Maternal AND CHILD HEALTH NURSING LECTURE

GESTATIONAL CONDITIONS  Conservative Management ( no dehydration)

 Have dry, low, high carbohydrate & bland diet
HYPEREMESIS GRAVIDARUM
 Severe nausea and vomiting that persist after the NURSING INTERVENTIONS
first trimester  Administer oral / IV fluids
 Common during first pregnancy and conditions such  Monitor fluid intake, v/s, skin turgor, weight,
as gestational trophoblastic disease, multiple electrolytes
gestation  Mouth care
 Proper nutrition, small frequent feeding
PATHOPHYSIOLOGY  Take dry crackers
 HCG is elevated in early pregnancy and persist even  Small frequent feeding
after 12 weeks  Avoid pressure around the stomach
 DHN occurs further causing concentration HCG in  Temporary cessation of iron supplement
the blood aggravating the condition.  Avoid highly seasoned and spicy foods
 Take vitamin supplement to correct nutritional
CAUSES deficiencies
 Linked trophoblastic activity, gonadotrophin  Upright 45 min after meals
production and psychological factors  High protein snack with small frequent feedings
 Possible causes:  Decrease liquid intake during mealtime. Consume
 Unknown fluid 1 hr after eating.
 elevated HCG  Calm restful atmosphere
 Thyroid dysfunction  Conserve energy, promote rest, relaxation
 Develop effective coping strategies
ASSESSMENT
 Unremitting nausea and vomiting Wernicks encephalopathy
 Weight loss  formation of varices at the gastroesophageal junction
 Hiccups due to excessive vomiting
 Oliguria
 Vertigo BLEEDING DURING PREGNANCY
 Headache  It is never normal
 Electrolyte imbalance  It is frightening
 Dehydration  It must be carefully investigated (amount, color,
 Metabolic acidosis onset)
 Jaundice , pallor  It can impair the outcome of pregnancy and the
woman’s life
TEST RESULTS CAUSES OF BLEEDING DURING PREGNANCY
 Serum protein, chloride, k level decreased 1st trimester (1-3 months)
 BUN increased  Miscarriage/ abortion
 HGB elevated  Ectopic pregnancy
 WBC elevated 2 nd
trimester (4-6 months)
 Hyatidiform mole
TREATMENT  Premature cervical dilatation
 Hospitalization: Fluid and electrolyte replacement 3 trimester (7-9 months)
rd

 Antiemetics- Metoclopromide  Placenta previa

 NPO initially then progression of oral diet  Abruptio placenta
 Total parenteral nutrition as necessary  Preterm labor

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 Maternal AND CHILD HEALTH NURSING LECTURE

FACTS!!! Miscarriage
 The degree of blood loss can not be assessed by the  Interruption of pregnancy that occurs
amount of blood being visualized (concealed) spontaneously
 Danger to the fetal blood supply occurs when the Age of viability: 20-24 weeks
body begins to decrease blood flow to the peripheral Premature: born after 24 weeks
organs Full term: after 37 weeks
 Signs of hypovolemic shock occurs when 10% of Post term: after 40 weeks
blood volume is lost 2 units of blood (900ml-1L of Elective abortion: panned termination of pregnancy
blood during blood transfusion)
 An adult human has about 5 to 6L (1-2 gal) of blood SPONTAENOUS ABORTION
which is roughly 7-8 % of the total body weight  Product of conception expelled before the age of
viability (20-24 weeks or weights 500g)
Development of shock associated with bleeding  Usually occurs during the 1st trimester
☛ Blood loss  Also called miscarriage
☛ Decreased intravascular volume COMPLICATIONS
☛ Decreased venous return, decreased CO, lowered  Infection (unclean)
BP  Hemorrhage (bleeding)
☛ Increased HR, vasoconstriction of peripheral vessels,  Abnormal plantation
increased RR, Apprehension CAUSES:
☛ Cold clammy skin, decreased uterine perfusion  Most common: abnormal fetal formation due to
☛ Reduced renal, uterine and brain perfusion teratogenic factor or the chromosomal aberration
☛ Lethargy, coma, decreased renal output (60%)
☛ Renal failure  Implantation abnormalities (<6 weeks: placenta is
☛ Maternal and fetal death tentatively attached to the decidua, 6-12 weeks:
moderately attached, >12 weeks: deeply attached)
 If CL(corpus luteum) fails to produce enough
S/S OF HYPOVOLEMIC SHOCK progesterone
 ↑ HR  Maternal infection (syphilis, CMV, rubella) causing
 ↓ BP fetal death
 ↑ RR  Ingestion of teratogenic drug (isotretinoin)
 Cold clammy skin due to vasoconstriction  Psychological issues, alcohol
 ↓ urine output  Genetic
 Dizziness/ ↓ LOC
 ↓ central venous pressure ASSESSMENT:
 Vaginal bleeding with pink discharge for several
MANAGEMENT OF HYPOVOLEMIC SHOCK days or scant brown discharge for weeks before
 Aims to restore BV and halt the source of onset of cramp and increase in vaginal bleeding
hemorrhage  Cervical dilatation
 IVF replacement/ ringer’s lactate  Passage of non viable fetus
 Be ready of BT  Continuous cramps and bleeding if any uterine
 O2 contents remain unexpelled
 Assess v/s, FHT, uterine contraction TEST RESULTS
 Flat in bed  Decrease HCG
Abortion  Passage of product of conceptus
 Interruption of pregnancy before age of viability  Utz reveals no FHT
(medically/surgically)

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 Hematocrit and hemoglobin decreased (due to MANAGEMENT

bleeding)  D&C
 If more than 14 weeks, labor can be induced
TREATMENT:  If more than 14 weeks, deliver the fetus (induce labor)
 Accurate evaluation of uterine content using misprostol followed bu oxytocin
 Hospitalization to control bleeding COMPLICATIONS:
 Bed rest  Hemorrhage, infection, DIC (Disseminated
 BT of PRBC (packed RBC), WB if needed intravascular coagulation)
 D &C
 IV oxytocin to stimulate uterine contraction 2. Recurrent pregnancy loss
 Cerclage(cervical stitch) to prevent abortion  Three consecutive miscarriages
 Rhogam for Rh negative patients  Formerly known as “habitual abortion”

NURSING INTERVENTION CAUSES:

 CBR(complete bed rest) w/o BRP(bathroom  Defective spermatozoa or ova
privileges), patient may expel uterine content  Endocrine factors, poor thyroid function
without knowing it  Deviation of the uterus (bicornuate uterus)
 Inspect bedpan contents carefully for intrauterine  Infection
content  Autoimmune disorders
 Monitor v/s, I &O, amount, color, odor of vaginal
bleeding, save sanitary pads for evaluation TREATMENT
 Provide perineal care  Identify and treat the cause
 Administer prescribe medicines
 Provide emotional support and counseling 3. Threatened miscarriage
 Begins as a scant bleeding and usually bright red
PATIENT TEACHING
 Dx and treatment S/SX
 Consultation about bleeding  Slight cramping but no cervical dilatation
 Signs of infection  Bleeding occurs within 28-48 hours
 Gradual resumption f activities (1-4 weeks)
 Abstinence of 2 weeks MANAGEMENT:
 Prevention of spontaneous abortion  Limiting activity to no strenuous activity for 24 to 48
 Follow up examination hours
 CBR is not indicated (to assess amount of vaginal
TYPES OF SPONTANEOUS ABORTION bleeding)
1. Missed miscarriage  Evaluate FHT and viability of fetus through UTZ
 Commonly referred to as early pregnancy failure  Instruct the client to save all pads
 Fetus dies in utero ut is not expelled  Coitus is restricted for 2 weeks after bleeding
 DES(Diethylestilbestrol) to preserve pregnancy:
S/SX causes teratogenic effect to the baby
 If a previous (+) FHB becomes (-) during prenatal  50% can proceed to normal pregnancy
visit
 If fundic height has not increased 4. Imminent (inevitable) miscarriage
 Sonogram reveals dead fetus  Loss of the products of conception that cannot be
prevented

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S/SX: 2) Septic abortion/infection: endometriosis, fever,

 (+) uterine contractions, (+) cervical dilatation abdominal tenderness and pain, foul smell vaginal
 Uterus expels the product of conception discharge
MANAGEMENT: 3) Isoimmunization:
 D&C to remove all the products of conception/ D and 4) Powerlessness: sadness and grief
evacuation
 Save all products of conception.. Sepsis
 Most common complication of abortion
5. Complete miscarriage  Causes maternal death
 The entire product of conception is expelled without
assistance (fetus, memebrane, placenta) ECTOPIC PREGNANCY
 Bleeding usually slows within 2 hours and stops  Pregnancy outside the uterus (intrauterine
within few days pregnancy)
 May occur in the cervix, fallopian tube, abdomen,
S/SX ovaries
 Abdominal pain  Implantation of the fertilized ovum outside the uterus
 Passage of tissue usually at the fallopian tube
 2nd most common causes of bleeding in early
TREATMENT: pregnancy
 No further medical or surgical treatment  Good prognosis with prompt prognosis, surgical
 Instruct patient to rest intervention and to control bleeding
 Poor fetal prognosis
6. Incomplete miscarriage  Complications: rupture of the FT, hemorrhage, shock,
 Some parts of the conceptus is expelled but some death
are retained
PATHOPHYSIOLOGY
S/SX:  Transport of blastocyst is delayed and implanted at
 Heavy vaginal bleeding the site
 Severe uterine cramping  Signs of pregnancy is present
 Open cervix  Enlargement of the uterus occurs in 25%
 Passage of tissue  HCG presents but lower
 UTZ reveals some products of conception are still in  Rupture could occur causing internal hemorrhage
the uterus LOCATION:
 D&C is performed to prevent bleeding  Internal cervical OS
 Explain that the pregnancy is lost and that D&C is  Fallopian tube: 95%
performed to protect the mother from hemorrhage  Interstitial: 8%
and infection  Isthmus: 12%
 Ampulla: 80%
7. Septic abortion  Ovary
 Infection accompanies abortion  Fimbriae
 May occur as a result of illegal abortion or from  Abdominal cavity
presence of intrauterine device
CAUSES:
COMPLICATIONS OF MISCARRIAGE/ABORTION  Congenital defect of the reproductive tract
1) Hemorrhage: more than one sanitary pad per hour is  Transmigration of the ovum (wrong
excessive turn/obstructed)

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 Maternal AND CHILD HEALTH NURSING LECTURE

 IUD (traps the ovum)  Oopherectomy

 Previous surgery (scar)  Hysterectomy
 Tumor  Laparotomy for abdominal pregnancy
 Common patients who:
 Smokes ABDOMINAL PREGNANCY
 Previous tubal surgeries  The product of conception is expelled in the pelvic
 Women who douche-infection cavity
 IUD  The placenta continuous to grow in the fallopian tube
 Previous ectopic pregnancy (10-20% chance) or can implant itself in the intestines
 The product of conception from the ruptured can be  Fetus is palpable directly below the abdominal wall
expelled into the pelvic cavity rather than into the  Placenta implanted abdominally may erode so
uterus deeply that causes bowel perforation and peritonitis
 Therefore, blood does not reach the vagina to  Survival rate: 60%
become evident  Cause gross deformity to the fetus
 Internal bleeding could progress
NURSING MANAGEMENT:
S/SX  Determine LMP
 Amenorrhea, HCG positive  Monitor V/S for changes
 Slight/scant vaginal bleeding  Assess amount and characteristics of vaginal
 Interstitial: severe intra-peritoneal bleeding bleeding
 Severe sharp knife-like abdominal pain possibly  Assess pain level
radiates to the shoulder and neck (phrenic nerve  Assess I and O
irritation)  Assess for signs of hypovolemia and impending
 Rapid thready pulse, rapid RR, falling BP shock
 Pain during IE(internal examination), excruciating  Prepare patient with excessive blood loss for
pain in the cervix when moved emergency surgery
 Boggy and tender uterus  Administer needed BT
 Cullen’s sign: bluish tinged in the umbilicus  Give Rhogam for Rh negative patient
 Provide relaxing environment
DIAGNOSIS:  Express feeling of fear, grief, and loss
 Culdoscopy/ laparoscopy  Help patient develop effective coping strategies
 UTZ
 CBC- decreased HCT, WBC increases SECOND TRIMESTER BLEEDING
 Culdocentesis: aspiration of bloody fluid from the
cul-de-sac of douglas GTD (gestational trohpoblastic disease)
 HCG test  Also called hyatidiform mole or molar pregnancy
 Developmental anomaly of the placenta that coverts
TREATMENT: the chronic villi into mass of clear fluid filled vesicle,
 Manage shock if rupture occurs they become filled with fluid and appear as grape like
 IVF vesicles
 Possible BT  Incidence: 1 in every 2000
 Mifepristone: an aborticacient that cause sloughing  Occurs to women who have low protein intake, under
of the tubal implantation site 18 y/o , older than 35vy/o, asian women
 Methotrexate: chemoterapeutic agent that attacks  Hx of Hyatidiform mole
fast grwoing cells
 Salpingectomy: 50% fertile per month

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TYPES: TREATMENT:
1. COMPLETE MOLE  Suction curettage
 Neither an embryo nor amniotic sac  Test for HCG
 Characterized by swelling and cystic formation of all  Analyzed every 2 weeks until level are normal, then
trophoblastic cells every 4 weeks for 6-12 months (some have still (+) at
 If embryo is developed, it was most likely 1-2 mm in 3 weeks /1/4 at 40 days)
size and dies  Declining result suggest no complication
 46 chromosome: contributed only by the father,  3 times increase suggest malignancy
ovum is empty  Woman should use oral contraceptive for 12 months
 Highly associated with chori-carcinoma  After 6 months and HCG is negative,the woman is
free of malignancy
2. PARTIAL MOLE  Methotrexate
 Embryo with miltiple anomalies or amniotic sac  Hysterectomy: 40 years above
 Edema of a layer of trophoblastic villi with some of
the villi forming normally NURSING INTERVENTION
 Fetal blood might be present, size of 9 weeks  Baseline vital signs
gestation  Save expelled tissue for laboratory analysis (Ca)
 Has 69 chromosome, 3 chromosome with every one  Prepare patient for possible surgery
pair  Offer emotional support
 1 egg and 2 sperm  Provide effective coping strategies

Gestational trophoblastic DS REVIEW QUESTIONS!!!

 Cells become edematous, appearing as grapelike 1. Upon assessment the nurse found the following:
cluster of vescicles fundus at 2 fingerbreadths above the umbilicus, last
 Embryo fails to develop menstrual period (LMP) 5 months ago, fetal heart
beat (FHB) not appreciated. Which of the following
CAUSES: is the most possible diagnosis of this condition?
 Unknown, poor maternal nutrition (protein and folic) A. Hydatidiform mole
 Previous molar pregnancy Rationale: Hydatidiform mole begins as a pregnancy but
 Choricarcinoma: fast growing highly invasive early in the development of the embryo degeneration
malignancy (complete mole) occurs. The proliferation of the vesicle-like substances is
rapid causing the uterus to enlarge bigger than the
ASSESSMENT: expected size based on ages of gestation (AOG). In the
 Uterus expnnads faster than normally situation given, the pregnancy is only 5 months but the
 No FHT size of the uterus is already above the umbilicus which is
 Vaginal bleeding seen as clear, fluid filled grape-like compatible with 7 months AOG. Also, no fetal heart beat is
vesicles appreciated because the pregnancy degenerated thus
 Strongly positive HCG/ PT (hyperemesis there is no appreciable fetal heart beat.
gravidarum)
 Snowflake pattern on sonogram 2. Which of the following signs and symptoms will most
 Vaginal bleeding may start at week 16 likely make the nurse suspect that the patient is having
 Begins as vaginal spotting of dark brown blood or as hydatidiform mole?
a profuse fresh flow Answer: Passage of clear vesicular mass per vagina
 3 consecutive increase indicates malignant Rationale: Passage of clear vesicular mass per vagina
transformation Hydatidiform mole (H-mole) is characterized by the

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degeneration of the chorionic villi wherein the villi PLACENTA PREVIA ( 5/1000 pregnancy )
becomes vesicle like. These vesicle-like substances when  low implantation of the placenta
expelled per vagina and is a definite sign that the woman TYPES:
has H-mole. a) low-lying placenta
b) marginal implantation
INCOMPETENT CERVIX c) partial implantation
 Also called cervical insufficiency, premature cervical d) totalis
dilatation
 Occurs 16-20 weeks PREDISPOSING FACTOR:
 chief cause is habitual abortion  increased parity
 dilation is usually painless  advanced maternal age
 rapid succession of pregnancies
CAUSES  past CS
 Congenital structural defect  past D & C
 Previous cervical trauma from surgery of delivery  multiple gestation
Increased maternal age repeated D&C
 Hydramnios
 Multiple gestation
ASSESSMENT
 Hx of one or more 2nd trimester abortion
 Cervical dilatation with out contraction
 Pink stained vaginal discharge or amniotic fluid
 PROM, pelvic pressure

TEST RESULTS
 UTZ reveal cervical defect ASSESSMENT:
 Nitrazine test may indicate ROM  sudden painless vaginal bleeding (bright red ) at 30
weeks
TREATMENT COMPLICATION:
 Cervical cerclage until full term  Hemorrhage
 Best rest after surgery  Infection
 Removal of cerclage at determined time  Prematurity
 Mc Donald- temporary nylon suture is place  compromised fetal oxygen supply
horizontally & vertically across the cervix and pulled
tight to reduce cervical canal MANAGEMENT:
 Remove at 37 wks  complete bed rest, side lying position
 Shirodkar Technique- sterile tape is threaded in a  Assess bleeding, estimate blood loss
purse string manner  monitor V/S and FHR
 prepare Oxygen and blood
THIRD TRIMESTER BLEEDING  refrain from doing IE delivery
A. PLACENTA PREVIA  Less than 30 % - nsd is feasible
B. ABRUPTIO PLACENTA  More than 30%- CS
C. PROM  IF THERE IS BLEEDING, LABOR BEGINS AND
D. PIH SIGNS OF FETAL DISTRESS, DELIVERY IS
INITIATED REGARDLESS OF AOG.

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 Maternal AND CHILD HEALTH NURSING LECTURE

 if bleeding is manage, patient is advised for bed rest DEGREES OF SEPARATION

and close observation. 0 – NO SEPARATION
 Bethamethasone- is given to hasten lung maturity  no symptoms of separation only evident after
 Caution mother that a possible CS can be done birth
 Patient with placenta previa are more prone to post 1- MILD SEPARATION
partum hemorrhage.  enough to cause bleeding and changes in
maternal vital signs. No fetal distress
REVIEW QUESTION!!! 2- MODERATE SEPARATION
In placenta praevia marginalis, the placenta is found at  evident fetal distress. Uterus is tense and
the: painful on palpation
Answer: External cervical os slightly covering the opening 3- EXTREME SEPARATION
 Without immediate intervention, maternal shock
ABRUPTIO PLACENTA and fetal death may occur
 also called placental abruption
 Premature separation of the placenta
 Common during the third trimester
 Common cause of bleeding during the second half of
pregnancy

FETAL PROGNOSIS
 variable by gestational age, amount of blood loss
and medical intervention
ASSESSMENT
MATERNAL PROGNOSIS  sharp stabbing pain high in the fundus
 Good if hemorrhage can be controlled  dark red vaginal bleeding if separation starts at the
edges.
PATHOPHYSIOLOGY  If separation starts at the center, blood pools at the
 the spontaneous rupture of blood vessels at the center and bleeding is concealed
placental bed maybe caused by lack of resiliency or  COUVELAIRE UTERUS- hard, boardlike uterus with
by abnormal changes in the uterine vasculature no apparent bleeding. Signs of shock can follow.
 Can be complicated by PIH, high multiparity, Multiple
Gestation TEST RESULTS
 Hgb and hct level decreased
CAUSES:  UTZ rule out abruptio placenta
 Unknown
CONTRIBUTING FACTORS: TREATMENT
 High parity, grand multiparity  Assess, control and restore loss blood
 Advanced maternal age  large gauge needle, o2
 Short umbilical cord  monitor FHT and vital signs q 15 min
 PIH  Place patient in lateral not supine, -prevent pressure
 Direct trauma on the vena cava
 Smoking, cocaine use  Do not disturb the injured placenta- no pelvic exam,
enema.
CLASSIFICATION:  Delivery of the neonate- CS
1. Covert/central: bleeding is concealed  If no fetal life induction of labor is done
2. Overt/marginal: bleeding on the side

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 Withhold oral fluids and solids until the delivery of the  fibrinogen level falls below effective limit
baby  occurs during extreme bleeding when a lot of fibrins
 Maintain patient on bed rest until delivery and platelet from the general circulation rush to the
 Immediate CS for maternal and fetal distress site of bleeding that there are not enough left for
blood Clotting
NURSING INTERVENTIONS SYMPTOMS
 Insert IFC and monitor I and O  easy bruising and bleeding from IV site
 Obtain blood samples. Hgb, hct, typing,
crossmatching, coagulation studies CAUSES
 Provide emotional support during labor  Abruptio placenta
 Provide information on the progress of labor and  PIH
condition of the fetus  amniotic fluid embolism
 Encourage patient to verbalize feelings  retain placenta
 Help patient to develop effective coping strategies  Septic abortion
 Give IVF and blood products  Retained dead fetus
 Monitor VS, bleeding, FHR, uterine contraction,
progress of labor MANAGEMENT
 stop the underlying insult
REVIEW QUESTION!!!  Heparin to halt clotting cascade
A nurse is assigned to assist in caring for a client with  Platelet replacement
abruptio placenta who is experiencing vaginal bleeding.
The nurse collects data from the client knowing that PREMATURE RUPTURE OF MEMBRANES
abruptio placenta is accompanied by which additional  Spontaneous tear or break of the amniotic fluid
finding? before the regular contraction begins
Answer: Uterine tenderness on palpation  Membrane rupture one or more hours before the
Rationale: Vaginal bleeding in a pregnant client most onset of labor
often is caused by placenta previa or a placental abruption. EFFECTS TO FETUS
Uterine tenderness accompanies abruptio placenta,  Infection
especially with a central abruption and trapped blood  Cord compression
behind the placenta. The abdomen will feel hard and  Cord prolapse
board like on palpation as the blood penetrates the
myometrium and causes uterine irritability. A Sustained CAUSES:
tetanic contraction can occur if the client is in labor and the  Unknown
uterine muscle cannot relax.  infection, most common
Test-Taking Strategy: Note the issue of the question,  Poor nutrition, hygiene
abruptio placenta. It can be easy to confuse a placenta  Lack of prenatal care
previa and abruption. Remember, the difference involves  Incompetent cervix
the presence of uterine pain and tenderness with an  Hydramnios
abruptio placenta as opposed to painless bleeding with a  Multiple pregnancies
placenta previa.Option 1, 2, and 3 describe the absence of  Malpresentation, contracted pelvis
a sign or symptom of abruptio placenta, whereas option 4
is the only one that describes the presence of one. ASSESSMENT:
 Blood tinged amniotic fluid containing vernix caseosa
DISSEMINATED INTRAVASCULAR COAGULATION particles gushing or leaking from the vagina
(DIC)  Maternal fever, fetal tachycardia, foul smell vaginal
 DIC- acquired disorder of blood clotting discharge

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TEST RESULTS: o Pain during urination sharp or prolonged pain in the

 Alkaline ph of fluid from the vagina nitrazine paper stomach
blue o Acute or continuous vomiting
 UTZ- reveal rupture or tear of the amniotic sac o Late or no prenatal care
o Smoking, drinking alcohol, using illegal drugs
MANAGEMENT o Domestic violence
 Depends on fetal age and risk for infection
 If full term- induction of labor/ cs MANAGEMENT:
 Amnioinfusion- replacing amniotic fluid with saline  CBR
 Preterm-bed rest, hospitalization and observation of  IVF therapy to keep woman well hydrated , thus
signs of infection. Wait for fetal maturation release of oxytocin is minimized
 Fatal resuscitation should be prepared  Vaginal and cervical cultures and clean-catch urine
 Bethametasone is not given- decrease amniotic to R/O infection
causes lung maturity  Administration of tocolytic (RITODRINE,
 Limit vaginal examination DUVADILAN ) incorporated in a mainline of D5W
 monitor for infection- fever occurs, antibiotic therapy  SQ injections of TERBUTALINE-slows contraction
initiated(prophylactic), culture and sensitivity done  Monitor v/s including FHT
 Administer BETAMETHASONE- to accelerate the
PRETERM LABOR formation of surfactant
 labor that occurs before the end of week 37  If labor is inevitable:
 pain medications are kept to a minimum bec.
CAUSES: This can lead to respiratory depression
 extreme fatigue  episiotomy may not be necessarily smaller than
 unknown but it can be r/t dehydration or UTI full term deliveries
 chorioamnionitis  forceps could be applied gently if necessary

S/Sx: Pregnancy Induce Hypertension (PIH)

 persistent, dull low backache  Called toxemias of pregnancy/ Gestational
 vaginal spotting hypertension
 feeling of pelvic pressure/abdominal tightening  A condition in which vasospasm of small and large
 menstrual like cramps vessels occur during pregnancy
 increased vaginal discharge
 uterine contraction RISK:
 Contractions or cramps more than 5 in one hour  Multiple pregnancy
 Bright red vaginal bleeding  Below 20 years old and above 40 years old
 Sudden gush of clear, watery fluid from the vagina  More than 5 pregnancies
 Low, dull backache  Hydramnios
 Intense pelvic pressure  Heart ds, DM,renal problem
 Low socio economic, poor calcium, magnesium
RISK FACTORS LEADING TO PREMATURE LABOR & intake
DELIVERY:
o Women who have had a previous preterm labor CLASSIC S/S
o Women who are pregnant with twins, triplets or more  HPN
o Women with certain uterine or cervical abnormalities  Proteinuria
o Swelling or puffiness of the face or hands  Edema

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 Maternal AND CHILD HEALTH NURSING LECTURE

CLASSIFICATION OF PIH  Cerebral vision disturbance

1. Gestational HPN  Pulmonary and heart involvement- SOB
2. Mild preeclampsia  Cerebral edema- h/a, hyperreflexia, muscle
3. Severe pre eclampsia clonus
4. eclampsia
NURSING INTERVENTION FOR SEVERE PRE
ECLAMPSIA
 Patient is admitted. Monitor BP, proteinuria.
 Promote bedrest
 place in private room, dark
 limit visitors
 noise and bright lights can trigger seizure
attacks
 stress can increase BP
 Monitor well being,
 BP q 4, CBC, hct increases due to shifting of
fluid into the interstitial space, wt, urine output
CLASSIFICATION OF PIH (N-30ml/hour)
1. Gestational Hypertension  Monitor fetal wellbeing
 BP- 140/90  FHT monitoring
 No proteinuria nor edema  biophysical profile
2. Mild pre-eclampsia  O2 administration for the mother
 BP- 140/90mmHg or  Diet
 S-more than 30mmHg  Administer medications to prevent eclampsia
 D- more than 15mmHg  Hydralazine- to decrease HPN- assess PR because
 Proteinuria 1+ or 2+ it causes tachycardia
 Edema - upper part of the body  Magnesium sulfate-cathartics- (decrease
 wt gain of more than 2 lb/wk in the 2nd trimester- edema )and
fluid retention  CNS depressant-(prevents seizure)
 Magnesium sulfate
NURSING MANAGEMENT FOR MILD PRE ECLAMPSIA MONITOR:
 Promote bed rest- recumbent position. promotes 1. RR (12cpm)- if blood serum level is more than
excretion of sodium and diuresis. 5-8mg/100ml, it can lead to respiratory and cardiac
 Promote good nutrition- law salt but not omit arrest.
sodiun intake 2. Ensure urine output of more than 30ml/hr
 Provide emotional support. 3. Good deep tendon reflex
Calcium gluconate
3. Severe pre-eclampsia  antidote for magnesium sulfate toxicity .
 BP 160/110mmhg  10ml of 100% Ca gluconate IV
 Protein 3+ 4+
 Extreme edema- upper part of the body
 Pitting edema
 Increase serum creatinine( 1.2mg/dl)
 Dec urine output 400-600ml/day
 Nausea, vomiting, epigastric pain- abd
invlovement, pancreas, liver

11 gestational conditions
 Maternal AND CHILD HEALTH NURSING LECTURE

NURSING MANAGEMENT FOR ECLAMPSIA

 Monitor for signs early signs of seizure
 sudden rise in BP
 temp to 39.4-40 degrees Celsius
 blurring of vision or severe headache
 hyperactive reflexes
 Seizure precautions; maintain patent airway
 Administer o2 by mask
 Prevent aspiration,
 Birth of the child. If more than 24 weeks, decision to
4. Eclampsia deliver the baby is made. NSD is more safe than CS.
 Most severe form, 20% mortality rate.  Post partum HPN can occur for 10-14 days.
 There is cerebral involvement Monitoring of BP is important.
 Seizure or coma occurs ( tonic clonic seizure)
 Causes cerebral hemorrhage, circulatory collapse HELLP SYNDROME
and renal failure  Variation of PIH with Hemolysis, Elevated liver
 Can happen before or after delivery (48hrs) enzymes, Low platelet.
 Tonic clonic seizure:  Cause is unknown though it is a serious syndrome
a) Tonic phase- muscle contracts, back arches, that causes 24%maternal mortality and 35% infant
jaw close, resp. stops,thoracic muscle contracts. mortality
last for 20 seconds S/SX
b) Clonic phase- relaxation of muscles  HPN
c) Postictal phase- 1-4 hours semicomatose  Proteinuria and edema plus
state  Nausea, epigastric pain, general malaise,rightupper
quadrant tenderness, low platelet count, elevated
S/SX BEFORE SEIZURE liver enzyme.
 Increase in BP
 Increase in Temp MANAGEMENT:
 Blurring of vision  Transfusion of FFP(fresh frozen plasma) or
 Decrease urinary output PC(platelet concentrate)
 Severe epigastric pain
MULTIPLE PREGNANCY
DURING SEIZURE:  more than one fetus
 Cyanosis
 Incontinence of urine and feces TYPES:
 Diazepam (Valium) is administered to relieve 1. MONOZYGOTIC
muscle spasm  also called identical twins
 Magnesium Sulfate- to prevent seizure  twins begin with a single ovum and
spermatozoon
EFFECTS OF ECLAMPSIA TO FETUS  always of the same sex, one placenta, 1
1. Hypoxia chorion, 2 amnion
2. Fetal acidosis 2. DIZYGOTIC
3. Premature separation of placenta- can lead to fetal  also called fraternal/non-identical
death  twins are the result of the fertilization of 2
separate ova and 2 separate spermatozoa
 may be of the same sex or different sex

12 gestational conditions
 Maternal AND CHILD HEALTH NURSING LECTURE

CAUSES:
 Heredity
 Use of fertility drugs
 Multiparity as a contributing factor

ASSESSMENT:
 uterus increase in size at a rate faster than the HYDRAMNIOS
usual POLYHYDRAMNIOS
 alpha-fetoproteins will be elevated  Excessive amniotic fluid formation
 multiple gestation sacs on sonogram  More than 2000ml of amniotic fluid
 on quickening- mother feels more than one  Normal is 500-1000ml at ter
expected fetal activity Amniotic Fluid
 multiple sets of heart sounds are heard on  Formed at the amniotic membrane and
Auscultation swallowed by the baby
 Absorb across the intestinal membrane, into the
MANAGEMENT blood stream and into the placenta
 Close maternal supervision
 Monitor for placenta previa, preterm labor, anemia, CAUSES
post partum bleeding  Fetus with anencephaly, thracheo-esophageal
 May lead to low birthweight fistula/stenosis, intestinal obstruction
 Fetus with increase urine output ( DM mothers)
DELIVERY
 Assisted delivery (after the delivery of the first ASSESSMENT
baby, assess for the fetal lie)  Unusually rapid enlargement of the abdomen
 CS  Small parts of the fetus difficult to palpate
 DOB
 Varicosities, increase weight

EFFECTS
 Fetal malpresentation
 PROM
 Preterm delivery
 Cord prolapse
 infection

13 gestational conditions
 Maternal AND CHILD HEALTH NURSING LECTURE

MANAGEMENT  (+) uterine contraction

 Bed rest for better uretero placental perfusion and
reduces chance of complications MANAGEMENT:
 Avoid constipation- straining- PROM  Bed rest
 Assess vital sign  IVF
 Assist for possible amniocentesis- removal of fluid  TOCOLYTIC ( TETRABUTALINE)
 If preterm and contraction begins- give tocolysis  Limit strenuous activity
and MG So4 to halt contraction
 Assess newborn for complications POST TERM
 Called past mature, post date, dysmature
OLIGOHYDRAMNIOS  38-42 weeks- normal
 Amniotic fluid of less than the average amniotic fluid  Beyond 42 weeks –post term
 The trigger that initiates labor did not turn
CAUSES: on( salicylates) interferes with synthesis of
 fetal renal anomalies Prostaglandin
 PROM
 IUGR, Post term pregnancy EFFECTS
 Decrease placental perfusion
EFFECTS:  Meconium aspiration
 Fetal weak muscle  Macrosomia
 Lungs fail to develop (Hypoplastic lungs)  oligohydramnios
 Distorted facial feature ( Potters syndrome)
MANAGEMENT
S/SX  At 41 weeks: UTZ, NST is done to document
 Decrease amount of amniotic fluid by UTZ placental perfusion and amount of amniotic fluid
 Induction of labor or CS if baby is Compromised
MANAGEMENT:
 Amnioinfusion PSEUDOCYESIS (false pregnancy)
 Frequent monitoring of maternal and fetal well being  A condition wherein the woman believe that she is
pregnant
Pre term Labor
 A labor that occurs before the end of 37 week of S/SX:
gestation  Nausea and vomiting
 Fatigue
PREDISPOSING FACTORS:  Amenorrhea
 UTI  Fullness of the breast
 Chorioamnionitis
 Adolescent w/ poor pre natal
 Dehydration
 Strenuous job
 Intimate partner abuse

S/SX
 Persistent full back ache
 Vaginal spotting
 Feeling of pelvic pressure

14 gestational conditions