Maternal Transes Preliminary Notes PDF

MATERNAL PRELIM TRANSCRIPT ABNORMAL OBSTETRICS LESSON TOPIC SUBTOPIC A condition in which the cervix begins to dilate...

MATERNAL PRELIM TRANSCRIPT ABNORMAL OBSTETRICS LESSON TOPIC SUBTOPIC A condition in which the cervix begins to dilate and efface (thin out) prematurely during Complications of pregnancy pregnancy, often leading to a miscarriage or premature birth. It may be treated with a Bleeding Disorders cervical cerclage (stitching the cervix closed) to support the pregnancy. Therapeutic Abortion: Hydatidiform Mole: The intentional termination of a pregnancy for medical reasons. It may be performed to preserve Also known as a molar pregnancy, this is a rare the health or life of the mother, to prevent the condition in which an abnormal fertilized egg birth of a child with severe abnormalities, or in develops into a mass of cysts rather than a cases where the pregnancy results from sexual viable fetus. It is a form of gestational assault. trophoblastic disease and may require medical intervention to remove the abnormal tissue. Spontaneous Abortion: Abortion Commonly referred to as a miscarriage, this is the natural loss of a pregnancy before the fetus - Pregnancy that ends before 20 weeks’ can survive outside the womb (usually before 20 gestation (Spontaneous or elective) weeks of gestation). It is typically caused by chromosomal abnormalities, maternal health Types of abortion conditions, or other factors.  Spontaneous Hyperemesis Gravidarum:  Induced  Threatened A severe form of nausea and vomiting during  Incomplete pregnancy that goes beyond typical morning  Complete sickness. It can lead to dehydration, weight loss,  Missed electrolyte imbalances, and hospitalization if not  Habitual managed properly. Assessment Ectopic Pregnancy: - Spontaneous vaginal bleeding occurs A pregnancy in which the fertilized egg implants - Passage of clots or tissue through vagina and grows outside the uterus, most commonly in - Lower uterine cramping / contractions a fallopian tube. This condition is a medical emergency, as it can cause life-threatening Spontaneous Abortion complications if not treated. - The loss of a fetus during pregnancy due Incompetent Cervix: to normal causes. The term miscarriage is the spontaneous termination of a C.A Bularon | BSN 2 1  MATERNAL PRELIM TRANSCRIPT pregnancy before fetal development has - Breast tenderness reached 20 weeks. - Breast enlargement - Discoloration of breast areola - Nausea - Light-headedness or dizziness - Missed periods Assessment Curettage is a surgical procedure that involves - Currently pregnant using a spoon-shaped instrument to remove - Vaginal Bleeding tissue from the body. - With or without abdominal cramps Therapeutic Abortion - Between periods - Low back pain or abdominal pain - Elective or therapeutic abortion is the - Dull or sharp or cramping deliberate termination of a pregnancy. - Persistent / constant or intermittent - Tissue or clot-like material that passes Symptoms from the vagina - Early pregnancy symptoms Test Signs and tests - Pelvic Examination may reveal moderate - Pelvic examination thinning of the cervix (effacement), o Is performed to confirm pregnancy increase cervical dilatation, and evidence and estimate the week of of raptured membranes. gestations. Induced Abortion - Serum HCG o (blood test) may be performed to - Elective or therapeutic abortion is the confirm pregnancy deliberate termination of a pregnancy. - Ultrasound o (Vaginal or Abdominal) may be Symptoms (early pregnancy symptoms used to determine gestational age include): and location. C.A Bularon | BSN 2 2  MATERNAL PRELIM TRANSCRIPT Threatened Abortion can exacerbate complications or delay recovery. - Developing spontaneous abortion Incomplete Abortion - Prepare client for surgical intervention (D&C or suction evacuation) if needed - Loss of some products of conception and o Rationale: retention of others. Surgical interventions such as dilation and curettage (D&C) or Complete Abortion suction evacuation are necessary to - Loss of all products of conception remove retained products of conception, which can prevent Missed Abortion complications like infection, excessive bleeding, or uterine - Retention of products of conception in scarring. utero after fetal death - Provide discharge teaching about limited Habitual Abortion activities and coitus after bleeding ceases. - Three or more successive abortions o Limiting physical activity and abstaining from sexual intercourse allows the body to heal and reduces the risk of infection or further FIRST TRIMESTER COMPLICATIONS bleeding. Proper education also Interventions helps the client understand signs of complications and promotes - Save all tissue passed (histopathology recovery. examination). o Rationale: - Administer rhogam if mother is Rh Collecting and preserving tissue negative. allows for histopathological o Rationale: examination to determine the cause Rhogam prevents Rh sensitization of pregnancy loss, such as in Rh-negative mothers, which chromosomal abnormalities, molar occurs when fetal Rh-positive blood pregnancy, or infection. This helps cells enter the maternal guide further treatment and bloodstream. This intervention management of future pregnancies. helps prevent hemolytic disease of the newborn in future pregnancies. - Increase fluids PO or IV as ordered. o Rationale: INCOMPETNENT CERVICAL OS PREMATURE Maintaining adequate hydration is DILATATION OF CERVIX essential, especially if the client has Definition experienced significant blood loss. Fluids support circulatory stability - A cervix (the structure at the bottom of and prevent dehydration, which the uterus) that is incompetent is C.A Bularon | BSN 2 3  MATERNAL PRELIM TRANSCRIPT abnormally weak, and therefore it can gradually widen during pregnancy - If left untreated, this can result in repeated pregnancy losses or premature delivery. Interventions - Provide bed rest, hydration and tocolytics to inhibit uterine contractions o Rationale: Bed rest helps reduce Symptoms: physical activity and pressure on the cervix, decreasing the risk of - Some factors that can contribute to the preterm labor. Hydration minimizes chance of a woman having an uterine irritability, as dehydration incompetent cervix include trauma to the can stimulate contractions. cervix, physical abnormality of the cervix, Tocolytics (medications that or having been exposed to the drug suppress uterine contractions) help diethylstilbestrol (DES) in the mother’s to delay labor and prevent womb. premature delivery, giving the fetus more time to develop. Painless condition in which the cervix dilates - Cervical cerclage (10-14 weeks of without uterine contractions and allow passage gestation) a band of fascia or non- of the fetus usually the result of prior cervical absorbable ribbon is placed around the trauma. cervix beneath the mucosa to constrict the - Premature dilation of the cervix internal os - Most common in 4th and 5th month of o Rationale: Cervical cerclage pregnancy reinforces a weakened or incompetent cervix, preventing Assessment premature dilation and reducing the risk of pregnancy loss or - Vaginal Bleeding preterm labor. Performing this - Fetal membranes visible through the procedure early (10-14 weeks) cervix. ensures that the cervix is properly supported during the critical period when the fetus begins to grow significantly. C.A Bularon | BSN 2 4  MATERNAL PRELIM TRANSCRIPT - Any that diminishes the tubal lumen may - Cerclage removal : 37 weeks gestation or predispose a women to ectopic pregnancy left in place if cesarean section - An ectopic pregnancy is a pregnancy o Rationale: Removing the cerclage which occurs outside the uterus. Often at 37 weeks allows the cervix to called a "tubal pregnancy," most ectopic dilate naturally in preparation for pregnancies occur in the fallopian tubes vaginal delivery. If a cesarean section is planned, the cerclage Assessment may be left in place since there is - Missed period no need for cervical dilation during - Irregular vaginal bleeding, often after a a surgical delivery. skipped period - Vaginal spotting to bleed that is dark red - If removed, must be repeated at every or brown pregnancy - Sharp pain in the abdomen or pelvis o Rationale: Since cervical which may be intermittent or constant incompetence is likely to recur in - Abdominal tenderness subsequent pregnancies, repeating - Dizziness or fainting the cerclage is necessary to provide - If raptured: increase pain, referred the same support to the cervix and shoulder pain prevent preterm complications. - Signs of shock - Most frequent in the fallopian tubes , - Report for increase uterine contractions or rupture of the site usually occurs before vaginal bleeding after the procedure. 12 weeks. o Rationale: Increased uterine contractions or vaginal bleeding Interventions after a cerclage procedure may indicate complications such as - Monitor bleeding and initiate measures to infection, premature labor, or prevent rupture an shock cervical irritation. Prompt reporting o Rationale: An ectopic pregnancy ensures early medical intervention can lead to severe complications if to protect maternal and fetal the fallopian tube ruptures, health. causing life-threatening internal bleeding and hypovolemic shock. Cervical cerclage is a surgical procedure used Monitoring bleeding allows for early to treat an incompetent cervix, a condition detection of worsening conditions, where the cervix weakens and opens while preventive measures stabilize prematurely during pregnancy, increasing the the patient and reduce risks. risk of miscarriage or preterm birth. - METHOTRXATE – ( Folic acid antagonist) ECTOPIC PREGNANCY – to inhibit the cell division in developing - Pregnancy that occurs in another than embryo uterine sites, with implantation usually o Rationale: Methotrexate is a non- occurring in fallopian tubes. surgical treatment for unruptured ectopic pregnancies. As a folic acid C.A Bularon | BSN 2 5  MATERNAL PRELIM TRANSCRIPT antagonist, it disrupts DNA o Choriocarcinoma synthesis and cell division in the developing embryo, causing it to stop growing. This approach helps resolve the ectopic pregnancy while preserving the fallopian tube and future fertility if administered early. - Prepare for laparotomy and removal of pregnancy and tube, or repair of tube. - Development of anomaly of the placenta o Rationale: If the ectopic pregnancy - Chorionic villi changes into a mass of has caused significant damage to vesicles the fallopian tube, surgical - Appears grapelike cluster may develop to intervention is necessary. A non- malignant or choriocarcinoma laparotomy (open surgery) or - Proliferation of trophoblast: embryo dies. laparoscopy (minimally invasive Unusual chromosomal patterns seen ( surgery) is performed to remove the either no genetic material in ovum or 69 ectopic pregnancy and either repair chromosomes). or remove the damaged tube. This - The chorionic villi change into a mass of is crucial for controlling bleeding, clear, fluid-filled grape like vessels preventing rupture, and preserving - More common in Oriental women and the patient’s overall health. women over 40 - Cause essentially unknown - Administration of RhoGA o Rationale: RhoGAM is Assessment administered to Rh-negative - No fetal heart tone individuals to prevent Rh - Vaginal bleeding occurs at 12th week; from sensitization. If the patient is Rh- dark red to brown color – slight profuse or negative and the embryo is Rh- imminent positive, exposure to fetal blood can - Vaginal bleeding in pregnancy during the trigger the production of antibodies first trimester against Rh-positive blood. RhoGAM - PIH symptoms before 20 weeks gestation prevents this immune response, - Increase fundal height reducing the risk of complications - An abnormal growth in the size of the in future pregnancies. uterus, for the stage of the pregnancy HYDATIDIFORM MOLE - Excessive growth in approximately ½ cases smaller than expected growth in - A hydatidiform mole is a rare mass or approximately ¼ cases growth that may form inside the uterus at - Increase HCG the beginning of a pregnancy. - Nausea and vomiting, severe enough to - Alternative names require hospitalization in 10% of cases o H. Mole o Molar pregnancy C.A Bularon | BSN 2 6  MATERNAL PRELIM TRANSCRIPT - Ultrasound : snow storm pattern; ensures quick treatment to prevent severe blood loss. HCG monitoring: ✓ Every 1-2 weeks until pre-normal pregnancy levels are attained ✓ Then, every 1-2 months for a year ✓ Birth control measures for a yea Interventions Placenta Previa - Prepare for uterine evacuation o Rationale: The abnormal tissue in Assessment Findings the uterus needs to be removed to - Painless bright red vaginal bleeding after prevent complications like heavy seventh month of pregnancy bleeding, infection, or the disease - Uterus remains soft spreading to other parts of the - FHR usually stable unless maternal shock body. present - Before evacuation: diagnostic test are - No vaginal exam by nurse, may result in done to detect metastatic disease. severe bleeding, of done by physician, o Rationale: Tests are done to check double set-up used. if the abnormal cells have spread - Diagnosis by sonography beyond the uterus so the right treatment can be planned. - Evacuation done by vacuum aspiration o Rationale: Vacuum aspiration is a safe and effective way to remove the abnormal tissue while causing the least harm to the uterus. - Laboratory confirmation of tissue o Rationale: The removed tissue is tested to confirm the diagnosis and Interventions check if it’s a molar pregnancy or - Ensure complete bed rest CBR something else, which helps guide o Rationale: Bed rest helps reduce further treatment. stress on the uterus and decreases - Hemorrhage post-procedure the risk of further bleeding or o Rationale: Bleeding after the complications. procedure can happen if the uterus doesn’t contract well or if some tissue is left behind. Monitoring C.A Bularon | BSN 2 7  MATERNAL PRELIM TRANSCRIPT - Maintain sterile condition for any invasive - Usually occurs after 20th week of procedures ( including vaginal pregnancy examination) - Seen frequently in women with o Rationale: Using sterile techniques hypertension, previous abruption prevents infection, which is placentae, late pregnancies, multigravida, especially critical in high-risk but cause essentially unknown. pregnancies or when invasive procedures are necessary. Symptoms - Small separation of the placenta: - Make provisions for emergency cesarean o Vaginal bleeding birth (double set-up procedure) o Mild pain or discomfort. o Rationale: Having everything ready o Unborn child remains healthy for an emergency cesarean ensures - Large separation of the placenta: a quick response if the baby or o Heavy signal bleeding mother’s condition worsens, o Severe pain in the lower abdomen especially in cases of severe or back bleeding. o Hard, tender abdomen o Shock (rapid heartbeat, rapid - Continue to monitor maternal/fetal vital breathing and dizziness) signs o Fetal distress; heartbeat of the o Rationale: Regular monitoring unborn child may be inaudible helps detect signs of distress in the o Coagulopathy mother or baby early, allowing for timely intervention. Interventions - Measure blood loss carefully - Ensure bed rest o Rationale: Accurately measuring o Rationale: Bed rest reduces the blood loss helps assess the severity strain on the body and can help of bleeding and guides decisions minimize the risk of further about treatment, such as fluid complications like bleeding or replacement or transfusions. preterm labor, particularly in high- risk pregnancy situations. - Assess uterine tone regularly o Rationale: Checking uterine tone - Check maternal/fetal vital signs ensures the uterus is contracting frequently properly and not at risk of o Rationale: Frequent monitoring of hemorrhage or other complications. vital signs allows for early detection of distress in the mother or fetus. Abruptio placenta This includes signs of shock, hypoxia, or other life-threatening - Separation of placenta from part or all of conditions that require immediate normal implantation site accompanied by intervention. pain C.A Bularon | BSN 2 8  MATERNAL PRELIM TRANSCRIPT - Prepare for IV infusions of fluids/blood as indicated o Rationale: Intravenous fluids or blood transfusions may be necessary if the mother is experiencing hemorrhage, dehydration, or other critical conditions. Preparing for this intervention ensures prompt treatment to stabilize the mother’s condition. - Monitor urinary output o Rationale: Monitoring urinary output is crucial to assess kidney Hyperemesis Gravidarum function and fluid balance. A decrease in urine output may - The presence of extreme, persistent indicate kidney failure or shock, nausea and vomiting during pregnancy both of which require immediate that may lead to dehydration. medical intervention. Symptoms - Anticipate coagulation problem (DIC) - Severe nausea o Rationale: Disseminated - Persistent excessive vomiting intravascular coagulation (DIC) is a (often leading to weight loss) serious complication where - Lightheadedness or fainting abnormal blood clotting occurs throughout the body, potentially Signs and Tests leading to severe bleeding. Early - Signs of dehydration may occur: recognition allows for timely o Ketones in urine management and interventions to o Increase hematocrit prevent or treat DIC. o Increased pulse rate o Decrease Blood Pressure - Provide support to parents as outlook for fetus is poor. Assessment o Rationale: In cases of poor fetal prognosis, emotional support for - Excess nausea & vomiting the parents is essential. They may - Leading to dehydration & electrolyte need counseling, information, and disturbance emotional guidance to cope with o Alkalosis the situation and make informed  HCG levels increased, HCG decisions about their care. levels peak around 6 weeks, plateau, then begin to decline after the 12th week. C.A Bularon | BSN 2 9  MATERNAL PRELIM TRANSCRIPT - Weight loss Interventions - Begin NPO and IV fluid and electrolyte replacement - Gradually re-introduce PO intake - Monitor TPN and Central Line placement if unable to eat - Provide mouth care - Offer emotional support RH Incompatibility - Rh incompatibility is a condition which develops when there is a difference in Rh blood type between that of the pregnant mother (Rh negative) and that of the fetus (Rh positive) Symptoms - Rh positive infant delivered of an Rh negative mother’ - Slowly or rapidly increasing jaundice - Prolong jaundice - Hypotonia - Motormental retardation - Polyhydramnios Signs and Tests Rh Sensitazation - Positive direct coombs - Evidence of hemolysis in the infants blood - The surface of red blood cells contains - Elevated cord blood bilirubin markers that the immune system can recognize. One of these markers is the Rh factor (Rh antigen). A person whose blood contains the Rh factor is Rh positive. A person whose blood does not contain the Rh factor is Rh-negative - A problem may occur when an Rh- negative women becomes pregnant with an Rh-positive fetus. This can happen only when the father is Rh-positive C.A Bularon | BSN 2 1  MATERNAL PRELIM TRANSCRIPT - The pregnant woman’s immune system Pre-Eclampsia may produce substances (antibodies) that can destroy the fetus’s blood. This process - Pre-eclampsia is an illness which occurs is called Rh sensitization. only during pregnancy or immediately - Sensitization occurs only if the fetus’s after delivery and can affect you and your blood mixes with the pregnant woman’s. baby. It is called pre-eclampsia because in Normally this does not occur, because the rare cases woman can go on to develop woman’s and fetus’s blood are kept fits, known in pregnancy as eclampsia. It separate during pregnancy used to be called toxaemia, and your - However, blood mixing sometimes occurs mother and other older relatives may have during labor or delivery, miscarriage, known it as this. It is quite common, abortion, or injury. affecting about one in every 10 - Rh sensitization is no danger to the pregnancies. The most at risk are the pregnant woman and usually no harm to first-time mother or pregnant for the first the frist Rh-positive fetus. time by a new partner. - However, future Rh-positive fetuses are in Symptoms: danger of having their red blood cells destroyed before birth by the pregnant Bad headache woman's immune system. - This danger can usually be prevented by Problems with vision - such as blurring or giving the woman an RH immunoglobulin flashing lights before the eyes injection (such as RhoGam) Bad pain just below the ribs Pregnancy Induced Hypertension Vomiting - Vasospastic hypertension proteinuria and Sudden swelling of your face, hands or feet edema - Probable cause gradual loss of normal pregnancy-related resistance to angiotensin II. Ecamplsia - Decreased production of some - Eclampsia is a Greek word meaning 'bolt vasodilating prostaglandins from the blue'. It describes one or more - 20th week of pregnancy convulsions, or seizures, occurring during - Primigravidas, multiple pregnancies, H. or immediately after pregnancy as a more, poor nutrition, essential complication of pre-eclampsia. hypertension; familial tendency. - Very few cases of pre-eclampsia culminate - Classic triad of symptoms includes in eclampsia. edema/weight gain, hypertension and proteinuria. Eclampsia includes Symptoms convulsion and coma. - Possible life threatening compilations. seizures HELLP syndrome (Hemolysis, elevated agitation (severe) liver enzymes, lowered platelets. - Only known cure is delivery. C.A Bularon | BSN 2 1  MATERNAL PRELIM TRANSCRIPT unconsciousness for a variable period of time Eclapmsia possible musculoskeletal aches and pains after an event caused by trauma Assessment: - Increased hpn precedes convulsion Severe Pre Eclampsia followed by collapse & hypotension - Coma may ensure Assessment: - Labor may begin, putting fetus in great - Headaches jeopardy - Epigastric pain - Convulsion may recur - Nausea and vomiting Interventions - Visual disturbances - Irritability - Minimize all stimuli - Blood pressure of 150-160/100-110 - Check vital signs and lab values - Increased edema and weight gain - Have airway, oxygen and suction - Proteinuria (5g/24hours)(4+) equipment available - Administer medication as ordered Management: Magnesium Sulfate - Prepare for C-section when seizures - myoneural junction, maternal stabilized vasodilatation, diminishing - Continue observations 24-48 hours neuromuscular transmission. postpartum. anticonvulsant effect Interventions Assesssment of reflexes - Promote complete bed rest, sidelying. Biceps - Carefully monitor maternal/fetal vital signs - Position thumb over biceps tendon while - Monitor I&O, results of laboratory tests supporting the clients elbow woth the - Take daily weights palm of the hand - Institute seizure precautions - Strike a down ward blow over the thumb - Instruct client about appropriate diet with percussion hammer - Continue to monitor 24-48 hours post - Normal response: flexion of the arm delivery - Administer medications as ordered; Patellar Peripheral vasodilator of choice usually - Position the client woth legs dangling over Hydralazine (Apresoline) Antidote :calcium the edge of examining table or lying at the gluconate or calcium chloride back with legs slightly flexed C.A Bularon | BSN 2 1 MATERNAL PRELIM TRANSCRIPT C.A Bularon | BSN 2 1