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Reproductive System Diseases and Disorders 377
Figure 17-12 Fibroid tumors.
Figure 17-11 Ovarian cyst.
the uterus (Figure 17-12). They are the most common
tumor of the female reproductive system, occurring in
one out of five women over age 35.
■ Etiology. The cause of fibroid tumors is unknown,
but it is known that these tumors are stimulated by
estrogen and, thus, tend to occur during reproductive
years and regress or calcify after menopause. They often
appear in multiples and vary in size from small to quite
large. Small fibroids are often asymptomatic.
■ Symptoms. Symptoms include abnormal uterine
bleeding, excessive menstrual bleeding, and pain.
■ Diagnosis. Diagnosis is made on the basis of pelvic
examination and ultrasound.
■ Treatment. Treatment depends on the individual’s age
and desire for childbearing. Fibroids can be removed
surgically, but in older individuals, a hysterectomy
is often the treatment of choice. A technology called
high-intensity focused ultrasound (HIFU) that uses
sound waves to destroy tumors can be used to treat the
uterine fibroids.
■ Prevention. Fibroid tumors cannot be prevented.
Estrogen therapy and oral contraceptives do increase
risk of developing these tumors.
Toxic Shock Syndrome
■ Description. Toxic shock syndrome (TSS) is a severe,
life-threatening illness found almost exclusively in men
struating females using tampons.
■ Etiology. TSS is thought to be caused by Staphylo
coccus aureus, a normal flora bacterium of the skin that
produces an increased amount of toxin when in contact
with the synthetic fibers found in tampons.
■ Symptoms. Symptoms include the sudden onset of
high fever, vomiting, diarrhea, and a dropping blood
pressure.
■ Diagnosis. Diagnosis is made on the basis of history
of tampon use and symptoms. Complete blood count
(CBC), chest X-ray, and electrocardiogram (ECG) may
be completed to rule out other serious conditions.
■ Treatment. Treatment includes intravenous fluids to
counteract shock and antibiotics to treat the infection.
Untreated or delayed treatment may be fatal.
■ Prevention. The best preventive measure is to avoid
use of tampons. If this is not a good option, proper tam
pon usage helps reduce risk. Proper usage includes:
■ Good handwashing to decrease the number of bacteria
on the individual’s hands prior to tampon insertion
■ Avoiding superabsorbent tampons
■ Changing the tampon every two to three hours
Uterine Prolapse
■ Description. Uterine prolapse occurs when the uterus
drops or protrudes downward into the vagina. There are
varying degrees of prolapse (Figure 17-13).
378 Chapter 17
STAGES OF UTERINE PROLAPSE
Normal Anatomy
Stage 1 -
the uterus is in
the upper half of the
vagina
Stage 2 -
the uterus has
descended nearly to the
opening of the vagina
Stage 3 -
the uterus
protrudes out of the
vagina
Stage 4 -
the uterus is
completely out of the
vagina.
Figure 17-13 Uterine prolapse—varying degrees.
■ Etiology. Prolapse is commonly due to aging and
childbirth because these weaken the pelvic floor
muscles.
■ Symptoms. Symptoms include heaviness in the pel
vic area; urinary stress, incontinence, or dysuria; and
low back pain. With a complete prolapse, one can eas
ily see the uterus bulging out of the vaginal opening
(Figure 17-14). Although quite uncomfortable, this
condition is not an emergency or even a health risk
unless there is bleeding or an inability to urinate.
■ Diagnosis. Diagnosis is made on the basis of a pelvic
examination.
■ Treatment. A hysterectomy is often the surgical
treatment of choice, depending on the woman’s age and
desire to bear children.
■ Prevention. This condition might not be preventable.
Preventive behavior includes not smoking, maintain
ing a healthy weight, exercising daily, performing Kegel
exercises to strengthen pelvic floor muscles, and con
trolling coughing.
Cystocele
■ Description. Cystocele (SIS-toh-seel; cysto = urinary
bladder, cele = hernia) is the herniation, or protrusion,
of the urinary bladder through the anterior vaginal wall
(Figure 17-15).
■ Etiology. Cystocele is often due to weakening of or
trauma to the pelvic muscles related to aging and childbirth.
■ Symptoms. Symptoms include pelvic pressure, uri
nary urgency, frequency, and incontinence.
Figure 17-14 Uterine prolapse—complete.
■ Diagnosis. Diagnosis is made on the basis of a pelvic
examination.
■ Treatment. Treatment depends on the degree of her
niation. Strengthening the pelvic floor muscles with
exercise can be beneficial. The specific exercise (Kegel
exercise) is performed by contracting the pelvic floor
muscles (this group of muscles is tightened to cut off
urine flow) and releasing the muscles several times a
day. If the cystocele is large or exercise is ineffective,
surgery (anterior colporrhaphy) might be necessary.
■ Prevention. Preventive activities include not smok
ing, controlling coughing, avoiding heavy lifting, main
taining a healthy weight, controlling constipation, and
performing Kegel exercises.
Rectocele
■ Description. Rectocele is the herniation or protrusion
of the rectum through the posterior vaginal wall (see
Figure 17-15).
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Reproductive System Diseases and Disorders 379
Cystocele
Uterus
Bladder
Rectum
Vagina
Rectocele
Figure 17-15 Cystocele and rectocele.
■ Etiology. Rectocele, like a cystocele, is due to trauma
to this area during childbirth.
■ Symptoms. Symptoms include discomfort, constipa
tion, and fecal incontinence.
■ Diagnosis. Diagnosis is made on the basis of a phys
ical examination.
■ Treatment. Treatment commonly is surgical repair
(posterior colpoplasty). Often, the affected individual
needs both a cystocele repair and a rectocele repair,
called an anterior-posterior, or A&P, repair.
■ Prevention. Preventive activities include not smok
ing, avoiding coughing, maintaining a healthy body
weight, and performing Kegel exercises.
Cervical Cancer
■ Description. This cancer usually begins with
carcinoma in situ—neoplastic cells that sit on the
basement membrane and have not invaded into deeper
tissue. As the cancer progresses, ulceration and cervical
bleeding occur (Figure 17-16).
■ Etiology. Infection with high-risk human papillo
mavirus (HPV) often causes changes to the cells of the
cervix and is the major cause of cervical cancer. There
are over 60 types of HPV. Some types cause warts on
the hands and feet of children, whereas other types
cause genital warts. Infection with HPV is also known
to cause cancers of the oropharynx, vagina, vulva,
penis, and anus.
HPV is generally acquired through sexual contact.
Condoms cannot prevent the spread of HPV because
it is found on all genital tissues of the infected individ
ual. Males and females are usually asymptomatic with
Figure 17-16 Cervical cancer.
HPV infection. Discovery of HPV is usually made when
cervical changes are found with a Pap smear. It is very
difficult to trace exposure to the virus because it can
lie dormant on the cervix for 20 years before it causes
changes to the cells of the cervix.
Activities that increase risk of HPV infection
include:
■ Beginning sexual intercourse at an early age. This
activity generally results in an increase in the number
of sex partners over the individual’s lifetime.
■ Having multiple sexual partners. Studies show that
approximately 40% of young, sexually active females
carry HPV in their vaginas. Presumably, a similar
percentage of males are infected.
380 Chapter 17
One fact in support of these identified risk factors
is that females who abstain from sexual intercourse
throughout life do not get cervical cancer.
HPV infection does not cause cervical cancer in
all females. Most women who have evidence of HPV
on their cervix never get cervical cancer. Studies sug
gest that whether a female will develop cervical cancer
depends on a variety of factors acting together with
HPV infection. These factors include:
■ Decreased resistance to infection.
■ Smoking. Women who smoke concentrate nicotine
in their cervix, which harms the cells.
■ Sexual intercourse with males who smoke. Men
also concentrate nicotine in their genital secretions
and can bathe the cervix with these chemicals during
intercourse.
■ Sexual intercourse with a male whose previous
sexual partner was diagnosed with cervical cancer.
Females having sexual intercourse with men whose
former sexual partner was diagnosed with cervical
cancer are at greater risk of also developing cervical
cancer.
■ Obesity.
■ Excessive alcohol consumption.
■ Symptoms. Development of cervical cancer is usually
slow, and symptoms of abnormal cervical bleeding are
easily noticed, leading to early detection of this form of
cancer.
■ Diagnosis. Diagnosis of cervical cancer is made on
the basis of a Pap smear.
■ Treatment. Treatment is usually surgical removal of
the tumor. If metastasis has occurred, surgery is often
followed by radiation therapy. If the tumor has spread
into adjacent tissues, a complete hysterectomy might be
performed. Untreated, the tumor becomes inoperable
and fatal.
■ Prevention. Cervical cancer is one of the few prevent
able cancers. Regular Pap smear testing aids in iden
tifying precancerous cells, allowing treatment prior
to cancer development. Other activities to reduce risk
include vaccination against HPV, not smoking, limiting
the number of sexual partners, using condoms, and fol
lowing up on abnormal Pap tests.
The Food and Drug Administration (FDA) has
approved two HPV vaccines, Gardasil® and Cervarix®,
for girls age 9 to 26. Gardasil® has also been approved
for both girls and boys age 9 to 26 for prevention of
genital warts caused by HPV.
These vaccines are given in three individual doses and
are proven to be effective only if given before infection with
HPV. It is also recommended that the vaccines be given
before the individual becomes sexually active.
Neither of these vaccines has been proven to pro
vide complete protection against all strains of HPV, nor
will they prevent other sexually transmitted diseases.
Approximately 30% of cervical cancers will not be pre
vented by these vaccines.
Cervical cancer at one time was a leading cause of
death in females. Increased screening and HPV vacci
nation have reduced the incidence of this cancer by over
50% in the last 35 years.
Uterine Cancer
■ Description. Uterine cancer develops in the inner lin
ing of the uterus, the endometrium, and spreads into the
uterine wall (Figure 17-17). Uterine cancer also may be
called endometrial cancer.
■ Etiology. This type of cancer usually occurs in post
menopausal females who have never had children.
Increased risk factors include infertility, obesity, and
prolonged estrogen stimulation as occurs with hormone
replacement therapy.
■ Symptoms. A symptom of uterine cancer is abnormal
bleeding, which is quite noticeable in postmenopausal
Figure 17-17 Uterine cancer.
Courtesy of Mark L. Kuss
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Reproductive System Diseases and Disorders 381
females and usually leads to early detection of this form
of cancer.
■ Diagnosis. Diagnosis is made on the basis of visual
examination and endometrial biopsy.
■ Treatment. Treatment is very successful if the cancer
is discovered in its early stages and includes surgical
removal of the ovaries and uterus, combined with radi
ation therapy.
■ Prevention. Most cases are not preventable, but
reducing risk factors is helpful. Risk reduction
includes a history of taking oral contraceptives or
birth control pills and taking hormone therapy with
progestin after menopause. Other activities to reduce
risk include not smoking and maintaining a healthy
weight.
Ovarian Cancer
■ Description. Ovarian cancer is quite common and
often fatal (Figure 17-18).
■ Etiology. The cause of ovarian cancer is unknown,
and the ovaries’ position deep in the pelvis makes dis
covery of this tumor difficult. Often, extensive metasta
sis will occur before noticeable symptoms present.
■ Symptoms. Symptoms include a feeling of pressure
on the bladder, low abdominal or pelvic pain, and a gen
eral feeling of ill health.
■ Diagnosis. Diagnosis is made on the basis of physi
cal examination and visualization of the mass during an
exploratory laparoscopy.
■ Treatment. Treatment depends on the stage of the
cancer and often includes a complete hysterectomy,
radiation, and chemotherapy. Prognosis is good with
early detection, but as stated previously, this is not
the usual case. If metastasis has occurred, this cancer
can be fatal in one to two years. The only preventive
measure is early detection through annual gyneco
logic exams.
■ Prevention. Activities that lower risk include a his
tory of taking oral contraceptive (birth control pills),
bearing at least one child, and breast-feeding for at
least one year. An interesting fact about preventive
activities is that having a tubal ligation reduces risk
more than having a hysterectomy. The reason for this
is unknown.
Diseases of the Breast
Diseases of the breast are quite common, affecting one
in eight women in the United States and ranging from
mild to life-threatening. Breast self-examination and
mammography are important methods of screening
for cancer. Although women are most often affected
with breast diseases, men also can be affected. Any
change from normal in tissue shape or appearance in
males or females should be called to the attention of
a physician.
Figure 17-18 Ovarian cancer.
Consider This...
Breast pain is the second most common
breast symptom for which women seek med
ical attention, second only to finding a lump
in the breast.
Fibrocystic Disease
■ Description. Fibrocystic disease of the breast is
the most common breast disorder of premenopausal
females between the ages of 30 and 55.
■ Etiology. It is thought that the development of cysts
is linked to estrogen levels.
■ Symptoms. This disorder is characterized by:
382 Chapter 17
■ An irregular, lumpy feeling in the breast, usually in
the upper outer quadrant area of the breast.
■ Breast discomfort that is persistent or occurs on and
off, typically peaking around the menstrual period
and receding afterward.
■ Breast often feeling heavy, full, and tender.
■ A tendency to run in families.
Fibrocystic disease causes an increased risk of can
cer approximately one-and-a-half times that of the
normal population. Multiple cysts also make detection
of neoplasm more difficult. For these reasons, affected
females need to perform monthly breast self-examina
tions routinely and have yearly mammograms. Females
with severe fibrocystic disease and at high risk of breast
cancer might decide to have a prophylactic (preven
tive) mastectomy.
■ Diagnosis. Diagnosis is made primarily by feeling,
or palpation, of lumpy areas in the breast. Breasts that
have many areas of fibrocystic disease can be difficult
to palpate and to mammogram properly. In this case,
breast ultrasound can be helpful. If there is a suspicious
area, a needle or surgical biopsy can be performed to
confirm diagnosis.
■ Treatment. Measures to decrease breast pain due to
fibrocystic disease include elimination of caffeine in the
diet, reduction of salt intake, the use of a mild diuretic
the week prior to menstruation, and the use of mild
analgesics. For severe cases, hormonal therapy with
synthetic androgen might be helpful.
■ Prevention. This condition is often not preventable,
but decreasing dietary fat and caffeine can be helpful.
Consider This...
There is no published medical literature
showing that wearing brassieres prevents
breast sagging.
Mastitis
■ Description. Mastitis (mas-TYE-tis; mast = breast,
itis = inflammation) is inflammation of the breast tis
sue and is a broad term covering a variety of diseases
and disorders. The type of mastitis commonly thought
of is puerperal (Pyou-ER-per-al; childbirth) mastitis
(Figure 17-19).
Figure 17-19 Mastitis.
Courtesy of Mark L. Kuss
■ Etiology. Puerperal mastitis occurs when bacteria
from the nursing baby’s mouth or mother’s hands enter
the breast tissue through the nipple and cause infection.
■ Symptoms. Symptoms include redness, heat, swell
ing, pain, and, often, bloody discharge from the nipple.
■ Diagnosis. Diagnosis is made on the basis of symptoms.
■ Treatment. Treatment includes antibiotics, applica
tion of heat, analgesics, and a firm support brassiere to
decrease discomfort.
■ Prevention. Preventive measures include complete
emptying of the breast when breast-feeding. The baby
should completely empty one breast before the other is
offered.
Breast Cancer
■ Description. Breast cancer is an adenocarcinoma
(adeno = gland, carcinoma = cancer) of the breast
ducts. It is second only to skin cancer as the most com
mon neoplasm affecting women. It is also the second
leading cause of cancer death in women (National
Breast Cancer Foundation, 2021). Monthly breast self
examinations and routine mammograms are a must for
early detection of breast cancer.
■ Etiology. The cause of breast cancer is unknown, but
possible identified risk factors include:
■ Age 40 and over
■ Family member affected with breast cancer
■ Early onset of menses
■ Late menopause
■ Nullipara (nuh-LIP-ah-rah; nulli = none or no,
para = births)
■ First child after age 30
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Reproductive System Diseases and Disorders 383
■ Obesity
■ Chronic breast disease
Researchers (Hiseh and Trichopoulos, 1991; Singer
and Grismaijer, 1995) reported that both brassiere wear
time and breast size respectively were risk factors for
breast cancer. In 2012, a study at Biomed Central Medial
Genetics determines that breast size can be of help when
determining breast cancer risk. They concluded that larger
breast size is associated with a slightly higher risk of breast
cancer (Biomed, 2012). In 2015, Susan G. Komen Founda
tion (2015) published that while brassiere wear time does
not increase breast cancer risk, it is undetermined at this
time whether larger breast size is a risk factor.
■ Symptoms. Symptoms of breast cancer include a
non-tender lump of varying size. These occur most
often in the upper outer quadrant of the breast, near
the axillary area. The lump might cause a dimpling of
the skin, or the nipple might be retracted. Often, there
are no visual symptoms.
■ Diagnosis. Diagnosis is made on the basis of the pres
ence of the lump, mammogram, and biopsy. A biopsy is
the definitive test and can be performed by aspiration
or surgery. Prognosis is good if the lump is found early.
However, metastasis is common and usually affects the
lungs, liver, brain, and bone. If metastasis has occurred,
the prognosis can be poor.
■ Treatment. Treatment is usually surgical removal
of the mass or the breast (mastectomy: mas-TECK-
toh-me; mast = breast, ectomy = excision), followed
by chemotherapy, radiation therapy, or both. Carcinoma
spreads through the lymphatic system, so removal of
the lymph nodes and lymph vessels is a common proce
dure. Several types of surgical procedures are performed
for breast cancer, depending on the location, size,
and metastasis of the tumor. Commonly, these types of
surgery include:
■ Lumpectomy, involving removal of the lump only.
■ Simple or total mastectomy, involving removal of the
breast and nipple.
■ Modified radical mastectomy, involving removal of
the breast, nipple, and lymph nodes.
■ Radical mastectomy, involving removal of the breast,
nipple, lymph nodes, and underlying chest (pectoral)
muscles (Figure 17-20).
Mastectomy surgery not only causes an alteration in
the physical image but also can lead to a variety of psy
chological disorders for a female. For this reason, many
women decide to have reconstructive surgery (mam-
moplasty) performed along with the mastectomy in an
effort to reduce the physical and psychological trauma.
Mammoplasty (MAM-oh-PLAS-tee; mammo =
breast, plasty = surgical repair or restructuring)
involves reconstruction of the breast with plastic sur
gery and prosthetic breast implants or skin flaps.
Many new post-mastectomy or post-lumpectomy
treatments are reducing the rate of recurrence of the
disease. Depending on the type of breast cancer, med
ications that target the specific problem (such as hor
mone, protein receptor, or blood vessel problems) are
having a positive impact on the disease.
■ Prevention. Preventive measures include reducing
identified risk factors.
Lumpectomy Simple or
total
Modified
radical
Radical
mastectomy
Figure 17-20 Types of mastectomy.
384 Chapter 17
Art and Music
Therapy to Improve
Quality of Life for
Breast Cancer
Patients
Complementary and Alternative Therapy
A
long with the physical trauma of breast cancer comes the emotional trauma due to
stress, treatments, fear, surgery, and change in quality of life. Even if the physical
aspects are corrected or the patient is determined to be a survivor after treatment, the
emotional burden seems to linger for extended periods of time. This study, a review of
many previous studies, found that art therapy and music therapy are forms of emotional
support for the individuals and have a positive impact on their emotional well-being.
Art and music therapy help with depression, anxiety, self-esteem, quality of life perspec
tive, and may even help reduce pain and fatigue during the cancer treatment period.
Some studies even found that these therapies are helpful during the cancer treatment,
not just after it is completed. This study recommended further that research in this area
be conducted and reported that complementary and alternative therapies like art and
music therapy be more widely used for oncology patients.
Source: Kievisiene et al. (2020)
Consider This...
The three things pregnant women dream
about most often during their first trimester
are frogs, worms, and potted plants.
Disorders of Pregnancy
Pregnancy is a normal condition of developing a fetus
in the female body. However, disorders of pregnancy
range from mild to life-threatening, sometimes risking
the lives of the mother and the fetus. For this reason,
the importance of prenatal care cannot be stressed
enough.
Ectopic Pregnancy
■ Description. Ectopic (eck-TOP-ick; displaced) preg
nancy occurs when a fertilized ovum attaches to tissue
outside the uterus, most commonly in the fallopian
tubes.
■ Etiology. Strictures, adhesions, and scarring of the
fallopian tubes due to PID, inflammation, infection, and
structural defects can cause the tube to be narrowed,
allowing microscopic-sized sperm to travel up the tube
and fertilize the ovum, whereas the larger ovum is
unable to travel down the tube and implant normally in
the uterus. Other ectopic sites include the ovary, cervix,
intestine, and outside wall of the uterus (Figure 17-21).
■ Symptoms. Symptoms of ectopic pregnancy include
acute pelvic pain, vaginal bleeding, and a positive preg
nancy test. If large blood vessels are ruptured, bleeding
can be heavy, and the affected female might show symp
toms of shock.
■ Diagnosis. Diagnosis is made on the basis of symp
toms, a pelvic examination, and ultrasound.
■ Treatment. Treatment is prompt surgery to terminate
the pregnancy and decrease the possibility of shock,
which can be life-threatening. Blood replacement also
might be needed. If the female wants to bear children,
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Reproductive System Diseases and Disorders 385
every effort is made to preserve the affected ovary
and tube.
■ Prevention. Two preventive measures are to not
smoke and to practice safe sex. Those who smoke, or
who have smoked in the past, are at higher risk of ecto
pic pregnancy. Practicing safe sex lowers the risk of
STD, the most common cause of this condition.
Spontaneous Abortion (Miscarriage)
■ Description. Spontaneous abortion is the natural ter
mination of pregnancy before the fetus is able to live
on its own. This type of abortion is commonly called
miscarriage.
■ Etiology. The cause of spontaneous abortion is
unknown. It is believed that it might be due to infec
tion, drug use by the pregnant mother, abnormal fetal
development, or an incompetent cervix (one that dilates
prematurely). Approximately one in every six pregnan
cies ends with spontaneous abortion, and 75% of these
occur in the first 12 weeks. The risk is higher during a
woman’s first pregnancy.
■ Symptoms. Symptoms of miscarriage include vaginal
bleeding, cramping, and pelvic pain, usually in the first
trimester of pregnancy. If bleeding is severe, shock is of
major concern.
■ Diagnosis. Diagnosis is made on the basis of symp
toms and pelvic ultrasound.
■ Treatment. Bed rest is the treatment of choice if
bleeding is not severe. Bed rest is continued until spot
ting stops. If the individual is hemorrhaging and show
ing signs of shock, hospitalization might be needed to
control hemorrhage and give blood replacement. After
spontaneous abortion begins, its progression is difficult
to stop. A surgical D&C can be performed to remove
any tissue remaining in the uterus after the abortion.
■ Prevention. There is no way to prevent spontaneous
abortion, but activities to reduce risk include not smok
ing, eating healthy foods, monitoring and controlling
chronic diseases, and taking folic acid prior to becom
ing pregnant.
Morning Sickness
■ Description. Morning sickness is the nausea and
vomiting associated with pregnancy, usually occurring
in the first trimester of pregnancy.
■ Etiology. The cause of morning sickness is unknown,
but it is thought to be due to hormonal changes related
to pregnancy. It is also believed that hunger might play
some part in the cause.
■ Symptoms. Morning sickness, as its name implies,
usually occurs in the morning, but it also can occur
later in the day. Approximately 50% of pregnant females
experience varying degrees of morning sickness.
■ Diagnosis. Morning sickness is diagnosed by symp
toms in a pregnant female.
■ Treatment. Treatment is not necessary unless there
is excessive vomiting, which can lead to dehydration
and weight loss. This condition is then termed hyper
emesis gravidarum. No antiemetic (anti = against,
emetic = vomiting) medication has been approved
by the FDA for morning sickness, and taking med
ications at this time in pregnancy can lead to fetal
abnormalities.
■ Prevention. Morning sickness might not be prevent
able, but activities that might help reduce morning sick
ness include:
■ Eating something light such as soda crackers before
getting out of bed in the morning.
■ Eating dry foods before drinking liquids.
■ Eating several small meals during the day instead of
three large ones.
■ Avoiding fatty foods such as fried foods, butter, and
margarine.
■ Resting after meals.
Hyperemesis Gravidarum
■ Description. Hyperemesis (hyper = excessive, emesis =
vomiting) gravidarum is excessive vomiting during
pregnancy.
■ Etiology. The cause is unknown but is thought to be
due to an increased production of chorionic gonado
tropin by the fetus. This thought is supported by the
fact that hyperemesis gravidarum occurs more often in
pregnancies with multiple fetuses.
■ Symptoms. This condition can lead to dehydration,
weight loss, and possible electrolyte imbalances in the
mother and baby. The condition is not usually life
threatening, but prompt medical attention is needed to
preserve the health of the mother and baby.
■ Diagnosis. Diagnosis is made on the basis of symptoms.
■ Treatment. Severe cases can be treated with intravenous
fluids and by withholding all foods and oral fluids. Most
cases subside by the second trimester of pregnancy.
386 Chapter 17
■ Prevention. This condition cannot be prevented.
Vomiting might be lessened by maintaining a healthy
diet, eating dry foods, taking several small meals
throughout the day, getting adequate sleep, reducing
stress, and eating soda crackers before rising from bed
in the morning.
Toxemia
■ Description. Toxemia is a condition usually appearing
in the third trimester of pregnancy. The name of this
condition is misleading because there is no toxin in the
blood, but it was once thought that the fetus produced
a toxin that led to toxemia.
■ Etiology. The cause of toxemia is unknown, but it
does tend to occur more frequently in:
■ Individuals with poor prenatal care.
■ Primigravid (PRE-mih-GRAV-id; primi = first,
gravid = pregnancy) females younger than 20 years
of age and older than 30.
■ Individuals with poor nutritional intake.
■ Those who are hypertensive prior to becoming
pregnant.
■ Multiparity (mul-TIP-ah-rah-tee; multiple births),
especially in individuals who have had five or more
pregnancies.
■ Symptoms. Toxemia is characterized by hyper
tension, sudden weight gain, proteinuria (protein =
blood protein, uria = urine), and edema in the face,
hands, and feet. It is also called preeclampsia (PREE-
ee-KLAMP-see-ah). The individual with toxemia is
preeclamptic before convulsions occur. Toxemia or
preeclampsia, if untreated or unresolved, can progress
into eclampsia (eh-KLAMP-see-ah), a condition char
acterized by all the symptoms of toxemia or preeclamp
sia plus convulsions. Eclampsia can lead to abruptio
placentae and become life-threatening to the mother
and baby.
■ Diagnosis. Diagnosis is made on the basis of symptoms.
■ Treatment. Treatment includes frequent monitoring
of blood pressure, weight, and urine protein as part of
prenatal care. If symptoms of toxemia occur, a low-salt
diet and antihypertensive medications might be rec
ommended. If toxemia becomes severe, hospitalization
in a quiet environment with frequent monitoring and
administration of antihypertensive medications is the
usual therapy to prevent convulsions. Prognosis is good
because delivery of the baby or termination of the preg
nancy resolves the problem.
■ Prevention. This condition is not preventable, but
good prenatal care and good nutrition greatly reduce
the risk of toxemia.
Abruptio Placentae
■ Description. Abruptio placentae is the sudden sepa
ration of the placenta from the uterus prior to or during
labor (Figure 17-22).
■ Etiology. Often, the cause is unknown, but convul
sions, trauma, multiple births, and chronic hyperten
sion are known causes.
■ Symptoms. The degree of separation determines
the symptoms. A partial separation during labor
might be asymptomatic, whereas a complete sepa
ration prior to labor can be life-threatening to the
mother and baby. Symptoms of a complete separa
tion can include severe abdominal pain with large
amounts of vaginal bleeding (hemorrhage), shock, a
decrease in fetal heart tones, and a decrease in fetal
activity. Complete separations are a medical emer
gency because these can lead to maternal death from
hemorrhage and death of the baby from a lack of
oxygen and nutrition.
■ Diagnosis. Diagnosis is usually made on the basis
of clinical history because there is not time for other
testing.
■ Treatment. Treatment is prompt delivery, either vagi-
nally or by surgical cesarean section (C-section). Blood
replacement also might be needed.
■ Prevention. Abruptio placentae is often not pre
ventable. Controlling risk factors such as not smoking,
preventing maternal trauma such as that caused by
domestic violence, and avoiding substance abuse are all
helpful in reducing risks.
Placenta Previa
■ Description. Placenta previa is the abnormal posi
tioning of the placenta in the lower uterus, often near
or over the cervical os or opening (see Figure 17-22).
If the placenta is totally over the os, it is a complete
placenta previa; partial covering is a partial placenta
previa.
■ Etiology. The cause of this condition is unknown.
Some risk factors include multiparity, maternal age over
35, and previous uterine surgery.
■ Symptoms. The affected individual has symptoms of
painless, bright red vaginal bleeding during the third
trimester of pregnancy. Vital signs can indicate shock
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