Nursing Role in Care of Family during Complications of Pregnancy, Birth, and Postpartal Period

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• Bleeding during Pregnancy

a. Abortion
b. Ectopic Pregnancy

2nd Trimester Definition Assessment Rx Test Intervention Drugs

Electronic Digital Bed rest
Devices:
Ultraound and
Pelvic
Examination
Contracindicated:
Internal
Examination

Classifications of Spontaneous Abortions

1st Trimester
Missed No vaginal Closed cervical No fetal cardiac
(d moa lam) bleeding os activity or empty
sac

Threatened Vaginal bleeding Cervix closed Fetal cardiac Vaginal spotting No tampoons
and cramping and soft activity and cramping Bed

Habitual (more
than 3 consecutive
abortion)

Imminent/ Vaginal bleeding Dilated Cervical Rupture of Vaginal spotting Disseminated

Inevitable and cramping OS Membrane and cramping intravascular
coagulation
(DIC): abnormal
blood clotting
Incomplete Vaginal bleeding Dilated Cervical Some products Cervical High risk for
(naiwan yung and cramping OS are expelled Dilatation uterine infection
kamay) and hemorrhage
Complete Vaginal bleeding Closed Cervical Products are Vaginal spotting
 OS completely and cramping
expelled and Cervical
Dilatation

Ectopic Tubal Pain in the Laparotomy Conceive after a Methotrexate

Pregnancy constrictions shoulder RUQ, year (control bleeding)
(ampulla) EPIGASTRIC
PAIN
Grayish skin
Pain unilateral
(isang side lang)
Amenorrhea
spotting

2nd Trimester Definition Assessment Rx Intervention Drugs

Molar Pregnancy Grape like - bleeding with Conceive after a No llive vaccine
structure cyst formation year Oxytocin
Benign (but can - no fetus in No long standing
be malignant) ultrasound Heavy lifting
-edematos
- GERD
High HCG test

Premature : painless Can apply

cervical bleeding cervical sutures
dilatation

2nd Trimester Definition Assessment Rx Test Intervention Drugs

Placenta Previa Low implantation Painless bright No vaginal
of placenta bleeding examination to
Buggy uterus minimize
placental trauma

Abruptio Premature Painful dark No sex

Placentae separation of the bleeding IE
placenta Rigid abdomen Bedrest, vs, fht
(peritonitis) IV fluid as
- Hypertension prescribed
- Sharp Surgery double
abdominal pain set up
- Vaginal Emergency CS if
Bleeding rupture
 - Fetal distress
- Hypovolemic
shock
- DIC

Preterm Labor Halted if <4cm - Etiologic Digital Corticosteroid for

(cervicitis) cervix factors: trauma, fetal lung
substance, maturity
- hypertension
- Pink-stained
vaginal discharge

Babies:
Behavioral
probelsm:
ADHD, autism

Other Causes Definition Assessment Rx Test Intervention Drugs

After Sex cervix being - Ultrasound,
tender blood/urine tests,
- MRI

Pelvic exam/ increased of

ultrasound hormone
Infection

• Preterm Labor
Definition Assessment Rx Test Intervention Drugs
Preterm Labor Regular Mother: - Group B
contractions after -Young and streptococci,
20 and 37 older. penicillin
- Excess -Lifestyle, stress - Tocolytics drug
Contraction -<12 >58 inhibiting
- Hydramnios contraction (i.e.
- Abruptio, Babies: Terbutaline,
- Many babies, - Preemies: Magnesium
- Ischemia, mental and Sulfate, Calcium
-Infection physical Channel Blocker)
disabilities, - Corticosteroids
-breathing (i.e.
difficulties Betamethasone,
-Behavioral Dexamethasone)
probelsm: - Consideration
ADHD, autism of progestin in
future
 pregnancies
Pregnant:
-Constant low,
dull backache r
lower abdominal
pressure,
-Vaginal
discharge —
watery,
-Mucus-like or
blood

• Premature Rupture of Membrane

Other Causes Definition Assessment Rx Test Intervention Drugs
Loss of AF <37 - Gush of fluid - pH (4.5-5.5) Corticosteroid:
wks - Constant >7.1 alkaline Bethamesone
Chorioamnionitis wetness in - ultrasound, - Surfactant (2 is to
(infection of the underwear examination of 1_
placental tissues) cervix Antibiotic: to
prevent infection
Tocolytics

• Pregnancy Induced Hypertension

Other Causes Definition Assessment Rx Test Intervention Drugs
Pre-eclampsia >20 weeks w/ - Proteinuria Albumin &
(mild) HTH symptoms (Albumin- holds Protein every 2
water in bvessels) wks
123,140-159) Kidney: proteiu - Rising BP Creatine: 0.5 –
- Edema 1.5 mg/dL
Liver - Severe BUN: 10-20
bonemarrow headache, mg/dL
brain: high ICP - Visual Platelets: 150-
disturbances, 400k
Normal protein: - RUQ or
150mg/hr epigastric pain, Reflex with
- rapid weight hammer (+2)
gain
-hyperreflexia
(+3)
- low urine
output,

Gestational HTH >20 weeks w/o

symptoms
Eclampsia Breeching of Lower platelets -Watch out for Diazepam
(Sever) mouth seizure Magnesium
160 up Body rigid - Call for help sulfate
<RR - Side-lying (respiratory
- Padded side depressant)
rails with pillows - 3-8 mg/dL
 - 02 Calcium
- Suction if Gluconate (A)
needed
-Don’t restraint, Toxicity
don’t leave RR<12
(Remain) Low DTR
- No spoon UOP<30mL/hr
(aspirate) (Low urine, high
mag)
EKG changes

• HELLP Syndrome
Other Causes Definition Assessment Rx Test Intervention Drugs
Hemolysis Usually present - Hypertension Liver Function Low salt, low fat Corticosteroid IV
Elevated liver in pts with pre - Right upper test diet Correct
enzymes low and eclampsia quadrant coagulopathy,
platelet count - tenderness Test: transfusion,
- Edema LDH >600 antihypertensive,
- Polyuria ALT/AST >70 labetalol
Platelets
Complications <100 TIMES 9/l
- Liver
hematoma/
infarct (jaundice)
- placenta
abruptio,
- DIC,
- ascites
- IUGR