SECOND TRIMESTER headaches

COMPLICATIONS visual changes

oliguria
Hypertensive Disorders in Pregnancy hyperreflexia
Gestational Hypertension epigastric pain
Pregnancy Induced Hypertension flu like symptoms
generalized edema
Pregnancy Induced Hypertension nausea and vomiting
severe elevated BP
• Incidence proteinuria
– 8% of all pregnant woman
– Appears before 20th week of pregnancy PIH Severe Preeclampsia - Management
– Proteinuria, HPN-increased BP, convulsion,
disappears 2 weeks after delivery • Dependent on severity of disease &
gestational age of fetus
• Etiology • Focus of Care
– Unknown, hormones:PGE prostaglandin, – Activity restriction / quiet environment/Seizure
estrogen, progesterone, renin angiotensin Precaution
– Preeclampsia is due to generalized – Suction Machine at Bedside
vasospasm – Pharmacologic therapy -anticonvulsive &
antihypertensive therapy: Magnesium Sulfate
• MILD PREECLAMPSIA Cardinal signs – Acts as a CNS depressant
1) hypertension 140/90 or increase of – Vasodilator
30mmHg in systolic, increase of 15 – Diuretic
diastolic
2) proteinuria albuminuria 24 hr urine Severe Pre-eclampsia
collection is 300mg/L
3) weight gain of 2 lbs in one week • Dosage of MgSO4:bolus dose
10gm is equivalent to 40ml
Pregnancy Induced Hypertension given per IM. This is not given
Mild Preeclampsia on one muscle site.
• NOT given per IV because it
• Nursing Responsibilities could depress the fetus
– Rest • AFTER birth it is ok to give per
– Increase protein in the diet, low fat, low IV
sodium, high carbo
– Visit MD 2x a week 5 signs of MgSO4 Toxicity

Severe Pre-eclampsia • Depressed DTR’s

• Depressed RR-14 breathes per minute is the
• Signs and Symptoms: lowest acceptable. If 12 you have to give the
– BP 160/110 or higher, antidote.
– generalized edema, oliguria, • BP-check for pulse pressure. Greater than 40
– Headache-frontal and occipital, means circulatory collapse.
– cerebral edema, vomiting, • Urine Output of less than 30cc/hr
– pulmonary congestion, • Decreased FHR- if the fetal heart rate falls below
– epigastric pain-an Impending sign of normal range, give the antidote
convulsion!
– Albumin in 24 urine collection is 5g/L Calcium Gluconate
(Antidote for MgSO4)
HELLP
• Reverses respiratory paralysis
– Criteria of diagnosis and heart block.
hemolysis • Dosage: 10mg of 10% solution per
elevated liver enzymes IV every hour for 10 doses.
AST(SGOT)>72U/L • Other drugs given:valium, apresoline
ALT(SGPT)>50U/L NOT GIVEN: diuretics
serum LDH>600IU/L
low platelet Pregnancy induced Hypertension
<100,000/mm
• Post-Partally-the 1st 48 hours is CRITICAL.
PIH - HELLP syndrome Possible convulsion.
reflects severity of disease • GRAND MAL CONVULSION: Aura, Tonic,
– Signs and Symptoms Clonic, Coma
• Nursing Responsibility: • No vaginal exams, restrict
– Turn patient to side, activity
– prevent injury, bed rails well padded,
– give O2 via face mask at 7-8LPM, suction Premature rupture of
secretions, membranes (PROM)
– Prepare for OR.
• Diagnosis is made when there is
Vena caval syndrome. cramping and vaginal discharge on
20 and 37 weeks gestation
PIH – eclampsia nursing • Nursing Care – monitor FHT &
contractions, provide emotional
interventions support, manage side effects of
• Reduce risk of aspiration tocolytics, teach what to do if occur
• Prevent maternal injury at home
• Ensure maternal oxygenation after seizure
• Ensure fetal oxygenation after seizure ABRUPTIO PLACENTA
• Establish seizure control with MgSO4
• Treat severe hypertension • Premature separation of a normally
• Correct maternal acidemia implanted placenta.
• Initiate process of delivery • Caused by: trauma, PIH, ischemia, too
much oxytocin, water intoxication, fetal
THIRD TRIMESTER distress, identical twins, polyhydramnios,
COMPLICATIONS short umbilical cord.

PROM ABRUPTIO PLACENTA

Placenta Previa
Abruptio Placenta • S & Sx:
Hydramnios – sudden sharp pain at fundus,Bleeding dark
Prolapse Cord red
– Couvallaire uterus-board like rigidity
Premature rupture of
membranes (PROM) TYPES OF ABRUPTIO PLACENTA

• Diagnose – Nitrazine or fern test • Concealed-center is

• Gestational age - more than 36 wks deliver separated first.
if: Shultz mechanism
– ripe cervix, leading to internal
– abnormal FHT, bleeding. Presence
– meconium stained fluid, of couvalaire uterus.
– possible infection, • Nursing Action:
– abnormal presentation Perform IE’s to
• Management – walking, Prostaglandin rupture the amnion
and the blood.
Premature rupture of
membranes (PROM) TYPES OF ABRUPTIO PLACENTA

• Gestational age between 32-35 weeks • Overt/Marginal-

deliver if Duncan Mechanism,
– mature fetal pulmonary status,
– abnormal FHT, there is overt
– possible infection bleeding.
• Management – tocolytics, steroids,
antibiotics PLACENTA PREVIA
– Tocolytics (Ritodrine, Bricanyl) act by
depressing smooth muscle, • Low lying placenta
– glucocorticoids accelerate fetal lung maturity • Caused by: tumor in the upper segment,
advancing age, multiparity, unfavorable
Nursing Care for PROM decidua.
• Sx/Sx: bright red bleeding, soft uterus,
• Stay hospitalized until birth painless vaginal bleeding
• Frequent VS & FHT q 4 hours • Possible pregnancy outcome is Preterm
• Frequent CBCs , records “kick
counts” TYPES OF PLACENTA PREVIA
• Check vaginal bleeding
Placenta Previa – Front Prolapse
– Vaginal Cord Prolapse
• Nursing Management
– Monitor amount of blood loss by pad PROLAPSE CORD
counting/weighing.
– Monitoring vital signs:check for signs and • S/sx: decreased FHT
symptoms • Nursing Focus:
of shock. – CBR w/o BRP
– Assess for LOC-irritability is the first sign of – Monitor fetal heart rate
oxygen – Prevent pressure on the CORD! Brain damage
deprivation. can
– Assess for skin color and temperature. occur if pressure persists greater than 5 minutes.
– Measure urine output – Position-trendelenburg, knee chest
– Position the client in trendelenburg, left side lying – If vaginal cord prolapse, place sterile OS soaked
in
Placenta Previa NSS to prevent atrophy of blood vessels.

• Nursing Management COMPLICATIONS OF LABOR

– Provide warmth-blanket
– Place on NPO DYSTOCIA
– Start IV line-use big needle to anticipate BT. AMNIOTIC FLUID
– Monitor I&O EMBOLISM
– Prepare 2 units of whole blood TWINS
– Monitor VS, FHT, Uterine contractions
– Provide emotional & psychological support DYSTOCIA

HYDRAMNIOS • Difficult labor

• Causes of dystocia
• Diagnosed thru pelvic ultrasound/Amniotic – Injudicious use of analgesics
Fluid Index – Minor degrees of pelvic contraction
• Oligohydramnios-below 300 less than – malposition
2cm;less than 5 at AFI
• Polyhydramnios-above 2000 greater than Stages of Labor
8cm; greater than 24 at AFI
– Stage 1: from onset of labor until full
HYDRAMNIOS dilation of cervix
• Latent phase: from 0-4 cm
• Causes • Active phase: 4-8 cm
– Post maturity • Transition: 8-10 cm
– Renal function – Stage 2: from full dilation of cervix to birth
– IUGR of baby
– Obstructive Uropathy – Stage 3: from birth of baby to expulsion of
– Rupture of membranes placenta
– DM – Stage 4: time after birth (usually 1-2 hours)
– Anemia of immediately recovery

HYDRAMNIOS Duration of Labor

• Effects of OLIGO • A.Depends on

– Cord compression – Regular, progressive uterine contractions
– Fetal distress – Progressive effacement and dilation of cervix
– Fetal pulmonary hypoplasia – Progressive descent of presenting part
• Effects of
POLYHYDRAMNIOS Duration of Labor
– Preterm labor
– PROM • B. Average length
– Perinatal death 1. Primipara
• Stage 1: 12-13 hours
PROLAPSE CORD • Stage 2: 1 hour
• Stage 3: 3-4 minutes
• Cord collapsed first before • Stage 4: 1-2 hours
the delivery 2. Multipara
• Types • Stage 1: 8 hours
– Occult Prolapse • Stage 2: 20 minutes
• Stage 3: 4-5 minutes • distress
• Stage 4: 1-2 hours
PRECIPITATE LABOR
POWER
• Labor takes place 3 hours or less
• Primary Power • Causes: Opposite of P’s
– Involuntary uterine contraction should be • Management: at the second stage of
present during labor labor, perform modified Ritgen’s maneuver
• Secondary Power by supporting the lower perinuem with
– Abdominal contraction which is voluntary towel to prevent laceration.
and should be present after labor is
established. PRECIPITATE LABOR

POWER • Effects of precipitate labor on

– Mother
• Hypotonic Uterus- late contraction, • Laceration
slowed contraction • Bleeding
– Management: oxytocin, pitocin to induce • Infection
labor – Fetus
• Head injury
• Hypertonic Uterus- tetanic contraction • Infection
that is continuous and fast • Fetal asphyxia
– Management: bricanyl and sedative
AMNIOTIC FLUID EMBOLISM
PASSENGER
• Amniotic Fluid enters the maternal
• Head is big circulation & enters the pulmonary
• Heavy or big baby capillaries.
• Breech presentation • It is a rare condition but the patient can die
immediately.
The most favorable position for child • S&Sx: dyspnea
birth is ROA/LOA • Sites of entry: endocervical, uteroplacental
area
PASSAGEWAY
TWINS
• Small contracted pelvis
• The distance between the ischial spines is • Identical-monozygotic
equal to or less than 9cms. – 2 amnion-2 cord
– 1 chorion-1 placenta
PASSENGER
• Fraternal-dizygotic
• Cardinal Mechanism of Labor is: – 2 amnion – 2 cord
– Engagement/descent – 2 chorion-2 placenta
– Flexion
– Internal Rotation TWINS
– Extension
– External Rotation • Complications:
• If not able to rotate fully- Consistent – Prematurity
Occiput Posterior (COP) – Uterine atony
– Hydramnios
Nursing Care – Anemia
– Dystocia
Rub the clients back as this would manifest severe – Prone to infection
backpain – Hemorrhage
– PIH
PERSON-PSYCHE – Abnormal Presentation

• Preparation of the mother is essential

• Prolonged labor can cause
– Mother
• Exhaustion
• Dehydration
• Infection
– Fetus