NCM 109 MCP: Nursing Care During Labor & Delivery PDF

NCM109MCP Care Of Mothers, Child, Family And Population Group At Risk Or With Problems  NCM109MCP: Care Of Mothers, Child, Family And Population Group At Risk Or With Problems Topic 2: NURSING CARE OF THE CLIENT DURING LABOR AND DELIVERY Topic 2: NURSING CARE OF THE CLIENT DURING...

NCM109MCP Care Of Mothers, Child, Family And Population Group At Risk Or With Problems  NCM109MCP: Care Of Mothers, Child, Family And Population Group At Risk Or With Problems Topic 2: NURSING CARE OF THE CLIENT DURING LABOR AND DELIVERY Topic 2: NURSING CARE OF THE CLIENT DURING LABOR AND DELIVERY A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication B. Nursing Care of a Family Experiencing a Complication of Labor or Birth C. Nursing Care of a Family Experiencing Postpartum Complications Topic 2: NURSING CARE OF THE CLIENT DURING LABOR AND DELIVERY 1. Bleeding during pregnancy A. Nursing Care of 2. Preterm Rupture of Membranes a Family 3. HELLP Syndrome 4. Multiple Pregnancy Experiencing a 5. Isoimmunization (Rh Incompatibility) Sudden 6. Fetal Death Pregnancy 7. Preterm Labor Complication 8. Post-term Pregnancy 9. Hypertensive Disorders of Pregnancy 10.Polyhydramnios 11.Oligohydramnios  A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 1. BLEEDING DURING PREGNANCY 1.1. DURING FIRST TRIMESTER OF PREGNANCY Bleeding during pregnancy can have various causes, ranging from minor to more serious concerns, while some light spotting maybe normal, heavy bleeding or persistent bleeding should be promptly addressed with healthcare professional.  1. BLEEDING DURING PREGNANCY 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.1 ABORTION is a medical term for any interruption of a pregnancy before a fetus is viable (able to survive outside the uterus of born at the time) termination of pregnancy before the age of viability (20 weeks or 5 months) a procedure, either surgical or medical, to end a pregnancy by removing the fetus and placenta from the uterus. A fetus born before this point is considered a miscarriage or termed a premature or immature birth. PREPARED BY: OB LECTURERS 6 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: a. Spontaneous Abortion/Miscarriage is an early miscarriage if it occurs before week 16 of pregnancy and a late miscarriage if it occurs between weeks 16 and 20. Signs And Symptoms: Low back pain or abdominal pain - that is dull, sharp, or cramping Vaginal bleeding – with or without abdominal cramps Tissue or clot–like material that passes from the vagina PREPARED BY: OB LECTURERS 7 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION For the first 6 weeks of pregnancy, the developing placenta is tentatively attached to the decidua of the uterus during weeks 6 to 12, it is moderately attached. After week 12, the attachment is penetrating and deep. Bleeding before week 6 is rarely severe; bleeding after week 12 can be profuse because the placenta is implanted so deeply PREPARED BY: OB LECTURERS 8 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: a. SPONTANEOUS ABORTION/MISCARRIAGE Common Causes: 1. Abnormal fetal development – due to teratogenic factor or chromosomal aberration 2. Immunologic factors 3. Implantation abnormalities 4. Failure of the corpus luteum on the ovary to produce enough progesterone to maintain the decidua basalis 5. Alcoholic beverages – ingestion 6. UTI 7. Systemic Infections (rubella, syphilis, poliomyelitis, CMV, toxoplasmosis) PREPARED BY: OB LECTURERS 9 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: a. SPONTANEOUS ABORTION/ MISCARRIAGE Signs and Tests: 1. Pelvic Exam thinning of the cervix (effacement) increased cervical dilatation evidence of rupture of membranes PREPARED BY: OB LECTURERS 10 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: a. Spontaneous Abortion/ Miscarriage Signs and Test: 2. HCG (Human Chorionic Gonadotropin) - qualitative and quantitative urine and blood - urine HCG test is a common method of determining if a woman is pregnant - detectable in the blood or urine 1 to 2 days after implantation of the fertilized egg (10 days after ovulation) PREPARED BY: OB LECTURERS 11 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: a. SPONTANEOUS ABORTION/MISCARRIAGE Treatment and management tissue passed from the vagina should be examined to determine the source (fetal vs H-Mole) if remaining tissue is present - surgery or D&C PREPARED BY: OB LECTURERS 12 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.1. Threatened Abortion Vaginal bleeding before 20 weeks AOG with a close cervix without evidence of fetal demise Signs and symptoms: ▪ Vaginal spotting (scant and bright red) ▪ slight abdominal cramping ▪ No cervical dilatation PREPARED BY: OB LECTURERS 13 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.1. Threatened Abortion Treatment And Management Assess for FHB UTZ Blood test for the presence of HCG complete bed rest (CBR) or pelvic rest for 24-48 hours – avoidance of strenuous activity abstaining from intercourse avoid douching and using tampons PREPARED BY: OB LECTURERS 14 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.2. Imminent / Inevitable Abortion An impending miscarriage indicated by bleeding and pain, symptoms cannot be stopped, and miscarriage will happen Signs and symptoms: Abdominal-pelvic cramps Purulent cervical or vaginal discharges Tachycardia Hypotension PREPARED BY: OB LECTURERS 15 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.2. Imminent / Inevitable Abortion Management: Save for any tissue fragments Assess for FHB D&C or D&E – ensure all products of conception are removed UTZ PREPARED BY: OB LECTURERS 16 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.3. Complete Abortion All products (tissue) of conception removed from the uterus; expelled spontaneously without any assistance Bleeding slows within 2 hours and then ceases within a few days after passage of the products. Management: Emotional support PREPARED BY: OB LECTURERS 17 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.4. Incomplete Abortion part of the conceptus (usually the fetus) is expelled, but the membranes or placenta are retained in the uterus. Maternal hemorrhage Signs and symptoms: ▪ Vaginal bleeding ▪ Low back pain or abdominal pain dull sharp or cramping ▪ Tissue or clot – passes from the vagina PREPARED BY: OB LECTURERS 18 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.4. Incomplete Abortion Management: D & C or Suction Curettage PREPARED BY: OB LECTURERS 19 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.5. Missed Abortion also commonly referred to as early pregnancy failure, the fetus dies in utero but is not expelled. Signs and Symptoms: Absence of FHT Abdominal Cramps or pain Vaginal discharges or fluid or tissue Vaginal Bleeding PREPARED BY: OB LECTURERS 20 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION Classification of Spontaneous Abortion: a.5. Missed Abortion Management: ▪ D&C ▪ Prostaglandin suppository or misoprostol (Cytotec) – induced labor to cause dilatation ▪ Administration of oxytocin (for contraction of the uterus to start labor and to stop bleeding) PREPARED BY: OB LECTURERS 21 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: b. RECURRENT PREGNANCY LOSS referred to 3 spontaneous miscarriages at the same gestational age were called “habitual aborters.” Possible Causes or Factors: ▪ Abnormal spermatozoa or ova ▪ Endocrine factors ▪ Deviations of the uterus ▪ Chorioamnionitis or uterine infection ▪ Autoimmune disorders PREPARED BY: OB LECTURERS 22 DEVIATIONS OF THE UTERUS 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION b. RECURRENT PREGNANCY LOSS Test to detect the cause: UTZ of the uterus or Transvaginal UTZ Blood test: Thyroid function test, Karyogram, CBC, WBC Management: ▪ Surgery for habitual abortion - if the cause in INCOMPETENT CERVIX PREPARED BY: OB LECTURERS 24 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION b. RECURRENT PREGNANCY LOSS Management: ▪ Temporary: - McDonald Procedure - Temporary Cerclage - Delivery: Normal Delivery PREPARED BY: OB LECTURERS 25 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION b. RECURRENT PREGNANCY LOSS Management: ▪ Permanent: Shirodkar Procedure ▪ Delivery: Cesarean Section ▪ Nursing Management: 1. Check for signs of infection 2. Check for signs of labor 3. Check for normal bleeding PREPARED BY: OB LECTURERS 26  1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: c. INFECTED/ SEPTIC ABORTION an abortion complicated by infection If women who have tried to self-abort or whose pregnancy was aborted illegally using a nonsterile instrument Signs and Symptoms: ▪ Fever ▪ Abdominal pain/cramps ▪ Tenderness of the uterus PREPARED BY: OB LECTURERS 27  1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY: ABORTION TYPES: Management: c. INFECTED/ SEPTIC ABORTION ▪ CBC, Blood typing ▪ Serum Electrolytes, Creatinine Danger Signs of Infection ▪ Cervical, Vaginal, and Urine - ▪ Fever Cultures ▪ Abdominal pain or tenderness ▪ Indwelling Catheter is inserted ▪ Prolonged or heavy vaginal ▪ IVF bleeding ▪ D&C ▪ Foul Smelling Vaginal discharges ▪ Tetanus Toxoid injection ▪ Backache ▪ UTZ May lead to toxic shock syndrome, ▪ Combination of Antibiotic septicemia, kidney failure, and death – if Regimen, left untreated PREPARED BY: OB LECTURERS 28 1. BLEEDING DURING PREGNANCY 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY implantation occurred outside the uterine cavity. the most common site is in the fallopian tube PREPARED BY: OB LECTURERS 29 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY Causes: 1. Surgery 2. Endometriosis 3. Smoking 4. Previous ectopic pregnancy 5. PID – chlamydia or gonorrhea 6. Fertility Drugs that increase egg production 7. Pelvic or abdominal Surgery 8. Fallopian tube damage often from infection PREPARED BY: OB LECTURERS 30 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY Signs and symptoms: ▪ Normal signs of pregnancy ▪ Pain – 1st red flag sign Other Signs and Symptoms: Vaginal spotting or bleeding Dizziness or fainting Low blood pressure Lower back pain PREPARED BY: OB LECTURERS 31 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY Unruptured ▪ Missed period ▪ Abdominal pain within 3-5 weeks ▪ Scant, dark brown vaginal bleeding ▪ Vague discomfort PREPARED BY: OB LECTURERS 32 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY Ruptured ▪ Sudden sharp severe pain ▪ Shoulder pain ▪ (+) Cullen’s Sign – bluish-tinged umbilicus PREPARED BY: OB LECTURERS 33 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY Diagnostic Test: Treatment: Urine pregnancy test Surgery (+) pregnancy test - quantitative Laparoscopy HCG test - to know the fetal age Pelvic Exam UTZ Culdocentesis PREPARED BY: OB LECTURERS 34 1. BLEEDING DURING PREGNANCY: 1.1. DURING FIRST TRIMESTER OF PREGNANCY 1.1.2. ECTOPIC PREGNANCY Nursing care: High-Risk women: ▪ Vital signs Age 35 and 44 years old ▪ Monitor I&O With PID Previous Ectopic pregnancy ▪ Administer IVF Surgery on the fallopian tube ▪ Monitor Vaginal Infertility problems or bleeding medication to stimulate ▪ Prepare for ovulation Culdocentesis PREPARED BY: OB LECTURERS 35 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 1. BLEEDING DURING PREGNANCY 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY A. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) ▪ Is abnormal proliferation and then degeneration of the trophoblastic villi ▪ Molar pregnancy ▪ With fluid and appear as clear fluid-filled, grape-sized vesicle ▪ Hydatid – means DROP OF WATER; mole – means SPOT PREPARED BY: OB LECTURERS 37 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) ▪ TYPES: a. Partial Molar – a pregnancy that includes an abnormal embryo (a fertilized egg that has begun to grow) but does not survive. b. Complete Molar – pregnancy in which there is small cluster of clear blisters or pouches that don’t contain an embryo PREPARED BY: OB LECTURERS 38 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) ▪ Etiology: UNKNOWN ▪ Other Causes: 1. Problems with the chromosome 2. Problem with the nutrition 3. Problems with the ovaries and uterus 4. Mole sometimes can develop from a placental tissue that is left behind in the uterus after a miscarriage or childbirth. Other PREPARED BY: OB LECTURERS 39 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) ▪ Signs and symptoms 1. (+) Pregnancy test 2. symptoms for the 1st 3-4 months 3. uterus grows abnormally fast 4. end of 3rd month – woman will experience vaginal bleeding ranging from scant spotting to excessive bleeding PREPARED BY: OB LECTURERS 40 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) ▪ May predispose the: 1. The presence of hyperthyroidism(overproduction of thyroid hormone) leads to weight loss, increased appetite, and intolerance to heat. 2. Grapelike cluster of cells itself will be shed with the blood during this time 3. Nausea and vomiting due to increase HCG and progesterone 4. (-) fetal Movement and fetal heart rate PREPARED BY: OB LECTURERS 41 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) EARLY SIGNS: 1. Vesicles passed thru the vagina 2. Hyperemesis gravidarum 3. Fundal height – rapidly increases 4. Vaginal bleeding (scant or profuse) 5. Pre-eclampsia at about 12 weeks PREPARED BY: OB LECTURERS 42 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) LATE SIGNS: 1. HPN before 20th week 2. Vesicles look like a “snowstorm” on sonogram 3. Anemia 4. Abdominal cramping SERIOUS LATE COMPLICATIONS: 1. Hyperthyroidism 2. Pulmonary embolism PREPARED BY: OB LECTURERS 43 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) DIAGNOSIS: 1. Suspect until 3rd month or later if a fetal heartbeat is present with bleeding and severe nausea and vomiting 2. Physician will examine the woman’s abdomen feeling for any strange humps or abnormalities in the uterus 3. Tubal pregnancy will ruled out 4. Abnormally increased HCG level with vaginal bleeding 5. (-)FHB 6. Unusually large uterus will indicate a molar pregnancy 7. UTZ – confirm no living fetus PREPARED BY: OB LECTURERS 44 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) DIAGNOSIS: 1. Suspect until 3rd month or later if a fetal heartbeat is present with bleeding and severe nausea and vomiting 2. Physician will examine the woman’s abdomen feeling for any strange humps or abnormalities in the uterus 3. Tubal pregnancy will ruled out 4. Abnormally increased HCG level with vaginal bleeding 5. (-)FHB 6. Unusually large uterus will indicate a molar pregnancy 7. UTZ – confirm no living fetus PREPARED BY: OB LECTURERS 45 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY 1.2. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE) THEREPEUTIC MANAGEMENT: suction curettage to evacuate the abnormal trophoblast cells PREPARED BY: OB LECTURERS 46 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY B. CERVICAL INSUFFICIENCY (PREMATURE CERVICAL DILATATION) previously termed an incompetent cervix. commonly occurs at approximately week 20 of pregnancy, when the fetus is still too immature to survive SIGNS AND SYMPTOMS: 1. Painless dilatation 2. Show (a pink-stained vaginal discharge) - often the first symptom and followed by rupture of the membranes and discharge of the amniotic fluid PREPARED BY: OB LECTURERS 47 1. BLEEDING DURING PREGNANCY: 1.2. DURING SECOND TRIMESTER OF PREGNANCY B. CERVICAL INSUFFICIENCY (PREMATURE CERVICAL DILATATION) CAUSE: 1. increased age at conception 2. congenital structural defects 3. trauma to the cervix (e.g. as might have occurred with a cone biopsy or repeated D&Cs) MANAGEMENT: 1. Cervical Cerclage – after the surgery, patients remain on bed rest (perhaps in a slight or modified Trendelenburg position) for a few days to decrease pressure on the new sutures. PREPARED BY: OB LECTURERS 48 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 1. BLEEDING DURING PREGNANCY 1.1. DURING THIRD TRIMESTER OF PREGNANCY 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR occurs before the end of week 37 of gestation always potentially serious because if it results in the infant’s birth, the infant will be immature PREPARED BY: OB LECTURERS 50 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR SIGNS AND SYMPTOMS: 1. persistent, dull, and low backache 2. vaginal spotting 3. feeling of pelvic pressure or abdominal tightening 4. menstrual-like cramping 5. increased vaginal discharge 6. uterine contractions 7. intestinal cramping PREPARED BY: OB LECTURERS 51 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR Associated with a myriad of conditions such as: 1. Previous preterm birth 2. Short intervals between pregnancies 3. Short cervical length 4. Smoking and illicit drug use 5. Perinatal infection 6. Placenta previa 7. Polyhydramnios 8. Uterine anomalies 9. Fetal birth defects PREPARED BY: OB LECTURERS 52 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR THERAPEUTIC MANAGEMENT: 1. Admitted to the hospital and placed on bed rest – to relieve the pressure of the fetus on the cervix. 2. Attached to CTG – to monitor FHR and the intensity of contractions. 3. Iv fluid therapy – to help stop contractions 4. Vaginal and cervical cultures and a clean-catch urine sample - to rule out infection PREPARED BY: OB LECTURERS 53 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR DRUG ADMINISTRATION 1. Terbutaline tocolytic agent drug approved to prevent and treat bronchospasm (i.e., narrowing of airways) it should not be used for over 48 to 72 hours of therapy because of the potential for serious heart problems and death for the pregnant patient. PREPARED BY: OB LECTURERS 54 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR DRUG ADMINISTRATION 2. Magnesium sulfate is used primarily to treat preeclampsia and prevent eclamptic seizures traditionally given to prevent preterm labor given fetal neuroprotection is used prior to 32 weeks to help prevent cerebral palsy in premature infants PREPARED BY: OB LECTURERS 55 1. BLEEDING DURING PREGNANCY: 1.3. DURING THIRD TRIMESTER OF PREGNANCY A. PRETERM LABOR FETAL ASSESSMENT 1. be certain to assess overall fetal welfare by assessing the FHR and activity 2. if contractions have ceased and there is evidence of fetal well-being, patients with arrested preterm labor can be safely cared for at home – no need to be on bed rest, limit strenuous activity, and record a daily fetal “kick” count. PREPARED BY: OB LECTURERS 56 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 2. PRETERM RUPTURE OF MEMBRANES (PROM) A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 2. Preterm Rupture Of Membranes (PROM) PRETERM RUPTURE OF MEMBRANES (PROM) is rupture of fetal membranes with loss of amniotic fluid before 37 weeks of pregnancy cause is unknown after a rupture - poses a major threat to the fetus (the seal to the fetus is lost and uterine and fetal infections may occur) cord prolapse - second complication development of a Potter-like syndrome PREPARED BY: OB LECTURERS 58 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 2. Preterm Rupture Of Membranes (PROM) PRETERM RUPTURE OF MEMBRANES (PROM) Assessment: 1. sudden gush of clear fluid from their vagina, with continued minimal leakage 2. a patient mistakes urinary incontinence caused by exertion for rupture of membranes 3. sterile vaginal speculum examination is done to observe for vaginal pooling of fluid 4. fluid is tested with Nitrazine paper – amniotic = blue; urine = yellow PREPARED BY: OB LECTURERS 59 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 2. Preterm Rupture Of Membranes (PROM) PRETERM RUPTURE OF MEMBRANES (PROM) Assessment: 5. ultrasound can be used - to assess the amniotic fluid index 6. cultures for Neisseria gonorrhoeae, group B streptococcus, and chlamydia 7. Laboratory test: WBC and C-reactive protein (CRP) 8. Avoid doing routine vaginal examinations PREPARED BY: OB LECTURERS 60 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 2. Preterm Rupture Of Membranes (PROM) PRETERM RUPTURE OF MEMBRANES (PROM) THERAPEUTIC MANAGEMENT: 1. Administration of corticosteroid – if pregnancy reaches viability 2. Bed rest either in the hospital or at home - if the fetus is not at a point of viability 3. Prophylactic administration of broad- spectrum antibiotics 4. Administration of a tocolytic agent – if patient has no signs of infection PREPARED BY: OB LECTURERS 61 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 3. HELLP Syndrome A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome is a variation of the gestational hypertensive process named for the common symptoms that occur: Hemolysis leads to anemia. Elevated Liver enzymes lead to epigastric pain. Low platelets lead to abnormal bleeding/clotting PREPARED BY: OB LECTURERS 63 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome occurs in both primi gravidas and multigravidas Is associated with APS or the presence of antiphospholipid antibodies APS- Antiphospholipid syndrome PREPARED BY: OB LECTURERS 64 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome Symptoms: 1. Proteinuria 2. Edema 3. increased blood pressure 4. Nausea 5. epigastric pain 6. general malaise 7. right upper quadrant tenderness from liver inflammation occur. PREPARED BY: OB LECTURERS 65 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome Laboratory Studies: 1. Hemolysis of red blood cells 2. Thrombocytopenia 3. Elevated liver enzyme levels (ALT and AST) **low platelet count - need extremely close observation for bleeding PREPARED BY: OB LECTURERS 66 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome COMPLICATIONS ASSOCIATED WITH THE SYNDROME: subcapsular liver hematoma hyponatremia renal failure hypoglycemia from poor liver function PREPARED BY: OB LECTURERS 67 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome Birthing Parents Risk For: cerebral hemorrhages aspiration pneumonia hypoxic encephalopathy Fetal complications: growth restriction preterm birth PREPARED BY: OB LECTURERS 68 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 3. HELLP Syndrome 3. HELLP Syndrome THERAPY: transfusion of fresh frozen plasma or platelets hypoglycemia corrected by an IV glucose infusion vaginal or cesarean birth - if the infant is born as soon as feasible be alert for hemorrhage no epidural anesthesia PREPARED BY: OB LECTURERS 69 PREPARED BY: OB LECTURERS 70 PREPARED BY: OB LECTURERS 71 PREPARED BY: OB LECTURERS 72 PREPARED BY: OB LECTURERS 73 PREPARED BY: OB LECTURERS 74 PREPARED BY: OB LECTURERS 75 PREPARED BY: OB LECTURERS 76 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 4. MULTIPLE PREGNANCY A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 4.Multiple Pregnancy 4. MULTIPLE PREGNANCY considered a complication of pregnancy because the body must adjust to the effects of more than one fetus the incidence of multiple births has increased dramatically because of the use of in vitro fertilization difficult to determine by ultrasound or at birth whether twins are identical or fraternal PREPARED BY: OB LECTURERS 78 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 4.Multiple Pregnancy 4. MULTIPLE PREGNANCY IDENTICAL TWINS monozygotic begin with a single ovum and spermatozoon zygote divides into two identical individuals single-ovum twins usually have one placenta, one chorion, two amnions, and two umbilical cords PREPARED BY: OB LECTURERS 79 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 4.Multiple Pregnancy 4. MULTIPLE PREGNANCY FRATERNAL TWINS dizygotic, nonidentical result of the fertilization of two separate ova by two separate spermatozoa double-ova twins have two placentas, two chorions, two amnions, and two umbilical cords. may be of the same or a different sex PREPARED BY: OB LECTURERS 80 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 4.Multiple Pregnancy 4. MULTIPLE PREGNANCY ASSESSMENT uterus increases in size at a rate faster than usual elevated alpha-fetoprotein (AFP) levels different portions of their abdomen report flurries at the time of quickening multiple sets of fetal heart sounds On auscultation of the abdomen multiple gestation sacs early in pregnancy during ultrasound PREPARED BY: OB LECTURERS 81 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 4.Multiple Pregnancy 4. MULTIPLE PREGNANCY MORE SUSCEPTIBLE TO COMPLICATIONS OF PREGNANCY: hyperemesis postpartum bleeding gestational low-birth-weight babies hypertension discordant infants - if monozygotic polyhydramnios twins placenta previa fetal distress - if a single amnion is preterm labor present anemia PREPARED BY: OB LECTURERS 82 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 4.Multiple Pregnancy 4. MULTIPLE PREGNANCY MORE SUSCEPTIBLE TO COMPLICATIONS OF PREGNANCY: hyperemesis postpartum bleeding gestational low-birth-weight babies hypertension discordant infants - if monozygotic polyhydramnios twins placenta previa fetal distress - if a single amnion is preterm labor present anemia PREPARED BY: OB LECTURERS 83 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 5. ISOIMMUNIZATION (Rh Incompatibility) A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) occurs when an Rh-negative pregnant patient (one negative for a D antigen or one with a dd genotype) carries a fetus with an Rh-positive blood type (DD or Dd genotype). PREPARED BY: OB LECTURERS 85 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) people who have Rh-positive blood have a protein factor (the D antigen) that Rh- negative people do not, when an Rh-positive fetus begins to grow inside an Rh-negative pregnant woman who is sensitized, her body reacts in the same manner it would if the invading factor were a substance such as a virus—they form antibodies against the invading substance - THE FETUS. PREPARED BY: OB LECTURERS 86 PREPARED BY: OB LECTURERS 87 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) the Rh factor exists as a portion of the red blood cell, so these antibodies cross the placenta and cause destruction the fetus can become so deficient in red blood cells from this that sufficient oxygen transport to body cells cannot be maintained. this condition is termed hemolytic disease of the newborn or erythroblastosis fetalis. PREPARED BY: OB LECTURERS 88 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) ASSESSMENT 1. Antibody titer done at a first pregnancy visit. If the results are normal: 0; a ratio below 1:8 is minimal, the test is repeated at week 28 of pregnancy, if this is also normal, no therapy is needed. If a patient’s anti-D antibody titer is elevated, (1:16 or greater), showing Rh sensitization, the fetus will be monitored every 2 weeks or more by Doppler velocity – a technique that can predict when anemia is present or fetal red cells are being destroyed PREPARED BY: OB LECTURERS 89 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) ASSESSMENT 1. Antibody titer if the results are low – fetus is in danger, immediate birth will be carried out if near term; if not near term – efforts to reduce the numbers of antibodies in the woman will be made or replacing damaged red blood cells in the fetus begun. PREPARED BY: OB LECTURERS 90 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) THERAPEUTIC MANAGEMENT 1. RhIG - a commercial preparation of passive Rh (D) antibodies against the Rh factor is administered to women who are Rh negative at 28 weeks or pregnancy it cannot cross the placenta and destroy fetal red cells because the antibodies are not IgG class which is the only type that crosses the placenta RhIG (Rhogam) – given again by injection to the woman in the first 72 hours after birth of the Rh positive child - to further prevent the woman from forming natural antibodies. PREPARED BY: OB LECTURERS 91 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 5. Rh Incompatibility 5. ISOIMMUNIZATION (Rh Incompatibility) NURSING CONSIDERATION AFTER BIRTH: 1. Determine the infant’s blood type if Rh positive, the mother will receive the RhIG injection if Rh negative, no antibodies have been formed in the mother’s circulation during pregnancy and none will form – no need for Rhogam injection PREPARED BY: OB LECTURERS 92 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication 6. FETAL DEATH A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 6. Fetal Death 6. FETAL DEATH most severe complications of pregnancy. Causes: 1. chromosomal abnormalities 2. congenital malformations 3. infections such as hepatitis B 4. immunologic causes 5. complications of parental disease. PREPARED BY: OB LECTURERS 94 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 6. Fetal Death 6. FETAL DEATH if occurs before the time of quickening, a pregnant woman will not be aware the fetus has died - no fetal movements yet. may be discovered at a routine prenatal visit when no fetal heartbeat can be heard through Ultrasound. PREPARED BY: OB LECTURERS 95 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 6. Fetal Death 6. FETAL DEATH fetus has died early in intrauterine life (before 20 weeks) - be revealed first by the miscarriage a woman begins painless spotting, gradually accompanied by uterine contractions with cervical effacement and dilatation fetus is born lifeless and the body’s tissues are often macerated. PREPARED BY: OB LECTURERS 96 A. Nursing Care of a Family Experiencing a Sudden Pregnancy Complication: 6. Fetal Death 6. FETAL DEATH if a fetus dies in utero past the point of quickening, a pregnant woman be very aware that fetal movements are suddenly absent may attribute the lack of movement to “sleeping” or “saving enough strength to be born on assessment, no fetal heartbeat can be heard - an Ultrasound will confirm the absence of a fetal heartbeat. PREPARED BY: OB LECTURERS 97 To Be Continued… to B. Nursing Care of a Family Experiencing a Complication of Labor or Birth