Maga, Jamaica Q.

PARTS OF UTERUS High in glucose baby will move and cause ↓glucose

1. Fundus FETAL DEVELOPMENT

2. Corpus
- 3 Trimester
3. Cervix
- Period of viability: 20-24 weeks
• TAHBSO- Total Abdominal Hysterectomy Bilateral
• 1st trimester
Salphingo Oophorectomy
- Period of organogenesis
PHYSIOLOGICAL ANEMIA
- Virus are dangerous
- Platelet: Normal (blood clot)
• Embryonic Development (Weeks 4-8)
- WBC: Normal (fights infection)
- Plasma - Heart begins to beat
 Responsible for flow in blood vessels - Arm buds appear
 Increased when pregnant
 ↑Hemodilution= ↑Plasma= ↑Blood • Week 4
volume= not enough O2 - Liver, pancreas, and gallbladder start to form
PLACENTA - Spleen appears
- Eyes start to form
• Cotyledons - Leg buds appear
- 20-25 cotyledons • Week 5
- Counted on the Duncan after delivery
- Pag may naiwan di magcocontract - Hands appear as paddles
- Blood begins to circulate
ABNORMAL IMPLANTATION OF PLACENTA - Facial features starts to develop
1. Accreta • Week 6
2. Increta
3. Percreta - Lung start to form
- Fingers and toes form
UMBILICAL CORD/ FUNIS
• Week 7
- 2 arteries for release of waste products
- 1 vein to carry nutrients and O2 - Hair follicles start to form
- Wharton’s Jelly is a cream-like that cover U.C to - Elbows and toes are visible
prevent kinking • Week 12
• Long UC - Fetal circulation is complete
- Possibility na masakal yung fetus - Placenta is complete
- Problem in delivery of nutrients - Organ systems are complete
- Can be a cause of “Small for Gestational Age” - Fingers and toe are distinct
- Fetus is 7cm-9cm W: 28g
• Short UC
• Week 16 (4 months)
- Too much nutrients
- “Large for Gestational Age” - Sex is differentiated
- Can be a cause of Macrosomia • Week 20
- Premature separation of Placenta (Abruptio
Placenta) - Quickening
- Fully mature placenta
Decrease glucose in baby can cause complications like
hypothermia.
Maga, Jamaica Q.
there, blood flows back into the placenta. There
the carbon dioxide and waste products are
• Week 28
released into the mother's circulatory system.
- Lecetin Sphyngomyalin (2:1 LS) for lung Oxygen and nutrients from the mother's blood
maturation are transferred across the placenta. Then the
cycle starts again.
• Week 32 5. At birth, major changes take place. The
- Fingerprints umbilical cord is clamped and the baby no
longer receives oxygen and nutrients from the
FETAL CIRCULATION mother. With the first breaths of air, the lungs
- 2 openings start to expand and the ductus arteriosus and
a. Foramen Ovale the foramen ovale both close. The baby's
b. Ductus Arteriosus circulation and blood flow through the heart
now function like an adult's.

COMPLICATIONS

• Open Foramen Ovale

- Cyanosis
- Clubbing
- Nasal Flaring

• Patent Ductus Arteriosus

- Cyanosis
- Nasal Flaring
- Tachycardia

PRESUMPTIVE S/SX

- Amenorrhea
1. When oxygenated blood from the mother
- PICA
enters the right side of the heart, it flows into
- Mood changes
the upper chamber (the right atrium). Most of
the blood flows across to the left atrium PROBABLE S/SX
through a shunt called the foramen ovale.
2. From the left atrium, blood moves down into - PT (Urine)
the lower chamber of the heart (the left - Chadwick’s (Bluish discoloration)
ventricle). It's then pumped into the first part of - Goodells (Softening of the cervix)
the large artery coming from the heart (the - Hegar’s (Softening of the lower uterine
ascending aorta). segment)
3. From the aorta, the oxygen-rich blood is sent to POSITIVE SIGN
the brain and to the heart muscle itself. Blood is
also sent to the lower body. - FHT
4. Blood returning to the heart from the fetal body - Fetal movement felt by examiner
contains carbon dioxide and waste products as - UTZ (Fetal skeleton, Placenta, Amniotic fluid,
it enters the right atrium. It flows down into the etc.)
right ventricle, where it normally would be sent
to the lungs to be oxygenated. Instead, it
bypasses the lungs and flows through the
ductus arteriosus into the descending aorta,
which connects to the umbilical arteries. From
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- Transvaginal approach
- Transcervical approach
THE INITIAL VISIT

• NAEGELE’S RULE
• Non Stress Test (NST)

- CTG machine (Cardiotocography)

- FHT and Uterine contraction
- 3rd trimester
- Last up to 20 minutes
- Increase FHT (normal) pag nag cocontract

• BioPhysical Profile

- Lie on back
- Fetal brathing movements
- Gross body movements
- Fetal tone
PRESENT PREGNANCY - Qualitative amniotic fluid volume
• McDonald’s Rule- to determine week of gestation - Reactive fetal heart rate
- SHouls be done with Non Stress Test
- Ginagamit pag 3rd trimester

• Amniotic Fluid Analysis

• Bartholomew’s Rule- A rule for determining the - Amniocentesis
duration of pregnancy by measuring the height of the - 20th weeks
fundus of the uterus above the pubic symphysis. - For lung maturation
ROUTINE MATERNAL EXAMINATION • Maternal Serum Alpha-Feto Protein (MSAFP)
1. Immunologic Test - Alpha-Feto Protein is released by liver and
 VDRL (Venereal Disease Research spleen
Laboratory) - An AFP blood test is used to check a developing
 Syphilis (Mouth and Vagina) fetus for risk of birth defects and genetic
2. Urinalysis disorders, such as neural tube defects or Down
3. Hematologic Test syndrome
 CBCPC
4. Rubella Antibody Tither • Percutaneous Umbilical Blood Sampling
5. Blood typing and Rh ± (Rhesus)
- Blood gas analysis of a baby
FETAL WELL-BEING EXAMINATION
POSTPARTUM PERIOD
• Ultrasound
- Begins after the delivery of the placenta and
1. UTZ transducer- gross examination (limbs, etc.) continues for 1 to 4 hours after delivery up to 6
2. Transabodominal- dapat di full ang bladder to 8 weeks
3. Transvaginal- ginagawa up to 2 months
POSTPARTUM CARE (BUBBLESHIE)
gestation
• Breast
• Chronic Villi Sampling
- What is the contour? (Firm, Circle, Tabingi)
- 10 weeks/ 14-16 weeks
- Are the breast full, firm, tender, thiny?
- Abnormalities in genetics
- Transabdominal approach
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- Are the veins distended? (Should not be - Pfannensteil ( --- )
distended) - Low Transverse ( l )
- Is the skin warm?
• Sexual Activity
- Does the patient complaint of sore nipples?
- Are the breast so engorged that she requires - 4-6 weeks pwede na ang sexual activity
pain medication

• Uterus
• Involution
- Should be firm, decrease approximately one
finger breath below - Begins during the third stage of labor,
- Unsatisfactory, involution may result if the accelerates after expulsion of the placenta, and
bladder is not completely empty continues over the next 5 to 6 weeks.
- If the uterus is not involving properly, check for - Mother needs to pee
INFECTION • Homan’s Sign
• Bladder - Located at the calf
- Voiding without difficulty - Pain or tenderness in the calf is a positive
- Bladder distention should not be present after homan’s sign
coiding - Dorsi flexion to assss (+) Homan’s Sign
- DO early ambulation if NSD
• Bowel movement - Dangl feet/ Elevate the feet if CS
- Px cannot go home unless she has a bowel • Emotional Response- Does the patient appear
movement dependent/ independent?
- 2-3 days no pupu administer laxatives
1. Taking In (1-3 days)- During this 2- to 3-day
• Lochia period, a woman is largely passive. She prefers
having a nurse minister to her (such as bringing
- Longer bleeding can cause infection
her a bath towel or a clean nightgown) and
- Assess color and amonut
make decisions for her, rather than do these
things herself
1. Rubra
2. Taking Hold (4-7 days) - After a time of passive
- 1-3 days
dependence, a woman begins to initiate action.
- Dark red
She begins to take a strong interest in caring for
- Profuse
her child.
- 3-5 maternity pad
3. Letting go (8-10 days)- A woman finally
2. Serosa
redefines her new role. She gives up the
- 4-7 days
fantasized image of her child and accepts the
- Pinkish to brown
real one; she gives up her old role of being
- Moderate amount
childless or the mother of only one or two (or
3. Alba
however many children she had before this
- 8-14 days
birth)
- Grayish
- Scanty/ Spotting 4 PARTS OF FALLOPIAN TUBE
• Episiotomy 1. Ismus- shortest part of fallopian tube (site of
ligation)
- Lateral/ Mediolateral
2. Ampulla- site of fertilization/ most common site
- Facilitates the delivery of the baby
of ectopic pregnancy
- 2 inch cut
3. Infundibular
If Cesarian: 4. Fimbriae
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Puerperium, Stage of Vigilance, Recovery Stage are the 1. Oxytocin
other term for postpartum 2. Carboprost Tromethamine- not use anymore, it
can cause HPN and diarrhea
POSTPARTUM COMPLICATIONS
3. Methergine- IM
1. Postpartum Hemorrhags 4. Misoprostol (cytotec)
2. Puerperal Infections
Other Management
3. Thrombophlebitis
4. Emotional and Psychological Complication 1. Bimanual Compression
2. Blood replacement
POSTPARTUM HEMORRHAGE
3. Hysterectomy (Total or Subtotal/ Partial)
4 T’s of PostPartum Hemorrhage
Nursing Considerations
1. Tone- Uterine Atony (no tone)
1. Elevate lower extremities
2. Trauma- Perineal Laceration
2. Bedrest without BRP
3. Tissue- Laceration, cephalo disproportion
3. Empty bladder
4. Thrombin- fats (thrombophlebitis)
4. Administer O2
POSTPARTUM HEMORRHAGE 5. Monitor VS
6. Fundal massage
1. Utrine Atony 7. Uterotonics
2. Lacerations
3. Retained Placental Fragments • LACERATIONS
4. Uterine Inversion
- Also known as tear of the birth canal
5. Disseminats Intravascular Coagulation (DIC)
6. Sub Involution Risk Factors
7. Perineal Hematoma
- Dystocia (difficulty in labor) or Precipitate birth
• UTERINE ATONY (no tone) (mabilis lumabas)
- Primigravidas
- Also known as relaxation of the uterus
- Large infant (LGA, Macrosomia)
- Most common caus of postpartum hemorrhage
- Litothomy position and use of instruments (i.e
- Most often in Asian, Hispanic, and Black Woman
forceps, vacuum)
- Nanganak pero di matigas ang uterus
Check if maayos ang pagkakaangat sa stirrups. Sabay
Risk Factors
tinataas ang paa para maiwasan ang trauma sa
- Deep anesthesia or analgesia perineal area
- Labor initiated or assisstd with an oxytocin
Therapeutic Management
agent
- High parity or Maternal (age over 35) - “Episiotomy repair”= Episiorrhaphy
- Previous uterine sergery
Types of Laceration
- Prolonged and difficult labor
- Chorioamnionitis or endometritis- a. Cervical Laceration
inflammation in chorion (placenta) and endo b. Vaginal Laceration
- Secondary maternal illness c. Perineal Laceration
- Hx of PPH  First degree- skin and some SQ part
- Prolonged Magnesium Sulfate  Second degree- Bulbocavernosus (muscle
 S/Sx: ↓PR, ↓RR/ Respiratory Depression, part)
Absent Patellar Reflex  Third degree- External anal sphincter
 Administer Calcium Gluconate  Fourth degree- External anal sphincter and
Rectal mucose, Internal Anal sphincter
Therapeutic Management
Nursing Management
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1. Perineal Care (front to back) 5. Administer Oxygen
2. Change pads 6. OB will manually replace the fundus
3. Cold compress for 24 hours 7. After replacement, resume oxytocin
Warm compress after 24h for blood circulation 8. Antibiotic therapy
4. Check discharge 9. Possible CS birth in future pregnancy
5. Sitz bath for steam use of commode

• RETAINED PLACENTAL FRAGMENTS

• DISSEMENATED INTRAVASCULAR COAGULATION
- A placenta doesn’t detach in its entirely
- An aquired disorder of blood clotting in which
Risk factors the fibrinogen levels falls to below levels

- Previous cesarean birth Risk Factors

- In Vitro Fertilization
- Premature separation of the placenta
- Succenturiate placenta
- Hypertension of pregnancy
- Placenta accreta- most common cause of
- Amniotic fluid embolism
retained placental fragments
- Placental Retention
Therapeutic Management - Septic abortion- infection in the uterus
- Fetal demise- dead fetus inside the womb (72h
- Dilation & Curretage (D&C)
pag di pa natatanggal can cause infection)
- Hysterectomy
Maceration- durog durog ang fetus
SIGNS NA LALABAS ANG PLACENTA
Early S/Sx
1. Lengthening of the cord
- Bruising
2. Sudden gush of blood
- IV site bleeding
3. Calkin’s sign- Globular shape of uterus
- Bleeding

• UTERINE INVERSION/ UTERINE PROLAPSE Diagnostic Test

- Also known as Uterine prolapsed Platelet Count </= 100,000/ UI

Normal: 150k-300,00
Risk Factors Prothrombin LOW
- Traction of Umbilical cord Thrombin time LONG
- Fundal push Fibrinogen Low <150 mg/dL
- Precipitate labor Fibrin Split products Elevated
D-dimer Positive
Types of Inversion

a. Inverted fundus- may part lang na inverted Therapeutic Management

b. Total inversion- lahat inverted
- Administration of Heparin (IV)
Nursing Consideration - Blood transfusion (Packed Platelet)
- Resolving the underlying insult
1. Never attempt to replace an inversion
2. Never attempt to move the placenta Nursing Considerations
3. D/C (discontinue) Oxytocin- stop hanggang
- Monitor VS
matanggal si placenta
- Monitor Blood Coagulation
4. Replace fluids
- WOF (Watch out for) Bleeding
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• SUB INVOLUTION • Internal FHT Electrode

- Main reason: full bladder, Mai-stretch ang - Contamination

uterus at mag contribute sa atony if full bladder
• Local Vaginal Infection
- Incomplete return of the uterus to its pre-
pregnant size and shape - Direct spread of infection
- Can be a result of small retained placental
fragments, a mild endometritis, and other • Uterus Exploration
problems - Infection introduced with exploration
- Tx: Methergine and/or antibiotics

• PERINEAL HEMATOMA
THROMBOPHLEBITIS
- A collection of blood in the SQ layer of tissue of
the perineum - Inflammation in veins caused by thrombus
- Inflammation of the lining of a blood vessel with
Risk Factors formation of blood clots
- Precipitate labor Risk Factors
- Perineal Varicosities
- Episiorrhapy - Fibrinogen level is high from pregnancy
- Dilation of lower extremities veins
Therapeutic Management - Inactivity in labor and during early puerperium
- Cold compress - Prolonged time in DR
- Pain reliever - Obesity
- 24hr Episiotomy - Varicose veins
 Check if may discharge - Postpartal infection
 Check for blood flow and color - Hx and FHx of thrombophlebitis
- Age older than 35
PUERPERAL INFECTIONS - Cigarette Smoking
1. Endometritis Diagnostic Test
2. Infection of the perineum
3. Peritonitis 1. Doppler Test
4. Mastitis 2. Contrast Venography (IV)- ginagamit para
5. Urinary Tract Infection malaman ang part na obstructed

CONDITIONS THAT INCREASE WOMAN’S RISK FOR Assessment

POSTPARTAL INFECTION - Signs of Inflammation present (0 days after
• PROM for 24h (Ascending infection) birth)
- Homan’s Sign
- Bacteria may have started to invade the uterus
while fetus was still in utero Therapeutic Management

• Retained Placental Fragment 1. Elevate affected leg

2. Cold compress 24-48 hours
- Tissue necrosis Warm compress after 72 hours
3. Never massage
• Postpartal Hemorrhage- Weakened body
4. Selective activities
• Pre-Existing Anemia- Weakened body 5. Bed rest
6. Antibiotic therapy
• Dystocia, Use Of Instruments
7. Anticoagulant therapy
- Trauma to the tissue- portal of entry 8. Heparin- drug of choice
Maga, Jamaica Q.
9. Dangling feet • CREDE’S MANEUVER

Different Types - Hila sa Umbilical Cord tas pinch yung fundus

1. Superficial Vein Disease (SVD) NEWBORN CARE

2. Deep Vein Thrombosis (DVT)
a. Femoral Thrombophlebitis
b. Pelvic Thrombophlebitis
3. Embolism- galing air, amniotic fluid, blood
a. Pulmonary Embolism
b. Amniotic Fluid Embolism
EMOTIONAL & PSYCHOLOGICAL COMPLICATIONS
POSTPARTAL BLUES
ONSET 1-10 days after birth
SYMPTOMS Sadness
INCIDENCE 70% of all births
ETIOLOGY Probable hormonal changes,
stress of life change
THERAPY Support, empathy
NURSING ROLE Utter compassion &
understanding
POSTPARTAL DEPRESSION
ONSET 1-12 months after birth
SYMPTOMS Anxiety, feeling of loss, sadness
INCIDENCE 10% of all births
ETIOLOGY Hx of depression, hormonal
response, lack of social support
THERAPY Counseling, possibly drug therapy
NURSING ROLE Screen for depression and refer
counseling
POSTPARTAL PSYCHOSIS
ONSET Within first year after birth
SYMPTOMS Delusion of hallucinations of
harming self/ infant
INCIDENCE 1-2% of all birth
ETIOLOGY Hx of mental illness, hormonal
change, FHx of bipolar disorder
THERAPY Psychotherapy and drug therapy
NURSING ROLE Refer to psychiatric care,
safeguarding mother from injury
to self and newborn
• Rub Chest- to stimulate circulation, skin to cause heat,
and for the baby to cry
TO DO AT NICU
- Aspirate→ Anthropometric Measurement→
Weigh
- BCG, Vitamin K, Hepatitis B, Eye ointment
NURSING CARE OF A FAMILY EXPERIENCING A
PREGNANCY COMPLICATIONS FROM A PRE-EXISTING
OR NEWLY ACQUIRED ILLNESSES
- GDM
- PIH
• HEAERT DISEASE
- Hemodynamics of pregnancy that adversely
affect the client with heart disease
- O2 consumption increased 10% to 20%; related
to needs of growing fetus
- PLASMA LEVEL and BLOOD VOLUME INCREASE;
RBC remains the same (physiological anemia)
*Nasal congestion due to ↑production of histamine due
to estrogen
FUNCTIONAL or THERAPEUTIC CLASSIFICATION of
HEART DISEASE during PREGNANCY
• CLASS I
- No limitation of physical activity
- No symptoms of cardiac insufficiency or angina
- Normal for pregnant
• CLASS II
- Slight limitation of physical activity
- May experience excessive fatigue, palpitations,
angina, and dyspnea
• CLASS III (CS)

- Moderate to marked limitation of physical

DELIVERY OF THE PLACENTA activity
- Dyspnea, angina, and fatigue occur with slight
• BRANDT ANDREW’S MANEUVER activity
- Hila sa Umbilical Cord tas push sa taas - Bed rest is indicated during most of pregnancy
Maga, Jamaica Q.
• CLASS IV INTAKE & • Monitor heart rate
OUTPUT • Provide for adequate rest
- Marked limitation of physical activity • Provide close supervision
- Angina, dyspnea, and discomfort occur at rest • Administer prescribed prophylactic
- Pregnancy should be avoided antibiotics
- Indication for termination of pregnancy

NURSING CARE HIGH RISK PREGNANCIES

- Assess weight gain to monitor edema that is - Any pregnancies where in maternal and fetal
caused by heart problems life is endangered by a disorder co-existing with
or unique to the pregnancy

PRENATAL
ASSESSMENT & INTERVENTION
ASSESSMENT CATEGORIES
VS Teach importance of rest and
avoidance of stress • Biophysical
WEIGHT GAIN Instruct regarding use of elastic - Genetic
stocking & periodic elevation of legs
- Medical (DM, HPN)
DIETARY Teach appropriate dietary intake;
- Obstetric (Problem in reproductive system such
PATTERNS adequate calories to ensure
appropriate but not excessive, weight as ectopic pregnancy and endometriosis)
gain, limited not restricted sodium • Behavioral
intake (2.5g/day)
EMOTIONAL Abdominal medications as ordered - Nutritional Status (PICA, Obesity)
OUTLOOK - Substance abuse (Alcohol, Cocaine, Marijuana)
KNOWLEDGE Monitor for signs of heart failure; may - Dental Hygiene (is di nagtutoothbrush possible
ABOUT SELF be precipitated by severe anemia na magkainfection then magtravel sa heart)
CARE - Abuse and violence
STRESS Teach importance of continued
FACTORS medical supervision • Psychological Status
INTRAPARTUM ASSESSMENT & INTERVENTION - Failure to seek prenatal care
VS • Encourage the mother to remain in - Extreme stress
semi-fowler’s or left-lateral position
• Semi-fowler’s to promote lung • Socio-Demographic
expansion
• Left-lateral position to prevent - Maternal age (18 below & 35 above)… if 35
supine hypotension/vena cava above, chromosomal abnormalities is possible
syndrome since the genes are not healthy at this age.
RESPIRATORY • Provide continuous cardiac monito- - Parity (# of pregnancies carried up to age of
CHANGES ring viability dead or alive)
DIETARY • Provide electronic fetal monitoring - Marital status
PATTERNS • Assist mother to cope with - Residence
discomfort - Ethnicity (practices)
• Monitor for signs of heart failure - Income
INTRAPARTUM ASSESSMENT & INTERVENTION - Racial/ Ethnic origin
VS • MOST CRITICAL TIME - Occupational hazards
SIGNS OF • Institute early ambulation schedule - Prolonged shifts
HEART FAILURE • Apply elastic stocking for good - Extreme heat
circulation and venous return - Exposure to radiation= congenital malformation
ASSESS • Monitor for signs of heart failure (radiation is terathogenic)
HEMORRHAGE
Maga, Jamaica Q.
ROLES OF THE NURSE b. Inevitable
c. Complete
- Identify risk factors and estimate the potential
d. Missed
effect of the pregnancy outcome
e. Habitual abortion
CAUSES OF MATERNAL MORTALITY 2. Induced- may ginawa ka para maabort yung
product of conception
- Normal delivery and other complications r/t a. Therapeutic abortion
pregnancy occurring in the courses of labor, b. Illegal abortion
delivery, and puerperium. 3. Fetal Demise
- Hypertension complicating pregnancy, child a. Antenatal demise- maliit pa pero namatay
birth, and puerperium na
- Postpartum hemorrhage b. Intrapartum demise- malaki na tas namatay
- Pregnancy with abortive outcome 4. Ectopic Pregnancy
- Hemorrhage r/t pregnancy a. Unruptured
ANTEPARTUM COMPLICATIONS (Before Pregnancy) b. Ruptured
1. SPONTANEOUS ABORTION
1. Hemorrhagic
2. Hypertensive disorders • THREATENED
3. Gestational DM Description Uterine Contraction, Vaginal
4. Labor problems bleeding, Close cervix
5. Multiple pregnancies Diagnosis Ultrasound of viable pregnancy
6. Placental anomalies Management CBR, no sex, progesterone meds,
instruct WOF passage of products of
• HEMORRHAGIC DISORDERS conception
• INEVITABLE
General Management
Description Uterine Contraction, Vaginal
- CBR bleeding, Open cervix
- Avoid coitus Diagnosis Blood Test
- Approximation or assess for bleeding Management D&C, Rhogam (counteract
production of antibodies)
- Counting pads
• COMPLETE
- Saturation: Fully saturated; 30-40cc (Weigh the
Description All products of conception are
pad first) Weight: 1mg=1ml/ 1cc
expelled, OK Uterus, OK Cervix
- Assess for complications: HYPOVOLEMIC SHOCK
(open)
(↓BP,↑RR, ↓Temp) Diagnosis Blood Test
- Some discharged for histopathology to Management Supportive care, emotional support
determine if product of conception has been • INCOMPLETE
expelled Description Not all products of conception are
- Prepare the mother for sonography or UTZ to expelled, NOT OK Uterus, Cervix,
determine the integrity of the sac (yolk sac) and Fetus
Diagnosis Blood Test
FIRST TRIMESTER BLEEDING
Management D&C, Rhogam
- Abortion (before reaching age of viability <20- • MISSED
24 weeks Description All products of conception are
- Fetal demise retained, NOT OK Uterus, Cervix,
- Ectopic pregnancy (pregnancy outside of the and Fetus
uterus) Diagnosis UTZ, Blood Test
Management D&C, Antibiotic Therapy, Rhogam
• ABORTION • HABITUAL
Description 3 or more consecutive pregnancies
1. Spontaneous- normal resulted in abortion which is usually
a. Threatened
Maga, Jamaica Q.

r/t incompetent cervix - Previous pelvic or abdominal surgery

Diagnosis UTZ, Co-Morbidity, Psychogenic - Cigarette smoking
Management > McDonald Operation- tinatahi - Vaginal bleeding- artificial contraception
> Shirodkar Procedure- lalagyan ng (banlaw after coitus)
knot ang cervix para magclose - Age of first intercourse <18 years

2. INDUCED ABORTION • Greater

a. Therapeutic - Previous genital infection

- Ensures the life of the mother especially if there - Infertility
are bioethical issues involved - Multiple sexual partners
- It has two-fold effect which opts for the choice • Greatest
of lesser evil
b. Illegal - Previous ectopic pregnancy
- Unwarranted termination of pregnancy - Previous tubal surgery or sterilization
- The mother’s and fetal life is not at stake - Diethylstilbestrol (chemotherapy drug)
- Not permitted by the laws in the Philippines exposure in utero
- Use of IUD (sinasabay sa PAPSMEAR)
3. FETAL DEMISE
Management
a. Antenatal Demise
- Occurs before labor - Terminate hanggat hindi pa nagrarupture
b. Intranatal/ Intrapartum demise - If nagterminate EXLAP (Exploratory
- Occurs after onset of labor Laparotomy)
- Pag nakita yung part na nagrupture, tahi lang
4. ECTOPIC PREGNANCY pero pag hindi, unilateral tubal ligation ang
- Extra uterine Pregnancy gagawin.
- Pregnancy located OUTSIDE the inner lining of SECOND TRIMESTER BLEEDING
the uterus
- Ampulla- most common site of ectopic HYDATIDIFORM MOLE or Gestational Trophoblastic
pregnancy Disease
- Pwede mag rupture then cause bleeding
- A spectrum of disease resulting from abnormal
a. Unruptured Ectopic Pregnancy
proliferation of the placenta
- Missed period
- Sometimes called “Bunch of Grapes”
- Abdominal pain within 3-5 weeks of
- Gestational anomaly of the placenta
amenorrhea
- Magdedevelop ang chorion and amnion before
- Scanty, dark brown vaginal bleeding (stuck and
maging placenta pero instead of placenta
obstructed blood)
nagiging h.mole
- Vague discomfort
- Benign neoplasm (abnormal cell growth) of the
b. Ruptured Ectopic Pregnancy
chorion
- Sudden, sharp, knife-like, unilateral severe pain
- Chorionic Villi Degenerate
- Shoulder pain (possible intraperitoneal
- Grows and enlarges the uterus rapidly
bleeding that extends to diaphragm and phrenic
- Increased in the number of the HcG (may
nerve)
chorion and amnion)
- (+) Cullen sign or the bluish-tinged umbilicus
(bruised-like) Sign and Symptoms
- Syncope (biglang nawalan ng malay)
• Early
RISK FACTORS FOR ECTOPIC PREGNANCY
- Vesicles passed thru vagina
• Lesser - Hyperemesis Gravidarum (severe nausea and
vomiting) due to HcG
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- ↑Fundic Height - Presence of fibroids (noncancerous tumors in
- No FHT uterus)
- Vaginal bleeding caused by pagsiksik/baon nang Types:
sobra ng vesicles
a. Low lying
- Metastasis (kumakalat sa bone, reproductive
b. Partial
area, spinal cord, and brain)
c. Total
- ↑HcG levels
- Pre-eclampsia at 12 weeks

• Late

- HPN before 20th weeks

- Snowstorm on sonogram
- Anemia (if di maltreat agad)
- Abdominal cramping
Sign & Symptoms
• Serious Late Complications
- Painless, bright-red bleeding beginning in the 7 th
- Hyperthyroidism month (fetus might kick the placenta)
- Pulmonary Embolism - Soft uterus in the latter part of pregnancy
Nursing Interventions - Signs of infection may be present
Nursing Management
- Instruct the patient not to be pregnant for 1 - Left Trendelenburg position
year to allow HcG to decrease in number - CBR without BRP
- Urine is examined every month for HcG - O2 Therapy
determination if due to pregnancy or - Control Bleeding
abnormalities - No IE (Internal Examination)
- Should not be given folic acid (can increase HcG) - Monitor FHT continuously
- ACID-ASH-DIET such as cranberry juice to - Vital Signs
prevent formation of stone - Administer Betamethasone (for lung maturity)
Medical Management - Prepare double set-up for CS

1. Suction Curettage • ABRUPTIO PLACENTA

2. Hysterectomy - Premature separation of a normally implanted
3. Chemotherapy placenta
Causes
THIRD TRIMESTER BLEEDING
- Gestational or Chronic Hypertension
PLACENTAL ANOMALIES
- Previous history of abruptio placenta
1. Placenta Previa - Trauma
2. Abruptio Placenta - Aggressive picotin use (old term for oxytocin)
- Maternal cocaine use
• PLACENTA PREVIA - Cocaine, Marijuana, Heroine, Oxydone, Shabu
- Abnormal implantation of the placenta in the (only cocaine cause abruption placenta)
lower uterine segment - Uses of 5 drugs can cause Intra-uterine Growth
Causes Retardation, Preterm labor, and Spontaneous
Abortion.
- Presence of Scars or tumors (blastocyst is not
Degree of Separation of Abruptio Placenta
able to stick into the uterus)
- Multiple pregnancy (there two or more placenta 1. Mild- 25%
inside the uterus) 2. Moderate- 50%
- Common in multigravida (scar formation) 3. Severe- 75%
Maga, Jamaica Q.
Sign & Symptoms

- Moderate to agonizing abdominal pain

- Persistent Uterine contraction; firm to board-
like abdomen
- Hyperactivity the cessation of fetal movement
- If continue to bleed→ Hyperfibrinogenemia=
Disseminated Intra-vascular Coagulation
Magkakaron ng bleeding sa uterus pag
natanggal yung placenta, hindi magcocontract
yung mga blood vessels don and magcocause ng
coagulation
- (+) fetal distress
Nursing Management

- Replacement of blood loss

- Bed rest in lateral recumbent position
- Monitor FHR & Vital Signs (mother and fetus)
- O2 Therapy
- Emergency CS for moderate to severe degree or
maternal or fetal distress
- Trial of induction of labor for mild, without fetal
distress, (+) cervical dilatation