MCN (ACUTE AND CHRONIC)

CHAPTER 1 (PRELIM TOPIC)

CASTILLO, GIA B. BSN2A
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CHAPTER 1
I. POST PARTUM ASSESSMENT
II. DIAGNOSTIC TESTS AND LABORATORIES
III. STATISTICS OF PREGNANCY FACTORS
IV. DEFINITION OF TERMS and DANGER SIGNS

I. POST PARTUM ASSESSMENT

“BUBBLEHE”
 Key point of a post partum assessment by learning the
acronym which stands for:

B – BREAST CHANGES
U – UTERUS (CONTRACTED)
B – BLADDER
B – BOWEL
L – LOCHIA
E – EPISIOTOMY (REEDA) II. DIAGNOSTIC TESTS AND LABORATORIES
H – HOMAN’S SIGN
E – EMOTIONAL CHANGES (POSPARTUM PSYCHOSIS AND 1. UTZ (ULTRASOUND)
BLUES) a. TRANSVAGINAL
 Dorsal Recumbent Position
LOCHIA – vaginal bleeding or discharge after a vaginal delivery.
 Urine voided and clean vagina
b. TRANSPELVIC/ABDOMINAL
 Supine Position
 Full bladder
c. TRANSRECTAL
 Avoid taking NSAIDS and aspirin
 Clean out bowel and empty bladder

2. U/A (Urine Analysis)

To detect:
 UTI (Ascending infection)
 Protein (Protenuria) for pre-eclampsia
 Glucose (Glucosuria) for GDM
 Ketones
 Oxalates (Kidney stones)
 RBC (presence of blood in urine risk for clotting and
abortion)

3. CBC (Complete Blood Count)

 Hgb (responsible for oxygen delivery in blood)
 Hct (percentage of rbc)
 WBC (Ascending infection for increased wbc)
 HBsAg (Hepatitis B Surface Antigen)

4. BT
 Rh Incompatibility
EPISIOTOMY - An episiotomy is a cut in the tissue between the
vaginal opening and the anus during childbirth. 5. Pt
 HcG (Human Chorionic Gonadotropin)
To detect pregnancy and H-mole (hyatidiform mole)

HELLP SYNDROME

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Alcoholic Mother – fetal alcohol syndrome
Incompetent Cervix – cerclage
CPD – Cephalopelvic Disproportion (when a baby’s head is too
large to fit)
III. STATISTICS OF PREGNANCY FACTORS
THE GLOBAL SITUATION
 529,000 women dies, annually from pregnancy-related
causes.
 Direct causes (75% hemorrhage, hypertension,
severe infection and obstructed labor.
 Indirect causes (25% malaria, severe anemia, and
other medical conditions.
 95% maternal deaths in 2,000 occurred in Africa and Asia;
 4% Latin America and less than 1% in developed regions;
 More than 1 million children are orphaned
 Children who have lost their mothers are 10x more likely to
die early.
THE PHILIPPINE SITUATION
 3.1 million pregnancies occur each year. Half of these
pregnancies are unintended and one third ends in abortion.
 About 473,000 abortion annually with induced abortion as
4th leading cause of maternal deaths.
 10 mothers dies everyday due to childbirth and pregnancy
related complications.
 Every mom dies leaves 3 orphans. In effect, 30 children are
orphaned everyday.
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HOSPITAL BIRTHS – 27&
HOME BIRTH – 70%
OTHERS – 3%
NURSING HEALTH GOALS
 Several national health guides are aimed at reducing
complications of pregnancy that arise from existing or
newly acquired disorders.
These goals are:
 Reduce the rate of fetal death to 4.1 per 1,000 live births
from a baseline of 6.8 per 1,000.
 Reduce the rate of maternal deaths to 3.3 per 100,000 live
births from a baseline of 7.1 per 100,000.
 Reduce the rate of maternal illness and complications
during pregnancy to 24 per 100 births from a baseline 31.2
per 100.
FACTORS THAT CATEGORIZE A PREGNANCY AS HIGH
RISK
Definition of Terms
HIGH RISK PREGNANCY – a pregnancy which the mother or
fetus has increase chance of illness (morbidity) or death (mortality)
DIRECT MATERNAL DEATH – death of mother from
complications of pregnancy labor and puerperium.
INDIRECT MATERNAL DEATH – death of the mother not
directly related to obstetrical cause but resulting from previously
existing disease of disorder that developed during pregnancy, labor
and puerperium and which was aggravated by adaptations to
pregnancy.
MATERNAL MORTALITY RATE – the total number of deaths in
the mother resulting from the reproductive process per 1,000 live
births.
REPRODUCTIVE MORTALITY – the total number of deaths in
the mother resulting from complications of the reproductive process
plus deaths resulting from the use of contraceptive techniques to
prevent pregnancy.
STILLBIRTH RATE/ IUFD (INTRA UTERINE FETAL
DEATH) - the total number of still born infants per 1,000 live births;
same as fetal death rate.
NEONATAL MORTALITY RATE – The total number of deaths
per 1,000 live births in infant from birth to 28 days or 4 weeks.
 EARLY NEONATAL DEATH – death of a live born
infants in the first 7 days after birth.
 LATE NEONATAL DEATH – death of a live born infant
after 7 days but before 29 days.
PERINATAL MORTALITY RATE – the total number of still
births plus neonatal deaths per 1,000 live births.
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DANGER SIGNS OF PREGNANCY  increased anxiety can cause physical complications in
pregnancy and psychologic problems
1. Vaginal bleeding no matter how slight
 Abortion – most common cause of bleeding for early Increase the incidence of:
pregnancy a. Mental illness
 Placenta Previa – the most common cause of bleeding in b. Child abuse or child battery
the late pregnancy. c. Psychosomatic illness
d. Failure to thrive
2. Fever and chills
3. Passage of watery discharge per vagina – may indicate 4. HABITS –smoking, alcoholism, drug abuse
premature rupture of membrane (PROM)
4. Severe vomiting – hyperemesis gravidarum 5. POOR OBSTETRIC HISTORY
5. Persistent headache, dizziness a. Previous fetal wastage – abortion, ectopic pregnancy,
6. Double/Blurring/Dimness of vision stillbirth
7. Swelling of hands and face b. Previous complications of pregnancy, labor and
puerperium
8. Abdominal pain 1. Multiple gestation
 Crampy, early pregnancy pains – abortion 2. Premature rupture of membrane (PROM)
 Low quadrant, radiating to the shoulder – 3. Dystocia, CS
ectopic pregnancy 4. Bleeding complications
 Hard, boardlike, painful abdomen with or 5. Hyatidiform mole (H-mole)
without vaginal bleeding – abruption placenta
9. Sudden, marked change in the character, frequency and
strength of fetal movement 6. Grand multiparity
7. Inappropriate of gestational age – SGA, LGA
PREVENTIVE HEALTH TEACHINGS
1. Hygiene of pregnancy
2. Prevention of Discomforts 6. CURRENT OBSTETRICAL STATUS
3. Proper nutrition
4. No smoking, drugs and alcohol a. No prenatal care; late prenatal care
b. Poor nutritional status – anemia
LEADING CAUSES OF MATERNAL MORTALITY c. Rh Sensitization
d. Pregnancy-induced hypertension
1. Hemorrhage – bleeding e. Multiple gestation; polyhydramnios
2. Pregnancy-induced hypertension (PIH) – modern term f. Abnormal presentation, position, lie
for toxemia of pregnancy g. Premature labor; postmaturity; PROM
3. Infection – mostly puerperal infection or postpartal pelvic h. Antepartal bleeding – placenta previa and
infection abruption placenta
i. Poor fetal well being – fetal distress

WHAT IS RMLE? – RIGHT MEDIOLATERAL EPISIOTOMY 7. MEDICAL HISTORY/MEDICAL STATUS

a. Maternal Infections – german measles, venereal and
HIGH-RISK FACTOS other infectious diseases
b. Cardiopulmonary diseases
1. DEMOGRAPHIC FACTORS c. Metabolic diseases – diabetes mellitus, thyroid
a. Maternal Age – under 16, over 35 years disease
b. Height – less than 5 feet ( increased risk of operative d. Chronic hypertension
obstetrics) e. Gastrointestinal and liver problems
c. Weight – over and underweight prior to pregnancy f. Malignancy, mental retardation, surgery in
below 90lbs or above 150lbs pregnancy
d. Marital Status – more complications in unmarried
than married women; unwed teenagers neglect
prenatal care. SCREENING PROCEDURES/DIAGNOSTIC TEST AND
LABORATORY EXAMS
2. SOCIO-ECONOMIC FACTORS
a. Poor occupation, inadequate finances ULTRASOUND
b. Nutritional deprivation – can result to severe  a scan that uses high frequency sound waves to study
malformation and small for gestation age (SGA) internal body structures
c. Poor housing, overcrowding  Ultrasound is used during pregnancy to check the baby’s
d. Poor hygienic measures development and to help pick up any abnormatlities
e. Maternal occupation

3. PYSCHOLOGIC HIGH-RISK FACTORS

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Use of ultrasound:
st
1 Trimester – to check that the embryo is developing inside the
womb (rather than inside a fallopian tube, for
example), confirm the number if embryos and calculate the Preparation:
gestational age and the baby’s due date
2nd Trimester – performed between weeks 18 and 20 is used to check
the development of fetal structures (spine, limbs, brain and internal
organs), size and location of the placenta and baby’s gender.
3rd Trimester – performed after 30 weeks is used to check that the
baby is continuing to grow at a normal rate. The location of the
placenta is checked to make sure it isn’t blocking the cervix.
 3D UTZ
 LEOPOLD’S MANEUVER (abdominal palpation)
INTERNAL EXAMINATION OR VAGINAL EXAMINATION
Purpose:
1. To confirm pregnancy and gestation - 1st clinic visit
2. To assess consistency of cervix, length and dilation, fetal
presenting part, bony architecture of the pelvis,
anomalies of the vagina and perineu
Preparation:
1. Explain
2. Let patient empty bladder
3. Provide good lighting
4. Position: lithotomy
5. Drape
6. Let the support person stay at the head part
7. Instruct to breathe thru the mouth
8. After the procedure: provide tissue
SPECULUM EXAMINATION
Purpose:
 To examine the internal genital tract and to obtain
specimen for cytological examination (pap smear)
Role of the nurse:
 Prepare the patient and equipments to be used
 To assist the physician
PAPANICOLAU SMEAR (PAPSMEAR)
 Pap smear or pap test
 To screen for cancerous and pre cancerous cells of the
cervix
 Named after Dr. George Papanicolau, the one who
designed the test and introduced in 1941.
Frequency of examination: depends on the woman’s age and risk
factors for cervical caner
 1st pap test – after 3 years of 1st sexual intercourse of at the
age of 18 whicherver comes 1st/
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 All women who are sexually active should have a pap test
every year during the 1st 3 years after the 1st coitus – if the
results are negative then succeeding test can be done after
3-5 years.
 Regular pap test should be continued until 65-70 y/o
1. Instruct woman to avoid coitus, tampons, vaginal
medications for atleast 24 hours before the test
2. Schedule the test 8 to 12 days from the start of LMP
3. Empty patient’s bladder
4. Instruct patient to breathe deeply during insertion of
the speculum
5. A small amount of vaginal bleeding is expected, instruct
to use panty liners or sanitary pads.
FRAMEWORK FOR MATERNAL AND CHILD HEALTH
NURSING
Maternal and child health nursing can be visualized within a
framework in which nurses, nursing theory, and evidence-based
practice.
Framework and Maternal and Child Health Nursing can be
visualized using:
1. Nursing Process
 ADPIE (assessment diagnosis, planning, implementation,
evaluation)
2. Nursing Theory
 Florence Nightingale, Patricia Benner, Martha Rogers,
Dorothy Orem, Rosemary Parse
3. Evidenced-based Practice
 (intregrate clinical expertise, pts. Values and best research
evidence – decide pts care)
4. Care for families during childbearing and childrearing
years.
ACUTE PAIN
Unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such
damage (International Association for the Study of Pain), sudden
or slow onset of any intensity from mild to severe with an
anticipated or predictable end, and with a duration of less than 3
months.
Skin wound/lesions and lacerations – Imparied skin integrity
 Altered epidermis and/or dermis.
Related factors:
EXTERNAL
 Chemical injury agent
 Excretions
 Humidity
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 This examination may be performed in a big institution
 Hyperthermia (teaching or non-teaching) or in a peripheral health center.
 Hypothermia  Some risk factors may later appear are detected at
 Moisture subsequent visits.
 Pressure over bony prominence  The cases are also reassessed near term and again in labour
 Secretions for any new risk factors.

RISK APPROACH (ACCORDING TO WHO)

INTERNAL
 The main objective of the risk approach is the optimal use
 Alteration in fluid volume of existing resources for the benefit of the majority. It
 Inadequate nutrition attempts to ensure a minimum of care for all while
 Psychogenic factor providing guidelines for the diversion of limited resources
to those who most need them.
 Inherent in this approach is maximum is maximum
GOALS AND PHILOSOPHIES OF MATERNAL CHILD utilization of all resources, including some human
NURSING resources, that are not conventially involved in such care.
e.g TBA, women’s group.

 Preconceptual health care

 Care of children during perinatal period
 Care of women during three trimesters of pregnancy
and the puerperium
 Care in setting (delivery/birthing room, NICU an d SCREENING/ASSSESSMENT
home)
 Care of children from birth to adolescence INITIAL SCREENING HISTORY
- Maternal age
STANDARDS OF CARE - Reproductive history
- Pre-eclampsia, eclampsia
STANDARD I: ASSESSMENT - Anemia
- Third stage abnormality
 nurse collects patient health data
- Previous infant with RH-isoimmunization or ABO
STANDARD II: DIAGNOSIS
incompatibility
 nurse analyzes the assessment data in determining
- Medical or surgical disorders
diagnosis
- Psychiatric illness
STANDARD III: OUTCOME IDENTIFICATION
- Cardiac disease
 nurse identifies expected outcomes individualized to the - Viral hepatitis
child and the family - Previous operations
STANDARD IV: PLANNING - Myomectomy
 nurse develops a plan of care that prescribes interventions - Repair of complete perineal tear
to obtain expected. - Repair of vesico-vaginal fistula
STANDARD V: IMPELEMENTATION
 nurse implements the interventions identified in the plan of FAMILY HISTORY
care.  Socio-economic status
 Family history of diabetes
 Hypertension
 Multiple pregnancy (maternal side)
STANDARD VI: EVALUATION
 Congenital malformation
 nurse evaluates the child’s and family’s progress towards
attainment of outcomes.
DIAGNOSTIC TEST
- It is a test is to establish the presence (or absence) of
SCREENING
disease as a basis for treatment decisions in
symptomatic or screen positive individual
 screening is a process of identifying apparently healthy
(confirmatory test).
people who may be at increased risk of a disease or
condition.
 They can then be offered information, further tests and DIAGNOSTIC TESTS FOR HIGH RISK PREGNANCY
appropriate treatment to reduce their risk and/or any
complications arising from the disease or condition. Noninvasive diagnostic tests
SCREENING OF HIGH RISK CASES
 Fetal ultrasound or ultrasonic testing
 The cases are assessed at the initial antenatal examination,
 Cardiotocography (CTG)
preferable in the first trimester of pregnancy.
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 Non-stress test (NST) - Negative result: No deceleration with the contractions
 Contraction stress test (CST) - Contraindication: any case where labour not allowed

2. Invasive diagnostic tests

Invasive diagnostic tests
a. Chorionic Villus sampling
 Chorionic vilus sampling -chorionic villi are small structures in the placenta that act
 Amniocentesis like blood vessels.
 Embryoscopy
-these structures contains cells from the developing fetus.
 Fetoscopy A test that removes a sample of these cells through a needle
is called chorionic villus sampling (CVS)
 Percutaneous umbilical cord blood sampling
-CVS is a form of prenatal diagnosis to determine
1. Non-invasive diagnostic tests
chromosomal or genetic disorders in the fetus.
a. Fetal ultrasound or ultrasonic testing
- a test done during pregnancy that uses reflected sound
waves to produce a picture of a fetus camer if the organ that
nourishes the fetus (placenta), and the liquid that surrounds
the fetus (amniotic fluid).
b. Amniocentesis
- the picture is displayed on a TV screen and may be in
-It is a test that can be done during pregnancy to look for
black and white or in color.
birth defects and genetic problems in developing baby.
- the pictures are also called a sonogram, echogram, or
-removes a small amount if fluid from the sac around the
scan, and they may be saved as part of baby’s record.
baby in the womb (uterus).
b. Cardiotocography (CTG)
-it is most often done in a doctor’s office or medical center.
-it is a technical means of recording (-graphy), the fetal
-do not need to stay in the hospital
heartbeat (cardio-) and the uterine contractions (-toco)
during pregnancy, typically in the third trimester. The
-Most often to women who are at increased risk for bearing
machine used to perform the monitoring is called a
a child with birth defects.
cardiotocograph, more commonly known as an electronic
fetal monitor (EFM).
This includes women who:
c. Non-stress test (NST)
-will be 35 or older when they give birth
-had screening test result that shows there may be a birth
-A non-stress test is a common prenatal test used to check
defect or other problem.
on a baby’s health. During a nonstress test, also known as
-have had babies with birth defects in other pregnancies
fetal heart rate monitoring, a baby’s heart rate is monitored
-have family history of genetic disorders
to see how it responds to the baby’s movements.
-it may choose genetic counseling before the procedure.
-Typically, a non-stress test is recommended for women at
This will allow to:
increased risk of fetal death. A non-stress test is usually
done after week 26 of
-learn about other prenatal tests
-make an informed decision regarding options for prenatal
pregnancy. Certain non-stress test result might indicate that
diagnosis.
client and baby need further monitoring testing or special
care.
This test:
- Is a diagnostic test
d. Contraction stress test (CST)
- 99% accurate for diagnosing down syndrome
-it is performed near the end of pregnancy to determine
- Usually done 14 and 20 weeks.
how well the fetus cope with the contractions of childbirth.

-the aim is to induce contractions and monitor fetus to

check for a heart rate abnormalities using a
cardiotocograph.
Amniocentesis can be used to diagnose many different gene and
chromosome problems in the baby, including:
- It is rarely used today.
- It measures the response of fetal HR to contractions.
- Anencephaly
- The test requires 3 contractions in 10 minutes
- Down syndrome
- A positive abnormal test results in decelerations in more
than half of the contractions.
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- Rare, metabolic disorders that are passed down through - It detects chromosome abnormalities (i.e down
families syndrome) and blood disorders (i.e fetal
- Other genetic abnormalities, like trisomy 18 hemolytic disease)

Cordocentesis may be performed to help diagnose any of the

c. Embryoscopy
- It is the examination of the embryo at 9-10
weeks’ gestation through the intact membranes
by introducing an endoscope into the
exocoelomic space/cavity transcervically or
transabdominally.
- This is likely to remain confined to the
management of an early pregnancy in selected
families affected by recurrent genetic syndromes
with recognizable external fetal abnormalities.
- The procedures-related risk of fetal loss is aroung
12 percent.
following concerns:
- Malformations of the fetus
- Fetal infections (i.e toxoplasmosis or rubella)
- Fetal platelet count
- Fetal anemia
- Rh-Isoimmunization
WHAT IS D&C (DILATION OR CURETTAGE)
Dilation and curettage refers to the dilation (widening/opening) of the
cervix and surgical removal of part of the lining and scooping
(curettage)

d. Fetoscopy Mostly used in first trimester miscarriage or abortion.

- It Is the examination of the fetus after 11 weeks
gestation
- This is performed transabdominally in the
amniotic fluid.
- The technique has evolved with the
miniaturization of the optical device by using
fibre-optics technology
- This procedure is likely to find new applications
with the development of uktrasound examination
at 10-14 weeks gestation in order to, either
confirm, or rule out suspected fetal abnormalities.
Dilation and curettage (D&C) is a surgical procedure in which the
cervix is opened (dilated) and a thin instrument is inserted into the
uterus. This instrument is used to remove tissue from the inside of the
uterus (curettage).
Fractional Curretage
Curettage of the endocervix before the dilatation of the cervix and
before curettage of the endometrial cavity, it Is important expecially
in postmenopausal women. It is important to diagnose if endometrial
CA has been extending to the cervix or not.

HIGH RISK PREGNANCY

1. Gestational Diabetes
2. Listeriosis
3. Toxoplasmosis
e. Percutaneous umbilical cord blood sampling/ 4. Ectopic Pregnancy
Cordocentesis 5. Placenta Previa
6. Mastitis
Also sometimes called percutaneous umbilical cord blood sampling 7. Urinary Tract Infection
(PUBS), is a diagnostic test that examines blood from the fetus to 8. Placental Abruption
detect fetal abnormalities. 9. Preeclampsia
10. Pre-term labor

- An advanced imaging ultrasound determines the

location where the umbilical cord inserts into the
placenta.
- The ultrasound guides a thin needle through the
abdomen and uterine walls to the umbilical cord.
- The needle is inserted into the umbilical cord to
retrieve a small sample of fetal blood.
- The sample is sent to the laboratory for analysis,
and results are usually available within 72 hours.
- The procedure is similar to amniocentesis except
the objective is to retrieve blood from the fetus PLACENTAL ABNORMALITIES
versus amniotic fluid.
- Cordocentesis is usually done when diagnostic TOPICS:
information cannot be obtained through
amniocentesis, CVS, ultrasound or the results of ABNORMAL PLACENTAL IMPLANTATION
these test were inconclusive. 1. PLACENTA ACCRETA, INCRETA, PECRETA
- It is performed after 17 weeks into pregnancy. 2. PLACENTA PREVIA
3. ABRUPTIO PLACENTA

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PLACENTA VARIANTS 2. Premature rupture of the membrane (PROM) – during
1. PLACENTA SUCCENTURIATA pregnancy, your baby is surrounded and cushioned by a
2. VASA PREVIA fluid –filled membrane called the amniotic sac. If the sac
3. CIRCUMVALLATE PLACENTA leaks or breaks before labor begins, the risk of certain
4. BATTLEDORE PLACENTA placental problems increase.
5. VELAMENTOUS PLACENTA
6. CIRCUMMARGINATE PLACENTA
7. BIPARTITE PLACENTA / TRIPARTE PLACENTA 3. High Blood Pressure – high blood pressure can affect your
placenta.
THE PLACENTA

- It is an organ where the nutrient and gas
exchange between the fetus and mother.
Parts
 Maternal Part is derived from the Decidua Basalis.
 Fetal Part – develops from the trophoblast.
4. Twin or other multiple pregnancy – if you’re pregnant
with more than one baby, you might be at increased risk of
certain placental problems.

FUNCTIONS OF THE PLACENTA

1. Protection
2. Nutrition
3. Respiration
5. Blood-clotting disorders – any condition that either impairs
4. Excretion
your blood’s ability to clot or increases its likelihood of
5. Hormone Production
clotting increases the risk of certain placental problems.
PLACENTA SIDES
1. MOTHER SIDE – dirty or duncan 6. Previous uterine surgery – if you’ve had a previous
2. MATERNAL SIDE – shiny or schultz surgery on your uterus such as a C-sectin or surgery to
remove fibroids, you’re at increased risk of certain
CLINICAL CHARACTERISTICS OF THE NORMAL PLACENTA placental problems.
Thickness: 2.0 to 2.5cm
Diameter: about 22cm 7. Previous placental problems – if you had a placental
Weight: about 470g (roughly 1lb) problems during a previous pregnancy, you might have a
higher risk of experiencing it again.

FROM OVULATION TO IMPLANTATION

8. Substance misuse – certain placental problems are more
more common in comen who smoke or use illegal drygs,
such as cocaine, during pregnancy.

9. Abdominal trauma – trauma to your abdomen – such as

from a fall or other type of blow that increase the risk of the
placenta prematurely separating from the uterus (placenta
abruption)

WHAT ARE SIGNS AND SYMPTOMS OF PLACENTAL

PROBLEMS?

V-A-B-U

1. Vaginal Bleeding
2. Abdominal Pain
3. Back Pain
4. Uterine Contractions

WHAT AFFECTS PLACENTAL HEALTH

Various factors can affect the health of the placenta during
pregnancy, some modifiable and some not. For example;

1. Maternal Age – certain placental problems are more

common in older women, especially after age 40.
PLACENTA ACCRETA, INCRETA AND PERCRETA
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PLACENTA ACCRETA  Heavy vaginal bleeding – it poses a major risk of severe

vaginal bleeding (hemorrhage) after delivery. Bleeding can
Placenta attaches strongly to the myometrium, but DOES NOT cause a life threatening condition that prevents your blood
penetrate it. from clotting normally. (disseminated intravascular
coagulopathy), as well as lung failure (adult respiratory
PLACENTA INCRETA distress syndrome) and kidney failure. A blood transfusion
will likely be necessary.
Placenta occurs when the placenta DOES penetrates the myometrium  Premature birth – might cause labor to begin early. If it
causes bleeding during pregnancy, you might need to
PLACENTA PERCRETA deliver your baby early.

The worst form of the condition when the placenta PENETRATES

THE ENTIRE myometrium to uterine serosa TREATMENT

 Hysterectomy (the most common intervention)

- Most healthcare professionals will monitor the
expectant mother very closely for the remainder
of her pregnancy to ensure that no further
complications arise.

PLACENTA PREVIA

Development of placenta in the lower uterine segment, partially or

completely covering the internal OS.

INCIDENCE
 0.5% of pregnancies
 It is more common in multiparas and in twin pregnancy due
to the large size of the placenta

CAUSE OF PLACENTA PREVIA

- The exact cause is unknown.

However, the following can increase your risk:

PENETRATIONS:
 If over the age of 35.
NORMAL (DECIDUA) – stratum basalis of endometrium
ACCRETA – 75-78%  Had more than four pregnancies
INCRETA – 17%  Have a history of uterine pregnancy (regardless of incision
PERCRETA – 5% type
 Smoking

SYMPTOMS

RISK FACTORS  Spotting (during first and second trimester

 Bleeding that is sudden, profuse and PAINLESS (during
(P-P-M-P) end of second trimester or during third trimester)

 Previous uterine surgery FOUR DEGREES OF PLACENTA PREVIA

 Placenta position
 Maternal Age (more common in women older than 35)  LOW LYING PLACENTA PREVIA
 Previous childbirth (risk increases as your number of - Lower than the upper implantation
pregnancies increases  MARGINAL PLACENTA PREVIA
- Extends just to the edge of the cervix
SIGNS & SYMPTOMS  PARTIAL PLACENTA PREVIA
- A portion of the cervix is covered by the placenta
 Often cause no signs or symptoms during pregnancy  COMPLETE PLACENTA PREVIA
 Vaginal bleeding during the third trimester is possible. - The cervical opening is completely covered

COMPLICATIONS
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LABOR AND DELIVERY

About 75 percent of women with placenta previa in the third

trimester deliver via C-section before labor starts. Although women
with a marginal previa can sometimes have a vaginal delivery, nearly
all partial and complete placenta previas require a caesarian to avoid
severe life-threatening bleeding.

MOST PHYSICIANS WILL ALSO RECOMMENT LIMITING

THE FF. ACTIVITIES:

 Avoid intercourse
 Limit traveling
 Avoid pelvic exams

PREVENTION AND TREATMENT

There is no way to prevent placenta previa. Once you’ve been
diagnosed and have reached your third trimester, your healthcare
provider may recommend measures to ensure safe pregnancy and
delivery, expecially if you experience any bleeding.

This might include:

PLACENTAL ABRUPTION
 PELVIC REST – this means abstaining from sexual
intercourse, discontinuing any use of tampons or vaginal Defined as premature separation of a normally situated placenta after
douches, and foregoing pelvic exams. 28 weeks gestation and before birth of the baby.
 INCREASED FETAL MONITORING – your doctor may
want to keep an eye on your baby to make sure his
heartbeat remains strong and his movements are consistent.
 HOSPITAL CARE - although studies have not shown bed
rest has clear benefits for women with placenta previa, your
practitioner may want you to remain at a hospital until your
delivery, particularly if you’ve had a bleeding incident, in
order to monitor you and your baby continuously.

BLEEDING IS AN EMERGENCY!!!

1. ASSESSMENT OF THE AMOUNT OF BLEEDING,

ACCOMPANYING PAIN IF ANY
2. BEDREST WITH OXYGEN AS PRESCRIBED
3. POSITIONING SIDELYING OR TRENDELENBURG
(72HOURS) RISK FACTORS
4. NO IE OR RECTAL EXAM, AS IT MAY INITIATE
MASSIVE HEMORRHAGE. MUST BE DONE IN Prevalence is high in:
THE OR WITH DOUBLE SET UP.  Smoking or substance abuse (e.g cocaine)
 History of previous abruption
5. MONITOR FETAL STATUS (FH AND MOVEMENT)
6. DETERMINE FETAL LUNG MATURITY  High birth order
(AMNIOCENTESIS)  Advancing maternal age
7. KEEP IV LINE AND MAKE BLOOD AVAILABLE  Poor-socioeconomic condition

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 Malnutrition
 Placental insufficiency

CLINICAL MANIFESTATIONS
DIFFERENT TYPES OF ABNORMAL PLACENTA
D-E-T-A-C-H-E-D
1. PLACENTA SUCCENTURIATA
D – DARK RED BLEEDING 2. VELAMENTOUS INSERTION
E – EXTENDED FUNDAL HEIGHT 3. CIRCUMVALLATE PLACENTA
T – TENDER UTERUS 4. CIRUMMARGINATE PLACENTA
A – ABDOMINAL PAIN/CONTRACTION (SHARP 5. BATTLEDORE PLACENTA
STABBING) 6. VASA PREVIA
C – CONCEALED BLEEDING 7. BIPARTITE PLACENTA
H – HARD ABDOMEN 8. TRIPARTITE PLACENTA
E – EXPERIENCE DIC (DISSEMINATED INTRAVASCULAR
CLOTHING) PLACENTA SUCCENTURIATA
D – DISRTRESSED BABY
Extra placenta separate from the main placenta. In anatomy,
“succenturiate” means accessory to an organ.
TYPES OF ABRUPTIO PLACENTA
CIRCUM VALLATE PLACENTA
1. REVEALED TYPE
2. CONCEALED TYPE A placental morphological abnormality, a subtype of placenta
3. MIXED TYPE extrachorialis in which which the fetal membranes (chorion and
amnion) double back” on the fetal side around the edge of the
 Revealed type – is the common type. Blood expel out placenta. After delivery, a circumvallate placenta has a thick ring of
through vagina. membranes on its fetal surface.
 Concealed type – the type that blood collects behind the
separated placenta. CIRCUMMARGINATE
 Mixed type – some part of the blood collects inside and
some part is expelled out usually one variety Insertion of membranes away from the placenta without a distinct
predominates over the other. ridge at the point of insertion.

A flattened edge with a ridge of fibrin demarking the edge of the

vascular plate. It often only involves a portion of the circumference.

BATTLEDORE PLACENTA

Cord inserted at or near the placental margin rather than in the center.

VELAMENTOUS PLACENTA

Umbilical vessels spread within the membranes at a distance from the

placental margin which they reach surrounded only by a fold of
amnion.

Their incidence is approximately 1%, and velamentous insertion

develops in more commonly with placenta previa and multifetal
MANAGEMENT gestations.

 Keep woman in LATERAL (NOT SUPINE) VASA PREVIA

 OXYGENATUON (TO LIMIT FETAL ANOXIA)
 FHT MONITORING ; VS MONITORING
 NO IE OR RECTAL EXAMINATION, NO ENEMA
 KEEP IV OPEN FOR POSSIBLE BLOOD
TRANSFUSION
Note: external bleeding may seem out of proportion to symptoms
(shock) displayed by the women.
If the leash of blood vessels happen to traverse through the
membranes overlying internal os, infront of the presenting part, the
condition is called vasa previa.
BIPARTITE PLACENTA
Two compete and separate parts are present each with cord leaving it.
The bipartite cord joins short distance from the two parts of the
placenta.

TRIPARTITE PLACENTA
A tripartite placenta is similar but with three distinct parts.
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An infant born less than 37 weeks of gestation with primary concern
relates to immaturity of all body systems. The preterm (also known as
premature) newborn is the most common admission to the neonatal
intensive care, since this category is considered high-risk, requiring
close monitoring by specialist.

PREMATURITY AS HIGH-RISK
 Most common cause of mortality (death) among infants
 Higher percentage of birth defects.
 Prematurity and low birth weight are associated with
increasing rate of neonatal morbidity and mortality.

CAUSES OF PRETERM

1. Multiple births
2. Illness of the mother (malnutrition, heart disease,
diabetes mellitus, infectious conditions or gestational
hypertension)
3. Placental abnormalities (placenta previa, premature
placental separation, or premature rupture of the
membranes)

MANAGEMENT HISTORY OF POVERTY, smoking, alcohol consumption, and

 NO IE abuse of cocaine or other drugs
 PELVIC REST
 AVOID SEXUAL INTERCOURSE
 WATCH OUT FOR BLEEDING ASSESSMENT

Signs and Symptoms:

NURSING CARE OF THE HIGHRISK NEWBORN
-Irregular respiration with apnea, hypothermia poor sucking and
The extrauterine life of a baby starts immediately after birth during swallowing reflexes diminished bowel sounds increased/decreased
the very first moment when the baby starts to cry. A child’s milestone urinary output
kicked off after the first breath – interdependent existence begins, and – thin with minimal creasing on soles and palms.
in sequence, continuous adaptation takes place. -able to extend extrimities and do not maintain flexion
-Lanugo in head with woolly patches visible blood vessels with
However, babies are born fragile and helpless. Structural functions minimal subcutaneous fat pads
are primitive that it takes adaptation to be fully developed. The - transparent loose skin
infant’s genetic background, the health of the recent uterine -appear jaundice
environment, a safe delivery, and the care during the first month of -labias are narrow in girls
life further contribute to this adjustment. The neonatal stage is highly -small genitalia
vulnerable requiring close supervision and care until maturity has -abundant cheese-like vernix caseosa short extremities protruding
reached a major goal. abdomen short nails

PROBLEMS RELATED TO MATURITY

Gestational age refers to the actual age of fetus inside the uterus from ASSESSMENT TOOLS:
the time of conception to birth. Infants (pre-term and post-term) are - APGAR SCORE
considered high risk newborns regardless of birth weight (WHO) - BALLAD SCORE
- FLACC PAIN SCALE
Normally, a full term infant is born between 39 to 40 weeks, 6 days, - CARDIAC/VITAL SIGNS MONITOR
for optimal fetal development.
Early term infant is born between 37-38 weeks, 6 days. TREATMENT AND MANAGEMENT (DEPENDENT
Late-term infant is one born between 41 – 41 weeks, 6 days. FUNCTIONS)

PREMATURITY / PRE-TERM NEWBORN Preterm birth deprives the newborn of the complete benefits of
intrauterine life, and the incubator will serves for that purpose.

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OXYGEN SUPPORTS FLACC PAIN SCALE
- Feeding and nutrition CARDIAC/VS MONITOR
- Management according to presenting problem
(s)

POSTMATURITY / POST-TERM NEWBORN

Infant born after 42 weeks of gestation.

BURNS
ASSESSMENT Injury to the skin and possibly the subcutaneous tissue caused by
thermal chemical, electrical or radio active causes.
SIGNS AND SYMPTOMS:

Hypoglycemia parchment-like skin (dry and cracked without

lanugo) – long fingernails

Profuse hair long and thin body wasting of fat muscle in extrimities
meconium staining

NURSING INTERVENTIONS
 Provide normal newborn care.
 Monitor for hypoglycemia
 Maintain newborn’s temperature
 Monitor for infection related to meconium aspiration
 Skin and nail care.

PROBLEMS RELATED TO GESTATIONAL WEIGHT

MEDICAL MANAGEMENT
A low birth weight (LBW) infant weighs 250g (5.8 lb) or less. An
infant may have a low birth weight because of IUGR, or the infant  Analgesics for pain control
may just be SGA, regardless, both are treatment as high-risk -Morphine sulfate
newborns.  Antibiotics for prevention of infection
-Mafenide (sulfamylon)
ASSESSMENT -Suliadizine (silvadene)
 H2-receptor antagonist to prevent ulcer
Signs and Symptoms -Cimetidine, Ranitidine

Fetal distress
Impaired thermoregulation NURSING MANAGEMENT
Physical abnormalities
Hypoglycemia  Fluid replacement (LRS)
Polycythemia (highly concentrated RBC’s due to low O2 level)  Insert foley catheter; monitor vital signs
Ruddy appearance due to polycythemia  Elevate burns site (if practical) to reduce edema
Cyanosis  Keep environment warm to minimize heat loss
Jaundice  Prevent wound infection
Signs of infections
Signs of meconium aspiration
 Monitor bowel function
Feeding difficulties
 Give high-calorie, high-protein, high-carbohydrate diet
to promote wound healing
LARGE FOR GESTATIONAL AGE (LGA)  Provide emotional support to child and family who may
Term infants over 4000g (8.8 lb) may be classified as large for fear pain and disfigurement
gestational age (LGA)

Signs and Symptoms IMPETIGO

Birth trauma of injury respiratory distress hypoglycemia
Bacterial infection of the skin caused by:
Assessment tools:  Group beta hemolytic streptococcus
APGAR SCORE  Staphylococcus Aureus
BALLARD SCORE
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Transmitted by direct contact with lesions 14. The part of endometrium that encapsulates the fetus
15. Where is Vita K injected
16. Where is BCG injected
MANIFESTATIONS 17. What are the organ involved in the production of prolactin
 Super infection of the skin 18. 3 types of Vita K
 Single papulovesicular lesion surrounded by erythema 19. Also known as the love hormone
 As more vesicles appeared they become purulent and 20. What is the medication where the Vitamin K is the antidote
honey-colored crusts. 21. RMLE means
 Found in extrimities and face 22. a pregnancy which the mother or fetus has increase chance
 Pruritus of illness (morbidity) or death (mortality).
23. death of a live born infant after 7 days but before 29 days.
MEDICAL MANAGEMENT 24. Infant born after 42 weeks of gestation.
 Oral administration of Penicillin Erythromycin or 25. Cord inserted at or near the placental margin rather than in
Mupirocin (Bactroban) ointment the center.
26. Defined as premature separation of a normally situated
NURSING MANAGEMENT placenta after 28 weeks gestation and before birth of the
baby.
 Advise parent to wash lesions with soap and water and pat
27. 3 types of abruption placenta
dry before applying ointment
28. 8 placenta abnormalities
 Instruct parents to use caution when applying ointment to
29. Bleeding that is sudden, profuse and PAINLESS (during
the eye as it is irritating to the eye.
end of second trimester or during third trimester)
30. PAINFUL CONTRACTIONS and SHARP STABBING
31. Placenta occurs when the placenta DOES penetrates the
myometrium
32. Extra placenta separate from the main placenta. In
anatomy, “succenturiate” means accessory to an organ.
33. Insertion of membranes away from the placenta without a
distinct ridge at the point of insertion.
34. it is performed near the end of pregnancy to determine how
well the fetus cope with the contractions of childbirth.
35. -It is a test that can be done during pregnancy to look for
birth defects and genetic problems in developing baby.
36. used during pregnancy to check the baby’s development
and to help pick up any abnormatlities
37. 3 types of lochia discharge
38. the total number of deaths in the mother resulting from the
reproductive process per 1,000 live births.
39. a cut in the tissue between the vaginal opening and the anus
SUMMARY
during childbirth.
40. It is the examination of the embryo at 9-10 weeks’
REVIEW QUESTIONARES:
gestation through the intact membranes by introducing an
endoscope into the exocoelomic space/cavity
1. The organ where the nutrient and the gas exchange takes
transcervically or transabdominally.
place between the mother and fetus
2. The term for the maternal side of placenta
3. The term of the fetal side of placenta -
4. What are the 5 functions of placenta
5. It is the placenta that strongly attaches to the myometrium
but does not penetrate
6. The most common surgical intervention for the placental
problems
7. The placenta that is strongly attached to the myometrium
but does not penetrate
8. It is defined as one in which a concurrent disorder,
pregnancy related complication, or external factor
jeopardize the health of the women, fetus or both.
9. The part of the placenta where the maternal part is derived
from
10. Agents that causes development of abnormal structures
11. The ability of sperm to release proteolytic enzymes and
penetrate the ovum
12. The part of endometrium which is located directly under
the fetus where placenta is developed.
13. Also known as FUNIS

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