ANTEPARTUM, INTRAPARTUM & POSTPARTUM

 Gestational hypertension presents as high BP around mid-pregnancy W/O

proteinuria

CONDITION TREATMENT

 bed rest in L. lateral position

MILD  Monitor BP daily
PREECLAMPSIA
 6-8oz (177-236mL) per day
 Frequent follow up

S&S/Labs
→ > 140/90 mmHg after 20 wks gestation
→ Proteinuria: 300 mg/L per 24h , greater than 1+ random
sample
→ NO seizure
→ NO Hyperreflexia
→ Mild facial edema
→ Weight gain (greater than 4.5lb/wk)
 Depends on fetal age
 Only cure is delivery of fetus (induction of labor)
SEVERE  Control BP (hydralazine) and prevent seizures (Mg
PREECLAMPSIA Sulfate)
 Prevent longterm morbidity and maternal mortality
 Emotional support (if delivery is before viability)
 S&S/Labs
→ > 160/110 mmHg
→ Proteinuria: > 500mg/L per 24h , greater than 3+
random sample
→ NO seizure
→ YES Hyperreflexia
→ Headache, Oliguria, Blurred vision, RUQ pain,
Thrombocytopenia
→ Hemolysis, Elevated liver enzymes, Low platelet count
(HELLP)
 Support through seizures and potential coma
ECLAMPSIA  Ensure patient airway and O2 support
(Emergency)
 DIC (DIC – blood clots form throughout the body)
management
 Delivery of fetus
 Emotinoal support (if delivery is before viability)
 In cases of severe HTN, seizures may still occur 24-48
hours postpartum

S&S/Labs
→ > 160/110 mmHg
→ Marked proteinuria
→ YES seizure
→ NO Hyperreflexia
→ Severe headache, Oliguria, Blurred vision, RUQ pain,
Thrombocytopenia
→ Hemolysis, Elevated liver enzymes, Low platelet count
(HELLP)
→ Renal failure

2
 → Cerebral hemorrhage

PLACENTA PREVIA
 Assessment:

 First and second trimester spotting

 Third trimester bleeding that is sudden, frank (bright red blood in the stool),
profuse but painless

 Ultrasound to show the degree of obstruction

Diagnosis

 The placenta is implanted in the lower uterine segment and may partially or
totally cover the cervical opening

 Nursing diagnosis:

o Impaired fetal gas exchange

o Risk for deficient fluid volume

o Deficient knowledge

o Anxiety/fear

Plan/Interventions

 Hospitalization initially:

o Side lying or Trendelenburg for 72 hours

o No vaginal or rectal exams

o Amniocentesis for lung maturity

o Assess daily Hgb

o Weigh peripads (I gram = 1 mL blood loss)

o Cross-matched blood available (2 units)

o Monitor blood loss

3
 Discharge if stable:

o Limit activity

o No douching, enemas or sex

o Record fetal movement

o Non stress test every 1-2 weeks

 Cesarean delivery:

o If evidence of fetal maturity, excessive bleeding or active labor

Evaluation

 Was the infant delivered safely (if applicable)?

 Were complications prevented?

o
 Diagnosis
 Intervention
 Evaluation