OB NURSING

FEATURE ABRUPTIO PLACENTA PLACENTA PREVIA

Definition Premature separation of the
placenta from the uterine wall. The
blood may pool in the cul-de-sac of
Douglas. If blood cannot escape,
there is pain.
Onset Sudden
Bleeding Painful vaginal bleeding
Hematoma The accumulated blood can form a
retroplacental hematoma, which
exerts pressure on the surrounding
tissues. This will eventually
manifest Cullen’s sign.
Timing Usually occurs after 20 weeks of
gestation
Pain Abdominal pain and uterine
tenderness
Uterine Tone Increased uterine tone (rigid, hard
abdomen)
Fetal Heart Rate May show signs of distress or
abnormalities
Risk Factors Hypertension, trauma, smoking,
multiple gestations, advanced
maternal age
Diagnosis Clinical assessment, ultrasound, and
fetal monitoring
Complications Shock, coagulation disorders, fetal
distress or death, maternal
morbidity
Management Immediate medical intervention,
possible delivery, monitoring and
stabilization
Nursing 1. Monitor vital signs and
Management fetal heart rate
2. Assess and quantify vaginal
bleeding
3. Administer IV fluids and
blood products as needed
4. Prepare for possible
emergency delivery
5. Provide emotional support
and education to the patient
and family
Placenta partially or completely covers
the cervical opening.
Gradual or sudden
Painless vaginal bleeding
No apparent hematoma.
Typically identified in the second or
third trimester
Usually no pain
Normal uterine tone
Usually normal unless severe
hemorrhage
Previous placenta previa, multiple
pregnancies, advanced maternal age,
uterine surgery
Ultrasound
Preterm birth, hemorrhage, placental
abruption, fetal growth restriction
Depends on gestational age and severity,
may include bed rest, cesarean delivery
if necessary
1. Monitor vital signs and fetal
heart rate Assess and quantify
vaginal bleeding
2. Avoid vaginal examinations
3. Prepare for possible cesarean
delivery
4. Provide emotional support and
education to the patient and
family
 GESTATIONAL TROPHOBLASTIC DSE
(HYDATIDIFORM MOLE)
• It is an abnormal proliferation and
degeneration of the trophoblastic villi,
they become filled with fluid and appear
as graped-like vesicles.
Incidence: is 1 for every 1,500 pregnancy
Risk factors:
1. Women older that 35 yrs old
2. Woman with low intake of protein
3. Hx of H mole
Types:
1. Complete
• All trophoblastic villi swell and becomes
cystic
• If embryo forms, it dies immediately
Chromosomes was only contributed by
the father or an empty ovum
2. Partial
• Some villi normally grow
• Fetal may grow about 9 weeks then
macerates
• mother’s chromosomes remain but there
are 2 sets from the father, placenta and
fetus are formed but failed to develop
• Rarely leads to chorio carcinoma
Treatment:
▪ Suction curettage
▪ Test for HCG
o Analyzed every 2 wks until level
are normal, then every 4 wks for
6-12 mos (some have still (+) @
3 weeks/ ¼ @ 40 days)
▪ Declining result suggest no complication
▪ While, 3x increase suggest malignancy
▪ Woman should use oral contraceptive for
12 mos
▪ After 6 months and HCG is negative, the
woman is free of malignancy
▪ METHOTREXATE is given as
prophylactic o Early screening for next
pregnancy
HYPERTENSIVE DISORDERS IN
PREGNANCY
is a condition which vasospasm occurs during
pregnancy in both small and large arteries.
Pre Eclampsia
▪ a pregnancy related disease process
evidence by hpn and proteinuria
▪ Also termed as Toxemia of pregnancy
Cause:
▪ Unknown
▪ Common in women younger than 20 and
above 40 y/o
▪ Underlying diseases DM, heart disease
TYPES
a. Gestational Hypertension
▪ elevated blood pressure of 140/90 but has
no proteinuria or edema
▪ BP returns to normal after birth
▪ No drug therapy is necessary
b. Preeclampsia without severe features or PE
c mild feature
▪ Blood pressure of 140/90 taken on 2
occasion with 6 hrs apart
▪ or systolic elevated 30mmhg
▪ or diastolic pressure elevated 15 mmhg
above pre pregnancy level,
▪ proteinuria of 1-2+, wt gain over 2 lbs per
week in the 2nd tri and 1 lb per week in
3rd tri
▪ mild edema on the upper extremities or
face
Management: usually managed at home
1. Promote bed rest
2. Monitor anti platelet therapy
3. Promote good nutrition
4. Provide emotional support
c. Preeclampsia with severe features
➢ Blood pressure of 160/110;
➢ Proteinuria 3- 4+, on a random sample
and 5g on a 24 hr sample,
➢ Oliguria,
➢ Altered creatinine,
➢ Cerebral and visual disturbances,
 ➢ Epigastric pain, ▪ Vaginal birth with minimum anesthesia
➢ Extensive peripheral edema is ideal
▪ CS if fetal distress is imminent
Management:
▪ Bed rest
▪ Monitor maternal and fetal well being HELLP SYNDROME
▪ Provide nutritious diet
▪ Administer Medication to prevent Is a variation of the gestational hypertensive
eclampsia process named for symptoms that occur:
a. Hemolysis that leads to anemia
Magnesium Sulfate b. Elevated liver enzymes that lead to
Action: prevent convulsion epigastric pain
c. Low platelets lead to abnormal bleeding
Intervention before the administration:
▪ + deep tendon reflex o RR= above Incidence:
12bpm Occurs 4%-12% of patients who have elevated
▪ Urine output of 30 ml per hr blood pressure during pregnancy
▪ Therapeutic range: 5-8 mg/ml Occurs primigravida and multi
▪ Antidote: Calcium Gluconate
▪ Induced labor/CS if pregnancy is 36 wks Cause: unknown
and there is evidence of fetal lung
maturity Signs and Symptoms:
1. Proteinuria
d. Eclampsia 2. Edema
▪ seizure accompanied by S/Sx of pre 3. Hypertension
eclampsia 4. Nausea
▪ Usually happens at late pregnancy up to 5. Epigastric pain
48 hrs after childbirth 6. Right upper quadrant pain and tenderness
7. Bleeding
Signs and Symptoms before seizure
1. Increase in BP Complications:
2. Increase in Temp ▪ hyponatremia, renal failure,
3. Blurring of vision hypoglycemia, renal failure, cerebral
4. Decrease urinary output hemorrhage
5. Severe epigastric pain ▪ FETUS: IUGR & Preterm Labor

During Seizure: Treatment:

▪ Cyanosis ▪ Transfusion of Fresh plasma or Platelets
▪ Incontinence of urine and feces ▪ Intravenous glucose
▪ Mother delivers either vaginal or CS
Treatment/ Management:
▪ Tonic -Clonic seizure
▪ Maintain airway
▪ Prevent aspiration
▪ Monitor FHT
▪ Administer MgSO4 or Valium
▪ Monitor for Vaginal bleeding and uterine
contraction
▪ Pt is NPO BIRTH
▪ Decision about birth will be made soon
after seizure ( 12hrs-24 hrs)
 CAESAREAN SECTION ▪ Estimated fetal size of over 9lbs(4.1kg).
A maternal disease or
It is a surgical delivery of an infant through an ▪ Condition that may be worsened by the
incision in the mother’s abdomen and uterus stress of labor, such as diabetes.
▪ A placenta that is blocking the cervix
Indications:
placenta previa
▪ CPD
▪ Open sores from active genital herpes
▪ Severe pre-eclampsia
near the due the date
▪ Placental accidents
▪ Fetal distress
PRE-OPERATIVE CARE:
▪ Previous classic CS and elective CS=
1. Check vital signs, uterine contractions
done prior to onset of labor
and FHR
2. Physical examination; routine lab tests,
TYPES
blood typing and cross matching
a. LOW-SEGMENT 3. Abdomino-perineal preparation
▪ “bikini” type, low transverse 4. Retention catheter is inserted to
▪ the best method of choice constantly drain the urine
▪ the incision is made in the lower uterine 5. Administer ATROPINE SULFATE. No
segment which is the thinnest and most narcotics are given bec. This can lead to
passive part during labor respiratory depression to the newborn

Advantages: POSTOPERATIVE CARE:

▪ Minimal blood loss ▪ Deep breathing, coughing exercises,
▪ Incision is easier to repair turning from side to side
▪ Lower incidence of postpartum infection ▪ Encourage ambulation after 12 hours as
▪ No possibility of uterine rupture tolerated
▪ Monitor vital signs
B. CLASSIC ▪ Watch for signs of hemorrhage
▪ vertical incision, recommended in a. Inspect lochia
bladder or lower uterine segment b. Check for involution
adhesions c. inspect operative site
Resulting from previous operations ▪ Encourage breastfeeding – 24 hours after
Low-lying/marginal placenta previa delivery
Fetal transverse lie
DISORDER OF PLACENTA NORMAL:
RISKS: ▪ Weight: 500 g
▪ Infection ▪ Diameter: 15-20cm
▪ Heavy blood loss >500 ml ▪ Thickness: 1.5-3cm
▪ A woman with previous CS has a lesser ▪ Extra large for DM, syphilis,
chance of delivering her next baby erythroblastosis
vaginally

PLANNED CAESARIAN
Medical reasons for planned caesarian section:
▪ A fetus in any position that is not head
down
▪ Decreased blood supply to the placenta
before birth
▪ The medical need to deliver and no
success with inducing labor