Podcast
Questions and Answers
What is the potential life-threatening disorder that usually develops after the 20th week of pregnancy?
Which type of rupture of membranes is associated with malpresentation and possible weak areas in the amnion and chorion?
What increases the risk of ascending intrauterine infection and is known as chorioamnionitis?
What is a basic and effective defense against the fetus contracting an infection that is lost after rupture of membranes?
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What management strategy aims to prevent infection and other potential complications after premature rupture of membranes?
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What nursing intervention helps in educating the client and family to prepare for labor and birth?
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What is the key diagnostic finding for abruptio placenta?
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Which of the following is the most appropriate immediate medical management for severe abruptio placenta?
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A pregnant woman presents with sudden onset of severe abdominal pain, vaginal bleeding, and an absent fetal heart tone. Which of the following is the most likely diagnosis?
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A pregnant woman at 28 weeks gestation presents with mild lower abdominal discomfort, uterine irritability, and regular fetal heart tones. What is the most appropriate next step in management?
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A pregnant woman at 35 weeks gestation presents with sudden onset of severe abdominal pain, a tender and firm uterus, and irregular fetal heart tones. What is the most likely diagnosis?
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A pregnant woman at 32 weeks gestation presents with sudden onset of vaginal bleeding and uterine contractions. Which of the following is the most appropriate next step in management?
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Which of the following is a cardinal sign of preeclampsia?
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What is the most serious complication associated with eclampsia, the convulsive form of PIH?
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Which of the following is a diagnostic finding for premature rupture of membranes (PROM)?
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What is the primary pathophysiology associated with pregnancy-induced hypertension (PIH)?
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Which of the following is a component of the HELLP syndrome associated with severe preeclampsia?
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Which of the following is a potential complication of pregnancy-induced hypertension (PIH) for the mother?
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Study Notes
Abruptio Placenta
- Occurs when the placenta separates from the uterine wall prematurely, usually after the 20th week of gestation, producing hemorrhage
- Degrees of severity:
- Mild: marginal separation, develops gradually, mild to moderate bleeding, produces vague lower abdominal discomfort, abdominal tenderness, and uterine irritability
- Moderate: about 50% placental separation, may develop gradually or abruptly, produces continuous abdominal pain, moderate dark red bleeding, a tender uterus that remains firm between contractions, barely audible or irregular and bradycardic fetal heart tones, and possibly signs of shock
- Severe: 70% placental separation, develops abruptly, causes agonizing, unremitting uterine pain, a board-like, tender uterus, moderate vaginal bleeding, and rapidly progressive shock
- Diagnostic findings: pelvic examination, ultrasonography, decreased hemoglobin levels, and platelet counts
- Medical management: IV infusion of lactated Ringer's solution, central venous pressure (CVP) line, urinary catheter, blood for hemoglobin level, hematocrit, coagulation studies, typing and cross-matching, external electronic fetal monitoring, and maternal vital signs and vaginal bleeding monitoring
Premature Rupture of Membranes (PROM)
- Also known as preterm premature rupture of membranes (PPROM) before 37 weeks, spontaneous premature rupture of membranes (SROM), and rupture of membranes (ROM)
- Associated with malpresentation, possible weak areas in the amnion and chorion, subclinical infection, and possibly incompetent cervix
- Basic and effective defense against the fetus contracting an infection is lost, increasing the risk of ascending intrauterine infection (chorioamnionitis)
- Nursing management: prevent infection, make an early and accurate evaluation of membrane status, minimize vaginal examinations, and provide client and family education
Pregnancy-Induced Hypertension (PIH)
- Also called hypertension of pregnancy or gestational hypertensive disorder
- A potentially life-threatening disorder that usually develops after the 20th week of pregnancy
- Cardinal signs: hypertension, proteinuria, and edema
- Preeclampsia: the non-convulsive form of the disorder, marked by the onset of hypertension after 20 weeks' gestation
- Eclampsia: the convulsive form, occurs between 24 weeks' gestation and the end of the first postpartum week
- Changes associated with PIH:
- Vascular: vasoconstriction, impaired organ perfusion
- Renal: reduced glomerular filtration rate, increased glomerular membrane permeability, oliguria, increased BUN and creatinine, proteinuria
- Interstitial tissues: fluid diffusion from vascular space to interstitial space, edema
HELLP Syndrome
- Hemolysis, elevated liver enzyme levels, and a low platelet count
- Managed through:
- Platelet transfusion via aphoresis
- Magnesium sulfate administration
- Corticosteroid (betamethasone) administration for lung maturity
- Bed rest
- Blood pressure management:
- Keep emergency resuscitative equipment and an anticonvulsant readily available
- Maintain patent airway and prepare oxygen
- Prepare for emergency CS delivery if indicated
- Maintain seizure precautions to protect from injury
- Monitor the extent and location of edema
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Description
Learn about the management of premature rupture of membranes (PROM), preterm premature rupture of membranes (PPROM), and spontaneous premature rupture of membranes (SROM) before 37 weeks. Understand how gestational age, estimates of viability, malpresentation, and other factors can affect the management of these conditions.
