Risk Pregnancies PDF

 risk pregnancies > Decidua Basalis provides nutrients to...

 risk pregnancies > Decidua Basalis provides nutrients to - tissue ttns layer it sheds off for menstruation Conditions w/ first Trimester not pregnant - , Bleeding : ◦ Infection ( rubella , syphilis poliomyelitis ) , in ① ABORTION - vaginal bleeding > UTI - associated preterm labor - termination before 20 Wks. gestation medical term TYPES : Abortion - miscarriage - layman stern ① Complete - all products of conception - > 20 -24 wks , > 50g are expelled , uterine bleeding & cramping ( viable ) w/ n 2hr5 Classification : management : Abortion no therapy report bleeding to H C spontaneous > - , * no need to admit - termination occurs naturally > causes : ◦ abnormal fetal development ② Incomplete - portion of products of factors conception is expelled & portion is - teratogenic > Chromosomal abnormalities retained Placenta & Fetal retained ingestion of alcohol membrane > - > > Fetus - expelled ◦ implantation abnormalities Management : > 50% zygote do not implant due to : > DIC - Dilation and Cnrretage * inadequate endometrial formation - check bubbles & hear sqnekirig sounds to * inappropriate site of implantation confirm retained products DIE - evacuation of Conception ◦ Corpus Luteum fails to produce enough progesterone to maintain Decidua ③ Threatened - product of conception Basalis has not been expelled bleeding ( bright red) Progesterone : > begins at vaginal ① thicken endometrial lining > upon exam no cervical dilatation ⑨ ↑ uterus > abdominal cramping ③ ↑ blood flow in the uterus > go to hospital to check fetal sounds should be ↑ I check Hog level > continues I can tell pt. to bed rest 25% - inevitable  Induced Abortion ⑨ Missed pregnancy becomes non * - - viable fetus dies in utero but - termination of pregnancy before viability , not expelled by medical / surgical " Failure Early Pregnancy - " Types : > detect prenatal visit * therapeutic - terminated because of management : wait for expectant health risk to mother & fetal disease * management - 8 wks * medication - MISOPROSTOL * surgical * Elective Abortion ( voluntary ) request of the misoprostol prostaglandin I analogue as client - - > - anti - ulcer but can cause uterine 2 contractions / induced signs symptoms : if 85% -90% effective < 10 Wks fetus Vaginal Bleeding - * vaginal suppository in 1st 1- rimes bloody discharge - - - w/ w/o cramping or > mifepristone - ⊖ p - code RU 486 ✓ check it cervical dilatation dilatation abortion is ✓ w/ cervical - ⑤ Habitual. 3 /more successive spontaneous inevitable abortion Bed Rest serial Lab test ✓ , " " Recurrent Pregnancy Abortion DIC ✓ - abstain coitus for minimum 2 Wks * Defective sperm / Ova - * Endocrine factors - thyroid problem Nursing Responsibilities : - detective luteal phase ✓ assess amount & character of La decidua b. formed loss blood * Resistance to Uterine Artery Flow for signs & symptoms of ✓ assx. - due to chronic hypertension shock I infection * Chromiorhitis / Uterine PID ° fever ≥ 38°C - PID caused of Mtl ° abdominal pain ✓ emotional support complications : * Hemorrhage * Infection  Closed cervix Cullen 's sign blush in * - tinge threatened to slowly seeping of blood - umbilicus , due complete cavity peritoneal - into - missed Management : Open cervix ① Ruptured : surgical Emergency - incomplete treatment - inevitable / imminent. laparoscopy = to ligate bleeding vessels I remove damage Fit ② ECTOPIC PREGNANCY ② Diagnosed before rupture OF FT - implantation of fertilized ovnz and most of bleeding medical treatment frequent cause - - methotrexate followed by Leucororin early in - pregnancy vile : Fallopian tube ↳ anti - cancer drug ↳ foliate - most common analogue 80% ampulla = _ reverse side ett. Of methotrexate precipitating Factors : - damage to fallopian tube * advantage of med tx : - adhesion _ FT is left intact w/o scar - previous injection ( KD) Abdominal Pregnancy Pip scars from tubal surgery of - _ product conception escapes into pelvic cavity signs I symptoms : in lower * sharp stabbing pain abdominal * bleeding - sloughing off of uterine decidua because progesterone secretion stops * Extension vaginal I abdominal pain * excruciating pain on cervix & pelvic exam * ammenorhla - absence of menstruation  conditions w/ 2nd Tri semester Bleeding mole Extraction : * Baseline Pelvic Exam * chest A. Gestational x-ray trophoblast-0 Disease * HCG serum test ( H - mole ) no embryo - fluid done every 2- 4 wks for 6 months filled grape sized vesicles - - -. - low titers suggest no complication titers > Trophoblast came from high suggest malignant - zygote - - transformation becoming trophoblast'C HCG E) women is after 6 mnths - , Factors : free from risk of malignancy 10N CAN intake Vit A for 1 yr ✓ women w/ - H mole refrain pregnancy -. - , - ✓ 18 yrs old & ↑ 35 yrs old ↓.. - use a reliable contraceptive for 6 months signs & Symptoms : so F) HCG preg. test will not be ✓ rapid development of uterus confused w/ high HCG & developing forms ( choriocarcinoma ) ✓ NO THT , no viable malignancy @ 16th wk of ✓ vaginal bleeding pregnancy l dark - brown blood ) prophylactic treatment : ✓ discharge of clear - fluid titled * methotrexate - DOC for vesicles choriocarcinoma ✓ serum or urine test I 2M 14 ( Beta HCG ) HCG - - ( normal pregnancy = 400,000 IU ) B. Incompetent cervix / Premature Cervical Dilation A- Mole s / sx : _ refer to cervix dilates prematurely therefore cannot hold the fetus f) F T CG Until term per emesis gravidanm eight I fundal ) TN causes : * Diethylstilbestrol IDEs ) exposure management : _ synthetic estrogen , morning I pill evacuate mole * suction & curretage - to - to prevent miscarriage - not used because of carcinogenic & teratogenic components  * trauma to cervix from previous OB "" "" " " "" "" NSD may deliver gyne procedures of pregnancy , - frequent DIC - if CS - sutures may left - 80-9090 success rate * Increased maternal bed trendelenburg age rest w/ slight - tone - loosing of muscle position for ten days decrease on sutures = pressure * Congenital Structural Defects Conditions w/ third Trisemester signs & Symptoms Bleeding : ① First symptom * Show pink stained vaginal A. Placenta Previq - discharge - low implantation of placenta - increase pelvic pressure → rupture of 4 Degrees : membrane uterine contractions Low lying placenta - a. - is implanted in lower placenta - internal Management uterine segment near : Cervical cervical OS 2cm Cerclage > * , surgical - 12-14 WKS AOG sutures placed b. Marginal Implantation - are in cervix by vaginal approach cervical OS route placenta edge - - sutures serve to strengthen but may extend onto OS during Unix I prevent from dilating dilation of cervix during labor - < 2cm * McDonald Procedure Partial P P placed horizontally c. sutures - nylon - Occludes portion of cervical OS & across cervix vertically - - tight to reduced conical canal d. total Pip * Shirodkar technique - totally obstructs cervical 0s sterile tape threaded in fully dilated - purse when cervix is string manner ?⃝  causes : - monitor urine output 1 hr ' * advanced maternal age - attach fetal monitor , FHT I Cs , past uterine uterine contraction * curettage * multiple gestation determine hgb hct.PT & - , platelet , blood type 2 cross - endometrial lining becomes thin match Assessment : PT = prothrombin painless vaginal bleeding just in case need for BT * abrupt - - due to placenta inability to if previa only 30% Cervical differing shape of lower covers 0s stretch > of cervix possible for NSD segment = uterine - > 30% = CS deliv is * Bleeding may stop as abruptly > if labor begun , bleeding it / continue as began as spotting continuing i fetus being compromise check LMP if bleeding stop * > , FAT are good , * time bleeding began maternal ifs good , fetus is * If accompanying pain not yet 36 wks A- 06 : * color of blood * women remains @ hospital - scant blood = on bed rest close monitor , - bright red = protnsed * if discharged - continue * site of bleeding bed rest & home care uterine decidua at risk Bethamethasone places * - for hemorrhage _ steroid hastens fetal * Risk for fetus = ↓ oxygenation lung maturity - help prevent respiratory management : disease syndrome - Monitor vital signs I fetal activity rest side bed on lying - - - inspect perineum for bleeding , estimate blood loss - N0IE_ - massive hemorrhage - 4s every 15 mins IVF -  B. Abmptio Placenta ✓ pregnancy must be terminated - premature separation of placenta because tetns cannot obtain 02 from uterine wall p- 20th wks & nutrients a- fetus is delivered ✓ administer blood products ✓ - may occur as late as 1st , 2nd amniotomy I IV Oxytocin stage of labor - check it bleeding inside ✓ Emergency CS Predisposing Factors : I monitor for DIC * short umbilical cord - disseminator intravascular * chronic hypertensive disease coagulation * hypertension of pregnancy * direct trauma * cocaine use C- Pregnancy Induced HPN ( MH ) * cigarette smoking - vasospasm occurs during pregnancy " " - toxemia of pregnancy signs & Symptoms : - sharp stabbing pain 1 Painful vaginal Incidence : bleeding ) - primipara ↓ 20 yrs. old ↑ 40 yrs Old. heavy bleeding w/ signs of shock low socio economic = poor nutrition - - - - abnormal Or absent FAT - 5 or more pregnancies - hypotension , tachycardia , cool - multiple pregnancy moist skin - board like abdomen classification : ① Gestational HPN Management : - 140190 mmHg ✓ 02 therapy No edema - ✓ monitor V15 I FHT - No drug therapy lateral not supine ✓ placed in - to prevent pressure in vena cava ⑥ mild Pre-eclampsia ✓ assx for vaginal bleeding. - 140/90 mmHg taken 2x at ✓ bed rest 6 hrs ✓ monitor uterine activity - ( t) proteinuria 1300 Mgs / more ✓ IVF pet 24 hrs / 100mg / dl ) - (t ) edema  gain of albs / Wk tri and ⑨ wt I Eclampsia -. 1lb in 3rd trimester - severe classification cerebral edema that a seizure word - -☐ greek occults Eklampsis sudden onset coma > = or or violent onset - convulsion ↳ seizures - occurs late in pregnancy but 48 hrs F Childbirth happen ③ Severe Pre-eclampsia > convulsion - involuntary muscular activity - 160/110 mmHg - diastolic is 30 mmHg above the - high temp 103 - IOYF ( 39.4 to 40°C ) pregnancy level pre blurring vision - - - marked proteinuria 12 t or more - severe headache , epigastric pain on random urine sample ) & nausea - extensive edema = woman 's face I hands > Grand Mal Seizure " " tonic clonic seizure puffiness - as - / RUQ pain looses consciousness Epigastric - - violent muscle contractions Thrombocytopenia - - > glomerular - podocytes 4> Vaso spasms management : proteins will sit thru a. mild HPN - Rest glomelurons * Bed * Promote good nutrition > Thrombopoeitin - production of - salt restriction = ↓ edema is no longer recommended because ↳ because of thrombocytopenia NA restriction may activate Renin - angiotensin → aldosterone system ↑ HE LLP I result high BP It hemolysis - E- elevated hemoglobin * Provide emotional support L - low platelet - take leave abscenoe from work > ↓ blood V01 stimulates juxta of production renin > renin → angiotensin cogent angiotensin * Hydra / azine → to I ACE Angiotensin I P * Mgs 04 DOC prevent - - magnesium sulfate eclampsia = ↑ BP Na secretion Vasoconstriction ◦ t CNS lessen depressant.. - = seizure = PBP = stimulate produce ANP ANP = atrial natriorethic Peptide - antihypertensive = ↓ BP - anticonvulsant b. severe HPN * Enforced Bed Rest Check for parameters : 1 For MGSOY ) - place in private , darkened room ① urine output = ↑ 30 cc / hr w/ side rails ⑥ RR = ↑ 12 1min - restrict visitors ③ DTRS = tt ↑ ⑨ BP 90/60 - _ * Monitor maternal well - being ⑤ serum mg = ↓ 7-5 ME 9 /L for BP every 4 hrs ④ Ca Gluconate = antidote - - Obtain blood studies ( CBG Platelet mg toxicity ( catapres) > Clonidine I Hydra / aime > Mg toxicity = ↓ BP. ↓ urine output - safe for pregnant women = areflexia w/ HPN c. Eclampsia * Monitor fetal well being - * priority care ( during seizures ) FHT monitoring - single doppler - maintain patient airway , 02 thru auscultation / external fetal face mask to protect fetus monitor - apply external fetal monitor - 02 administer to mother to - place on side to prevent aspiration maintain adequate fetal increase saliva collected in month 02 , prevent bradycardia - NPO for vaginal bleeding D- mins - Check * Diet moderate to high CHON Assx FH sound & uterine contraction - -. - moderate Na diet * Administer medication to prevent eclampsia  2. Birth ✓ ↑ 24 wks - delivery made as women stabilize 12 - 24 hrs F ✓ Cs is more hazardous ✓ Vaginal Deir - preferred it labor not begin spontaneously - tuptrre membrane / induce labor w/ IV oxytocin ✓ it ineffective 2 fetus imminent danger Cs is indicated d. Postpartum Hypertension - to -14 days I birth - most cases first 48hrs7 birth - monitor BP to detect residual HPN - rare case =