nle - high-risk pregnancy

8/14/2019 Nle - High-risk Pregnancy

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HIGHHIGH--RISK PREGNANCYRISK PREGNANCY

Prepared by:

ROSELYN S. PACARDO, MAN, MM, RN, RM


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A. ABORTIONAny interruption of pregnancy

before 20 to 24 weeks of

gestation; at least 500 g

BLEEDING IN PREGNANCY

First Trimester

Bleeding


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TYPES SIGNS AND SYMPTOMS MANAGEMENT

1.

Threatened

*Avoid strenuous

activity for 24 to

48 hours; if

bleeding will stopit usually stops

within this time.

No coitus for 2

weeks after

bleeding stops.

Advise patient to

save all pads,

clots, and

expelled tissues

TYPES OF ABORTION

Slight, bright red

vaginal bleeding

Mild abdominal

cramping No cervical

dilatation on IE

No passage of

fetal tissue


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2. Inevitable

AbortionModerate vaginal

bleeding

Rupture of

membranes

Cervical dilatation

Strong abdominal

cramping

Possible passage

of products of

conception

Vacuumcurettage

Prostaglandin

analogs to

empty uterus ofretained

tissue


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3. Incomplete

abortion (passage

of some of the

products of

conception)

Client stabilization

Dilatation andcurettage

4. Complete

abortion (passage

of all products of

conception)

No surgical or

medical intervention

necessary

Follow-up

appointments to

discuss family

planning

Intense abdominalcramping

Heavy vaginal

bleeding

Cervical dilatation

History of vaginal

bleeding and

abdominal pain

Passage of tissue

with subsequent

decrease in pain and

significant decrease in

vaginal bleeding


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6. Habitual

Abortion

Identification and

treatment ofunderlying cause

Cervical cerclage in

second trimester if

incompetent cervix is

the cause

History of three ormore consecutive

spontaneous abortions

Not carrying the pregnancy

to viability or term


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B. ECTOPIC PREGNANCY- Any pregnancy

outside the uterus


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Signs and Symptoms Management

Severe, sharp, knife-like

stabbing pain

in either the right or left lower

quadrant

Rigid abdomen

(+) Cullens sign (bluish

umbilicus)

Excruciating pain when

cervix is moved on IE

Signs of shock: falling BP,

PR more than 100/min, rapid

RR, lightheadedness

Laparoscopy

Salpingostomy if fallopian

tube can still be replaced and

preserved, but the pregnancy

has to be terminated

Sal[ingectomy removal of

fallopian tube plus blood

transfusion

Combat shock:

-Elevate foot of the bed

- Cover with a thick blanket


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A. HYDATIDIFORMMOLE

- Abnormal proliferation

and degeneration ofthe

trophoblastic villi

SECOND TRIMESTER BLEEDING


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COMPLETE MOLE


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PARTIAL MOLE


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SIGNS AND SYMPTOMS

Highly positive urine test for

Pregnancy (marked hCG level) Marked nausea and vomiting

Rapid increase in fundic

height and weight

PIH signs and symptoms

appear before the 24th week ofgestation

No fetal heart tones

Vaginal bleeding seen as

clear, fluid-filled, grape-sized

vesicles

ultrasound snowstorm

pattern

MANAGEMENT

D & C to evacuate the mole

Prophylactic course ofmethotrexate, the drug of

choice for choriocarcinoma

Following evacuation, pelvic

exam and chest x-ray are

done; Serum test for hCGevery 2 weeks till normal

Serum hCG tested every 4

weeks for 6 to 12 months

Advise not to get pregnant

for at least a year

* The client with H-mole is at risk of

developin choriocarcinoma.


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B. PREMATURE CERVICAL DILATATION/INCOMPETENT

CERVIX-Cervix that dilates prematurely and cannot hold a fetus until

term;- Chief cause of habitual abortionSIGNS AND SYMPTOMS MANAGEMENT

Presence of show (pink-

stained vaginal discharge)

Painless dilatation Increased pelvic pressure

followed by rupture of the

membranes and discharge of

amniotic fluid

Uterine contractions

McDonald/Shirodkar

Procedure

Cerclage procedure whereinpursed string sutures are

placed around the cervix on the

14th to 18th week of gestation;

McDonalds

Removed during a vaginaldelivery; in caesarean section,

Shirodkar method is used


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SHIRODKAR

METHOD


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Third Trimester BleedingThird Trimester Bleeding

A. Placenta Previa -Low implantation of the

placenta

Low-lying placenta


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Partial placenta previa Complete placenta

previa


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Painless, bright red

vaginal bleeding

Ensure that the client

gets adequate rest

Monitor V/S of the

mother and the FHR

Prepare oxygen and

blood

Never perform an IE If IE should be done,

prepare a double set-

up


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B.ABRUPTIO

PLACENTA

Premature separation of a

normally implanted

placenta


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Premature Separation of the

Placenta: Degrees of

Separation

Grade Criteria

0 No symptoms of separation were apparent

from maternal or fetal signs; diagnosis is

made after the delivery of the placenta

when there is a recent adherent blood cloton the maternal surface.

1 Minimal separation but enough to cause

vaginal bleeding & changes in maternal

V/S; no fetal distress or shock

2 Moderate separation; with fetal distress;uterus is tense and painful

3 Extreme separation; without immediate

interventions, maternal shock and fetal

death will result


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Severe knife-like stabbing

pain high in the fundus

Hard, board-like uterus;

rigid abdomen

Signs of shock

Concealed bleeding, ifextensive causes the uterus

to lose its ability to contract;

becomes ecchymotic and

copper-colored called

Couvelaire uterus, causingsevere bleeding

Fluid replacement

Oxygen by mask to limit

fetal anoxia

Monitor FHR

Monitor maternal V/S every

5 to15 minutes Lateral or side-lying

position

No IE or pelvic exam

No enema

For Grades 2 and 3separation: Caesarean

section

Massive bleeding:

hysterectomy


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POSTPARTUM HEMORRHAGEPOSTPARTUM HEMORRHAGE


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A. EARLY POSTPARTUM HEMORRHAGE occurs during

the

first 24 hours; greater than 500 mL blood loss in a 24 hourperiod

Types Signs and Symptoms Management

Uterine Atony

(most common

cause)

Uterus not well-

contracted,

relaxed or boggy

Lacerations Bleeding even if

the uterus is well

contracted and

there is no retained

Repair

Massage first nursing

action

Ice compress

Oxytocin administration

Empty the bladder

Bimanual expression of

retained

placental fragments Hysterectomy last

resort


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B. LATE POSTPARTUM HEMORRHAGE -Blood loss more

than 500 mL ;

occurs 24 hoursafter birth up to 6

weeksTypes Signs & Symptoms Management

RetainedPlacental

fragments

Bleeding even if theuterus is well

contracted and there

are no lacerations

Dilatation andCurettage

Hematoma injury to blood

vessels

Collection of blood inthe subcutaneous

tissue of the perineum

Ice compress Analgesics

Site is incised

and bleeding

vessel is ligated


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HEMATOMA


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SITUATION H: Georgina attended a lecture about high

risk pregnancy. One of the most common danger signalsis hemorrhage.

36. In taking care of a client with placenta previa, the

nurse should do the following, EXCEPT:A. Perform an internal examination.

B. Inform significant others to prepare blood for possible

transfusion

C. Monitor the vital signs

C. Prepare a double set-up delivery when labor is

imminent


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SITUATION H: Georgina attended a lecture

about high risk pregnancy. One of the most

common danger signals is hemorrhage.

36. In taking care of a client with placenta previa,

the nurse should do the following, EXCEPT:

A. Perform an internal examination.B. Inform significant others to prepare blood for

possible transfusion

C. Monitor the vital signs

D. Prepare a double set-up delivery when labor isimminent

Pillitteri p. 414


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37. If a pregnant woman on her first

trimester of pregnancy has abdominal

cramping and bright red vaginal spottingbut the cervix is not dilated the woman

should suspect that she is most likely

experiencing a/an:

A. Missed abortion

B. Threatened abortionC. Inevitable abortion

D. Complete abortion


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37. If a pregnant woman on her first trimester of

pregnancy has abdominal cramping and bright

red vaginal spotting but the cervix is not dilatedthe woman should suspect that she is most likely

experiencing :

A. Missed abortion fetal death in utero

B. Threatened abortion

C. Inevitable abortion cervix is dilated

D. Complete abortion products of conceptionare expelled

Pillitteri p. 404


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38. The nurse giving the lecture explains

further that a manifestation of a knife-likestabbing pain in either the right or left

lower quadrant of the abdomen with a

bluish umbilicus is an indication of:

A. Gestational trophoblastic disease

B. Incompetent Cervical osC. Ectopic pregnancy

D. Abruptio placenta


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38. The nurse giving the lecture explains further that

a manifestation of a knife-like stabbing pain in

either the right or left lower quadrant of the

abdomen with a bluish umbilicus is an indication of:

A. Gestational trophoblastic disease grape-likeB. Incompetent Cervical os painless, pink-stained

bleeding

C. Ectopicpregnancy

D. Abruptio placenta painful vaginal bleedingwith low back pain; uterus board-like

Pillitteri p. 409


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39. What would the first nursing action if

a client is having a uterine atony?

A. Massage the hypogastric area slightly

B. Apply cold compressC. Administer the oxytocin as prescribed

D. Encourage the client to empty her

bladder


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39. What would the first nursing action

if a client is having a uterine atony?A. Massage thehypogastric area

slightly

B. Apply cold compress

C. Administer the oxytocin as

prescribed

D. Encourage the client to empty her

bladder

Pillitteri pp. 657 - 658


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40. Which of the following measurements, best

describes delayed postpartum hemorrhage?

A. Blood loss in excess of 300 mL, occurring 24

hours to 6 weeks after delivery

B. Blood loss in excess of500 mL,occurring

24 hours to 6 weeks afterdeliveryC. Blood loss in excess of 800 mL, occurring 24


D. Blood loss in excess of 1000 mL, occurring 24


Ricci p. 614


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PREGNANCYPREGNANCY--INDUCEDINDUCED

HYPERTENSIONHYPERTENSION

-A vascular disease of unknown cause which occurs any

time after the 24th week of gestation up to two weeks

postpartum; vasospasm occurs both in small and largearteries.

Triad of Symptoms:

a. Hypertensionb. Edema

c. Proteinuria


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Diagnosis: Roll-over

Test

-Assesses the probability

of developing PIH when

performed between the28th and 32nd week of

pregnancy

Procedure:

Patient lies in the lateralrecumbent position for15

minutes until BP is

stabilized.

Patient then rolls over to

supine position.

BP is taken at one

minute and 5 minutes

after having rolled over.

Interpretation:

If diastolic pressureincreases

20 mmHg or more,

patient is prone to PIH.


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a. Mild Preeclampsia

Sudden excessive weightgain of1 to 5 lbs per week

(earliest sign); 2 lb per wk in

2nd trimester and 1 lb/wk in

3rd trimester due to edema

which is found in the upper

half of the body (e.g. cantwear wedding ring)

Systolic BP of140, or an

increase of30 mmHg or

more; Diastolic BP of 90

or a rise of15 mmHg or more

taken 6 hours apart Proteinuria: 1+ or 2+ on a

reagent test strip in a

random sample; or 0.5

gm/liter or more

b. Severe Preeclampsia

BP of160/110 mmHg on at leasttwo occasions 6 hours apart at bed

rest

Proteinuria: 5 gm/liter or more in 24

hours; 3+ or 4+ on a random urine

sample Oliguria of 500 mL or less in 24

hours (normal urine output per day =

1500 mL); elevated serum creatinine

more than 1.2 mg/dL

Cerebral or visual disturbances Pulmonary edema and cyanosis

Epigastric pain considered an

aura to the development of

convulsions

1.

PREECLAMPSIA


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2. ECLAMPSIA with seizure

(convulsions) accompaniedby signs and symptoms of

preeclampsia plus:

a. Increased BUNb. Increased uric acid

c. Decreased carbon dioxide

combining power

* Seizure Precautions


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MANAGEMENT

MILD PIH Bed Rest

-Sodium is excreted faster

when the body is in a

recumbent position (promote

lateral) Emotional Support

SEVERE PIH Hospitalized forBed Rest

to be enforced

Limit visitors

Avoid loud noise

Private room Darken the room

Raise side rails

Avoid stress

Let client verbalize feelings

Monitor maternal well-being

Monitor fetal well-being

Diet: Moderate to high in

protein and moderate sodium


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MEDICATION

Magnesium sulfate

Muscle relaxant CNS depressant

prevents seizures

Vasodilator decreases

BP

Cathartic causes a shift

of fluid for the

extracellular spaces into

the intestines to excrete

the fluid

Antidote for toxicity:

10 mL of10% calcium

Drug of choice

Loading dose IV 4 to 6 g;

Maintenance dose 1 -2 g perhour IV

Infuse slowly over15 30

minutes

Always administer as a

piggyback infusion

Maintain a serum level of 5 to 8

mg/mL

Assess respiratory rate, urine

output, DTR, and clonus everyhour

Criteria for administration:

a. Urine output: over30 mL per

hour

b. Respiratory rate: over12 per


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PATELLAR REFLEX

SCORING

Absence of DTR

earliest sign of toxicity

0 No response;

hypoactive; abnormal

1+ Somewhat diminished

response but not

abnormal

2+ Average response

3+ Brisker than average

but not abnormal4+ Hyperactive; very brisk;

abnormal


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ANKLE CLONUS

2

Movements

Mild

3 5

movements

Moderate

Over 6

movements

Severe


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SITUATION I: Andrea, 30 year old G4P3 is

admitted to the high risk antepartal unit with a

diagnosis of pregnancy-induced hypertension.

41. Which of the following is the main

difference between preeclampsia andeclampsia?

A. Increased blood pressure

B. Proteinuria

C. Oliguria

D. Presenceofconvulsions

Pillitteri p. 428


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42. What is the prodromal symptom of

the seizures associated with PIH?

A. (- ) deep tendon reflex

B. Sudden elevation of blood pressureC. Oliguria

D. Epigastric pain


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42. What is the prodromal symptom of the

seizures associated with PIH?A. (- ) deep tendon reflex sign of toxicity

B. Sudden elevation of blood pressure - PIH

C. Oliguria sign of toxicityD. Epigastric pain due to abdominal edema

or ischemia to thepancreas and liver

Pillitteri p. 428


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43. Andrea receives magnesium sulfate for

severe preeclampsia. Which of the

following adverse effects is associated

with magnesium sulfate?

A. Anemia

B. Decreased urine outputC. Hyperreflexia

D. Increased respiratory rate


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43. Andrea receives magnesium sulfate

for severe preeclampsia. Which of thefollowing adverse effects is associated

with magnesium sulfate?A. Anemia

B. Decreasedurineoutput below 30

mL/hour

C. Hyperreflexia absent DTRs

D. Increased respiratory rate - decreased

Pilltteri p. 430 - 431


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44. The latest assessment of Andrea reveals

that she has deep tendon reflexes of (+) 1, BP

of 150/100 mmHg, a pulse of 92 beats perminute, and urine output of 20 mL per hour.

Which of the following actions would be

most appropriate?

A. Continue monitoring per standards of care.

B. Stop the magnesium sulfate infusion.

C. Increase the infusion rate by 5gtts/minute

D. Decrease the infusion rate by 5

gtts/min


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44. The latest assessment of Andrea reveals that

she has deep tendon reflexes of (+) 1, BP of150/100 mmHg, a pulse of 92 beats per minute,

and urine output of 20 mL per hour. Which of the

following actions would be most appropriate?

A. Continue monitoring per standards of care.

B. Stop themagnesium sulfate infusion.

C. Increase the infusion rate by 5 gtts/minute

Decrease the infusion rate by 5 gtts/min



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45. Which of the following drugs is the

antagonist for magnesium sulfate toxicity?

A. Calcium gluconateB. Hydralazine hydrochloride

C. Naloxone

D. Rho (D) immune globulin Rh in


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45. Which of the following drugs is the

antagonist for magnesium sulfate toxicity?

A. Calciumgluconate

B. Hydralazine hydrochloride - (Apresoline)

for HPNC. Naloxone hydrochloride hydrochloride

(Narcan) for Demerol toxicity

D. Rho (D) immune globulin (RhoGAM) for

Rh incompatibility; (Mother Rh (-); Fetus Rh(+)

Pillitteri p. 430; Leifer p.95


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DIABETES MELLITUSDIABETES MELLITUS

-Chronic hereditary disease characterized by

hyperglycemia due to relative insufficiency or lack

of insulin from the pancreas which leads to

abnormalities in the metabolism of carbohydrates,proteins, and fats.

- Normal blood sugar: 80 to 120 mg/dL


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Effects of Hyperglycemia Effects of Hypoglycemia

* Baby

Hydramnios

Gestational hypertension

Ketoacidosis

Preterm labor secondary to

PROM

Cord prolapse Stillbirth

Hypoglycemia

UTI

Moniliasis

Difficult labor Macrosomia

Others

Pallor

Tremors

Jitteriness

Lethargy

Poor feeding


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Goals: To maintain glycemic control and minimize the risks

of the disease on the fetus.

1. Dietary Management

Adhere to the same nutrient requirements and

recommendations for weight gain as the non-diabetic

client. Avoid weight loss and dieting during pregnancy.

Ensure food intake is adequate to prevent ketone

formation and promote weight gain.

Eat three meals a day plus three snacks to promote

glycemic control. (1,800 2, 200 calorie diet) Include complex carbohydrates, fiber, and limited fat and

sugar in the diet.

Continue dietary consultation throughout pregnancy.

MANAGEMENT


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2. Insulin Requirements

-Medication of choice

- Increased need during the 2nd

and 3rd

trimesters- Regulated to keep +1 for sugar (minimal glycosuria is

necessary to prevent acidosis) but negative for acetone

- Long-acting insulin (Ultralente) will have to be changed to

regular insulin (Lente) during thelast few weeks of

pregnancy.4.3. Fetal and Maternal Surveillance

4. Mode of Delivery:

a. Vaginal birth preferred if at all possible.

b. Cesarean section for macrosomic baby


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SITUATION J: Bianca, 30 years old G2P0, on her

37 weeks of gestation is admitted to the labor room

and is having gestational diabetes mellitus.

46. The physician estimates that the fetus weighs at

least 10 pounds. Bianca asks the nurse, What causes

the baby to be so large?The nurse should explain that fetal macrosomia is usually

related to:A. Genetic history of large infants

B. Fetal anomalies

C. Maternal hyperglycemia leads tofetal hyperglycemia;

increased insulin tocounteract hyperglycemia acts a

growth stimulantD. Fetal hypoglycemia

Ricci p. 546;Pillitteri p. 377


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47. The goal of nursing care for Bianca is

to achieve and maintain normal maternalglucose at which of the following levels in

a 24-hour period?

A. 30 to 50 mg/dL

B. 120 to 140 mg/dL

C. 60 to 80 mg/dLD. 80 to 120 mg/dL


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47. The goal of nursing care for Bianca is to

achieve and maintain normal maternalglucose at which of the following levels in a

24-hour period?

A. 30 to 50 mg/dL

B.120 to 140 mg/dL

C. 60 to 80 mg/dL

C. 80 to 120 mg/dL

Source:Pillitteri p. 377


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48. The recommended calorie intake

for Bianca is:

A. 1000 1500 calories

B. 500 1000 calories

C. 1800 2200 calories

D. 2200 3000 calories


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48. The recommended calorie

intake for Bianca is:

A. 1000 1500 caloriesB. 500 1000 calories

C. 1800 2200 calories

D. 2200 3000 caloriesPillitteri p. 380


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49. The delivery of choice for

Bianca is:

A. Normal spontaneous vaginal

deliveryB. Caesarean section

C. Forceps delivery

D. Vacuum extraction


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49. The delivery of choice for

Bianca is:

A. Normal spontaneous vaginal

deliveryB. Caesarean section

C. Forceps delivery

D. Vacuum extractionPillitteri p. 383; p.605


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50. All of the following are the

manifestations of hypoglycemia

in Biancas baby, EXCEPT:

A. Tremors

B. Shrill, high-pitched cry

C. Vigorous suck

D. Hypotonia


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50.All of the following are the

manifestations of hypoglycemia

in Biancas baby, EXCEPT:

A. Tremors

B. Shrill, high-pitched cry

C. Vi

gorous s

uckD. Hypotonia

Ricci p. 678


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CARDIAC DISEASECARDIAC DISEASEClassificatio

n

Class Description

1 Uncompromised: No limitation of

physical activity; ordinary physicalactivity causes no discomfort; no

symptoms of cardiac insufficiency and

no anignal pain (asymptomatic)

II Slightly compromised: Slight limitationof activity; ordinary activity causes

excessive fatigue, palpitation, and

dyspnea or anginal pain (symptomatic

with increased physical activity)


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III Markedly compromised: moderate to

marked limitation of physical activity;

less than ordinary activity, experience

excessive fatigue, palpitations,dyspnea, or anginal pain

(symptomatic)

1V Severely compromised: unable to

carry out any physical activity withoutexperiencing discomfort; experience

symptoms of cardiac insufficiency or

anginal pain

Prognosis:

a. Classes I and II normal pregnancy and delivery

b. Classes III and IV poor candidates


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Signs and Symptoms

Shortness of breath on exertion

Cyanosis of lips and nail beds Swelling of face, hands, and feet

Rapid respirations

Abnormal heart beats, racing heart, or

palpitations (murmurs) Chest pain

Syncope

Increasing fatigue

Moist, frequent cough

Decreased cardiac output

Ascites


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SITUATION K: Loida, 30 years, 36 weeks of

gestation is admitted to the hospital with a

Class III heart disease.

51. All of the following are the cardiac

manifestations of Loida, EXCEPT:

A. Loud, harsh murmur associated with thrill.

B. Cardiomegaly

C. Increased cardiac outputD. Decreased cardiac output


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SITUATION K: Loida, 30 years, 36 weeks of

gestation is admitted to the hospital with aClass III heart disease.

51. All of the following are the cardiac

manifestations of Loida, EXCEPT:A. Loud, harsh murmur associated with thrill.

B. Cardiomegaly

C. Increasedcardiacoutput

D. Decreased cardiac output

Pillitteri pp.354 356; Ricci p. 556


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52. The primary goal of nursing care for

a client with cardiac problem is to:

A. Limit physical activity

B. Prevent anemiaC. Avoid excessive weight gain

C. Reduce the cardiac workload


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52. The primary goal of nursing carefor a client with cardiac problem is to:

A. Limit physical activityB. Prevent anemia

C. Avoid excessive weight gain

D. Reduce the cardiac workload(umbrella)

Pillitteri p. 356


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53. Which of the following drugs

should not be given to Loida:

A. Iron preparations

B. Epinephrine

C. DigoxinD. Diuril


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53. Which of the following drugs

should not be given to Loida:

A.Iron preparations prevent anemia

B. Epinephrine causes

palpitations increasing workload

C.Digoxin decrease contractility ofthe heart

D. Diuril diuretic to reduce edema

Pillitteri p. 359


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54. Class III classification of heart disease is

best described as:A. Uncompromised: women have no

limitations of physical activity.

B. Slightly compromised: women have slight

limitation of physical activity.

C. Severely compromised: women are unable

to carry out any physical activity without

experiencing discomfort.D. Markedly compromised: women have a

moderate to marked limitation of physical

activity.

54 Class III classification of heart disease is


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54. Class III classification of heart disease is

best described as:

A. Uncompromised: women have nolimitations of physical activity.

Slightly compromised: women have slight

limitation of physical activity.

Severely compromised: women are unable tocarry out any physical activity without

experiencing discomfort.

Markedly compromised: women have a

moderate to marked limitation of physical

activity.

Source Pillitteri p. 354


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55. The preferred position thatLoida should assume during

delivery of the baby would be:

A. Dorsal recumbent position

B. Lithotomy position

C. Supine positionD. Semi-sitting position


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55. The preferred position that Loida

should assume during delivery of thebaby would be:

A. Dorsal recumbent position

B. Lithotomy positionC. Supine position

D. Semi-sittingposition facilitate

easyrespirations

Pillitteri p. 359


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DYSTOCIADYSTOCIA

- Abnormal or difficult labor and

delivery

1. Uterine Inertia - Sluggishness of contractions


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gg

Causes Inappropriate use of analgesics

Pelvic bone contraction Poor fetal position

Overdistension

Types

a. Primaryhypertonic

dysfunctionManagement:

Sedation

relaxations are inadequate and mild,

thus, ineffective; uterine muscles are in

a state of greater-than-normal tension,the latent phase of the first stage of

labor is prolonged.

b. Secondary

uterine

dysfunctionManagement:

contractions have been good but

gradually become infrequent and of

poor quality and cervical dilatation

stops


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2. Precipitate Delivery - Completed in less than 3

hours after the onset of true

labor pains

Causes: oxytocin administration

amniotomy

Complications: Extensive lacerations

Abruptio placenta

Hemorrhage


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3. Prolonged Labor Primis: lasting more than

18 hours

Multis: lasting more than12 hours

Complications: Maternal exhaustion

Uterine atony

Caput succedaneum

4. Uterine Rupture - Uterus undergoes more

straining than it is capable of

sustaining

Causes: Scar from previous classic

CS Unwise use of oxytocics

Overdistension

Faulty presentation

Prolonged labor


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4. Uterine Rupture Occurs when the uterus undergoes

more straining than it is capable of

sustaining

Causes Scar from a previous classic CS

Unwise use of oxytocins

Overdistension

Faulty presentation

Prolonged labor

Signs and Symptoms Sudden, severe pain

Hemorrhage and signs of shock

Change in abdominal contour

Management Hysterectomy


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Physiologic Retraction Ring


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Pathologic retraction ring or

Bandls ring


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5. Uterine Inversion Fundus is forced through the cervix

and the uterus turns inside out


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Causes Insertion of the placenta at the

fundus

Strong fundal push when motherfails to bear down properly during the

second stage of labor

Attempts to deliver the placenta

before signs of placental separation

appearSigns and Symptoms Dramatic

Woman in labor suddenly sits up

and grasps her chest due to dyspnea

and sharp chest pain

Pallor then bluish-gray colorassociated with pulmonary embolism

Death may occur in a few minutes

Management Emergency measures to maintain

life: IV, oxygen, CPR


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6. Trial Labor Borderline pelvic measurements but

fetal position and presentation are

good; can be continued if there isprogressive fetal descent of the

presenting part and the cervix

continues to dilate

Management Monitor FHRs and uterine

contractions

Empty the bladder

Emotional support


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7. Premature Labor and

Delivery

Uterine contractions occur

before the 38th week of

gestationManagement No bleeding, cervical

dilatation; FHR good

premature contractions can be

stopped by drugs:

-Ethyl alcohol blocks the

release of oxytocin

- Vasodilan IV vasodilator

- Ritodrine muscle relaxant

given orally- Bricanyl - bronchodilator


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With premature uterine contractions

accompanied by fetal descent and cervical

dilatation, delivery is inevitable-Pain medications kept to a minimum to

prevent respiratory depression

- Steroids (glucocorticoids) given for

maturation of the fetal lungs

- Caudal, spinal or infiltration anesthesia does not compromise with fetal respiration

- Forceps applied gently

- Cut cord immediately; do not wait for

pulsation to stop


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INSTRUMENTALINSTRUMENTAL

DELIVERIESDELIVERIES


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1. Forceps Delivery metal instrument to extract the

baby; applied at +3 to +4

station and the sagittal suture

is in an anteroposterior

position in relation to the

outlet

Purpose -Shorten the 2nd stage of labor- Prevent excessive pounding on

fetal head

- Poor uterine contractions or

rigid

perineum

Criteria No CPD

Fetal head deeply engaged

Full cervical dilatation and

effacement


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FORCEPS MARK


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2. Vacuum Extraction


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3. Cesarean Section Delivery of the fetus through an

incision in the abdomen and uterus

Indications CPD most common cause PIH, placental accidents, fetal

distress

Use of electronic fetal monitoring

maternal age

Types a. Low segment method of choice;

incision in the lower uterine

segment

Advantages:-Minimal blood loss; Incision easy to

repair; low incidence of PP

infection; no possibility of uterine

rupture

b. Classic vertical incision


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SITUATION L: A group of women on their third


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SITUATION L: A groupofwomen on their third

trimesterofpregnancy aregiven information

during a prenatal class about themanifestationsofabnormal ordifficult labor anddelivery as well

as theuseofinstrumental deliveries.

56. All of the following are the causes of dystocia

during labor and delivery, EXCEPT:

A. Maternal exhaustion

B. AnalgesicsC. Pelvic bone contraction

D. Maternal Activity

SITUATION L: A group of women on their third


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SITUATION L: A groupofwomen on their third

trimesterofpregnancy aregiven information

during a prenatalclass about themanifestations ofabnormal or

difficult labor anddelivery as well as theuseof

instrumental deliveries.

56. All of the following are the causes of dystociaduring labor and delivery, EXCEPT:

A. Maternal exhaustion

B. Analgesics

C. Pelvic bone contraction

D. Maternal Activity

Pillitteri p. 590


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57. Hypertonic contractions would lead to

which of the following complications:

A. Inverted uterus

B. Precipitate deliveryC. Prolonged Labor

D. Preterm delivery


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57. Hypertonic contractions would

lead to which of the followingcomplications:

A. Inverted uterus

B. Precipitatedelivery

C. Prolonged Labor

D. Preterm delivery

Pillitteri p. 591- 592, 595; Ricci p. 587


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58. These are the signs of complete uterine

rupture, EXCEPT:

A. Sudden, sharp abdominal pain

B. Continuation ofuterinecontraction

C. Cessation of uterine contractionD. Change in the abdominal contour

Pillitteri p. 596

59 Which of the following is the criterion


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59. Which of the following is the criterion

for induction of labor?

A. Twins

B. Cervix not dilated

C. Cephalopelvic Disproportion

D. Above 32 weeks of gestation


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59. Which of the following is the

criterion for induction of labor?

A. Twins

B. Cervix not dilatedC. Cephalopelvic Disproportion

D. Above 32 weeks ofgestation

Pillitteri p. 606; Ricci p. 596

60 What type of cesarean section


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60. What type of cesarean section

would have minimal blood loss?

A. Classic CS

B. Low segment CS

C. Peritoneal CS

D. None of the above


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60. What type of cesarean section

would have minimal blood loss?

A. Classic CS

B. Low segment CS

C. Peritoneal CS

D. None of the above


nle - high-risk pregnancy

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