Disseminated Intravascular Coagulation (DIC) Finals
(Maám Glorimae Rizabal)
• state of diffuse clotting in which clotting factors
are consumed
• leads to widespread bleeding.
• Platelet are decreased because they are
consumed by the process, coagulation studies
show no clot formation (and are thus normal to
prolonged); and fibrin plugs may clog the
microvasculature diffusely, oozing from injection
sites, and presence of hematuria are signs
associated with the presence of DIC
• Swelling and pain in the calf of one leg are more
likely to be associated with thrombophlebitis
Predisposing /Contributing Factors
• Overwhelming infections particularly bacterial
sepsis
• #1 abruption placenta; eclampsia;
• amniotic fluid embolism; IUFD(Intra-uterine fetal
death) or retention of dead fetus; burn; trauma;
fractures; major surgery; fat embolism; shock;
hemolytic transfusion reaction; malignancies
particularly of lung, colon, stomach, and
pancreas
Initial Sign
• Coolness and mottling of extremities;
• pain;
• dyspnea;
• abnormal bleeding
Late Sign
• Altered mental status;
• acute renal failure
Minimizing Bleeding
1. Institute Bleeding precautions
2. Monitor pad count/amount of saturation during
menses; administer or teach self-administration of
hormones to suppress menstruation as prescribed.
3. Administer blood products as ordered. Monitor for
signs and symptoms of allergic reactions, anaphylaxis,
and volume overload.
4. Avoid dislodging costs. Apply pressure to sites of
bleeding for at least 20 mins, use topical hemostatic
agents. Use tape cautiously.
5. Maintain bed rest during bleeding episode.
6. If internal bleeding is suspected, assess bowel sounds
and abdominal girth.
7. Evaluate fluid status and bleeding by frequent
measurement for vital signs, central venous pressure,
intake and output.
Promoting Tissue Perfusion
1. Keep patient warm
2. Avoid vasoconstrictive agents (systemic or topical).
3. Change patient’s position frequently and perform ROM
exercises.
4. Monitor electrocardiogram and laboratory test for
dysfunction of vital organs caused by ischemia –
arrhythmias, abnormal arterial blood gases, increased
blood urea nitrogen and creatinine.
5. Monitor for signs of vascular occlusion and report
immediately.
a. Brain – decreased level of consciousness, sensory and
motor deficits, seizures, coma.
b. Eyes – Visual deficits.
c. Bone – Pain
d. Pulmonary vasculature – chest pain, shortness of
breath, tachycardia.
e. Extremities – cold, mottling, numbness.
f. Coronary arteries – chest pain, arrhythmias.
g. Bowel – pain, tenderness, decreased bowel sounds.
Screening or Initial Diagnostic Test
• PT; PTT; Platelet count
Confirmative Test Decreased Fibrinogen level; increased
fibrin split products; decreased anti-thrombin III level
Diagnostic Result
• Beside Equipment ECG; CVP
• Best Drug Heparin inhibits clotting components
of DIC
• Nature of the Drug Anticoagulant
Hyperemesis Gravidarum
• Hyperemesis gravidarum is persistent,
uncontrolled vomiting that begins in the first
weeks of pregnancy and may continue
throughout pregnancy. Unlike “morning
sickness,” hyperemesis can have serious
complications, including severe weight loss,
dehydration, and electrolyte imbalance.
• NOTE: The defining factor for hyperemesis
gravidarum should be the time of occurrence –
and that is the 2nd trimester, usually the 14 –
16th week. If this is on the 1st trimester, usually
this is morning sickness.
Causes:
• Gonadotropine production
• Psychological factors
• Trophoblastic activity
Assessment
• Continuous, severe nausea and vomiting
• Dehydration
• Dry skin and mucous membranes
• Electrolyte imbalance
• Metabolic acidosis
• Non-elastic skin turgor
• Oliguria
• Arterial blood gas and analysis reveals alkalosis
• Hgb level and HCT are elevated.
• Serum potassium level reveals hypokalemia
• Urine ketone levels are elevated.
• Urine specific gravity is increased
• Total parenteral nutrition (TPN)
• Restoration of fluid and electrolyte balance
• Anti-emetics, as necessary for vomiting, for
example Plasil , Hydroxyzine and
Prochlorperazine
Interventions
• Monitor vital signs and fluid intake and output
to assess for fluid volume deficit.
• Obtain blood samples and urine specimens for
laboratory tests, including Hb level, HCT,
urinalysis, and electrolyte levels.
• Provide small frequent meals to maintain
adequate nutrition.
• Maintain I.V. fluid replacement and TPN to
reduce fluid deficit and pH imbalance.
• Provide emotional support to help the patient
cope with her condition.
• Teaching Topics
• Using salt on foods to replace sodium lost by
vomiting.
PRETERM LABOR
• labor that occurs before the end of week 37of
gestation.
• It occurs in approximately 9% to 11% of all
pregnancies.
• It is responsible for almost two-thirds of all • Be certain all women receive information the
infant deaths in the neonatal period . signs and symptoms of preterm labor so they do
not overlook the more subtle signs.
• Any woman having persistent uterine
contractions four every 20 minutes) should be
considered to be in labor.
Therapeutic Management
• A woman is documented as being in actual labor
• presence of fetal fibronectin, a protein produced
rather than having false labor contractions if she
by trophoblast cells
is having uterine contractions that cause cervical
effacement over 80% or dilation over 1 cm. • If this is present in vaginal mucus, it predicts
that preterm contractions are ready to occur;
• Preterm labor is always serious because if it
absence of the protein predicts that labor will
results in the infant’s birth, the infant will be
not occur for at least 14 days.
immature.

• Some diagnose their contractions as -Braxton

Hicks contractions (innocent)

• treatment available to delay labor until a fetus

reaches a level of maturity that will allow a
newborn to survive in the outside environment

• evaluation and the institution of therapy before

membranes rupture are vital, as ruptured
membranes make it that much more difficult to
halt labor.

• It can happen for unknown reasons, but it is

associated with dehydration, urinary tract
infection, periodontal disease, and
chorioamnionitis.
• Women who continue to work at strenuous jobs
during pregnancy or perform shift work that
leads to extreme fatigue may have a higher
incidence than others
• Common symptoms of early preterm labor
include a
Medical attempts can be made to stop labor if :
• the fetal membranes are intact,
• fetal distress is absent,
• there is no evidence that bleeding is occurring,
• the cervix is not dilated more than 4 to 5 cm,
and effacement is not more than 50%.

• persistent, dull, low backache;

• vaginal spotting;
• a feeling of pelvic pressure or abdominal
tightening;
• menstrual-like cramping;
• increased vaginal discharge;
• uterine contractions; and
• intestinal cramping
• Listen carefully to any woman who has these
symptoms or believes she is in preterm labor
because beginning symptoms of labor are subtle
and best recognized by a woman herself.
A woman who is in preterm labor
• admitted to the hospital and placed on bed rest
to relieve the pressure of the fetus on the cervix.
• Intravenous fluid therapy to keep her well
hydrated is begun because hydration may help
stop contractions. If a woman is dehydrated, the
pituitary gland is activated to secrete
antidiuretic hormone, and this may cause it to
release oxytocin as well.
• Oxytocin strengthens uterine contractions. By
keeping a woman well hydrated, the release of
oxytocin may be minimized.
• Vaginal and cervical cultures and a clean-catch
urine sample are obtained to rule out infection
(antibiotic)
 • antibiotic for group B streptococcus prophylaxis
• a tocolytic agent, an agent to halt labor, such as
terbutaline may be prescribed.
• Following this initial therapy, women in preterm
labor can be safely cared for at home as long as
they can dependably drink enough fluid to
remain well hydrated and continue to take an
oral tocolytic agent
• a woman should limit strenuous activities,
maintain adequate nutrition and do not smoke
cigarettes (high risk for preterm birth)
Drug Administration
• corticosteroid -accelerate the formation of lung
surfactant
• (betamethasone) attempt to hasten fetal lung
maturity (two doses of 12 mg betamethasone
given intramuscularly 24 hours apart, or four
doses of 6 mg dexamethasone given
intramuscularly 12 hours apart).
• Calcium channel blockers: nifedipine (Procardia)
or a prostaglandin antagonist: indomethacin
(Indocin) can be used as tocolytic agents, these
are not drugs of choice because of their side
effects. (decreased fetal urine output- resulting
in oligohydramnios
• premature closure of the fetal ductus
arteriosus with resultant fetal pulmonary
hypertension can occur, after indomethacin
administration
Before a tocolytic drug is administered
✓ obtain baseline blood data (hematocrit, serum
glucose, potassium, sodium chloride, and PCO2)
✓ Electrocardiogram
✓ Eternal uterine and fetal monitor should be in
place
When administering terbutaline, mix the drug with
Ringer’s lactate rather than a dextrose solution to
prevent any unnecessary hyperglycemia
Fetal Assessment
• A woman may be instructed to use a daily fetal
movement count or “count to 10” test.
• Teach her how to do this before hospital
discharge so she can continue it when she is at
home.
• The typical fetus moves 10 times in an hour.
• To evaluate fetal movement, a woman lies down
on her left side and times the number of
minutes it takes for her to feel 10 fetal
movements (about an hour) or counts the
number of fetal movements she feels in 1 hour
(the average is 10 to 12)
• If the time it takes to feel 10 fetal movements is
twice what it was the day before or if she feels
fewer than 5 movements during an hour (half of
what she should feel), she monitors again for a
second hour.
• If at the end of this second hour fetal activity is
still under 10 per hour, she should report it
immediately.
Labor That Cannot Be Halted
• If membranes have ruptured or the cervix is
more than 50% effaced and more than 3 to 4 cm
dilated, it is unlikely labor can be halted.
• “point of no return” - increased risk of infection
that begins from that point.
• If the fetus is very immature -a cesarean birth
may be planned to reduce pressure on the fetal
head (possibility of subdural or intraventricular
hemorrhage from a vaginal birth)
• artificial rupture of the membranes is not done
as a rule in preterm labor until the fetal head is
firmly engaged - increased risk for prolapse of
the cord
• pain relief-epidural is preferable.
• A woman may assume that (head is small) an
episiotomy will not be needed for birth, and to
avoid the discomfort of postpartum stitches –
head is more fragile.
 • Excessive pressure could result in a subdural or response to the foreign protein of the growing
intraventricular hemorrhage fetus, the toxin leading to the typical symptoms.

• the cord of the preterm infant is usually clamped
immediately -difficult time excreting the large
amount of bilirubin - extra amount of blood
could also overburden the circulatory system.
Assessment
• Rupture of the membranes is suggested by the
history.
• sudden gush of clear fluid from her vagina, with
continued minimal leakage.
• Amniotic fluid cannot be differentiated from
urine by appearance -vaginal speculum
examination - vaginal pooling of fluid.
• (separate from chronic hypertension)
• PIH tends with a multiple pregnancy
• primi paras younger than 20 years or older than
40 years
• women from low socioeconomic backgrounds
(poor nutrition)
• had five or more pregnancies
• hydramnios (overproduction of amniotic fluid;
underlying disease such as heart disease,
diabetes with vessel or renal involvement, and
essential hypertension.

• If the fluid is tested with Nitrazine paper,

amniotic fluid causes an alkaline reaction on the
paper (appears blue) and urine causes an acidic
reaction (remains yellow).

• The presence of a high level of alpha-fetoprotein

(AFP) in the vagina is also diagnostic.

Therapeutic Management

• If labor does not begin and the fetus is not at a

point of viability - placed on bed rest either in
the hospital or at home
Assessment
• corticosteroid to hasten fetal lung maturity.
• additional symptoms such as vision changes
• Prophylactic administration of broad-spectrum
antibiotics - delay the onset of labor and reduce • hypertension, proteinuria, and edema are
the risk of infection considered the classic signs of PIH.

PREGNANCY-INDUCED HYPERTENSION • Of the three, hypertension and proteinuria are

the most significant as extensive edema occurs
• PIH is a condition in which vasospasm occurs only after the other two are present.
during pregnancy in both small and large
arteries.

Signs of : Gestational Hypertension

• hypertension • develops an elevated blood pressure (140/90

mm Hg) but has no proteinuria or edema.
• proteinuria
• Perinatal mortality is not increased with simple
• edema develop gestational hypertension, no drug therapy is
necessary.
• It is unique to pregnancy and occurs in 5% to 7%
of pregnancies Mild Pre-eclampsia

• Originally it was called toxemia because a toxin • If a seizure from PIH occurs, a woman has
of some kind being produced by a woman in eclampsia, but any status above gestational
 hypertension and below a point of seizures is
pre-eclampsia.

• mildly pre-eclamptic -proteinuria and blood

pressure rises to 140/90 mm Hg (taken on two
occasions at least 6 hours apart)

• The diastolic value of blood pressure is

extremely important to document because it is
this pressure that best indicates the degree of
peripheral arterial spasm present.

• Edema - protein loss, sodium retention, and

• severe epigastric pain and nausea and
lowered glomerular filtration rate, accumulate in
vomiting(because of abdominal edema or
the upper part of the body.
ischemia to the pancreas and liver)
• weight gain of more than 2 lb/wk in the second
• If pulmonary edema develops(short of breath)
trimester
• If cerebral edema occurs - visual disturbances
• or 1 lb/wk in the third trimester - indicates
such as blurred vision or seeing spots before the
abnormal tissue fluid retention. This is likely to
eyes.
be the first symptom a woman notices, or it
may be discovered when a woman is weighed at • severe headache and marked hyperreflexia and
a prenatal visit. ankle clonus

• Noticeable edema may or may not be present (a continued motion of the foot)
when this sudden increase in weight first occurs

Severe Pre-eclampsia
Eclampsia
• blood pressure rises to 160 mm Hg systolic and
110 mmHg diastolic or above on at least two
occasions 6 hours apart at bed rest (the position
in which blood pressure is lowest)
• Or her diastolic pressure is 30 mm Hg above her
pre pregnancy level.
• Marked proteinuria, 3 or 4 on a random urine
sample or more than 5 g in a 24-hour sample,
and extensive edema are also present.
• extreme edema is most readily palpated over
bony surfaces (tibia on the anterior leg, ulnar
surface of the forearm, and cheekbones)
• If there is swelling or puffiness but cannot be
indented with finger pressure, the edema is
nonpitting.
▪ This is the most severe classification of PIH.
▪ cerebral edema is so acute - grand-mal seizure
(tonic-clonic) or coma occurs.
▪ maternal mortality rate is as high as 20%
(cerebral hemorrhage, circulatory collapse, or
renal failure)
▪ The fetal prognosis – poor (hypoxia and
consequent fetal acidosis)
▪ If premature separation of the placenta - fetal
mortality rate is approximately 10%.
▪ If eclampsia develops, the mortality rate
increases to as high as 20%
Interventions

• If the tissue can be indented slightly, this is 1
pitting edema
• moderate indentation is 2
• deep indentation is 3
• and indentation so deep it remains after
removal of the finger –4 pitting edema
1. Monitor Antiplatelet Therapy (increased
tendency for platelets to cluster along arterial
walls)
▪ a mild antiplatelet agent - low-dose aspirin, may
prevent or delay development of pre-eclampsia
▪ (50–150 mg only) as excessive salicylic levels can
cause maternal bleeding at the time of birth.

2. Promote Bed Rest.

 3. Promote Good Nutrition.

With Severe PIH

▪ systolic blood pressure of more than 160 mm Hg

▪ diastolic blood pressure of more than 110 mm

Hg after a woman has been on bed rest

▪ extensive edema;

▪ marked proteinuria [3 to 4]

▪ cerebral or visual disturbances; marked

hyperreflexia
▪ or oliguria [500 mL per24 hours or less], a
woman may be admitted to a health care facility
▪ If 36 weeks or further or fetal lung maturity can
be confirmed (amniocentesis) - labor can be
induced or a cesarean birth performed
▪ If the pregnancy is less than 36 weeks or
amniocentesis reveals immature lung function,
interventions will be instituted to attempt to
alleviate the severe symptoms and allow the
fetus to come to term.
Administer Medications to Prevent Eclampsia
A hypotensive drug such as
❑ hydralazine (Apresoline)
Mg SO4- Overdose
❑ decreased urine output
❑ depressed respirations
❑ reduced consciousness
❑ and decreased deep tendon reflexes
Mg SO4- Administration
❑ 10 ml of a 10% calcium gluconate solution (1 g)
should be kept ready for immediate
intravenous administration should a woman
develop signs and symptoms of magnesium
toxicity
❑ calcium is the specific antidote for magnesium
toxicity

❑ labetalol (Normodyne), or

❑ nifedipine may be prescribed to reduce

hypertension.

*lower blood pressure by peripheral dilatation and (do

not interfere with placental circulation)

SE- maternal tachycardia (assess PR and BP) before and

after administration.

Diastolic pressure should not be lowered below 80 to

90 mm Hg - inadequate placental perfusion could occur.

Magnesium sulfate - drug of choice to prevent eclampsia HELLP- Hemolysis, Elevated liver Enzymes, Low
Platelet Levels

- variation of PIH named for the common

Magnesium Sulfate
symptoms that occur:
❑ To achieve immediate reduction of the blood
- hemolysis that leads to anemia
pressure - first given intravenously in a loading
or bolus dose. - elevated liver enzymes that lead to epigastric
pain
❑ Given intravenously over 15 minutes, the drug
acts almost immediately; the effect lasts only 30 - and low platelets that lead to abnormal
to 60 minutes, so administration must be bleeding/clotting and petechia
continuous.
❑ occurs in 4% to 12% of patients with PIH
 ❑ maternal mortality rate as high as 24% and an • The twins are always of the same sex.
infant mortality rate as high as 35%.
• Two thirds of twins are fraternal (dizygotic,
❑ In addition to proteinuria, edema and increased nonidentical), the result of the fertilization of
blood pressure two separate ova by two separate spermatozoa
(possibly not from the same sexual partner)
❑ additional symptoms of nausea, epigastric pain,
general malaise, and right upper quadrant
tenderness from liver inflammation occur.

❑ Laboratory studies reveal hemolysis of red blood

cells

Management

❑ Improve the platelet count by transfusion of

fresh-frozen plasma or platelets.

❑ If hypoglycemia is present, this is corrected by

an intravenous glucose infusion

❑ The infant is born as soon as feasible by either

vaginal or cesarean birth.

❑ Maternal hemorrhage may occur at birth

because of poor clotting ability.

❑ Epidural anesthesia may not be possible

because of the low platelet count and the high
possibility of bleeding at the epidural site.

Complications

❑ The liver enzyme levels are elevated from

hemorrhage and necrosis of the liver.

❑ Complications - subcapsula liver hematoma,

hyponatremia, renal failure, and hypoglycemia
from poor liver function.
❑ Mothers are at risk for cerebral hemorrhages,
aspiration pneumonia, and hypoxic
encephalopathy.
❑ Fetal complications can include growth
restriction and preterm birth.
MULTIPLE PREGNANCY
• woman’s body must adjust to the effects of
more than one fetus. The incidence has
increased dramatically of in vitro fertilization but
still only occurs in 2% to 3% of all births
• Identical (monozygotic) twins begin with a single
ovum and spermatozoon. In the process of
fusion, or in one of the first cell divisions, the
zygote divides into two identical individuals.
Assessment
• Uterus begins to increase in size at a rate faster
than usual.
• Alpha-fetoprotein levels are elevated.
• At the time of quickening, a woman may report
flurries of action at different portions of her
abdomen rather than at one consistent spot
• On auscultation of the abdomen, multiple sets
of fetal heart sounds are heard
• An ultrasound can reveal multiple gestation sacs
early in pregnancy.
• complications - PIH, hydramnios, placenta
previa, preterm labor, and anemia
• more prone to postpartum bleeding -additional
uterine stretching

• Single-ovum twins usually have one placenta, • multiple pregnancy usually ends before the
one chorion, two amnions, and two umbilical normal term, 25% of low-birth-weight babies are
cords. from multiple pregnancies.
 • There is a higher risk of congenital anomalies in
twins- spinal cord defect, than with single births.
• There is a higher incidence of velamentous cord
insertion (the cord inserted into the fetal
membranes) with twins than with single births -
risk of bleeding
• knotting and twisting of umbilical cords, causing
fetal distress or difficulty with birth.
HYDRAMNIOS
• Normal amniotic fluid volume during pregnancy
is 500 to 1000 mL at term.
• Excess fluid more than 2000 mL or an amniotic
fluid index above 24 cm is considered
hydramnios
• can cause fetal malpresentation because the
additional uterine space can allow the fetus to
turn to a transverse lie.
• It also can lead to premature rupture of the
membranes from the increased pressure with
possible prostaglandin release.
• Preterm rupture of the membranes adds the
additional risks of infection, prolapsed cord, and
preterm birth
Assessment
• Amniotic fluid is formed by a combination of the
cells of the amniotic membrane and from fetal
urine.
• swallowed by the fetus, absorbed across the
intestinal membrane into the fetal bloodstream,
and transferred across the placenta.
• accumulation of amniotic fluid suggests
difficulty with the fetus’s ability to swallow or
absorb or else excessive urine production.
• Excessive urine output occurs in the fetuses of
diabetic women (hyperglycemia in the fetus).
• Rapid enlargement of the uterus*
• The small parts of the fetus are difficult to
palpate because the uterus is unusually tense.
• Auscultating the fetal heart rate is difficult
• extreme shortness of breath as the overly
distended uterus pushes up against her
diaphragm.
• She may develop lower extremity varicosities
and hemorrhoids because of poor venous return
from the extensive uterine pressure.
• She will have increased weight gain.
• Ultrasound - document the presence of
hydramnios and to discover a reason for the
excessive amount of fluid.
Therapeutic Management
• admitted to a hospital for bed rest and further
evaluation (increase uteroplacental circulation
and reduces pressure on the cervix, which may
help prevent preterm labor)
• report any sign of ruptured membranes or
uterine contractions. (straining to defecate could
increase uterine pressure and cause rupture of
membranes - eat a high-fiber diet)
• Suggest stool softener be prescribed if diet
alone is ineffective.
• Assess vital signs and lower extremity edema
frequently (extremely tense uterus - pressure on
both the diaphragm and the vessels of the
pelvis)
• A regimen of a nonsteroidal anti-inflammatory
agent may be started to reduce inflammation
• Amniocentesis can be performed to remove
some of the extra amniotic fluid. Because
amniotic fluid is replaced rapidly, however, this
has to be repeated almost daily.
• If contractions begin, tocolysis may be begun to
prevent or halt preterm labor (rupture of the
membranes - excessive pressure, followed by
preterm birth)
• To prevent the sudden loss of fluid and the
accompanying danger of a prolapsed cord,
membranes can be “needled” (a thin needle is
inserted vaginally to pierce them) to allow a
slow, controlled release of fluid.
• After birth, the infant must be assessed carefully
for factors that may have interfered with the
ability to swallow in utero .
OLIGOHYDRAMNIOS
• less than the average amount of amniotic fluid
• usually caused by a bladder or renal disorder in
the fetus that interferes with voiding.
• It can occur from severe growth restriction.
Because the fetus is so cramped for space,
muscles are left weak at birth, lungs fail to
develop (hypoplastic lungs), leading to severe
difficulty breathing after birth, and features of
the face become distorted (termed Potter’s
syndrome).
• It is confirmed by ultrasound when the pockets
of amniotic fluid are less than average.
• Amnio transfusion or instillation of fluid into the
uterus by amniocentesis procedure can help
relieve this concern.
• Infants need careful inspection at birth to rule
out kidney disease and compromised lung
development
POST TERM PREGNANCY
• A term pregnancy is 38 to 42 weeks long.
• A pregnancy that exceeds these limits is
prolonged (post term pregnancy, postmature,
or postdate).
• placental insufficiency has interfered with fetal
growth.
• Post term pregnancy occurs in 3% to 12% of all
pregnancies
• Included in this group are some pregnancies
that appear to extend beyond the due date set
for them because of a faulty due date.
• In other instances, the pregnancy is truly
overdue. The trigger that initiates labor did not
turn on.
• Prolonged pregnancy can occur in a woman
receiving a high dose of salicylates (for severe
sinus headaches or rheumatoid arthritis) it
interferes with the synthesis of prostaglandins,
which may be responsible for the initiation of
labor.
• Myometrial quiescence, or a uterus that does
not respond to normal labor stimulation.
• Remaining in utero for longer than 2 weeks/
beyond term creates a danger to a fetus for
several reasons.
• Meconium - fetal intestinal contents are more PSEUDOCYESIS
likely to reach the rectum.
• In pseudocyesis (false pregnancy), nausea and
• Macrosomia vomiting, amenorrhea, and enlargement of the
abdomen occur in either a nonpregnant woman
or a man .

• theories regarding why the phenomenon occurs

❑ wish-fulfillment theory suggests a woman’s

desire to be pregnant actually causes physiologic
changes to occur

❑ conflict theory suggests a desire for and fear of

pregnancy create an internal conflict leading to
physiologic changes; and

❑ depression theory attributes the cause to major

Interventions
depression.
❑ Lack of growth. A placenta functioning ability for
❑ In any event, a woman’s body responds with
only 40 to 42 weeks. (decreased blood
physiologic symptoms such as breast tenderness
perfusion, lack of oxygen, fluid, and nutrients)
and an enlarging abdomen. Her abdomen can
• Oligohydramnios (a decreased amount of become so enlarged that she appears to be 7 or
amniotic fluid from lessened urine production in 8 months pregnant.
the fetus) can lead to variable decelerations
❑ Ultrasound imaging will rule out pregnancy.
from cord compression.
❑ Both men and women with the disorder need
• If labor has not begun by 41 weeks, the
psychological counseling to help them better
following ,ay be performed:
handle their needs.
❑ a maternal vaginal fibronectin level

❑ a nonstress test, and/or a

❑ biophysical profile (state of placental perfusion

and the amount of amniotic fluid present)

• If these are normal- the due date was

miscalculated.

• If the test results are abnormal or the physical

examination or biparietal diameter measured on
ultrasound suggests the fetus is term size, labor
will be induced .

• Prostaglandin gel or misoprostol (Cytotec)

applied to the cervix to initiate ripening or
stripping of membranes followed by an oxytocin
infusion are common methods used to begin
labor.

• If oxytocin is ineffective, cesarean birth will be

necessary.

• Monitor the fetal heart rate closely during labor

to be certain placental insufficiency is not
occurring from aging of the placenta.