Professional Documents
Culture Documents
CERVIX
• Internal cervical os opens into the uterus
• external cervical os opens into the vagina
• cervical canal is located between the internal os and the external os
FALLOPIAN TUBES
• Also called as oviducts
• tubes that propel the ova from the ovaries to the uterus
• Has four parts:
a) fimbriae
b) ampulla
c) isthmus
d) interstitial portion
OVARIES
VAGINA
• Known as the birth canal
• The organ for copulation
• passageway for menstrual blood flow
• passageway for fetus
MENSTRUATION
1
Body structures involved:
a. Hypothalamus
b. Anterior Pituitary gland
c. Ovary
d. Uterus
FSHRF
FSH
Primordial follicle
Estrogen in the graafian follicle will stimulate the uterine endothelium to proliferate
Estrogen + progesterone – pushes the mature ovum to the surface of the ovary
Graafian follicle- rupture and release the mature ovum on the 14th day of
menstrual cycle ( process of ovulation).
PROGESTERONE cause the gland of the uterine endothelium to become corkscrew or twisted in
appearance because of the amount of capillaries
24TH day of menstrual cycle- if the mature ovum is not fertilized by sperm, the corpus luteum will
degenerate. It will turn to white appearance- CORPUS ALBICANS.
• 3-4 days- the thickened lining of the uterus produced by the estrogen starts to
degenerate and slough and the capillaries rupture
2
It’s good to continue moderate exercise during menses because it increases abdominal
tone. Sustained excessive exercise, such as professional athletes, can cause
amenorrhea.
Sexual relations not contraindicated during menses ( the male should wear a condom to
prevent exposure to body fluids.) Orgasm may increase menstrual flow.
Activities of daily life is not contraindicated (many people believe incorrectly that things
like washing hair are harmful)
Mild analgesic is helpful. Prostaglandin inhibitors such as ibuprofen are specific for
menstrual pain. Applying local heat may also be helpful.
More rest may be helpful if dysmenorrhea interferes with sleep at night.
Many women need iron supplementation to replace iron lost in menses. Eating pickles or
cold food does not cause dysmenorrhea.
FERTILIZATION
• takes place when sperm and ovum unite
• occurs in the ampulla of the fallopian tubes
• Once fertilized, the membrane of the ovum undergoes changes that prevents the entry of
other sperm
• The sperm carries the hormone HYALURONIDASE
• The ovum has two coverings; Zona Pellucida and Corona Radiata
IMPLANTATION
• Zygote is propelled toward the uterus
• zygote implants 7 to 10 days after ovulation
• blastocyst secretes choronic gonadotropin to ensure that the corpus luteum remains
viable and secretes estrogen and progesterone for the first 2 to 3 months of gestation.
AMNION
• encloses the amniotic cavity
• is the inner membrane that forms about the second week of embryonic development
• forms a fluid-filled sac that surrounds the embryo and later the fetus
CHORION
• is the outer membrane
• becomes vascularized and forms the fetal part of the placenta
DECIDUA
• Is the specialized endometrium of pregnancy.
a) Decidua Basalis
b) Decidua Capsularis
c) Decidua Vera
PLACENTA
• Is the organ that sustains and nourishes the growing pregnancy.
• Begins to develop during the 5th week after fertilization at the site of implantation.
• Made up of many lobes or sections, called cotyledons.
• Is the exchange site for nutrients and wastes between the fetal and maternal circulatory
systems.
• Weight at term is 400 – 600 grams
3
Estrogen
Progesterone
Human Chorionic Gonadotropin (HCG)
Human Placental Lactogen (hPL) also called as Human Chorionic Somatomammotropin
ESTROGEN functions to provide a rich blood supply to the decidua and placenta.
PROGESTERONE is necessary to maintain the nutrient-rich decidua. It also functions to
keep the myometrium quiet, so that contractions do not occur prematurely.
HCG sustains the corpus luteum at the beginning of the pregnancy. This hormone is also
responsible for the POSITIVE PREGNANCY TEST.
hPL regulates the glucose that is available for the fetus.
1. Fetal side
white, shiny, with blood vessels
2. Maternal side
Red, rough, with cotyledons
1. Schultze’s mechanism
fetal part appears first
White, shiny, with blood vessels
most common, occurs to 80% of deliveries.
2. Duncan’s mechanism
Maternal part appears first
Red, rough, with cotyledons
Less common, occurs to 20% of deliveries
4
Chromosomal abnormalities
Fetal infection
Placental infarcts
Maternal nutritional deficiencies
Maternal hypertension
PIH
Maternal renal disease
Maternal smoking
Maternal illegal drug use
Toxin/teratogen exposure
Multifetal pregnancy
AMNIOTIC FLUID
Functions:
Physical protection
Temperature regulation
Provision of unrestricted movement
provision of symmetrical growth
pH is 7.2, alkaline
clear
Sometimes with white specks
Normal amount is 800 to 1200 cc
AMNIOCENTESIS
Definition:
- is the withdrawal of amniotic fluid through the abdominal wall for analysis at the 14th to
16th week of pregnancy.
The procedure can be done at the physician’s office or an ambulatory clinic.
Nursing Consideration:
Ask the woman to void before the procedure (to reduce the size of the bladder, thus
preventing in advertent puncture).
During the procedure and for the 30 mins afterward, assess the fetal heart rate monitor
and uterine contraction monitor to be certain the fetal heart rate remains normal and no
uterine contractions are occuring.
If the woman has Rh – negative blood, Rho (D) immune globulin (RhoGAM) may be
administered after the procedure to prevent fetal isoimmunization.
COLOR:
Normal amniotic fluid is the color of water.
A strong yellow color suggests a blood incompatibility (the yellow results from the presence of
bilirubin released with the hemolysis of red blood cells)
A green color suggests meconium staining, a phenomenon associated with fetal distress.
ALPHA-FETOPROTEIN
Is a substance produced by the fetal liver that is present in amniotic fluid and maternal
serum.
• The level is abnormally high if the fetus has an open spinal defect (such as neural tube
defects) because the open defect allows more alpha-fetoprotein to appear.
• The level is low if the fetus has a chromosomal defect, such as Down syndrome.
LECITHIN/SPHINGOMYELIN RATIO
5
Lecithin and sphingomyelin are the protein components of the lung enzyme surfactant that the
alveoli begin to form about the 22nd to 24th weeks of pregnancy.
A ratio of 2:1 is traditionally accepted as lung maturity.
Mature lung profiles are usually found after 35 weeks gestation.
COMPLICATIONS:
Premature labor
Infection
Rh isoimmunization
Fetal deaths
Complications can be prevented if amniocentesis is done by an experienced
obstetrician with the aid of ultrasound.
UMBILICAL CORD
Average length is 50 – 55 cm
contains two arteries and one vein
Arteries carry deoxygenated blood and waste products from the fetus
vein carries oxygenated blood and provides oxygen and nutrients to the fetus
Wharton’s jelly – clear gelatinous substance that gives support to the cord and helps
prevent compression of the cord.
MESODERM
o Supporting structures of the body (connective tissues, bones, cartilage, muscle,
ligaments and tendons)
o Dentin of teeth
o Upper portion of the urinary system (kidneys and ureters)
o Reproductive system
o Heart
o Circulatory system
o Blood cells; Lymph vessels
ENTODERM /ENDODERM
Lining of the pericardial, pleura, and peritoneal cavities
Lining of the GIT, Resp. tract, tonsils, parathyroid, thyroid, thymus gland
Lower Urinary system (bladder and urethra)
ORGANOGENESIS
6
Organ formation
Will be completed at 8 weeks gestation
TERATOGENS
Teratogens are substance that cause birth defects.
The severity of the defect depends upon when during the development the conceptus is
exposed to the teratogen and the particular teratogenic agent to which the fetus is
exposed
Exposure to a teratogen during the embryonic stage produces the greatest damaging
effects than exposure during the fetal stage.
INFECTIOUS AGENTS:
Varicella Fetal Varicella syndrome, which ranges in severity from
ENVIRONMENTAL AGENTS:
Mercury Neurologic damage, blindness
FETAL ORGANS
CARDIOVASCULAR SYSTEM
The first system to be functioning
Heart beating will start on the 24th day from fertilization
can be heard with the use of doppler at 10th to 12th week gestation
Can be heard with the use of stethoscope at 18th to 20th week gestation
Normal FHR is 120 – 160 beats per minute
RESPIRATORY SYSTEM:
Alveoli and capillaries begin to form at 24th to 28th week gestation
SURFACTANT is a phospholipid substance formed and excreted by the alveolar cells at
about 24th week of pregnancy
NERVOUS SYSTEM
7
Anoxia
Hypoxia
DIGESTIVE SYSTEM:
Meconium is present at GIT on the 16th week
MUSCULOSKELETAL SYSTEM:
Quickening is the first fetal movement felt by the mother
quickening is on the 20th week gestation
INTEGUMENTARY SYSTEM:
Lanugo are fine downy hair
Vernix caseosa is the white cheezy substance found on the skin of the baby, secreted by
the sebaceous glands of the skin
MILESTONE OF DEVELOPMENT
END OF 8 WEEKS GESTATION
Organogenesis is complete
Heart is beating rhythmically
Sonogram shows a gestational sac
END OF 12 WEEKS
Sex is distinguishable
Kidney secretion has begun
END OF 16 WEEKS
FHR are audible with an ordinary stethoscope
Lanugo is well formed
Liver and pancreas are functioning
END OF 20 WEEKS
Fetal movement can be sensed by the mother
Meconium is present in the upper intestine
Vernix Caseosa begins to form
Sleeping and activity patterns are distinguishable
End of 24 weeks
Active production of lung surfactant begins
Eyelids open
Pupils are capable of reacting to light
End of 28 weeks
Lung alveoli begin to mature
Testes begin to descend into the scrotal sac
End of 32 weeks
Subcutaneous fat begins to be deposited
Delivery position may be assumed
Fingernails grow to reach the end of fingertips
End of 36 weeks
Amount of lanugo present begins to diminish
End of 40 weeks
Fingernails extend over the fingertips
Creases on the soles of the feet cover at least two thirds of the surface
Nagele’s rule:
Count back 3 months then add 7 days from the first day of the last
menstrual period.
Mc Donald’s Rule:
The fundal height in cm is equal to the age of gestation between 20 - 31 weeks
of pregnancy
8
NST is the assessment of the Fetal Heart Rate in relation to Fetal Movement
Preparation:
Patient should eat snacks.
RESULT:
REACTIVE ( NORMAL)
FHR should increase of 15 beats from the baseline that will last for 15 seconds,
when the baby moves.
CST is the assessment of the fetal heart rate in relation to uterine contraction
There must be at least three uterine contraction that will last for 40 seconds or more.
RESULT:
NEGATIVE (NORMAL)
- there are no late decelerations after any of the contractions
POSITIVE (abnormal)
2. FETAL MOVEMENTS:
INSTRUMENT USED: Sonogram
CRITERIA FOR A SCORE OF 2:
At least 3 separate episodes of fetal limb or trunk movement within a 30 mins
observation
3. FETAL TONE
INSTRUMENT USED: Sonogram
CRITERIA FOR A SCORE OF 2:
The fetus must extend & then flex the extremities or spine at least once in 30
mins.
5. PLACENTAL GRADE
INSTRUMENT USED: Sonogram
CRITERIA FOR A SCORE OF 2:
Placenta is grade 3. Grading is based on structure & amount of calcium present.
DIAGNOSIS OF PREGNANCY
9
I. PRESUMPTIVE SIGNS
o Breast changes
o Nausea, vomiting
o Amenorrhea
o Frequent urination
o Fatigue
o Uterine Enlargement
o Quickening
o Linea Nigra
o Melasma / Chloasma
o Striae gravidarum
PROBABLE SIGNS
o Serum Lab Test
o Goodell’s sign
o Hegar’s sign
o Chadwick’s sign
o Sonographic evidence of gestational sac
o Ballotement
o Braxton Hicks
o Fetal outline felt by examiner
POSITIVE SIGNS
o Sonographic evidence of fetal outline
o Fetal heart audible
o Fetal movement felt by examiner
b) Hegars sign
c) Ballotement
Ballotement occurs when the examiner pushes up on the uterine wall
during a pelvic examination, then feels the fetus bounce back against the
examiner’s fingers.
d) Braxton Hicks Contractions
Amenorrhea
Cervical changes
a) Mucus plug
- tenacious coating of mucus
b) Goodel’s sign
Vaginal Changes
a) Leukorrhea
b) chadwick’s sign
c) vaginal pH changes from 7 or above to 4 or 5 (acidic)
d) favors candida albicans which will cause oral thrush or oral moniliasis
Ovarian changes
no ovulation
Breast changes
10
a) increase in size, darkened and enlarged areola, fullness
b) colostrum will be seen on the 16th week AOG
Skin
a) Striae gravidarum
b) melasma
c) Linea Nigra
GIT
a) slow peristalsis
b) Nausea and vomiting
c) hyperptyalism
d) hypertrophy of the gumlines
Skeletal system
a) Lordosis - “pride of pregnancy”
- lordosis causes back pains
- Pelvic rocking or pelvic tilting -management of back pains caused by lordosis.
OBSTETRICAL HISTORY
GRAVIDA (G) is the number of pregnancies.
Constipation
have a regular time for bowel movements.
Increase fiber in the diet
drink additional fluids.
11
eat six small meals per day rather than three.
Eat a piece of dry toast or some crackers before getting out of bed.
Pyrosis or Heartburn
eat small, frequent meals each day.
Avoid overeating, as well as spicy, fatty, and fried foods.
Avoid bending or lying after eating.
Avoid carbonated drinks.
Fatigue
schedule rest period daily
Have a regular bedtime routine.
Use extra pillows for comfort.
Muscle cramps
avoid pointing your toes.
Straighten your leg and dorsiflex ankle.
Increase calcium intake
Varicosities
walk regularly.
Rest with feet elevated.
wear a well support stockings
avoid constricting stockings
Hemorrhoids
Avoid constipation and straining with a bowel movement.
Take a sitz bath.
Leukorrhea
wear cotton underwear.
Bathe daily.
Avoid tight pantyhose.
Ankle edema
rest with feet elevated.
Avoid standing for long periods and avoid restrictive clothings.
1. Tailor sitting
2. Kegel’s exercise
3. Squatting
4. Pelvic rocking
12
Lightening
Frequently occuring braxton hicks
Increased level of activity
Ripening of the cervix
COMPONENTS OF LABOR
4 P’s of Labor
P – Passenger
P – Passage
P - Power
P - Psyche
PASSAGE
1. Vaginal Canal
2. Cervix
a) Cervical dilatation
10 cm is the fully dilated cervix
b) Cervical effacement
100% is the fully effaced cervix.
3. Pelvic bone
4 Types of pelvis
ANDROID
• Narrow, heart-shaped
• - Male type pelvis
ANTHROPOID
• Narrow, oval shaped;
• - resembles ape pelvis
Gynecoid
• Classic female pelvis
• Suitable for vaginal delivery
• Wide and round in all directions
PLATYPELLOID
• Flattened, oval, transverse shape
• Broad pelvis with shortened AP diameter
PASSENGER
FETAL SKULL:
Occipital bone
Frontal bone
Parietal bones
Temporal bones
13
SUTURES are fibrous joints of the fetal skull
Types of suture:
Coronal suture – the joint between the frontal bones and the parietal bones
SAgittal suture – the joint between the two parietal bones.
Lambdoidal suture – the joint between the two parietal bones and the occipital bones
ATTITUDE
- the degree of flexion of the fetus
- the relationship of the fetal parts towards each other.
STATION:
is the relationship of the presenting part to the ischial spines of the maternal’s pelvis
FETAL LIE
is the relationship between the long axis of the mother to the long axis of the fetus.
Types:
Longitudinal
Transverse
Oblique
PRESENTATION
Is the part of the fetus that is first in contact with the cervix.
TYPES:
1. Cephalic
2. Breech
3. Shoulder
1.VERTEX
- The head is sharply flexed, making the parietal bones or the space between the
fontanelles (the vertex)the presenting part.
2. BROW
- Because the head is only moderately flexed the brow or the sinciput becomes
the presenting part
3. FACE
- The fetus has extended his head to make the face the presenting part.
4. Mentum
The fetus has completely hyperextended the head to present the chin.
2. FRANK
- Attitude is moderate because the hips are flexed but the knees are extended to
rest on the chest. The buttocks alone present to the cervix.
3. FOOTLING
- Neither the thighs nor lower legs are flexed. If one foot presents, it is a single
footling breech; if both presents, it is a double footling breech.
POSITION
is the relationship of the presenting part to the 4 quadrants of the maternal’s pelvis
14
D – Descent
F - Flexion
I - Internal Rotation
R
E - Extension
E – External Rotaion (Restitution)
R
E - Expulsion
POWER
STAGES OF LABOR
Starts with the signs of true labor and ends with a fully dilated cervix
a) Latent phase
1 – 3 cm cervical dilatation
uterine contractions lasts from 20 – 40 seconds
Mild uterine contractions
MANIFESTATIONS: Abdominal cramps; backache; Client generally excited, alert,
talkative and in control; may rupture membranes
b) ACTIVE PHASE
4 – 7 cm cervical dilatation
uterine contraction will last from 40 – 60 seconds
Uterine contractions – moderate in intensity
Manifestations: Moderate increase in pain; Client more apprehensive, fear of
losing control; focusing on self; skin warm and flushed
c) TRANSITIONAL PHASE
8 – 10 cms cervical dilatation
uterine contractions will last from 60 to 90 seconds
Strong uterine contractions
Manifestations: Client may be irritable and panicky; may lose control; Perspiring;
Nauseous and vomiting is common; Trembling of legs; Pressure on bladder and
rectum; backache; increased show
2) SECOND STAGE
also called as the FETAL EXPULSION STAGE.
It starts with a fully dilated cervix and ends with the delivery of the fetus.
15
Signs of placental separation:
• Increased gush of blood
• Uterus becoming globular with fundus rising in the abdomen
• Apparent lengthening of cord
UTERUS:
The uterus contracts in the midline of the abdomen with the fundus midway between the
umbilicus and symphysis pubis.
MANIFESTATIONS:
• Lochia rubra
• Exploration of newborn
• Parent-infant bonding begins
• Newborn alert and responsive
TACHYCARDIA
More than 160 bpm lasting longer than 10 minutes
Early signs of hypoxia
Associated with maternal fever, fetal anemia, fetal or maternal infection.
Maternal hyperthyroidism, heart failure
Not reassuring when associated with late decelerations, severe variable deceleration, or
absence of variability
BRADYCARDIA
Less than 110 bpm lasting longer than 10 minutes
Late signs of hypoxia
Associated with maternal drugs (anesthetics), maternal supine hypotensive syndrome
Prolonged cord compression
Not reassuring when associated with loss of variability and late decelerations
ACCELERATIONS:
15 bpm rise above baseline followed by a return to baseline
Usually in response to fetal movement or uterine contractions
Indicates fetal well being
16
EPISIOTOMY is a surgical incision made into the perineum to enlarge the vaginal opening just
before the baby is born.
PHASES:
1. Taking – in: 1 to 2 days
2. Taking hold: 3 days to 8 weeks
3. Letting go
POSTPARTUM BLUES
Experienced by 50% to 70% of postpartum mothers
Sometimes called the “baby blues”
Usually begins on the 3rd day and lasts for 2 to 3 days
the woman may be tearful, have difficulty sleeping and eating, and feel generally let down
This is a normal reaction; however, if the depression lasts for more than several days, or
if the symptoms become severe, further psychological evaluation is needed.
INVOLUTION
Involution is the return of the pregnant reproductive system to its non pregnant state.
UTERUS:
Immediately after birth weighs 1000 g
One week postpartum estimated as 500g
At the end of 6 weeks postpartum, will return to its pre pregnant weight which is 50 – 70g
LOCHIA
1. Lochia rubra
Red
Present on the 1st to 3rd day postpartum
2. Lochia serosa
Pink or brown
Present on the 4th to 10th day PP
3. Lochia Alba
White
Present on the 10th day up to the 14th
B-U-B-B-L-E-E
17
B – Breast
U – Uterus
B – Bowel
B - Bladder
L – Lochia
E – Extremeties
E - Episiotomy
ANTEPARTUM COMPLICATIONS
ECTOPIC PREGNANCY:
COMPLICATIONS:
Hemorrhage
Shock
Peritonitis
DIAGNOSTIC EVALUATION
Culdocentesis:
Aspiration of fluid from the cul-de-sac of Douglas
Presence of bloody fluid indicates peritoneal bleeding
Culdoscopy:
visualization of the pelvic organs thru the punctured posterior fornix.
Ultrasound
Confirm extrauterine pregnancy
THERAPEUTIC INTERVENTIONS
• Diagnosis confirmed by ultrasound examination, laparoscopy, or culdocentesis.
• Immediate blood replacement if blood loss is severe.
• Surgical repair or removal of ruptured fallopian tube may be attempted.
• Chemical therapies to salvage fallopian tube ( e.g.Methotrexate, Leucovorin.
NURSING INTERVENTIONS
• Assess continuously for signs of shock.
• Administer blood transfusion if ordered for excessive blood loss.
• Administer analgesics as ordered for pain.
• Provide emotional support.
• Administer RhoGAM to Rh negative client
HYDATIDIFORM MOLE
TYPES:
1. Complete Mole
chromosomes are either 46XX or 46XY but are contributed by only one parent and the
chromosome material duplicated
this type usually leads to chriocarcinoma
2. Partial Mole
has 69 chromosomes. There are 3 chromosomes for every pair instead of 2.
this type rarely leads to choriocarcinoma
18
Severe nausea and vomiting
Absence of fetal heart tones
NURSING MANAGEMENT
ABORTION
NURSING INTERVENTION
amount and type of bleeding. Save and count number of pads.
fundus for firmness after products of conception are expelled.
for hypovolemia, shock and infection.
INCOMPETENT CERVIX
THERAPEUTIC INTERVENTIONS:
Cerclage
PRETERM LABOR
Preterm labor is labor that begins after 20 weeks’ gestation and before 37 weeks’ gestation.
ASSESSMENT:
Low back pain
Suprapubic pressure
Vaginal pressure
Rhythmic uterine contractions
Cervical dilation and effacement
Possible rupture of membranes
CONSERVATIVE TREATMENT:
Bedrest
Hydration
Tocolytic Therapy (not needed if contraction stops)
Discharge planning includes:
Complete bedrest
Stress management
Promotion of nutrition
Increased fluid intake
No sexual activity
19
Evaluate the following:
Fetal status
Respiratory status
Muscular tremors
Contractions pattern
Palpitation
Hypotension
Dizziness
GESTATIONAL HYPERTENSION
Increased BP during pregnancy that resolves within 6 weeks after birth
No edema or proteinuria is present
MILD PREECLAMPSIA
elevated bp – BP of above 140/90
Weight gain
Edema
Proteinuria + 1 or +2
Hypereflexia + 3
SEVERE PREECLAMPSIA
Elevated BP - ≥ 160/110
Edema
Proteinuria - +3 or + 4
Hypereflexia +4
Oliguria
ECLAMPSIA
All changes associated with preeclampsia, plus tonic and clonic convulsions (grand mal seizure),
cerebral hemorrhage, liver rupture, and coma.
PIH TREATMENT
Bedrest in the left lateral recumbent position
High-protein diet.
Ambulatory care; frequent visits to obstetrician.
Frequent rest periods with feet elevated.
Sedatives to ensure rest and sleep.
Administer magnesium sulfate.
MAGNESIUM SULFATE
ACTION:
20
Is a central nervous system depressant that acts to block neuromuscular transmission to
halt convulsions.
NURSING IMPLICATIONS:
Administer continuos infusion “piggybacked” into a main IV line so it can be
discontinued immediately without interfering with fluid administration.
Assess maternal blood pressure and FHR continuously.
Assess DTR every 4 hours during continuos infusion
Monitor I and O every hour . Urine output should be 30 ml / hr.
Assess client’s level of consciousness
Stop infusion if DTR are absent or if RR is less than 14 or urine output is less than 30
ml/hr.
may cause depression in the NB.
PLACENTA PREVIA
Types:
Type I or LOW LYING PLACENTA PREVIA
TYPE II Placenta Previa or Marginal Placenta Previa
TYPE III Placenta Previa
or PARTIAL PLACENTA PREVIA
TYPE IV Placenta Previa or Total Placenta Previa or sometimes called as Complete Placenta
Previa
ABRUPTIO PLACENTA
3. Mixed hemorrhage
- placental separation both at the edge and center.
Signs and symptoms:
Same as revealed hemorrhage
21
Excessive amount of amniotic fluid
more than 1,500 ml to 3000ml
Types:
a)Chronic – gradual
b) Acute – sudden (very rare.
Possible causes:
Esophageal atresia
Multiple pregnancy
diabetes
2. Oligohydramnios
Scanty amount of amniotic fluid.
300 ml or less
Causes:
Kidney malfunction
Complication:
Compression deformity
GESTATIONAL DIABETES
NURSING MANAGEMENT:
CARE OF THE MOTHER
Stress importance of ongoing, regular, and more frequent antepartal care
Strict adherence to prescribe dietary regimen and insulin requirements. Record results.
Regulate insulin dose as prescribed by blood glucose levels not by urine tests. Expect altered
requirements in intrapartal and postpartal periods.
Promote good personal hygiene to prevent infection.
Assure that she will be able to breastfeed her infant if she wishes.
Reinforce importance of various tests to assess fetal well-being such as U/S, stress and
non-stress tests, amniocentesis, L/S ratio.
INTRAPARTUM COMPLICATIONS
DYSTOCIA – difficult labor
22
I. PROBLEMS OF THE POWER:
1. Inertia – sluggishness of uterine contractions
- also called as dysfunctional labor
Common causes:
a) Hypotonic uterine contractions
usually happens during the active phase of labor
Management: Oxytocin
b) Hypertonic uterine contractions
usually happens during the latent phase of labor
Management: Sedative
2. PRECIPITATE LABOR
Rapid labor and birth of less than 2-hour duration.
Hazards to mother are perineal laceration and postpartum hemorrhage.
Hazards to infants are anoxia and intracranial hemorrhage.
ASSESSMENT
Rapid cervical dilation
Accelerated fetal descent
History of rapid labor
Rapid uterine contractions with decreased periods of relaxation between contractions
NURSING MANAGEMENT
Remain with mother and monitor closely.
Keep mother and partner informed throughout process of labor and birth
Support and guide fetal head through birth canal when birth occurs
UTERINE RUPTURE
CAUSES
23
• Rising pulse rate and skin pallor
• Loss of fetal heart tones
UTERINE INVERSION
Uterus turns completely or partially inside out during 3rd stage of labor.
Occurs immediately following delivery of the placenta or in the immediate postpartum period.
TYPES
FORCED INVERSION
caused by excessive pulling of the cord or vigorous manual expression of the placenta or clots
from an atonic uterus.
SPONTANEOUS INVERSION
due to increased abdominal pressure from bearing down, coughing, or sudden abdominal muscle
contraction.
PREDISPOSING FACTORS
Straining after delivery of the placenta
Vigorous kneading of the fundus to expel the placenta
Manual separation and extraction of the placenta
Rapid release of excessive amniotic fluid
CLINICAL MANIFESTATIONS
Excruciating pelvic pain with a sensation of extreme fullness extending into the vagina
Extrusion of the inner uterine lining into the vagina or extending past the vaginal introitus
Vaginal bleeding
MEDICAL MANAGEMENT
GOAL:
Restore the uterus to its normal position.
Often involves the use of general anesthesia and tocolytic therapy (use of terbutaline, ritodrine,
or magnesium sulfate).
Blood replacement to correct shock.
After the uterus has been restored to its normal position, oxytocin is given to contract the uterus.
NURSING MANAGEMENT
Recognize signs of impending inversion and immediately notify physician and call for
assistance.
Immediate manual replacement of the uterus at the time of inversion. (prevent cervical
entrapment of the uterus)
If reinversion not performed, rapid blood loss may occur. (Hypovolemic shock)
ASSESSMENT
Cord may be protruding from the vagina
Cord may be palpated in the vaginal canal or cervix
Fetal distress may occur as the cord is compressed between the presenting part and the bony
prominence
FHR pattern may show variable decelerations with contractions or between contractions
Fetal bradycardia present
If the cord is exposed to the cold air, there may be reflex constriction of the umbilical vessels
(restricts O2 flow to fetus)
MEDICAL MANAGEMENT
• Delivery of the fetus as soon as possible
NURSING MANAGEMENT
If prolapsed cord is identified, notify the physician and prepare for emergency cesarean birth.
If the client is fully dilated, the most emergent delivery route may be vaginal. Encourage the
client to push and assist with delivery.
Lower the head of the bed and elevate the client’s hips on pillow, or place the client in knee-chest
position (minimize pressure on the cord.)
Administer O2 at 10-12 L/min
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Apply firm upward manual pressure to the presenting part of the fetus with sterile gloved hand
(elevate the fetus and relieve pressure on the cord.
Gently wrap gauze soaked in sterile normal saline solution the prolapsed cord.
RH INCOMPATIBILITY
Also called as Isoimmunization
Two types:
Rh – ( negative of D-antigen)
Rh + ( positive of D - antigen
Coombs test
to test the presence antibodies against D
Two types:
Indirect Coombs test – blood sample is of the mother
Direct Coombs test – blood sample is of the fetus
Rhogam
Is given to prevent development of antibodies.
Given only to Rh – mothers
Indications for Rhogam:
On the 28th gestation of an Rh – mother pregnant with Rh + baby
Every after ectopic pregnancy
After amniocentesis
Every after abortion
72 hours postpartum
POSTPARTUM COMPLICATIONS
Postpartum Hemorrhage
any blood loss from the uterus greater than 500 ml within a 24 hour period (some
agencies – 1,000ml)
Types:
a) Early PP hemorrhage – first 24 hours
b) Late PP hemorrhage – after 24 hours to 6 weeks PP.
Causes:
1. Uterine Atony – the most frequent cause
2. Lacerations
3. Retained placental fragments
4. Disseminated intravascular coagulation
ASSESSMENT:
Vaginal bleeding
Signs of impending shock
NURSING MANAGEMENT
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Massage the uterus, facilitate voiding and report blood loss.
Monitor blood pressure and pulse rate every 5-15 minutes.
Prepare for IV infusion, oxytocin, and blood transfusion if needed
Administer medications and oxygen as prescribed. (Oxytoxic methylergonovine maleate (IM, PO,
IV)
Measure and record fluid intake and output.
Be prepared for a possible D&C.
PUERPERAL INFECTION
Assessment:
Puerperal morbidity is marked by a temperature of 38ºC (100.4ºF) or higher after the first 24
hours postpartum;
NURSING MANAGEMENT
Inspect the perineum for redness, edema ecchymosis, and discharge
Evaluate for abdominal pain, fever, malaise, tachycardia, and foul-smelling lochia
Obtain specimens for lab. analysis and report findings.
Offer a balanced diet, frequent fluids and early ambulation
Administer prescribed antibiotics or medications and document patient response
Stress careful perineal hygiene and handwashing
THROMBOPHLEBITIS
Thrombophlebitis is the inflammation of the lining of a blood vessel with the formation of blood
clots.
Women most prone are:
Obese
With varicosities
With previous thrombophlebitis
Above 30 years old
High parity
PREVENTION OF THROMBOPHLEBITIS:
Early ambulation
Limiting the time in obstetrics stirrups
Padded stirrups
Wearing support stockings for the first 2 weeks PP especially if the woman has
varicosities.
MEDICAL MANAGEMENT
• Strict bedrest.
• Anticoagulant therapy
Heparin therapy given continuously for 7-10 days
Dicumarol/ Warfarin Na (Coumadin) administration follows Heparin therapy
Antibiotics
• Maintain hydration
MASTITIS
ASSESSMENT:
Symptoms usually don’t appear until the third or fourth postpartum week (or even months later)
NURSING MANAGEMENT
Administer antibiotics and complete antibiotic regimen.
Offer comfort measures such as:
Suggest supportive bra
Apply cold or heat application over localized abscess.
Breast feed frequently.
Perform adequate breast and nipple care.
Avoidance of harsh cleansing agents and decrusting the nipple.
Frequent breast pad changes.
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Intermittent exposure of nipples to the air.
Observe for signs of infection
Elevated temperature, chills, tachycardia, headache, pain and tenderness, firmness and
redness of the breast.
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