Professional Documents
Culture Documents
Ob Maternity Notes
Ob Maternity Notes
com)
Maternity nursing
care of mother from fertilization, pregnancy, labor, impregnation, fecundation.
Fertilization = union of ovum & spermatozoa
Pregnancy = 266 days or 280 days lunar months/ full term is 40 weeks.
1st tri. = 1-3 months or stage of organogenesis
2nd tri. = 4-6 months or stage of growth
3rd tri. = 7-9 months or stage of storage
3 PERIODS OF LABOR
> Antepartum = from conception to the onset of labor > Pregnancy
> Intrapartum = beginning of contraction to the 1st 4 hrs. after delivery > Labor
> Post-partum = period from 6 wks. After delivery > Delivery
Reproductive System
FEMALE REPRODUCTIVE SYSTEM
Copyright © Gpramos 1
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Internal Genitalia
1. Vagina > muscular, tubular, musculomembranous organ that lies bet. the rectum
> depository of semen after ejaculation, part of birth canal
> conveys the sperm to the cervix so sperm can meet the ovum
2. Uterus > hollow muscular-shaped organ, located at the lower pelvis & posterior
to the bladder & anterior to the rectum
> site for reception, retention, implantation, nourishment to the ovum
3. Fallopian tubes > arise from each outer cotner of the uterine body
> provides nourishment for the fertilized ovum
> serves as conduit pipes for spermatozoa to travel
> receives the ova from the ovary
Copyright © Gpramos 2
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
4 TYPES OF PELVIS
1. GYNECOID > typical female pelvis w/ rounded outlet
2. ANDROID > typical male pelvis w/ heart-shaped inlet
3. ANTHROPOID > apelike pelvic w/ oval inlet
4. PLATYPELLOID > flat-female type pf pelvis w/ transverse oval
Terms to remember:
LIBIDO = sexual drive
ORGASM = highest peak/point of sexual excitement
HYSTERECTOMY = surgical removal of the uterus
OXYTOCIN = aids to constrict milk gland cells
GYNECOMASTIA = increase in male breast
MASTITIS = inflammation of the breast
MAMMOGRAPHY = genography of the mammary gland/breast examination
MASTECTOMY = surgical removal /excision of the breast
BREAST ENGORGEMENT = usually occurs 2-5 days after
PELVIMETRY = measuring of the internal & external pelvis
PERINEOGRAPHY = repair of the vagina
2 ISCHIAL TUBEROSITY = portion of the bones on w/c the person eats
ISCHIAL SPINE = small projection that extends from the lateral aspect to the pelvic cavity
SYMPHYSIS PUBIS = junction of the innominate bones at the front of the pelvis
REPRODUCTIVE CYCLE
MESTRUATION >complex cycle of events that occur in the hypothalamus, pituitary gland,
uterine endometrium, cervix & ovaries
MENARCHE > menstruation of a woman, 9-17 yrs old
MENOPAUSE >essation of menstrual flow cycles, 40-55 yrs. Old
MENSTRUAL CYCLE >eproductive cycle, periodic uterine bleeding in response to cyclic
hormonal changes (estrogern, progesterone (FSH, LH)
28 DAYS >average lenth of menstrual cycle
2-7 DAYS/3-5 > average flow of menstrual cycle
30-80 ml. Of blood > average amount of menstruation
11 mg. > iron loss during menstruation
PHYSIOLOGY OF MENSTRUATION:
Copyright © Gpramos 3
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
OVULATION > maturation & release of the egg from the ovary, occurs on the day 14
LMP > 1st day of the last normal menstrual cycle
COMPUTE FOR OVULATION DATE > get LMP & lenth of cycle then less 14 days
PHASES OF MENSTRUAL CYCLE > 1ST Phase: Proliferative CNS response: 5th-14th day
> 2nd Phase: Secretory/ Ovarian response: 14th-16th day
> 3rd Phase: Ischemic/ Endometrial response:
> 4th Phase: Menses/ Cervix & Cervical mucuos
1. TESTES > 2 ovoid glands that lies in the perineum, diff. In size
2. EPIDIDYMIS > seminifirous tubule of each testes, 2 feet long
> reservoir for sperm storage & maturation
> responsible for absorption of seminal fluid
> responsible for the addition of substances to the s. fluid
3. VAS DEFERENS > carries sperm from the epididymis thru the inguinal canal
4. SEMINAL VESICLE> secretes a viscos portion of semen w/c has a high content
of basic sugar, protein & alkaline in ph
5. EJACULATORY DUCT > 2 ducts passed to the prostate gland, joined the
Copyright © Gpramos 4
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Terms to remember:
GTPALM SYSTEM:
Copyright © Gpramos 5
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
SEXUALITY
SEXUALITY > multidimensional phenomenom that includes feelings, attitudes & actions.
Both biologic & cultural components, gives direction to a person’s
physical,emotional,social & intellectual responses throughout life.
3 DEVELOPMENTAL TASKS:
5. TRANSVESTISM > an individual who dresses to take the role of the opposite sex
6. VOYEURISM >sexual arousal by looking at another’s body
7. SADOMASOCHISM > involves inflicting pain (sadism), or receiving pain
(masochism) to achieve sexual satisfaction.
8. EXHIBITIONISM >revealing genitalia in public
9. PEDOPHILES > individuals interested in sexual encounters w/ children
10. BESTIALITY > brutal & inhuman sexual activity, ex. To animals
Copyright © Gpramos 6
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
4. VAGINISMUS > involuntary contraction of the muscles at the outlet of the vagina
when coitus is attempted.
5. DYSPAREUNIA > pain during coitus ( those w/ cervicitis)
6. INHIBITED SEXUAL PLEASURE >lack of desire for sexual relations, maybe a
concern of young or middle age adults
SECONDARY DYSFUNCTION
1. Chronic diseases such as peptic ulcers or CPD that cause frequent pain may
interfere w/ the overall being & interest in sexual activity
BEGINNING OF PREGNANCY
BASIC GENETIC COMPONENTS
1.CHROMOSOMES > elements w/in the cell nucleus carrying genes & composed of
DNA & protein
DNA > nucleic acid that carries genetic information into the cells
DIPLOID > 46 chromosomes (23 pairs =22 somatic cells, 1 sex cell)
HAPLOID > 23 chromosomes
2. GENES >factors on a chromosome responsible for hereditary
characteristics of offspring.
> small segments of DNA contained in the chromosomes, some
recessive, some dominant, some sex-linked
XX >female
XY > male
SEX DETERMINATION > established at the time of fertilization by the male sex
chromosome.
FERTILIZATION
> union of the ovum & spermatozoan
Copyright © Gpramos 7
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
* After one sperm has entered, changes occur w/in the zona pellucida that
prevent other sperm from entering.
PRE-EMBRYONIC STAGE > period until primary villi appeared, usually 12-
14 days after conception
Copyright © Gpramos 8
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
EMBRYONIC STAGE > period from end of ovum stage until measurement reaches
3 cm or 54-56 days
FETAL STAGE > from week 9 to birth
Terms to remember:
QUICKENING > first fetal movement felt by the mother
> 18 wks. For multipara
> 20 wks. For nullipara
VERNIX CASEOSA > a cream-cheese like structure covering the fetal skin
> for lubrication & prevent the skin from macerating
LANUGO > translucent, soft downy hair charaterstics of a new born
Copyright © Gpramos 9
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
HORMONES OF PREGNANCY
1. ESTROGEN (PRIMARILY ESTRIOL) > stimulates the growth of muscle &
induces the synthesis of receptors of progesterone
> stimulates uterine growth, breast dev’t,
> enhances growth of all organs
> indicates placental function, fetal maturity
2. PROGESTERONE > helps for development of deciduas
> stimulates growth of acinicells for lactation
> promotes thickening & increased viscosity of cervical
mucous, relaxes uterine smooth muscle
3. HUMAN CHORIONIC GONADOTROPIN (HCG)
>1st indicator of + pregnancy test & detected in the urine
(14 days) & plasma by day 8
> stimulates the male testes, responsible for maintaining
the corpus luteum
4. HUMAN PLACENTAL LACTOGEN/ HUMAN CHORIONIC SOM.
> facilitates glucose transport across the placenta
> stimulates breast dev’t. to prepare for lactogen
> antagonizes insulin
5. PROLACTIN (milk production) > increased concentration at 8 months
> suppressed by estrogen & progesterone
> increased level after placenta is delivered
> ensures lactation
6. OXYTOCIN (milk ejection) > causes uterus to contract when oxytocin levels exceed
those of estrogen & progesterone
7. MELANOTROPIN > responsible for chloasama ( mask of pregnancy), linea
nigra, deeper color of the areola & genitalia
8. FOLLICLE-STIMULATING HORMONE (FSH)
> no ovulation during pregnancy
Terms to remember:
DECIDUALIZATION > process of deciduas, pregnancy outside the uterine cavity
DIFUSION > oxygen diffuses from maternal blood across the placental membrane into
the fetal Blood
PRESUMPTIVE FINDINGS:
Copyright © Gpramos 10
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
22 WKS. > LINEA NIGRA > line of dark pigment on the abdomen
24 WKS. > MELASMA > dark pigment on the face
24 WKS. > STRIAE GRAVIDARUM > red streaks on the abdomen
PROBABLE FINDINGS:
1 WK. > SERUM LABORATORY TESTS > test of blood serum reveal the
presence of HCG
6 WKS. > CHADWICK’S SIGN > color change of the vagina from pink to
violet
6 WKS. > GOODELL’S SIGN > softening of the cervix
6 WKS. > HEGAR’S SIGN > softening of the lower uterine segment
6 WKS. > SONOGRAPHIC EVIDENCE > characteristic ring is evident
OF GESTATIONAL SAC
6 WKS. > PISKACEK SIGN > enlargement & softening of the uterus
16 WKS. > BALLOTEMENT > when lower uterine segment is tapped on a
bimanual examination, the fetus can be felt to
rise against abdominal wall
20 WKS. > BRAXTON HICKS SIGN > periodic uterine tightening occurs
20 WKS. > FETAL OUTLINE FELT > fetal outline can be palpated thru the abdomen
BY THE EXAMINER
POSITIVE FINDINGS:
8 WKS. > SONOGRAPHIC EVIDENCE > fetal outline can be seen & measured by
OF FETAL OUTLINE sonogram
8-12 WKS. > FETAL HEART AUDIBLE > Doppler ultrasound revelals heart
beat
20 WKS. > FETAL MOVEMENT FELT > fetal movement can be palpated thru the
BY EXAMINER abdomen
AMNIOTIC FLUID >cushions the fetus, allows freedom of movement & permits
skeletal development
> helps maintain body temp., acts as a source of oral fluid as
well as waste repository, serves as lubrication bet. fetus &
membranes.
800-1,200 ml. = average amount
UMBILICAL CORD /FUNIS > extends from fetus to the center of placenta
> formed from the amnion & chorion & ppprovides
a circulatory connecting the embryo to the chorionic
Copyright © Gpramos 11
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Arteries > carry deoxygenated blood & fetal waste from the fetus to
placental villi
Vein > carries oxygen & nutrition from placental villi to fetus
WHARTON’S JELLY > protects umbilical vessels from pressure, cord kinking &
interference w/ fetal-placental circulation
> the 3 vessels of umbilical cord are characterized by “spiraling”
or twisting (dextral direction)
- serves to alternate from “snarling”
What to watch out for:
If the cord doesn’t fall off in 2 weeks time
The cord smells bad
There is drainage from the bottom of the cord
There is a red area on the skin around the bottom of the cord
If the newborn develops fever or app4ears unwell
If the navel and surrounding area becomes swollen or red
If pus appears at the base of the stump
PREGNANCY
PREGNANCY >normal physiologic process , 280 days/ 142 weeks
>9 calendar months / 10 lunar months
Copyright © Gpramos 12
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
C. CERVICAL CHANGES
Consists of 7 bones
2 frontal – presenting part
2 parietal – presenting part
2 temporal – not a presenting part
1 occipital
Suture lines of the skull
1. Sagittal suture – a membranous interspace, joins the 2 parietal bones of the skull
2. Coronal suture – is the line of the junction of the frontal bones and the 2 parietal bones
3. Lambdoidal suture – is the line of junction of the occipital bone and the 2 parietal bones
Closed – anterior fontanelle (diamond)
12-18 months posterior fontanelle (triangular)
Fontanelles
1. Anterior fontanelle (Bregma)
- is at the junction of the 2 parietal bones and the two fused frontal bones
- diamond-shaped
- normally closes at age 12-18 months
measures 2 cm to 3 cm and 3 cm to 4 cm in length
2. Posterior fontanelle
- is at the junction of the parietal bones, and occipital bones
triangular-shaped
- normally closes by age of 2 months
Copyright © Gpramos 13
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
FETAL PRESENTATION
- denotes the body parts that will first contact the cervix or deliver first
- determined by fetal lie, or the degree of flexion or the attitude or habitus
3 Types of fetal presentation
1. Cephalic presentation – means that the head is the body part that 1st contacts the cervix and
it is the most frequent type of presentation
4 Types of Cephalic Presentation
1. Vertex – head is sharply flexed, making the parietal bones or the space
between the fontanelles and the presenting part
2. Brow – head moderately flexed, the presenting part is the brow
3. face – head is extended, presenting part is the face
4. sinciput – the head is completely hyperextended, the head is nor flexed,
the presenting part is the sinciput
2. Breech presentation - means either the buttocks or feet are the first body parts to contact
the cervix
3 Types of breech presentation
1. Complete – thighs tightly flexed on the abdomen, the presenting part are
both the buttocks and tightly flexed feet
2. Frank – the hips are flexed but the knees are extended to rest on the
chest, the presenting part is the buttocks alone.
3. Footling – (incomplete breech presentation) neither the thigh nor the
lower legs are flexed, presenting part is the foot
- single footling breech – one foot is present
- double footling breech – both feet is present
3. Shoulder presentation - fetus is lying horizontally in the pelvis so that its long axis is
perpendicular to that of the mother, presenting part is the shoulder
Four types
1. Complete flexion (normal fetal position)
- the spinal column is bowed forward, the head is flexed forward, the chin touches the
sternum, arms are flexed and folded on the chest, thighs are flexed on the abdomen and the
calves of the legs are pressed against the posterior aspect of the thighs
2. Moderate flexion (military position) sinciput
- the chin is not touching the chest (frank, sinciput)
3. Partial extension (brow presentation)
- presents the brow of the head to the birth canal
4. Complete extension (face presentation/incomplete footling)
- presents the face and the back is arched, the neck is entended
FETAL LIE
- is the relationship between the long axis of the featl body and the long axis of the woman’s
body
1. Transverse lie – fetus is lying horizonally. Ex. Shoulder presentation
2. Longitudinal lie – fetus is lying vertically
POSITION
- is the relationship of the fetal presenting part to the maternal bony pelvis
- is determined by locating the presenting part in relation to the pelvis
Copyright © Gpramos 14
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Engagement
- refer to the settling of the presenting part of the fetus (midpoint of the pelvis)
- largest diameter / widest diameter of the presenting part
- usually take place two weeks before labor
- maybe assessed by Leopold’s maneuver, vaginal / rectal examination / cervical examination
Copyright © Gpramos 15
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
3 PHASES OF CONTRACTIONS
1. Increment – when the intensity of the contractions increase
2. Acme – when the contraction is at its strongest peak
3. Decrement – when the intensity of the contraction decreases
Copyright © Gpramos 16
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
NORMAL LABOR
a. Intra-partum care
- refer to the medical and nursing care given to a pregnant woman and her family during labor
and delivery
Intra-partum period
- extends from the beginning of contractions that cause cervical dilatation to the 1st 1-4 hours
after delivery of the newborn and placenta
Labor / parturition
- is the process by which the fetus and products of conception are expelled as the result of the
regular, progressive and strong uterine contractions
- is the last few hours of human pregnancy characterized by thunderous uterine contractions
that affect dilatation of the cervix and the force of the fetus through the birth canal
- myometrial contractions of labor are painful that is why pains is used to describe labor
2. passenger – refers to the fetus and its ability to move through the passageway which is
based on the following:
a. size of the fetal head
b. fetal presentation
c. fetal attitude
d. fetal position
5. Psyche – refers to the client’s psychological state, available support system, preparation for
childbirth, experiences and coping strategies
Copyright © Gpramos 17
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
5. Burst of energy or increased tension and fatigue may occur right before the onset of labor
6. Weight loss of about 1 – 3 lbs may occur 2-3 days before the onset of labor
Length of labor
a. 1st stage
nullipara – 8-12 hrs
multipara 6-8 hrs
b. 2nd stage
nullipara 1-2 hrs
multipara 30 minutes
C. 3rd stage
nullipara 5-60 minutes
multipara 5-60 minutes
STAGES OF LABOR
Copyright © Gpramos 18
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
b. Active phase
- dilatation from 4 – 7 cm
-contractions lasts 40 – 60 seconds
- contractions becomes stronger, more frequent, longer and more painful
c. Transition phase
- the culmination of the 1st stage of labor is the transition phase during which the cervix
dilates from 8 to 10 cm
- intensity, frequency and duration of contractions peak and there is an irresistible urge to
push lasting for about 60-90 seconds
-dilatation 8-10 cm
- contractions lasts 60-90 seconds
-intervals of 2-3 minutes
a. contractions are severe at 2-3 minutes intervals, with a duration of 50 seconds or less
- membranes rupture spontaneously
b. newborn exits into the birth canal with the help of the mechanism of normal labor or
cardinal movements
c. “crowning” occurs when the newborn’s head or presenting part appears at the vaginal
opening
d. Episiotomy – surgincal incision of the perineum, may be done to facilitate delivery and
avoid laceration of the perineum
e. Clamping the umbilical cord. The cord is but between 2 clamps placed 4 to 5 cms from
the fetal abdomen and later on an umbilical cord clamp is applied 2-3 cm from the
fetal abdomen
2. Flexion – a movement which the chin is broight about into more intimate contact with the
fetal thorax
3. Internal rotation – turning of the head in such a manner that the occiput gradually moves
from its original position anteriorly toward the symphysis pubis
4. Extension – back of neck pivots under s.p. allows head to be born by extension
Copyright © Gpramos 19
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
5. Restitution (external rotation) – head returns to normal alignment with shoulders, presents
smallest diameter of shoulders to outlet
Rationale:
1. surgical incisions reduces laceration
2. heals more easily than lacerations
3. protects infants head from pressure exterted by resistance
4. protect infants from signs of fetal distress
5. gives sufficient progress of delivery
6. shortens the 2nd stage of labor
2. 2nd degree – skin and mucous membrane, the faschia and muscle of the pernial body but
not the rectal spinchter thus forming triangular injury, usually can be sutured under local
anaesthesia
3. 3rd degree – extends to the skin, mucous membrane and perineal body and involved the
anal spinchter can be sutured by an expert obstetrician. Complications: fecal incontinence and
fistulas
4. 4th degree – extends to the rectal mucosa to expose the lumen of the rectum and it bleeds
profusely
Health teachings
Comparison
Characteristics Midline Mediolateral
1. surgical repair easy more difficult
2. faulty healing rare more common
3. post-operative pain minimal common
4. anatomical results excellent occasionally faulty
5. blood loss less more
6. dyspareunia rare occasional
7. extensions common* uncommon
* only disadvantage of midline
Copyright © Gpramos 20
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
b) Placental expulsion
1. Placenta is deliver by natural bearing down effort of the mother
2. Crede’s maneuver is performed by the doctor or nurse by gentle pressure over the
contracted uterine fundus
3. Duncan placenta / mechanism – as the placenta separates, the blood from the
implantation site may escape into the vagina immediately. It looks raw and red in
color
- edges, meaty, everted, maternal side
Copyright © Gpramos 21
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Sign 0 1 2
Heart rate absent slow (<100) > 100
Respiratory effort absent slow, irregular weak cry good, strong
cry
Muscle tone flaccid some flexion of extremities well flexed
Reflex no response grimace cough,
sneeze, cry
&
withdrawal
of foot
Color blue, pale body pink, extremities blue completely
pink
DECELERATION
- periodic decrease of featl heart rate (FHR)
- normal FHR is 120 to 160 bpm
Copyright © Gpramos 22
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
- FHR begins to fall and the height of UC and returns to baseline after contraction
has ceased
- 70 bpm
- indicates Utero Placental Insufficiency (not enough supply from the placenta)
3. Variable Deceleration
- abrupt transitory decrease of FHR
- indicates Umbilical Cord Compression (UCC)
Nursing Interventions
1. Change maternal position to the left
2. turn off pitocin (oxytocin)
3. begin 02 mask @ 8-10 L/min
4. check BP & PR
5. possible candidate for CS
****** Interventions for Late deceleration
6. observe perineum for blob show & appearance of amniotic fluid
7. assess for fetal distress
8. assess for bright red vaginal discharge / bleeding
***** interventions for variable deceleration
c. NCP / implementation
- ensure patent airway
- suction with bulb syringe
- maintain body temp
- identify infant
- prevent eye infection
- facilitate prompt identification / vigilance for potential neonatal complications
1. history of pregnancy
2. history of delivery
- facilitate prompt identification / intervention in hemolutic problems of the newborn
Copyright © Gpramos 23
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
POSTPARTUM (puerperium)
- six weeks after delivery or beginning with the termination of labor and ending with the
return of the reproductive organ to its non-pregnant state
- sometimes called as “4th trimester of pregnancy”
Copyright © Gpramos 24
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
6. 6-7 weeks
- to heal site of placental attachment
3 phases of puerperium
1. taking-in phase
2. taking-hold phase
3. letting go phase
Taking-in phase
- occurring 1-2 days after delivery
- time for reflection – talkative
- mother typically passive & dependent
- review her labor & delivery experience frequently
Taking-hold phase
- extending 2-4 days after delivery
- time for initiating action
- expressed little interest in caring for her child
- strives to master newborn care skills
Letting go phase
- this phase generally occirs after the new mother returns home
- time of family reorganization; time for a new role
- assumes responsibility for newborn care
- adapt to the demands of newborn dependency
- post partum depression most commonly occur during this phase
Copyright © Gpramos 25
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Post-partum blues
- also known as “baby blues”
- due to hormonal changes
- evidenced by tearfulness, feelings of inadequacy, moody, anorexia & sleep
disturbance
- serious depression, postpartal psychosis – requiring formal counseling or
psychiatric care
Rooming-in
- the infant stays in the room with the mother rather than staying in the central
nursery
CONTRACEPTION
- voluntary prevention of pregnancy
- intentional prevention of conception through the use of various devices, agents, drugs, sexual
practice or synthetic products
CONTRACEPTIVE
- device, drug or chemical agent that prevents conception or acapbale of preventing
pregnancy
b. ND
1. knowledge deficit regarding family planning methods
c. NCP
GOAL: health teachings to
1) facilitate informed decision-making;
2) selection of options appropriate to individual needs and desires
Copyright © Gpramos 26
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Health teachings
1. describe, explain, discuss options available & appropriate to the woman, include
information on advanatagse and disadvanatages of each option
2. demonstrate as necessary method selected
3. quick health teachings – reminders for missed oral hormone preparations
a. 1 pill should be taken at the same time every day for 21 days
b. if woman misses 1 pill, she should take it as soon as she remembers it
and then take the next pill about the usual time
c. if woman missed 2 or more pills in a row, in the 1 st 2 weeks of her cycle,
she should take 2 pills for 2 days and use a backup method of
contraception for the next 7 days
d. Evaluation:
Woman avoids / achieves a pregnancy as desired
CONTRACEPTIVE DEVICES
a. Hormonal contraceptives
1. Combination of estrogen and progesterone
actions:
- suppresses ovulation by suppressing production of FSH & LH
- most efficient form of contraception
advantages
- convenient, easy to take, withdrawal bleeding cycles are predictable
- not related to sex act, safe for older non-smoking women until menopause
- many contraceptives health benefits
disadvantages
1. absolute CI: thromboembolic, or CAD (coronary artery disease), some
cancer (CA) and liver disease
2. relative CI: migraines, HPN, abnormal genital bleeding, immobility
3. no protection against STD
4. effectiveness decreased during use of barbiturates, phenotoin, antibiotics
5. some decrease in glucose tolerance
action
- impairs fertility, thickens cervical mucus, decreases sperm penetration
- alters endometrial maturation
- effectiveness: undertermined, can reach 100% reliability if used exactly
advantages
- (O) convenient, easy to take
-(IM) 2-4 times/ year. Lactation ok during this time
- subdermal
- not related to sex act
disadvantages
- ovulation may occur
- irregular bleeding
- may change glucose and insulin values
- no protection against STD
Copyright © Gpramos 27
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
action
- prevents fertility: damages sperm in-transit to the fallopian tube
- effectiveness: 90-99%
advantages
- can be used by women who cannot use hormonal contraceptives
- no disruption of ovulation pattern
- less blood loss during menses and decreased primary dysmenorrheal
- copper can be used effectively for 10 years; progesterone: yearly
disadvantages
- Hx of PID (pelvic inflammatory disease), pregnancy, unDx genital
bleeding, genital malignancy, ANG
- uterine perforation, infection
- heavy flow, spotting between periods, cramping within few months of
insertion
- must check for string after each menses and before intercourse
- no protection against STDs
C. Mechanical barriers
1. Diaphragm
- shallow rubber device that fits over cervix
action
- barrier preventing sperm from entering cervix
- effectiveness: 83-90%, 99% in highly motivated women
advantages
- does not interrupt sex act
- insert 6 hours before intercourse and leave in place for 6 hours after last
intercourse
- no SE from well-fitted device
- decreased incidence of vaginitis, cervicitis, PID
disadvantages
- require careful cleansing with warm water and mild soap
- size/fit needs to be checked after term birth, and or 3rd trimester abortion,
weight gain or loss of 20 lbs or more
- spermicide must be inserted for additional acts that may follow initial
intercourse
- no protection against STDs
2. Cervical cap
- 1 ¼ - 1 ½ in soft, natural rubber dome with a firm but pliable rim
action
- physical barrier to sperm
- spermicide inside cap adds a chemical barrier
- effectiveness: same with diaphragm
advantages
- worn for 8 hours but not longer than 48 hours
- no need to add spermicide for repeated acts of intercourse
disadvantages
- needs a yearly papsmear
- if in place for over 48 hours it produces an odor
- cannot be worn during menstrual flow (menses) or up to 6 weeks
postpartum
- CI abnormal papsmear, hard to fit, genital infection, allergy
- must be checked regularly
Copyright © Gpramos 28
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
3. Female condom
- vaginal sheath of natural latex rubber with flexible rings at both the closed and the
open areas
action
- barrier preventing sperm from entering the vagina
- effectiveness: similar to other mechanical methods used with spermicide
note: male and female condoms should not be used at the same time
advantages
- apply well in advance of intercourse, spermicide added just before sex
- heightens sensation for man
- about as satisfying for both woman and man as intercourse without it
- provides protection from STDs
disadvantages
- cost is high
- a new one must be used for every act of intercourse
4. Male condom
- thin, stretchable latex sheath to cover penis
action
- barrier preventing sperm from entering vagina
- applied over erected penis before loss of preejaculatory drops
- spermicidal foan or jelly or cream is also used
- effectiveness: 64-98% when used with spermicide
advantages
- increased effectiveness of mechanical barriers
- ease of application
- aids in the lubrication of the vagina
- requires no medical exam or Rx
- maybe used during lactation
- backup for missed or oral contraceptive pills
- may provide some protection from STDs
disadvantages
- messy
- some people are allergic to preparations
- tablets/suppositories take 10-15 mins to dissolve
- if it is the method being used, each intercourse should be preceded (by 30
mins) by a fresh application
E. Other methods
Copyright © Gpramos 29
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
4. Symptothermal method
- combination of BBT and CMM
disadvantage
- more complex and difficult to learn and requiring regular and daily effort
5. Mittleschmerz
- pain experienced by women in between menstrual cycle (time when the
ovary releases eggs)
- rarely, the pain may be accompanied by discharge
6 Coitus interruptus
- requires withdrawal of the penis from the vagina before ejaculation
disadvantage
- highly ineffective because sperm exists in pre-ejaculatory fluid
- unreliable, interrupts sexual excitation or the plateau phase and diminishes
satisfaction
Copyright © Gpramos 30
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
LEOPOLD’S MANUEVER
- is a systematic abdominal palpation of the pregnant woman to determine position and presentation of
the fetus. It is done by about 32 weeks and over. The nurse should develop skills related to
this.
1st maneuver
- outline the contour of the uterus
- ascertain how nearly the fundus approaches the xyphoid process
- palpates the fundus with tips of fingers of both hands to define which fetal pole is present
a. normal: if buttocks, soft, nodular body, non-ballotable
b. breech: head, hard, round, ballottable
2nd maneuver
- put palms on either side of the abdomen
- gentle but deep pressure is exerted
- palpates the sides to detect location of fetal back and fetal small parts
a. back: hard, resistant structure, smooth
* best site for auscultation
b. small parts: numerous small, irregular, nodular with bony prominences, mobile
parts
3rd maneuver
- using the thumb and fingers of one hand, the nurse grasps the lower portion of the maternal
abdomen, just above the symphysis publis
- to detect if the presenting part is engaged or not engaged
a. if not engaged: get the attitude of the head
- cephalic prominence same side with the small parts
- is the head is flexed, vertex presenting
- if same side with the back, head is extended
- moveable body
b. if deeply engaged
- the lower pole of the fetus is fixed in the pelvis
4th maneuver
- face the mother’s feet
- with the tips of 1st fingers of each hand, exert deep pressure in the direction of the axis of the
pelvic inlet
- to detect degree of flexion, position and station
a. if head presents: one hand is arrested sooner than the other by a rounded body, the
cephalic prominence, while the other hand descend more deeply into the
pelvis
b. vertex: same side as the back
Copyright © Gpramos 31
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
ANTEPARTUM COMPLICATIONS
1. spontaneous abortion
2. gestational trophoblastic disease (hydatidiform mole)
3. ectopic pregnancy
4. incompetent cervix
5. hyperemesis gravidarum
6. placenta previa
7. abruption placentae
8. pregnancy-induced hypertension (PIH)
ANTERPARTUM COMPLICATIONS
1. Spontaneous abortion (miscarriage)
- expulsion of the feyus and other products of conception from the uterus before the fetus is
viable
- the termination of pregnancy before 20 weeks based upon the date of the 1 st day of the last
normal menses
- the delivery of the fetus-neonate that weigh less than 500 grams (2,500 – 4,250 grams
normal)
* products of conception
1. fetus
2. membranes (amniotic membranes)
3. placenta
etiology and pathophysiology
- spontaneous abortion may result from unidentified natural causes from fetal,
placental or maternal factors
Copyright © Gpramos 32
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
1. threatened abortion
S/S
- cramping and vaginal bleeding in early pregnancy
- abdominal pain
- slight bright red vaginal bleeding that persist for days or weeks
* coming from uterus of the mother
* minimal bleeding
- persistent low backache
- no cervical dilatation (closed)
- pregnancy test +
- it may subside or an incomplete abortion may follow
* 50% may subside
* 50% incomplete abortion may follow
NCP
Goal: Health teaching
- suggest to avoid coitus and orgasm to present the possibility of infection
and to avoid possibility inducing further bleeding
Case: if an IUD is still present and the string is visible:
- device should be removed
results in = late abortion
= sepsis
= preterm birth
3. Incomplete abortion
- expulsion of only one part of the products of conception
(fetus first, placenta and membranes likely to be expelled together
in abortion occurring before 10 weeks but separately thereafter)
Signs
Copyright © Gpramos 33
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
4. Complete abortion
- complete expulsion of all products of conception
- the entire products of conception are expelled spontaneously w/o any
assistance
Signs:
- vaginal bleeding minimal
- cervical dilatation
5. Missed abortion
- defined as the retention of dead products of coneption in utero for several
weeks (4-6 weeks)
Signs:
- early fetal intrauterine death w/o expulsion of the products of conception
- client may report dak brown vaginal discharge
- uterus seems to remain stationary in size
- fetal heart sound cannot be heard
- cervix is closed
- PT negative
NCP
Goal: safeguard status
- save all perineal pads, clots, tissue for expert Dx
- report STAT any changes in status, excessive bleeding, signs of
infection, shock
- prepare for surgey – dilatation & curettage (D&C)
Medical management
- endomterium scraped with metal curetter or flexible aspiration tip under
local anesthesia.
(paracervical block) procedure for 15 minutes
- replace blood loss, maintain IV fluid levels
note:
- if pregnancy is over 14 weeks – labor may be induced by means
of prostaglandin / oxytocin to dilate cervix
- replace blood loss, maintain fluid levels with IV
etiology
- defective spermatozoa or ova
- endocrine factors – luteal phase defect
- deviations of the uterus
- infections
- autoimmune disorder
ND
a. fluid volume deficit
b. anticipatory grieving
c. dysfunctional grieving
d. risk for infection
Signs
1. anorexia – loss of appetite
2. body malaise
3. headache
Copyright © Gpramos 34
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
etiology
- the embryo dies and the trophoblastic cells continue to grow forming an
invasive tumor
* choriocarcinoma = because it produces an increase in HCG
= extremely malignant form of trphoblastic villi
- placental tumor that develops after pregnancy has occurred, a
hydatidiform mole maybe benign or malignant
- blood vessles are absent, as are the fetus & amniotic sac
- sperm enters empty egg and its chromosome replicate (complete) or
triplicate (incomplete)
- characterized by proliferation of placental villi that becomes edematous
and form “grapelike clusters” vesicle or “snowstorm”
- genetic abnormalities at the time of fertilization are thought to be
responsible for trophoblastic disease
- PT + or –
2 types of GTD
a. complete mole
- there’s neither an embryo nor an amniotic sac
- this phenomenon is referred to as “androgenesis”
- 46 xx chromosomes contributed by the paternal material
- karyotype = haploid sperm
b. partial more
- there is an embryo (multiple abnormalities) & an amniotic sac
- typically has stigma of triploidy which includes multiple
congenital malformation and growth restriction – it is
nonviable
- karyotype – haploid findings
- 69 chromosomes from the father
Signs
1. severe nausea and vomiting = because of severe increase in
HCG due to the proliferation of trophoblastic villi
2. PIH before 20 weeks gestation (convulsion, edema)
3. vaginal bleeding
- brownish in color “prune juice”
- as early as 14 weeks or 3 months
4. uterus larger than expected for the duration of the pregnancy
5. inconsistent fundal height w/ gestational estimate
6. abdominal cramping from uterine distention
7. no fetal heart sounds will be heard
8. infection because te woman is at risk of a perforation of the
abdominal wall
associated findings
1. abnormal high serum levels of HCG
normal = 400,000 intl unit
abnormal 1-2 million intl unit
Copyright © Gpramos 35
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
etiology
1. presence of IUD
2. tubal or uterine anomalies, tubal spasm
3. PID (pelvic inflammatory disease
4. 43% caused by STD
5. adhesion from PID of past surgeries
6. endometritis
7. use of progestin only
associated findings
1. early signs
- abnormal menstrual period
- vaginal bleeding
- spotting
- dizziness
2. impending or post-tubal upture
- sudden & acute, sharp lower abdominal pain
- nausea & vomiting
- signs of shock
* Kehr’s sign – referred to neck and shoulder-strap sharp pain, neck pain
due to the presence of blood in the peritoneal cavity
* Cullen’s sign – ecchymotic blueness of the umbilicus which is indicative
of hematoperitoneum
Medical management
Copyright © Gpramos 36
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
etiology
1. history of traumatic birth (abortions)
2. foreceful D&C / repeated D&C
3. client’s mother treated with DES when pregnancy with the client
4. congenitally small cervix
5. uterine anomalies
6. unknown etiology
Signs
1. show = pink-stained vaginal discharge
2. increased pelvic pressure
3. followed by rupture of membrane
4. discharged of amniotic fluid
5. expulsion of the immature fetus
medical management
1. cervical cerclage (shirodkar / Mcdonald)
- done 3 to 4 months (13 to 14 weeks)
- surgical procedure to prevent incompetent cervix to happen again
- if CS, cervical cerclage remove after CS, CS done 14 days before
EDC to avoid dilatation & contractions
- sutures serve ti strengthen the cervix & prevent it from dilating
- purse string sutures are placed in the cervix by vaginal route
NCP
1. avoid coitus or orgasm
2. provide routine post-op
3. maintain bed rest for 24 hours (modified trendelenburg position)
4. observe for ruptured membranes and bleeding
5. monitor FHR and Doppler ultrasound
6. avoid strenuous play activity
evaluation
1. states intention of seeking immediate medical care if labor begins
2. continues pregnancy to term
ND
1.body image disturbance RL to feelings of failure and feelings of guilt
2. anticipatory grieving RL to loss of expected baby
3. knowledge deficit RL to cerclage procedure and effect on pregnancy
4. pain RL to early dilation of the cervix
5. situational low self-esteem RL to inability to complete pregnancy
5. Hyperemesis gravidarum
Copyright © Gpramos 37
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
- severe nausea and vomiting, leading to electrolyte metabolic and nutrition imbalances in the
absence of other medical problems
- sometimes called “pernicious vomiting” during 14 to 16 weeks gestation
- peak: 10th week of gestation
etiology
1. signs and symptoms occur during the 1st 16 wks of pregnancy and are
intractable
2. continued vomiting results to dehydration
3. secretion of HCG, decrease in free gastric HCl., decreased
gastrointestinal motility
4. increased incidence in H-mole and multifetal pregnancy
5. hospitalization may be required for severe symptoms
Signs
1. unremitting / intractable nausea and vomiting
2. hiccups
3. abdominal pain
4. marked weight loss
5. dehydration – thrist, tachycardia, skin turgor
6. increased respiratory rate
7. elelvated blood urea nitrogen
ND
1. altered nutrition, less than body requirements RL to retain oral feedings
2. fluid volume deficit RL to dehydration
3. Ineffective individual coping RL to symptoms, insecurity in role
4. personal identity disturbance RL to symptoms or perception of self as
inadequate in role, sick, socially unrepresentable
NCP
Goal: physiological stability
a. rest GI tract (keep NPO), maintain IVF, parenteral nutrition
b. progress diet, as ordered, present small feedings attractively
c. weigh daily, assess hydration, note weight gain
Goal:minimize environmental stimuli
a. limit visitors and phone calls
b. bed rest with BRP
Goal: emotional support
a. establish accepting, supportive environment
b. enouragce verbalization of anxiety, fears, concerns
c. support positive self-image
Evaluation
a. woman s/s subsdies, she takes oral nourishment & gains weight
b. woman’s pregnancy continued to term /o recurrence of hyperemesis
Comparison
Morning sickness HG
Onset occurs in 1st trimester & resolves in 2nd onset in 1st trimester and
continues throughout
pregnancy
Weight is maintained weight loss
Serum electrolytes remain normal serum electrolytes are
abnormal
Ketosis doesn’t develop ketosis occurs or maybe
developed
Skin turgor remains hydrated skin turgor is dehydrated
Serum thyroid level normal serum thyroid levels are
abnormal
Skin color – normal jaundice may occur
6. Placenta Previa
Copyright © Gpramos 38
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Predisposing factors
1. multi parity (5% in grand multiparous Px)
2. advanced maternal age (35 yrs above – high risk)
3. multiple gestations – twins, triplets, etc
4. previous CS
5. uterine incisions – prior uterine insult or injury
6. prior placenta previa (4-8%)
7. prior induced abortion
8. smoking
Assessment S/S
a. bright red, painless vaginal bleeding
b. soft, nontender uterus
c. FHR stable and within limits – normal FHT
d. hypotension
e. tachycardia
f. absence of contractions
Diagnosed by:
1. ultrasound
2. double set-up examination – vaginal exam in operating room only,
in preparation for CS
3. CBC
4. Speculum exam or careful spec exam – to determine if bleeding is
from mother or from fetus
Nursing care plan
1. take and record vital signs, assess bleeding and maintain pad count
2. observe for shock
3. monitor FHR
4. enforce strict bed rest
5. explain condition and management options
6. instruct client to avoid intercourse until after birth
Medical management
1. ultrasound is used to locate the placental site
Copyright © Gpramos 39
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
7. Abruptio Placenta
- premature separation of normally implanted placenta from the wall of the uterus
- occurs as late as during the 1st or 2nd stage of labor
Types
1. partial abruption placentae – small part of the placenta
2. marginal – occurs at the edges, external bleeding
3. compete – total placenta separates
Etiology
1. Cause is unknown
2. risk factors
a. uterine anomalies
b. multiparity (before birth or second twin)
c. PIH (preeclampsia / eclampsia)
d. previous CS delivery
e. renal or intravascular disease (chronic renal hypertension)
f. trauma to abdomen
g. previous 3rd trimester bleeding
h. abnormally large placenta
i. traction on umbilical cord
j. cigar smoking (cocaine addiction)
Copyright © Gpramos 40
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
- strict NPO
- observe vaginal bleeding for 30 mins
Planning and implementation
1. continuously evaluate maternal and fetal physiological status:
vital signs
bleeding
electronic fetal and maternal monitoring tracings
signs of shock
decreased urine output
2. never perform a vaginal or rectal exam or take any action that would stimulate
urine activity
3. Assess the need for immediate delivery
- CS
- vaginal delivery (NSD)
* CS - necessary for live, distressed or uncontrolled bleeding, because the
mother can die within 30 mins from severe hemorrhaging
* NSD – should be attempted when the fetus is dead, maternal bleeding is mild,
mother is in stable condition – induction of artificial labor
8. Pregnancy-induced Hypertention
- a hypertensive disorder of pregnancy, developing after 20 weeks of gestation and
characterized by edema, hypertension and proteinuria
- associated with poor calcium in the urine and magnesium sulfate
- vasospasm occur during pregnancy
Etiology
1. cause is unknown
2. possible contributing factors
- poor renal care, particularly inadequate nutrition
- primigravid status
- multiple pregnancies
- preexisting maternal diabetes mellitus or hypertension
- age younger than 18 or older than 35 yrs
- Hydatidiform mole
- low socioeconomic form
Assessment
Mild preeclampsia
- hypertension – systolic increase of 30 mmHG or more over baseline;
diastolic rise of 15 mmHG or more over baseline (ex. 140/90)
- proteinuria – 1 g/d
edema – digital and periorbital; weight gain over .45 kg (1 lb) per week
Severe preeclampsia – increasing hypertension – systolic at or above 160
mmHG or more than 50 mmHG over baseline; diastolic 110 mmHG or
more
WARNING SIGNS
- rapid rise in BP
- rapid weight gain
- generalized edema
- increased proteinuria
- epigastric pain
- severe headache
- visual disturbances
- oliguria
- irritability
- severe nausea and vomiting
Eclampsia
- tonic and clonic convulsions (grand malseizures), coma
- renal shutdown – oliguria, anuria
Copyright © Gpramos 41
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Copyright © Gpramos 42
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Induction of labor
- is the deliberate initiation of labor before spontaneous contractions begin
- means that the labor is artificially started may be either mechanical, physiologic or chemical
* mechanical = amniotomy
* physiologic = ambulation
* chemical = methergine
Primary reasons for inducing labor
1. overdue (at least 1 to 2 weeks)
2. toxemia (elevated blood pressure)
3. PROM (prolonged rupture of membrane)
4. chorioamnionitis (infection of membrane)
5. oligohydramnios
6. macrosomia
7. prior poor obstetrical Hx (prior stillborn)
8. intrauterine fetal death
Reasons for not inducing labor
1. placenta previa (after birth in front of the baby's head)
2. prior classical C-section (incission is up and down on the uterus
3. breech baby or other abnormal fetal positions
4. fetal distress
5. active herpes infection (can affect fetus - opthalmia neonaturum)
Before inducing labor, these conditions must be considered:
1. abscence of CPP, malpresentation or malposition
2. cervix is ripe, or ready for birth
3. engaged vertex of single gestation
4. the fetus is estimated to be matured by date
Methods of inducing labor
1. induction by AROM (artificial rupture of membrane - amniotomy)
- may be adequate to stimulate contractions and increased effectiveness of
labor
- is initiated when the cervix is soft, partially effaced, and slightly dilated,
preferably when the fetal presenting part is engaged
- maybe done after oxytocin administration establishes effective contraction
Assessment during induction of labor
1. observe fluid - note color,amount
2. monitor FHR, assess for fetal distress
3. observe for signs of prolapsed cord
4. assess fetal activity
- excessive activity may indicate distress
- absence of activity may indicate distress or demise
advantages
- the more favorable the cervix, the less like the induction is needed
- sometimes this is all that is needed
disadvantages
- takes longer to get into active labor
- mother becomes nauseated or has headaches
- trigger labor or lead to over-stimulation by the uterus
- hyperstimulation results in C-section
Copyright © Gpramos 43
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
advantages
- easier to control the AROM
- faster effect
disadvantages
- can cause fetal distress
- may or may not cause contractions - absent; last too long
Cesarean delivery
- surgical / operative by which infant or newborn is delivered through incisions in abdominal
and uterine walls to give brith
Indications of CS
1. previous CS
2. dystocia
3. hemorrage
4. fetal distress
5. preeclampsia
6. prolonged rupture of membrane
7. prolapsed cord
8. intrapartum infection
9. elederly primigravidas
10. Rh incompatibility
11. previous surgery
12. placenta previa / abruptio placenta
13. macrosomia
14. fetal maternal death
Types of cesarean incisions
1. classic cesarean incision
- a vertical midline skin incision is made in the skin and the body of the
uterus
- indicated in emergency situations
- necessary for anterior placenta previa and transverse lie
- permitting easier access to the fetus
- blood is increased
2. low segment incision
- this is the most common type of incision
- the incision is low (bikini or Pfannestiel's incision)
- the uterine incision is horizontal in the lower urterine segment
- blood loss is minimal / less adhesion formed
3. porro's hysterotomy followed by hysterectormy
- hemorrage from uterine atony
- placenta previa, accreta
- large uterine mayomas
- ruptured uterus
- cancer of uterus or ovary
ND
1. self-esteem disturbance RL to failure to give birth vaginally
2. anxiety and fear RL to surgical operation
3. ineffective individual coping
4. fluid volume deficit RL to blood loss
5. pain RL to abdominal surgery
6. constipation RL to decreased bowel activity
NCP
1. pre-operative
Copyright © Gpramos 44
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
etiology
- prematurity (SGA) - allows space for cord descent
- unengaged cephalic presentation w/ ruptured membranes
- shoulder and footling presentation
- polyhydramnios
- placenta previa
assessment
- signs of fetal distress may develop as the cord is compressed
- the prolapse of the cord may be visible or palpable
NCP
Goal: reduce pressure on cord
- position = place client in knee-chest position; lateral modified Sim's
with hips elevated; modified Trendelenburg position
- with gloved hand, suport fetal presenting part off cord
Goal: increase fetal-maternal oxygenation
- O2 per mask (8-10 L/min)
Goal: protect exposed cord
- cord with warm sterile saline dressing
Goal: expedite termination of threat to infant
- prepare for immediate vaginal / cesarean birth
*Cervix is fully dilated @ the time of prolapsed cord - the
physician may choose to deliver the infant quickly with possibly
forceps delivery to prevent period of anoxia.
Pre-term labor
(20-37 weeks)
- labor that begins after 20 weeks gestation and before begining of week 38
etiology
-PROM
- preeclampsia
- hydramnios
- placenta previa
- abruptio placenta
- incompetent cervix
- trauma
- multiple gestation
- intrauterine infection
- uterine structural anomalies
- congenital adrenal hyperplacia
- fetal death
Manifestations of preterm labor
- rhythmic uterine contyractions
- cervical effacement and dilatation
- possible rupture of membranes
Copyright © Gpramos 45
The Filipino Nursing Herald (http://nursingherald.blogspot.com)
Prevention
A. primary - close obstetric observation; education is warning signs and symptoms
of preterm labor
1. dull lower backache that radiates like a wave to the front of the abdomen
2. contractions every 10 minutes for 2 hours even after position changes
3. low back pain and light bloody discharge (bloody show)
4. pelvic pressure extending to the back and thighs
B. secondary - prompt, effective treatment of associated disorders
C. tertiary - suppression of preterm labor
1. bedrest
2. position: side-lying - to promote placental perfusion
3. hydration - IV fluids
4. pharmacologic - like Beta-andrenergic agents - to reduce sensitivity of
uterine myometrium to oxytocic and prostaglandin stimulation;
increase blood flow to teh uterus
5. may be maintained at home with adequate follow up and health teaching
Copyright © Gpramos 46