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MATERNAL NURSING PART 2
MARIE THERESE A. PACABIS, RN, RM, MAN
TESTS TO EVALUATE FETAL WELL BEING
A. Daily Fetal movement count
5 to 10 movements/ hr Lower than 5 movements/ hr may
indicate fetal jeopardy
Assess for fetal sleep patterns
TESTS TO EVALUATE FETAL WELL BEING
B. Nonstress Test (NST)
Reactive test – 3 accelerations of FHR 15 beats/min above baseline FHR lasting for 15 sec. Or more, over 20 minutes
Non reactive test – no accelerations or acceleration less than 15 beats/ minute above baseline FHR. May indicate fetal jeopardy.
TESTS TO EVALUATE FETAL WELL BEING
C. Contraction Stress Test (CST) or oxytocin challenge test (OCT)
Corelates FHR response to spontaneous or induced uterine contractions
Indicate interoplacental insuffiency
INTERPRETATION:
Negaative results indicate absence of late decelerations with all contractions
Positive results indicate late FHR decelerations with contractions
TESTS TO EVALUATE FETAL WELL BEING
D. Biophysical Profile (BPP)
Observation by ultrasound of 4 variables for 30 minutes and results of non stress testing:
FM Fetal tone AFV (Amniotic Fluid Volume) Respiratory movements
Each variable is score 2 if present and 0 if absent
A score below 6 is associated with perinatal mortality.
TESTS TO EVALUATE FETAL WELL BEING
E. Ultrasound
Non invasive procedure making use of hi frequency sound waves thru uterus to obtain data re: fetal growth, placental positioning and the uterine cavity
Purposes
1. Pregnancy Confirmation2. Fetal viability3. Estimate AOG4. Biparietal Diameter5. Placental location6. Fetal abnormalities7. Fetal death8. Multiple gestation9. AFI
TESTS TO EVALUATE FETAL WELL BEING
F. Amniocentesis
Invasive procedure for amniotic fluid analysis to assess fetal lung maturity done after 14 weeks gestation
Possible Complications:
1. Onset contractions2. Infections (amnionitis)3. Placental punctures 4. Cord puncture5. Bladder or fetal punture
TESTS TO EVALUATE FETAL WELL BEING
G. Analysis of Amniotic Fluid
Chromosomial studies to detect genetic abnormalities
Detect inborn errors of metabolism
Determines LS ratio Presence of meconium may
indicate fetal hypoxia.
TESTS TO EVALUATE FETAL WELL BEING
H. Chronic Villus Sampling (CVS)
Cervically invasive procedure
Removal of small piece of tissue (chronic villus) from the fetal portion of placenta- tissue reflects genetic makeup of fetus
Advantage:
- results can be obtained after 10 weeks gestation due to fast growing fetal cells
Risks:
- spontaneous abortion, infection, IUFD, fetal limb defects etc.
TERMSFetal attitude
-refers to the relation of the fetal parts to the one another
Fetal lie- refers to the relationship of the cephalocaudal axis (of the fetus to the cephalocaudal axis of the woman.
TERMSFetal Presentation
- Is determined by fetal lie and by the body part of the fetus that enters the pelvic passage first.
CLASSIFICATION OF CEPHALIC
PRESENTATIONVertex presentation
– the most common presentation, the fetal head is completely flexed onto the chest, and the most smallest diameter of the fetal head.
Military Presentation
– the fetal head is neither flexed nor extended
CLASSIFICATION OF CEPHALIC
PRESENTATION
Brow presentation- the fetal head is partially extended
Face presentation- the fetal head is completely extended
TERMSStation
- refers to the relationship of the presenting part to an imaginary line drawn between to the ischial spines of the maternal pelvis.
TERMSFetal Position
- refers to the relationship of a designated landmark on the presenting fetal part to the front, sides, or back of the maternal pelvis.
CRITICAL FACTORS IN LABOR
The birth passage
Size of pelvis(diameters of the pelvic inlet, midpelvic or pelvic cavity, and outlet)
Type of pelvis (gynecoid, android, anthropoid, platypelloid, or a combination)
Ability of the cervix to dilate and efface and ability of the vaginal canal and the external opening of the vagina (the introits) to distend
CRITICAL FACTORS IN LABOR
The Fetus
1. fetal head(size and presence of molding)
2.Fetal attitude(flexion or extension of the fetal body and extremeties
3.Fetal lie
CRITICAL FACTORS IN LABOR
The Fetus
4.Fetal presentation (the part of the fetal body entering the pelvis first in a single or multiple – gestation pregnancy)
5.Placenta (implantation site)
CRITICAL FACTORS IN LABOR
The relationship between the passage and the fetus
1.Engagement of fetal presenting part
2.Station (location of fetal presenting part within the maternal pelvis)
3.Fetal position (relationship of the presenting part to one of the four quadrants of the maternal pelvis
CRITICAL FACTORS IN LABOR
Primary forces of labor
1.Frequency, duration, and intensity of uterine contractions as the fetus moves through the birth passage
2.Effectiveness of maternal pushing effort
3.Duration of labor
CRITICAL FACTORS IN LABOR
Psychosocial consideration
1.Physical preparation of childbirth
2.Support from significant others
3.Emotional status
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
1. Time: multipara 5-6 hr; nullipara 8-10hr, average
Usually comfortable, euhpric, excited, talkative, and energetic, but may be fearful an withdrawn
Provide encouragement, feedback for relaxation, companionship, hydration, nutrition
0 – 4 cm: Latent Phase and Early Active Phase
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
2.Contractions:
regular, mild, 5-10min apart, 20-30seconds duration
Relieved or apprehensive that labor has begun
Coach during contractions
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
3. Low back pain and abdominal discomfort with contractions
Alert, usually receptive to teaching, coaching, diversion, and anticipatory guidance
Comfort measures: position change of comfort; praise; keep aware of progress; maintain hydration
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
5. Cervix thins: some bloody show
6. station: Multipara (-)2 to (+)1; nullipara 0
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
1. Average Time:
Nullipara 1-2 hr
multipara 1 ½ - 2 hr
Tired, less talkative, and less energetic
Coach during contractions
4 – 8 cm: Midactive Phase, Phase of Most Rapid Dilation
FIRST STAGE OF LABORPhases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
2.Contractions:
2-5 min apart, 30-40 seconds’ duration, intensity increasing
More serious, tendency to hyperventilate, may need analgesia, needs constant coaching
Position for comfort; encourage relaxation, keep aware of progress; offer analgesics and anesthetics, provide hygience: mouth care, ice chips, clean perineum; warmth.
FIRST STAGE OF LABORPhases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
3. Membranes may rupture now
Monitor progress of labor and maternal / fetal response, color of fluid, time of rupture of membranes (PROM)
4. Increased bloody show
5. Station: 1 to 0
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
1. Average Time:
Nullipara 40min-1hr
Multipara-20 min.
If not under regional anesthesia, more introverted; may be amnesic between contraction
Stay with woman
8-10cm: Transition, Deceleration Period of Active Phase
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
2.Contractions:
1 ½-2min apart, 60-90sec duration, strong intensity
Feeling she cannot make it; increased irritability, crying, nausea, vomiting and belching; increased perspiration over upper lip and between breasts; leg tremors; and shaking
Continue to coach with contractions: coach panting or “ he-he” respirations to prevent pushing
FIRST STAGE OF LABOR
Phases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
3. Increased vaginal show; rectal pressure with beginning urge to bear down
May have uncontrollable urge to push at this time
Comfort measures, offer ice chips
FIRST STAGE OF LABORPhases of first stage
Assessment: Expected Maternal Behavior
Nursing Care Plan/ Implementation
4.Station:
regular, mild, 5-10min apart, 20-30seconds duration
Monitor contactions, FHR, vaginal discharge, perineal bulging
Assess for bladder filling
DIFFERENCTIATION OF FALSE/ TRUE LABOR
False Labor True Labor
Contractions: Braxton, Hicks intensify
(more noticeable at night); short, irregular, little change
Contractions: Begin in lower
back, radiate to abdomen
(“ girdling”), become reglar, rhytmic; frequency, duration, intensity increase
DIFFERENCTIATION OF FALSE/ TRUE LABORFalse Labor True Labor
Discomfort: Mostly abdominal and
groin
Discomfort: Mostly low back
Relieved by change of position or activity(e.g.walking)
Unaffected by change of position, activity, drinking two glasses of water, or moderate analgesia
Cervical changes – none; no effacement or dilation progress
Cervical changes – progressive effacement and dilation
CARE OF THE WOMAN AT BIRTH
Position - any comfortable position - squat – ideally
Vital signs – BP= every 5-15min - FHR= every 5(High Risk)
= every 15(Low Risk)
Uterine Contraction- Monitored- continuously
CARE OF THE WOMAN AT BIRTH
Episiotomy may be done – when indicated- Median- Mediolateral
Check illimination
CARE OF THE WOMAN AT BIRTH
Nutrition – ice chips & clear liquids(as needed)
MedicationsAnesthetic – for suturingOxytocics – methergin/
- syntocinon
Main Goals
Relax the woman
Relieve her discomfort-without having a significant effect on her contractions, pushing efforts or the fetus.
PHARMACOLOGICAL PAIN RELIEF
Opiods are commonly used because they significantly reduce pain
Common drugs used:- meperidine (Demerol)- nalbuphine(Nubain)- butorphanol(stadol)
PHARMACOLOGICAL PAIN RELIEF
Additional effects in labor:- relaxes the cervix
Disadvantage:depress the CNS of the fetus w/c leads to respiratory depression
if a neonate is born with respiratory depression,
*Naloxone(Narcan)- is given to counteract the effects of the opiod.
PHARMACOLOGICAL PAIN RELIEF
Drug of choice:
Meperidine- sedation & antispasmodic actions- gives the mother feelings of well being
& euphoria- relaxes cervixit is a “labor’s feel good drug”
Route:IM, IV or intrathecally (subarachnoid space of the spinal cord)
PHARMACOLOGICAL PAIN RELIEF
EPIDURAL ANESTHESIA- Infection of a narcotic medication such as fentanyl, bupivacaine or lidocaine like drug, thru a needle or catheter into the epidural space.
- women with pre existing medical conditions such as heart disease, diabetes, PIH choose this method because it makes labor almost pain free, w/c reduces physical & emotional stress
PHARMACOLOGICAL PAIN RELIEF
EPIDURAL ANESTHESIA
Effect: Lowers blood pressure that can lower
blood flow to uterus & the placenta
Before anesthesia, woman should receive 500-1000ml of IV fluid such as D5LR to prevent hypohension
Avoid glucose solution because of the risk of hypoglycemia in the neonate
PHARMACOLOGICAL PAIN RELIEF
IMMEDIATE CARE OF THE NEWBORN
Maintain body temperature- conserve energy & O2 needs, prevent chills
- dry quickly, minimize exposure
- apply hat/ bonnet, keep warm
- take temperature hourly until stable
IMMEDIATE CARE OF THE NEWBORN
Prevent eye infection (gonorrheal & chlarrydial Opht. Neonatorum)
- apply within one hour of birth
IMMEDIATE CARE OF THE NEWBORN
Give Vitamin K to facilitate clotting1 mg =.1cc of Vit.K or Aquamyphyton
Vaccines- BCG, Hepa B
IMMEDIATE CARE OF THE NEWBORN
Ensure patent airway- suction mouth first, then nose may cause aspiration of mucus
- avoid prolonged, vigorous suctioning
*may traumatize tissue, cause edema bleeding,
laryngospasm & cardiac arrythmia
PUERPERIUM- period where reproductive organs return to its pre gravida stage
1.B-reasts *engorged breasts, may elevate temperature
*prepare for Lactation- add 500 calories
PHYSIOLOGICAL STATUS:
COLOSTRUMyellowish fluid, 2-3 days has
immunologic & nutritive value
Encourage first feeding w/in one hour after giving birth
Encourage emptying of both breasts at each feeding & before engorgement ot stimulate milk production, prevent mastitis
R.A. 7600 – Rooming In Law
2.Uterus Immediately after birth, uterus below
navel
Midline, contracted like a firm grapefruit
Descends one fingerbreath daily until day 10
Day 10 – behind symphysis pubis, non palpable
PHYSIOLOGICAL STATUS:
3.Lochia Bloody discharge from the uterus during
puerperium
*Day 1-3: rubra (red)*Day 3-7: serosa(pink to brown)*Day 10: alba(creamy white)
Amount:- Moderate flow- Fishy odor- Clots, few small clots
PHYSIOLOGICAL STATUS:
4.Perineum
Immediately after birth – edematous
Check for hematoma, complains of pain, perineal distention, painful, tense
PHYSIOLOGICAL STATUS:
5. Cardiovascular system
Immediately after birth, increased cardiac load due to:
Return of uterine blood flow to general circulation
Blood volume – returns to prepregnant state in about 3 weeks. Major reduction-during 1st week due to diuresis & diaphoresis
PHYSIOLOGICAL STATUS:
5. Cardiovascular system
Blood values
High WBC during labor & 1st few days postpartum
Blood coagulationhypercoagulability maintained during 1st few days postpartum, predisposes to thrombophlebitis & pulmonary embolism
PHYSIOLOGICAL STATUS:
6. Urinary Tract
Output, increased due to diuresis daily output 3000ml.
PHYSIOLOGICAL STATUS:
7. Legs
Homan’s sign – should be negativeno calf pain when knee is extended & gentle pressure applied to dorsiflex foot
PHYSIOLOGICAL STATUS:
8. Menstruation
First menstrual cycle maybe unovulatory
Non Nursing-ovulation=4-6weeks 6-8
wks.menstruation begins
Nursing/Lactation An ovulatory period No menstruation up to 6 mos. LAM
PHYSIOLOGICAL STATUS:
HIGH RISK PREGNANCY
Mother prone to Fetus morbidity
and mortality
RISKS FACTORS1. Maternal Age
- below 18 & above 35 yearsAdolescents – Higher PIH
LBW-Preterm Labor & delivery -Anemia-Labor dysfunctions-CPD
- above 35 years – placenta previaH- MoleCHVDsBabies with chromosomial
abnormalities
RISKS FACTORS2. Maternal Parity
- risk to hemorrhage- abortion
3. OB & Gynecologic HX- 2 or more premature deliveries or abortions- stillbirths- cervical incompetency- malposition- malpresentation- multiple pregnancies- previous dystocia- placental abnormalities etc.
4. Maternal Medical Hx- cardiac disease- CHVD- Renal disease, diabetes, asthma- TB- Family history- STDs
RISKS FACTORS
5. Lifestyle- lifestyle & Occupation- What she consumes & what she is exposed to can seriously afect her pregnancy
Ex. OTC drugs Cigarette Smoking Alcohol Substance abuse
RISKS FACTORS
GENERAL CAUSES OF MATERNAL MORTALITY
Hemorrhage
Hypertension
infection
SELECTED STDS AND PREGNANC
Y
STD Causative organism
Assessment findings Treatment Special considerations
Candidiasis
•Thick, cheesy like vaginal discharge
•Intense pruitus•Vaginal redness and irritation
•Wet mount slid positive for organism
Antifungal agent, such as micronazole cream (Monistat) or oral fluconazole (Difucan)
•Common during pregnancy because increased estrogen levels cause changes in vaginal pH
•Most commonly occurs in women receiving antibiotic therapy for another infection and women with gestational diabetes or human immunodefieciency virus infection
•Possible neonatal infection if infection is present at the time of delivery
STDCausative organism Assessment
findingsTreatment
Special considerations
Trichomoniasis
Single-cell protozoan infec-tion
•Yellow-gray, frothy, odorous vaginal discharge
•Vulvar itching, edema, and redness
•Vaginal secretions on a wet slide treted with potassium hydoxide positive for organism
•Topical clotrimazole (Gyne-lotrimin) instead of metronoida•zole(flagyl)because of its possible teratogenic effects if used during the first trimester of pregnancy
•Possible associated with preterm labor, premature rupture of membranes, and postcesa•rean infection
•Treatment of partner required, even if asymptomatic
STDCausative organism Assessme
nt findings
TreatmentSpecial
considerations
Bacterial vaginosis
Gardnerella vaginalis infection
(most commonly
)
•Thin, gray vaginal discharge with a fish like odor
•Intense pruiritus
•Topical vaginal metronidazole after the first trimester, usually late in pregnancy
•Rapid growth and multiplicaion or organisms, replacing the normal lactobacilli organisms that are found in the healthy woman’s vagina
•Treatment goal of reestablishing the normal balance of vaginal flora
•Untreated infections associated with amniotic fluid infections and possibly, preterm labor and premature rupture of membranes
STDCausative organism Assessment
findingsTreatme
nt
Special considerations
Chlamydia
Chlamydia trachomatis
•Commonly produces no symptoms; suspicion raised if partner treated for nongonococcal urethritis
•Heavy, gray-white vaginal discharge
•Painful urination
•Positive vaginal culture using special chlamydial test kit
•Amoxicillin (Amoxil)
•Possible premature rupture of the membranes, preterm labor, and endometritis in the postpartum period resulting from infection
•Possible development of conjunctivitis or pneumonia in neonate born to mother with infection present in the vagina
STDCausative organism Assessmen
t findingsTreatment
Special considerations
Syphilis Treponema pallidum
•Painless ulcer on vulva or vagina (primary syphilis)
•Penicillin G benza-
thine (Bicillin L-
A) I.M. (single dose)
•Possible ransmission accross placenta after approximately 18 weeks’ gestation, leading to spontaneous miscarriage, preterm labor, stillbirth, or congenital anomalies in the neonate
STDCausative organism Assessment
findingsTreatme
nt
Special considerations
Genital herpes
Herpes simplex virus, type 2
•Painful, small vesitcles witherythematous
•Acyclovir (Zovirax) orally or in ointment form
•Primary infection transmission possible across the placenta, resulting in congenital infection in the neonate
•Cesarean delivery recommended if patient has active lesions
•Associated with spontaneous miscarriage, preterm birth, and endometritis in the postpartum period
STDCausative organism Assessment
findingsTreatm
ent
Special considerations
Gonorrhea
Neisseria gonorrhoeae
•Yellow-green vaginal discharge
•Cefixime (Suprax) as a one-time I.M. Injection
•Associated with spontaneous miscarriage, preterm birth, and endometritis in the postpartum period
•Major cause of pelvic infectious disease and infertility
•Severe eye infection leading to blindness in the neonate(ophthamia neonatorum) if infection present at birth
STDCausative organism Assessment
findingsTreatmen
t
Special considerations
Condyloma acuminate
Human papillomavirus
•Discrete papillary structures that spread, enlarge, and coalesce to form large lesions; increaseing in size during pregnancy
•Topical application of trichloroacetic acid or bichloroacetic acid to leasions
•Lesion removal with laser therapy, cyyocautery, or knife excision
•Serious infections associated with the development of cervical cancer later in life
•Lesions left in place during pregnancy unless bothersome and removed during the postpartum period
STDCausative organism Assessmen
t findingsTreatmen
t
Special considerations
Group B streptococci infection
Spirochete
•Usually no symptoms
•Broad-spectrum penicillin such as ampicillin
•May lead to urinary tract infection, intra-amniotic infection leading to preterm birth, and postpartum endometritis
Threatened:
Spotting, vaginal bleeding cervix closed, (+) BOW
20% of women have spotting during pregnancy of these 50% abort
Mother is made to rest Save pads for further assessment, Note amount ,
color, odor Administer drugs as ordered
antibiotics in IV fluid Vital signs, no Administer blood as ordered
BLEEDING IN PREGNANCY
Incomplete Abortion
1. cervix open, BOW ruptured2. Placental parts retained3. Mother bleeds until, D&C is
done
Habitual abortion1. 3 or more abortions2. 2nd trimester, cerclage is done
until term, sutures may be removed so NSD is possible. If sutures remain, C/S is performed
Inevitable abortion
1. Open cervix, BOW ruptures2. As contractions continue,
products of conception are expelled
Missed abortion1. uterus retains the products of
C for 2 months or more & the fetus is dead
2. Uterus AOG3. Prolonged retention of dead
products may cause coagulation defects, like DIC (disseminated intravascular coagulation
Inevitable abortion
1. Open cervix, BOW ruptures2. As contractions continue,
products of conception are expelled
Management- D&C
Bleeding will continue for several days
Report bleeding that lasts more than one week
Watch for signs of infection – T=37˚C up and foul discharge
Abstain from sexual intercourse for approximately 2 weeks
use contraception when you resume coitus
follow up visit after one month
A Rh (-) female should receive RhoGam to prevent future hemolytic disease
ECTOPIC PREGNANCY
- Inplantation of a fertilized ovum outside the uterine cavity.
Sites: cervix, fallopian tube, abdominal cavity
Causes: - PID- IUD, STDs- Tumors- Previous FT surgery,
tubal ligation etc.
ECTOPIC PREGNANCY
Management:
1.If ruptured- sharp abdominal pain radiating to the shoulder- salphingoopherectomy
ECTOPIC PREGNANCY
Management:
2.If detected earlyNon surgical management- Methotrexate (FOLEX) that
stops cell production. Destroys trophoblasts
GESTATIONAL TROPHOBLASTIC DISEASE
- H. Mole, rapid deterioraion of trophoblastic Villi cells
As they deteriorate, they are filled wih fluid, grapelike clusters as a result, the embryo dies
GESTATIONAL TROPHOBLASTIC DISEASE
Causes: - chromosomial abdnormalities - deficiencies in protein & folic
acid
Signs: - brownish red spotting to bright red bleeding
- passes grapelike clusters - uterus that is larger than
size - No FHB
GESTATIONAL TROPHOBLASTIC DISEASE
UTZ: - done on 3rd month shows grape clusters
Management: - D& C
Complications: - hemorrhage - infection - Perforation - Choriolarcinoma
GESTATIONAL TROPHOBLASTIC DISEASEDischarge Management: - monitor HCG levels - weekly for 3 weeks at 2 mos for 6 mos, then monthly for 6 months until HCG levels & Chest X-Ray (-)
- no pregnancy for one year
- prophylaxis is methotrexate to prevent malignancy
ABRUPTIO PLACENTA
VS. PLACENTA
PREVIA
PATHOLOGY ETHIOLOGY
ASSESSMENT Nursing Care Plan/Inplemetation
Placenta Previa
Types:Marginal – low-lying
Partial – partly covers internal cervical os
Complete- covers internal cervical os
•Fibroid tumors
•Endometriosis
•Old uterine scars
•Multiple gestatio
Painless, bright red vaginal bleeding
Bedrest
PATHOLOGY ETHIOLOGY ASSESSMENT Nursing Care Plan/Inplemetation
Abruptio Placentae
Types:Partial – small part separates from uterine wall
Complete – total placenta separates from uterine wall
Retroplacental –bleeding (concealed
Marginal – occurs at edges; external bleeding
•Preeclampsia/ eclampsia
•Traction on cord
•Cocaine use
Pain: sudden, severe
Monitor: vital signs, blood loss, fetus
Prepare for surgery
Fluid, blood replacement
Types:1. Type 1 diabetes (absolute insulin
insufficiency)*usually occurs before 30years. Requires insulin
2. Type 2 diabetes (insulin resistance)*occurs after age 40*treated with diet & exercise in combination with antidiabetic drug
DIABETES
Types:3. Gestational diabetes
*emerges during pregnancy, usually middle part when insulin resistant is most apparent
Causes: Heredity Environment (diet, infection, virus), lifestyle
DIABETES
Risk factors:
Obesity Hx of delivery large babies Family history of diabetes Age older than 25
DIABETES
Tests:
24-28wks - OGCTG=501 hr glucose testcut off- 140mg/del
OGTT-3 hr glucose test
1˚=1902 ˚=1653 ˚=145
2 abdominal levels mean positive for diabetes
DIABETES
Management:
More frequent PNC
Adequate nutrition & exercise
Insulin may be given (parenteral) since oral hypoglycemic drugs aretogenic
Insulin – 1st trimester is reduced - 2nd & 3rd trimester increased
DIABETES
Fetal monitoring:
AFP test – done between 16-18 weeks
- detect neural tube defects
DIABETES
UTZ – 18-20 weeks detect gross anomalies
Bioprofile = 36-38 weeks
Amniocentesis= for LS ratio
Effects:
Maternal FetalPIH Macrosomia
Infection (cardiasis) Congenital anomalies
Polyhydramnios(higher urine production caused by hyperglycemia)
Stillbirths
Spontaneous abortion
Method of delivery: NSD
PREGNANCY INDUCED HPN
Potentially life threatening disorder that develops after the 20th week of pregnancy.
Occurs commonly in the nulliparous below 18-35 years above women& low socio economic groups
PREGNANCY INDUCED HPN
Types:1. Preeclampsia Mild2. Preeclampsia Severe3. Eclampsia
Signs:1. Edema- sudden weight gain2. HPN – 140/90 – 16/100 up3. Preteinuria - +1 - +5 up
PREGNANCY INDUCED HPN
management:
Diet – lower F, moderate salt, higher protein
Activity – frequent rest periods Medication – hydralazine methyldopa
If condition persists, MgSO4 – IVLD – 4-6grms over 20 minutes
maintain at 1 G/hr.
PREGNANCY INDUCED HPN
management:
Hospitalization may be indicated Provide quiet, dark room Enforce complete bed rest Follow safety measures
Higher padded rails O2 by the bedside Suction
Calcium gluconate by the bedside
PREGNANCY INDUCED HPN
management:
if measures fail to improve condition, then an emergency C/S is done
COMPLICATIONS
BRAIN KIDNEYS
LUNGS EYES
HEART BLOOD VESSELS
LIVER
HELLP SYNDROME
Stands for hemolysis, elevated liver enzymes & low platelets.
12% of women with PIH develops this ailment
Maternal & infant mortality is high
Approximately ¼ of women & 1/3 of infants die from this disorder.
HELLP SYNDROME
Management:
MgSO4
Transfusion of fresh frozen plasma or platelets
Immediate delivery
Caesarean birth may be a planned or an emergency procedure. Factors that lead to cesarean birth may be maternal, placental, or fetal in nature.
CESAREAN FACTORS
CESAREAN FACTORSMaternal: Cephalopelvic disproprotion
Active genital herpes or papilloma
Previous cesarean birth by classic incision
Disabling conditions, such as severe pregnancy-induced hypertension and heart disease, that prevent pushing to accomplish the pelvic division of labor
CESAREAN FACTORS
Placental:
Placenta previa
Premature separation of the placenta
CESAREAN FACTORS
Fetal :
Transverse fetal lie
Extremely low fetal size
Fetal distress
Compound conditions, such as macrosomic fetus in a breech lie
INFECTIONS
Puerperal infection is a common cause of child related death.
Fever of 38˚C
Lasts 2 consecutive days
Occurs 1st 10 days postpartum
Accompanied by chills, headache malaise, anxiety
INFECTIONS
Predisposing factors:
Prolonged laborInterventionsRetained products of conceptionBleedingC/SEpisiotomies/ lacerationsFrequent IEPROM
INFECTIONS
COMMON INFECTIONS:
Endometritis
Wounds
Mastitis
thrombophlebitis
INFECTIONS
TESTS:
CulturesUBC
30% above baseline data over a 6 hr.period.
MANAGEMENT:
Antibiotics
SAMPLE QUESTIONS
1. Maternal factors indicating the need fo c/s include:
a) Breech presentationb) Previous c/s with bikini incisionc) Active genital herpesd) hypotension
SAMPLE QUESTIONS
2. Nenita, a G1P1, just delivered 10min ago. The doctor ordered an oxytocin to be given to Nenita. She is a PEM, with BP of 140/100. which oxytoxin would you choose?
a) Syntocinonb) Ergotratec) Methergind) estriol
SAMPLE QUESTIONS
3. Luisa is admitted at 9am. Data upon admission –G2P1 32 yrs old, ceph presentaion FHB=140/min. Effacement=7-%=cx=4cm. Approximately, at what time would you expect Luisa to be wheeled into the DR?:
a) 12 pmb) 1pmc) 2pmd) 3pm
SAMPLE QUESTIONS
4. If she presents the ff. uterine contraction pattern-moderate intensity, 40-45sec duration, every 5min interval, at what phase of labor is she in now?
a) Latentb) Activec) Transitionald) Birthing phase
SAMPLE QUESTIONS
5. Which among the ff. nursing procedures should not be done to Luisa at this stage?:
a) Pain medication can be administeredb) Bladder elimination is encouraged
more oftenc) Breathing exercises are coached
when contractions occurd) Hot soup can be offered to increase
energy