NCLEX Review Guide: Additional Complications During Pregnancy

Hyperemesis Gravidarum

• Hyperemesis gravidarum is severe nausea and vomiting during pregnancy that leads to dehydration, electrolyte imbalances, and weight loss >5% of pre-pregnancy weight. It typically occurs in the first trimester and differs from normal morning sickness by its severity and persistence.
• Monitor for ketosis, dehydration, and electrolyte imbalances - check urine ketones, serum electrolytes, and daily weights.

Gestational Diabetes Mellitus (GDM)

• Gestational diabetes develops during pregnancy due to insulin resistance caused by placental hormones. It typically appears between 24-28 weeks gestation and increases risks for both mother and baby.
• Screening occurs at 24-28 weeks using glucose tolerance test - fasting glucose >92 mg/dL or 2-hour glucose >153 mg/dL indicates GDM.

Incompetent Cervix (Cervical Insufficiency)

• Cervical insufficiency occurs when the cervix opens prematurely without contractions, typically in the second trimester. It often results from previous cervical trauma or congenital weakness.
• Painless cervical dilation is the hallmark sign - patient may report pelvic pressure or vaginal discharge without contractions.

1. Diagnosis via transvaginal ultrasound showing cervical length <25mm
2. Cervical cerclage placement between 12-14 weeks gestation
3. Activity restriction and pelvic rest
4. Cerclage removal at 36-37 weeks or with labor onset