NCM 107 - RLE

OB WARD/ EBMC
Common
Cases in
OB WARD
1. Abruptio placenta
 Premature separation of the placenta from
its implantation
 Occur after 20th weeks AOG

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 CAUSES!
 Trauma  Malnutrition
 Multiparity  Medical complication
 Short umbilical cord (PIH)
 Smoking

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Assessment findings:
+ Painful vaginal bleeding
+ Additional signs of shock
+ Note the fetal bradycardia and late
decelerations absent
+ Tender, board-like uterus

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Nursing Care
 Check maternal/fetal VS frequently
 Rest
 Ready the patient for possible CS
 Anticipate coagulation problem (DIC)
 Monitor urinary output
 Prepare for IV infusions of fluids/blood as indicated
 Support to parents as outlook for fetus is poor.

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2. Placenta Previa
 Low implantation of the placenta that
overlays some or all of the internal cervical
os
 Classifies as:
 Low lying placenta previa
 Partial placenta previa
 Total placenta previa

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 CAUSES!
 Poor vascularity
 Fibriod tumors
 Multiple pregnancy

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Assessment findings:
+ FHR usually stable unless maternal shock
present
+ Uterus remains soft
+ No vaginal exam
+ Intermittent bleeding (gushes or continuous)
+ Painless bright red vaginal bleeding after 7th
month of pregnancy

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Diagnostic Exam
 Based on clinical manifestation
 By ultrasound

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Nursing Care
 Assessing VS, amount of bleeding
 Maintain sterile conditions for any invasive procedure
 Make sure provisions for emergency CS
 Measure blood loss carefully
 Assess uterus
 Continue to monitor maternal/fetal VS
 Ensure CBR

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3. Cardiac Disease in pregnancy
 Complicates about 1% of pregnancies
 Underlying cause is congenital defects of
the heart

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Assessment findings:
+ Palpitations
+ Rales
+ Evidenced of cardiac decompensation
+ Edema
+ Cough and dypsnea
+ Heart murmurs

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Nursing Intervention:
+ Promote frequent rest periods and adequate sleep,
decreased stress.
+ Anti coagulant therapy
+ Limit weight gain, diet: Low Sodium intake
+ VS
+ Classify the patient accordingly
+ Recognize and report signs of infection, and danger
signs

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4. Ectopic Pregnancy
 Implantation of the fertilized ovum outside
the endometrial cavity.
 Usually due to previous Hx of Pelvic
Inflammatory Disease (PID) which prevents
or slow the passage of the fertilized ovum in
the fallopian tube.

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4. Ectopic Pregnancy
 Abdominal pain
 Vaginal bleeding
 Amenorrhea

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Assessment findings:
+ Hx of missed periods and symptoms of early pregnancy
+ Abdominal pain
+ Rigid, tender abdomen
+ Bleeding
+ HCG titers
+ Low hemoglobin and hematocrit, rising of white blood
cell count

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Diagnostic Exam
 CULDOCENTESIS
 Managed surgically with exploratory
laparotomy followed by
Salphingoophorectorectomy or
Salpingostomy

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5. Gestational Trophoblastic Disease (H-mole)
 Rapid deterioration of trophoblastic villi
cells and the embryo fails to develop past
the initial stages
 Presence of grape-like vesicles per vagina,
with soft abdomen and absent fetal parts
on palpation

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Assessment findings:
+ Size of the uterus disproportionate to the length of
pregnancy
+ UTZ shows no fetal skeleton
+ No FHR, palpation of fetal parts
+ Symptoms of pre eclampsia
+ High levels of HCG with excessive nausea and vomiting
+ Anemia
+ Dark red to brownish vaginal bleeding after 12th week

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Management
 Suction curettage and can be
followed by chemotherapy

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Nursing Care
 Assessing VS, amount of bleeding
 Maintain sterile conditions for any invasive procedure
 Make sure provisions for emergency CS
 Measure blood loss carefully
 Assess uterus
 Continue to monitor maternal/fetal VS
 Ensure CBR

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Nursing Intervention:
+ Teach contraceptive use
+ Regular check up
+ VS, intake and output
+ Follow up lab work to detect rising HCG levels
+ Teach about risk for future pregnancies
+ Determine any malignant transformation
+ Provide pre- and post-operative care for evaluation of
uterus
+ Emotional support

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6. Abortion
 Loss of pregnancy before viability of fetus;
+ Spontaneous
+ Therapeutic or elective

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Types:
1. Threatened abortion
2. Inevitable
3. Incomplete
4. Complete
5. Missed
6. Habitual

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Assessment findings:
+ Contractions; pelvic cramping, backache
+ Lowered hemoglobin
+ Vaginal bleeding
+ Passage of fetus/tissue

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Nursing Intervention:
+ Save all tissue passed (histopathology examination)
+ Emphasize CBR
+ Increased fluids PO or IV as ordered
+ Prepare client for surgical intervention
+ Provide discharge teaching about limited activities and
coitus
+ Emotional support

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7. HIV Infection
 Sexually transmitted disease
 CS lowers the risk of transplacental
transmission
 Breastfeeding is contraindicated

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 CAUSES!
 Retrovirus that targets the helper T cells
containing CD4 antigen

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TREATMENTS
 Managed with Anti retroviral agents
like ZIDOVUDINE (AZT)

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Diagnostic Exam
 ELISA and Western Blot to conform
the disease,
 CD4 count less than 200 cells/ul
 Viral load measure the amount of HIV
in the blood stream

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Nursing Care:
+ Institute standard precaution
+ Teach to minimize risk of virus transmission
+ Monitor CD4
+ Withhold blood sampling and injections in the neonate
until after all the maternal blood has been removed from
the neonate on the initial bath.
+ Emotional support

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8. Pregnancy-Induced Hypertension
 Refers to condition unique to pregnancy where vasopastic
hypertension is not accompanied by proteinuria and
edema;
 Gradual loss of normal pregnancy-related resistance
to angiotensin II
 Decreased production of some vasodilating
prostaglandins
 Onset after 20th week of pregnancy,
 Wide spread vasospasm

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 CAUSES!
 Primigravidas, multiple pregnancies, H-mole,
poor nutrition, essential hypertension, familial
tendency

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Classification
1. PIH
+ Hypertension
+ Pre eclampsia: mild/ severe
+ Eclampsia

1. Chronis Hypertension
2. Chronic hypertension with superimposed PIH

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+ Possible life threatening complication. HELLP syndrome

+ TRIAD SYMPTOMS:
 Hypertension
 Edema/ weight gain
 protenuria

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A. Mild Preeclampsia
 Assessment findings:
+ Increased BP
+ Weight gain
+ Slight generalized edema
+ Proteinuria of 300 mg/liter in a 24 hour urine specimen (>+1)
+ Appearance of symptoms between 20th and 24th week of
pregnancy
 Nursing Interventions:
+ Promote bed rest
+ Emphasize follow up check up
+ Well- balanced diet: no Sodium diet

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B. Severe Preeclampsia
 Assessment findings:
+ Headaches, epigastric pain, nausea and vomiting, visual
disturbances, irritability
+ Increased BP
+ Proteinuria (5g/24 hours) (4+)
+ Increased edema and weight gain

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Medical Management: “MAGNESIUM SULFATE”
 Magnesium Sulfate acts upon the myoneural
junction, diminishing neuromuscular transmission.
 It promotes maternal vasodilation, better tissue perfusion and
has anti convulsant effect.

 NURSING MANAGEMENT:
1. Three parameters to monitor
 Deep tendon reflexes (DTR ++)
 RR more than 12/minutes
 Urine output more than 30 cc/hr
2. Administer medications either IV or IM
+ Antidote for excess levels is CALCIUM GLUCONATE

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Nursing Interventions:
+ Daily fundoscopic examination
+ Monitor I&O
+ Seizure precaution
+ Take daily weights
+ Administered medication as ordered
+ Promote CBR, side-lying
+ Diet
+ Monitor VS
+ Continue monitor 24-48 hours after delivery

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c. Eclampsia
 Assessment findings:
+ Increased hypertension precedes convulsion followed by
hypotension and collapse
+ Coma may ensue
+ Labor may begin
+ Convulsion may recur
 Nursing Interventions:
+ VS and lab values
+ Have airway, oxygen and suction equipment available
+ Administer medication as ordered
+ Minimize all stimuli
+ Prepare for CS when seizure stabilized.

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9. Premature labor
 Uterine contractions that produces cervical changes
after period of fetal viability before fetal maturity
 Treatment:
+ Suppression of the contractions
+ Corticosteroid
 Nursing Care:
+ Closely observe client
+ Maintain on bed rest
+ Ensure hydration
+ Observe fetal responses

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10. Premature Rupture of Membranes (PROM)
 Spontaneous break or tear in the amniotic sac before
the onset of regular contractions
 Maternal complications includes:
+ Amnionitis, endometritis, and septic shock
 Fetal complications includes:
+ Asphyxia, pulmonary hypoplasia, malpresentation, and cord
prolapse
 Predisposing factors includes:
+ Lack of proper prenatal care, poor nutrition and hygiene, maternal
smoking and incompetent cervix

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Diagnostic Exam
 Nitrazine paper test
 Ferning test

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Nursing Care:
+ Provide sterile gloves and sterile lubricating jelly during
examination
+ Observe and record color, odor, amount of Amniotic fluid
+ Watch for signs and symptoms of maternal infection
+ Examine mother for signs of prolapsed cord
+ Perineal prep before and after examination
+ Give anti-microbial meds

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 CAUSES!
 PIH, PROM, Multiple pregnancy, placenta previs,
abruptio placenta, trauma, hx of uterine
contractions

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 “
-Leo Buscalgia

“Too often we underestimate the power

of a touch, a smile, a kid word, a listening
ear, an honest accomplishment, or the
smallest act of caring, all of which have
potential to turn a life around.”

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Activities:
 Charting/ Students
kardex
 NCP
 Case Study

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Other topics:
 Charting
 Documentation error
 Consent Signing

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Thanks!
Any questions?

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