomatic
⚫ Ultrasound- detects bleeding
⚫ Clotting studies-
⚫ reveal DIC: small fibrin clots in the circulation
⚫ Hypofibrinogenemia: decrease normal
fibrinogen
Etiology results in the absence of normal blood coagulation
⚫ Multiparity,
⚫ preeclampsia, Complications
⚫ direct trauma, ⚫ Hemorrhagic shock
⚫ advanced maternal age, ⚫ DIC
⚫ Drug useor smoking, ⚫ Couvelaire uterus
⚫ uterine anomalies, - the placenta does not contract well postpartum
⚫ short umbilical cord ⚫ CVA
⚫ Hypofibrinogenemia
Types of Abruptio Placentae ⚫ Renal failure
⚫ Infection
⚫ MARGINAL ABRUPTION ⚫ Prematurity
- separates only at the edges causing vaginal
bleeding & a little pain Management
⚫ CENTRAL (CONCEALED) ABRUPTION ⚫ Bed rest, left side-lying position
- may not result in bleeding but increasing uterine ⚫ IVT(18-gauge needle for fluid replacement)
irritability & tenderness ⚫ O2 therapy
⚫ COMPLETE SEPARATION (100%) ⚫ Monitor: FHR, maternal VS q 5 to 15 mins,
- complete separation from the uterine wall fibrinogen
resulting in profuse bleeding levels, I & O, labor onset, pain, bleeding
⚫ Psychological support
⚫ Prepare for emergency CS or vaginal birth
⚫ Observe for postpartal complications

l HYPERTENSIVE DISORDERS OF
PREGNANCY/PREGNANCY-INDUCED HYPERTENSION
(PIH)
Assessment Definition
⚫ Sharp, stabbing pain, ⚫ It is a disorder that begins during pregnancy in
⚫ rigid, boardlike abdomen which
⚫ (+/-)vaginal bleeding vasospasm in both small & large arteries occur.
⚫ Abdominal circumference may increase as ⚫ It is associated with signs of hypertension,
⚫ bleeding increases; dark red bleeding proteinuria &
edema.
COUVELAIRE uterus (UTEROPLACENTAL APOPLEXY) ⚫ It is unique to pregnancy
- if the placenta separates first at the center, ⚫ Previously known as TOXEMIA
blood pools under the placenta & is hidden from view;
- blood then may infiltrate uterine muscles Factors:
forming a hard, board like uterus with no apparent ⚫ Young primigravidas
bleeding ⚫ women older than 35
⚫ multiple gestation
⚫ genetic or immunologic factors
⚫ poor nutrition
⚫ DM
⚫ H mole

Classifications of PIH

1. GESTATIONAL HPN
⚫ BP = 140/90 mm Hg or systole elevated 30
mm Hg or diastole elevated 15 mm Hg above
prepregnancy level; returns to normal after
childbirth
Assessment cont’d ⚫ No proteinuria or edema

⚫ Shock if bleeding is extensive 2. MILD PREECLAMPSIA

⚫ DIC may occur as the fibrinogen is used up to ⚫ BP = 140/90 mm Hg taken on 2 occasions at
stop the least 6 hours apart
bleeding ⚫ systolic BP > by 30 mm Hg & diastole > by 15
⚫ FHR may be present or absent mm Hg from prepregnancy levels
⚫ Contractions may be present ⚫ Proteinuria- 1+ or 2+ on a random sample
 Nursing Care of the Client during Labor and Delivery
⚫ edema in the upper body, weight gain > 2 lbs/wk CLONIC PHASE
in - all muscles relax & contract &
the 2nd trimester or 1 lb/week in the 3rd trimester relax repeatedly causing extremities to flail wildly;
⚫ inhales & exhales regularly & may aspirate her
3. SEVERE PREECLAMPSIA saliva;
⚫ BP = 160/110 mm Hg or above on at least 2 ⚫ incontinence is possible; lasts up to 1 minute
occasions 6 h apart & at bed rest
⚫ diastole is 30 mm Hg above prepregnancy (POST-ICTAL STAGE)
level
⚫ marked proteinuria- 3+ or 4+ in a random ⚫ Semi-comatose for 1 to 4 hours
sample or > 5 g in a 24-hr sample *fetal prognosis is poor due to hypoxia &
⚫ extensive edema- puffiness in the face & hands consequent acidosis
*nonpitting edema- cannot be indented with finger
Pressure complications:
⚫ cerebral hemorrhage,
EDEMA GRADING ⚫ liver rupture,
⚫ coma,
⚫ 1+ pitting edema- can be indented slightly ⚫ fetal death
⚫ 2+ pitting edema- moderate indentation
⚫ 3+ pitting edema- deep indentation HELLP SYNDROME
⚫ 4+ pitting edema- indentation so deep it remains ⚫ variation of PIH named for the symptoms:
after removal of the finger hemolysis, elevated liver enzymes, & low
platelet count
⚫ at risk for hemorrhage, pulmonary edema,
hepatic rupture
⚫ Symptoms: RBC hemolysis, platelet ct <
100T/mm3, elevated liver enzymes

Management

Mild Preeclampsia
-can be managed at home
⚫ Bed rest(left side-lying)
⚫ oliguria – 400 to 600 ml urine per 24 hours or < - Na tends to be excreted faster
30 cc/hour ⚫ Good nutrition
⚫ headache, blurred vision, epigastric pain, - balanced diet with mod. salt &
dyspnea, protein; low Na increases aldosterone secretion
N/V ⚫ Provide emotional support
⚫ hyperreflexia (+1 hyporeflexia, +2 normal, +3
brisk, +4 hyperreflexia) Severe Preeclampsia
⚫ CBR in the hospital
4. ECLAMPSIA ⚫ Institute seizure precautions:
⚫ most severe classification ⚫ private room,
⚫ cerebral edema is so acute that seizure or coma ⚫ dim lighting,
occurs ⚫ minimal handling,
⚫ happens late in pregnancy & up to 48 hours after ⚫ avoid jarring of bed,
birth ⚫ avoid noise,
⚫ raise side rails
TONIC-CLONIC seizures ⚫ Prepare at the bedside:
⚫ before a seizure BP rises suddenly, ⚫ tongue blade,
⚫ temperature rises to 39.4 or 40°C, ⚫ O2 tank,
⚫ vision blurs, ⚫ suction machine
⚫ head aches, ⚫ Avoid stress
⚫ reflexes become hyperactive - give clear explanations of what is happening &
what is planned
⚫ Monitor BP q 4 hours or continuously

Laboratory studies:
⚫ CBC,
⚫ platelet count,
⚫ hematocrit,
⚫ hemoglobin,
⚫ liver & kidney function tests,
⚫ blood typing,
⚫ cross-matching
STAGES OF A SEIZURE: ⚫ Obtain daily weights at the same time each day
⚫ Aura, using
⚫ then all the muscles contract, her back arches, the same type of clothing
arms & legs stiffen, jaw closes abruptly (may ⚫ Monitor urine output (I & O)
bite her tongue off), respirations halt-TONIC ⚫ Monitor fetal well-being
STAGE ⚫ Diet with moderate or high protein & moderate I
 Nursing Care of the Client during Labor and Delivery
Sodium Assessment
⚫ Sudden gush of clear fluid from her vagina with
Medications: continued minimal leakage
1. hypotensive drug, hydralazine (Apresoline) or ⚫ Turns nitrazine paper to blue
labetalol (Normodyne) ⚫ Test for ferning
⚫ Amniotic fluid index via ultrasound
Magnesium sulfate- ⚫ WBC count and C-reactive protein
⚫ cathartic to reduce edema, ⚫ AVOID DOING ROUTINE EXAMINATION TO
⚫ CNS depressant; ⚫ MINIMIZE THE RISK FOR INFECTION
⚫ 1st given via IV infusion in a loading or bolus
dose Therapeutic Management
over 15 mins( BP lowers immediately but lasts for ⚫ Induction of labor by Oxytocin (for Term
only 50 to 60 mins) pregnancy,
⚫ to prevent convulsions,TL= 5 to 6 mg/100 ml with no labor for 24 hours)
⚫ Always as a piggyback infusion - to prevent infection
⚫ urine output must be > 30 ml/hr & ⚫ Preterm babies
⚫ RR > 12/min, -immediate delivery
⚫ serum Mg < 7.5 mEq/L ⚫ Administer corticosteroid to hasten lung maturity
⚫ MgSO4 toxicity leads to respiratory depression, ⚫ Prophylactic administration of Broad spectrum
arrhythmia, cardiac arrest antibiotics
⚫ Amnioinfusion to reduce pressure on the fetus or
*MgSO4 toxicity symptoms: (BURP) cord to allow a safer transfer

BP low
Urine output low( < 100 ml in 4 hours)
RR < 12 breaths/min
**Keep CALCIUM GLUCONATE at bedside (antidote to
MgSO4)
Patellar reflexes absent

Eclampsia
⚫ Maintain patent airway
⚫ Administer O2; assess oxygenation
⚫ Monitor FHT, contractions, vaginal bleeding (q 15
mins)
⚫ Position on her side to prevent aspiration raise
side rails, remove sharp or pointed objects
⚫ Keep her NPO

Medications:

MgSO4, diazepam
⚫ If > 24 weeks AOG, delivery within 12 to 24 hours
preferably vaginal delivery
⚫ Postpartum HPN- may occur up to 10 to 14 days
after
birth, usually within 48 hours

Premature Rupture of Membranes

⚫ Loss of amniotic fluid before 37 weeks AOG

⚫ Strongly associated with infections of
Membranes (Chorioamnionitis)
⚫ Preterm labor follows rupture of membranes and
ends
the pregnancy
⚫ Associated with vaginal infection (Neisseria
Gonorrhea, Group B streptococcus and
chlamydia)
⚫ Cause:unknown

Complication

⚫ Cord Prolapse
⚫ Potter-like Syndrome