MATERNITY NURSING (Care Of Women With Problems In The Ante Partum Intra!

artum An" Post Partum Phase# T$E PE%&IS 'alse Pel(is) wide area above linea terminalis, supports the uterus during pregnancy True Pel(is) narrow area below the linea terminalis, serves as birth canal AREAS O' T$E TRUE PE%&IS *+ IN%ET,-RIM,CO.ANE area bounded by sacral promontory, R & L ileopectineal lines, and superior symphisis pubis AP dm- 11 cm ditane from superior symphiis pubis to sacral promontory Transverse dm- 1 cm The greatest dm of the fetal head is AP dm 1!"#cm /+ MI0PE%&IS Area bounded by the sacral wall, R & L ischial spine and P symphisis pubis AP from s" pubis to sacral wall 1! cm Transverse dm R & L ischial spine 1$cm The AP dm of fetal head must occupy the AP dm of the cavity thru internal rotation to allow the !nd descend, En1a1ement 2+ OUT%ET Area bounded by cocy%, R & L ischial tuberosities and inferior symphisis pubis AP dm- 1 cm if in labor, &cm if not in labor AP dm of the fetal head must occupy the AP dm of the outlet to facilitate final descent called CROWNING
-

-ONES O' T$E PE%&IS 'leum 'schium Pubis (acrum )ocy% TYPES O' PE%&IS *ynecoid Android Anthropoid Platypelloid

T$E P%ACENTA is formed from the chorionic villi and decidua basalis 1! A+*, functional wt #$$gm at term 1,-!$ cotyledons Types -./)A/( 0maternal side1 beefy red ()2L.T3 0fetal side1 glistening Functions R- respiratory organ of the fetus 4- 4%cretory organ P- protection 4- endocrine organ of mother and fetus /- /utritive Abnormalities

P%ACENTA

*+ Multi!le !la3enta) 5ipartia- not completely -ivided into ! lobes -uple%- separated completely into ! parts !" Su33enturiate Pla3enta) has accessory lobe with blood vessels connected to it " Cir3um(allate Pla3enta) 6hen suh ftal surface present a central depression sorrounded by a thic7ened whitish-grayish ring which is double layer amnion and chorion with degenerated decidua and fibrin bet ! layers 8" Cir3ummar1inate Pla3enta) whitish-grayish ring is located at the margin of the placenta T$E MEM-RANES Chorioni3 membrane) originates from the portion of chorionic villi not involve in implantation" 't supports amniotic membrane" 't 9oins the placenta Amnioti3 membrane) A smooth, thin, tough and translucent membrane directly enclosing the fetus and the amniotic fluid" 't 9oins the umbilical cord

T$E AMNIOTIC '%UI0

#$$-1#$$ ml amount )ompose of &#: water, mineral salts, uric acid, nutrients 0)2+/1, lanugo, v"caseosa, epithilial cells normal appearance- straw colored *reen- meconium stained e%cept for brech presentation *olden ;ellow- hemolytic disease 0A5+, Rh incompatibility1 *ray- infection p2 <"$- <"!# neutral to al7aline (p" *ravity 1"$$# to 1"$!# Functions: 2elps dilate the cervi% Prevents ascending infection 4=uali>es pressure during labor and delivery Produces the amniotic fluid ?aintains normal temp" Provide medium for free movement ?edium for fetal e%cretion @or nourishment @or diagnostic purposes a" 5ubble sha7e test b" @oam stability test -ubble sha4e test Amniotic fluid is place on sterile test tube, A ethyl alcohol, (ha7e for 1# sec"'f bubble is present, the amniotic fluid is A for sphyngomyelin 'oam Stabilit5 test Allow the test tube to tand for 1# min, if bubble is still present, it means that amniotic fluid has more lecithin Al!ha)feto !rotein) presence of this suggest neural tube defects Nitra6ine test) determines the p2 of fluid T$E UM-I%ICAR0 COR0 )onnects the fetus to placenta )arries o%ygen and nutrients from the placenta to the fetus and return uno%ygenated blood and fetal waste 5lood vessels- ! arteries, 1 vein #$-## cm long and !cm in dm +riginates in the yol7 sac and umbilical vessels 2as whartons 9elly found inside the cord

2 STAGES O' $UMAN PRENATA% 0E&E%OPMENT O&UM) from fertili>ation to ! w7s EM-RYO B w7s to C w7s 'ETUS & w7s onwards

Con3e!tus- products of conception 7 8ee4s) all system in rudementary formD beginning formations of eyes, nose, girtD heart chambers formedD heart beating 0 18days1D with arm leg buds 9 8ee4s B head large in proportion to body, neuromascular developmentD e%ternal genitalia appears */ 8ee4s) placenta fully formedD functioning 7idneys developD secretes urineD center of ossification of most bonesD with suc7ing and swallowingD se% distinguishableD @2T detected by ultrasound 01$-1! w7s1 *: 8ee4s) more human appearance, =uic7ening- multigravidaD scalp hair developsD formed eyes, ears, nose, @2T by stethoscope /; 8ee4s B with verni% caseosa and downy lanugo, =uic7ening for primigravida /7 8ee4s B body well proportionedD s7in red and wrin7ledD eyebrows and eyelashes recogni>able when bornD may breathe but do not survive /9 8ee4s B!# cm, wt 11$$g, if born by this time, with e%pert care can survive 2: 8ee4s B deposition of subcutaneous fat Normal %en1th of Pre1nan35 -aysE !,<-!C$ wee7sE 8$ lunar mosE 1$ calendar mosE & TrimesterE F *st trimester) period of organogenesis < /n" trimester)most comfortable for the mother with continued fetal growth < 2r" trimester) rapid deposition of fats, period of rapid growth

STEPS

IN

PRENATA%

CARE

*+ $istor5 Ta4in1 Personal -ata- ageE1C- # yGo 5elow 1CyGoEanemia, premature labor, hyperemesis gravidarum, P'2 Above #yGoE trisomy, ?R

wt"E &$-1#$ lbs 5elow &$ lbsE malnutrition, goiter, T50c" anomaly1,abortion Above 1#$ lbsE heart disease, -?, 2P/ ht"E less 8H1$0)(1 b" (tatus c" 4ducational Attainment d" 4mployment /+ 'amil5 $istor5) )" anomalies, mental retardation, twins, asthma, -?, *erman ?easles, .T'I 2+ So3ial Status) ?ultiple se%ual partners, smo7ing, alcohol, drug dependency 7+Obstetri3al histor5 8" +5 (core T-term P-premature A-abortion L-living eg"?rs (antos is , w7s preg", she had 1 abortion, 1 2-mole,a child who is currently enrolled at ?ontessori born at # w7s A+*, a twin born at 8 w7s A+*, only 1 survived,and a 1 yGl child born at & w7s A+*, find out her +5 (core ANSWER= (*)/)/)2# >+ Me"i3al $istor5) allergies, heart disease, -?, 2P/, .T', (urgeries :+ AssessmentE 2ead to Toe a" J( B 5PE unchange in 1st trimester decresed at !nd & rd increased during labor 0 $G1#1 and ! days after labor 2eadache-1st sign of 2P/ b" Temp- elevated by "#-"C only in the 1 st trimester c" PR B increased by 1$ bpm d" RR B unchanged but deeper to get more o%ygen :+ Wt+ 1ain

1st trimester E !- lbs !nd trimester E 1$-1! lbs rd trimester E 1$-1! lbs ?+ %eo!ol"@s Maneu(er a+ 'un"al Pal!ation A presentation and lie b+ %ateral Pal!ation A fetal bac7 and e%tremeties 3+ Pauli4s Pal!ation A engagement "+ 0ee! Pel(i3 Pal!ation A fle%ion Ns1 Inter(entionE 'nform the client about the procedure

4mpty the bladder -orsal recumbent Provide privacy Palms should be warm

9+ Pa! Smear B cytological study of the cervi% -one anually as early as age !$ in se%ually active women 5est done 1 wee7 after menstration 'in"in1s = )lass ' B absence of atypical cells )lass ''- presence of atypical cell but not malignant )lass '''- atypical cells suggest malignant )lass 'J B atypical cells strongly suggest malignancy )lass J - atypical cell is conclusive of malignancy Sta1es of Cer(i3al Can3er 1 B )ancer cell are in situ ! B )ancer cells invade vaginal wall B invade the pelvic wall 8 B invade bladder and rectum B+ &a1inal ECam A done only on the initial visit to E assess for signs of pregnancy and assess for vaginal discharge *;+ $istor5 of Present Pre1nan35 E00- e%pected date of delivery %MP B last day of menstration AOG) age of gestation Im!ortant estimation of AOG D E00 *+-artolome8@s Rule) 2t" of the fundus 1! 644K(Elevel at the symphisis pubis, 1, 644K(E halfway at symphisis pubis to umbilicus !$ 644K(E level of umbilicus !8 644K(E ! fingers above the umbilicus $ 644K(E midway from umbilicus and %yphoid process , 644K(E at the level of %yphoid process 8$ 644K(E ! fingers below umbilicus /+ M3 0onal"@s Rule B it estimates A+* in lunar months by getting the fundic height in cm devided by 8 4%" 1, cm G 8 L 8 L? 2+ $ase@s Rule B is used to determine the length of the fetus 1-# lunar month % the no" of month ,-1$ lunar month % # 7+ Nae1el@s Rule B most accurate estimate for A+* and 4-) only if L?P is 7nown Add < days to the 1st day of menstration and count bac7 months

'f the woman forgot her L?P, as7 the date of =uic7ening, add !! w7s for primi, add !8w7s for multi

Health Teaching s ECer3ise B strengthen the muscles used for labor and delivery Promote circulation, prevent and relieve problems li7e varicosities and hemorrhoids Relieve tension and an%iety 'mprove posture and appetite 'mproves metabolic efficiency )ontraindicated if the woman has P'2, twin pregnancy, '.*R, severe heart disease Em!lo5ment- can continue to wor7, avoid heavy lifting, standing, sitting for long period of time Immuni6ation- vaccine with live viruses is contraindicated 0 ?easlesRubella, +PJ, ?umps1 !- months before pregnancy 2epa 5 vaccine is given only if ris7 factors are present TT vaccine is given by the -+2 in all pregnant women TT1 B anytime during pregnancy TT! B 1 month after TT1 TT B , months after TT! TT8 B 1 year after TT TT# B 1 year after TT8 Clothin1- lightweight, non-constrictive and loose fitting, flat heeled shoes, wear supportive bra -athin1 A daily, tub is discouraged, can be allowed on swimming but no diving, contraindicated when there is bleeding and when membranes have ruptured -reast Care A nipple rolling, use water only in cleaning the breast Tra(el A travel at !nd trimester, avoid long trips at rd trimester, 1#-!$ min" rest period every ! hours, use seat belts SeCual relations) contraindicated when PR+?, bleeding, incompetent cervi%, threatened abortions Al3ohol A refrain ta7ing alcohols Smo4in1 A stop smo7img MINOR 0ISCOM'ORTS 0URING PREGNANCY *+Nausea an" (omitin1 B M morning sic7nessH a" 4at dry crac7ers before getting out of bed b" (mall fre=uent feeding /" 'reEuent urination a" Limit fluid before bedtime b" Kegel e%ercise 2+ 'ati1ue
7

a" C hours of sleep at night and fre=uent rest periods b" Avoid standing for long periods of time c" 4at well balanced diet 7+ %eu4orrhea a" Perineal hygiene #" $eart -urn or P5rosis (mall meals 5end at 7nees not in waist when pic7ing ob9ects from the floor, avoid lying flat :+ &ari3ose (eins Avoid long standing, massaging the legs, constricting garters 4levate the legs against the wall Rest with pillows under the hips ?odified 7nee chest Avoid constipation 2ot sit> bath %A-OR PRE%IMINARY SIGNS O' %A-OR

%i1thenin1) setting of the presenting part to the pelvic brim or inlet 1$-18 days before labor onset a" Relief of (+5 b" increase urination c" leg pains d" 'ncrease vaginal discharge /+ In3rease" le(el of a3ti(it5) due to epinephrine that is initiated by decreased Progesterone produced by the placenta 2+ -raCton $i34s Contra3tion- painless contraction to prepare the myometrium for labor 7+ Ri!enin1 of the 3er(iC) buttersoft >+ Wei1ht loss) !- days before labor woman losses 1-!lbs due to decreased progesterone level :+ 0iarrhea) due to increased peristalsis SIGNS O' TRUE %A-OR Uterine 3ontra3tion) effective, productive, involuntary uterine contraction, increase in duration and decreased in interval, ambulation intensify the pain, girdle li7e pain, pain starts from the bac7 radiating to abdomen (.R4(T ('*/ T2AT LA5+R 2A( 54*./ Sho8- blood mi%ed mucus, pin7-tinge (.R4(T ('*/ +@ )4RJ')AL -'LATAT'+/ IE re(eals 3er(i3al "ilatation an" effa3ement) surest sign that labor is true

Com!onents of %abor PASSEGE) 0womanIs pelvis1 route of the fetus must travel from the uterus through the cervi% and vagina to the e%ternal perineum PASSENGER) fetus, the head of the fetus is the most important part of its body a" )ranial bones1" one frontal bone !" two parietal bones " two temporal bones 8" one occipital bone #" one sphenoid ," one ethmoid Sutures

Sa1ittal suture- membraneous interspace, 9oins the ! parietal bones /+ Coronal) line of unction of the frontal bones 2+ %amb"oi") line of 9unction of the occipital bone and ! parietal bone 7+ 'rontal suture) located between parietal and occipital bones (uture lines are important in birth because they allow the cranial bones to move and overlap 'ontanelles) members covered spaces located between the intersection of suture lines 0position and presentation1 -re1ma (Anterior#) intersection of the sagittal, frontal and coronal suture, diamond shape closes at 1!-1C mos %amb"a ( Posterior# -lies at the 9unction of the lambdoidal and sagittal suture, triangle shape closes at !- mos 0IAMETERS O' T$E 'ETA% SFU%% The fetal head is wider in its anteroposterior dm" than its tranverse dm *+Trans(erse "m+ a, 5iparietal -iameter- most important transverse dm because it is the greatest dm that must be presented to the pelvic inlet 0AP1 and outlet 0T1 !" AP "iameter a" (uboccipitobregmatic- the smallest dm of the fetal head"&"#cmfrom inferior aspect of occiput toanterior fontanelle b" +ccipitofrontal- 1! cm, bridge of the nose to the occiptal prominence c" +ccipitomental- 1 "# cm, widest, from chin to the posterior fontanelle MO%0ING B change in shape of the fetal s7ull produced by the force of uterine contractions passing the verte% against the not yet dilated cervi% 'ETA% POSITION D PRESENTATION ATTITU0E

't is the degree of fle%ion of the fetus assume during labor or relation of the fetal parts to each other Com!lete fleCion) good- spinal column is bowed forward, chin touches the sternum, arms fle%ed and folded on the chest, thighs fle%ed into abdomen Mo"erate fleCion) chin is not touching the chest but is in alert or military position Partial fleCion) M5rowH bac7 is arched, nec7 e%tended, fetus is in complete e%tension %IE Relationship of the long a%is of the fetus to the long a%is of the mother

%on1itu"inal lie) a%is of the fetus is parallel to the long a%is of the mother /+ Tran(erse lie A the long a%is of the fetus is at right angle to the long a%is of the mother 2+ ObliEue lie) the fetus assuming this lie usually rotates to transverse or longitudinal lie in the course of labor

'ETA% PRESENTATION

Ce!hali3) head is contact with the cervi% 0&#:1, verte%, brow, face,chin -ree3h) buttoc7s or feet, 0 :1, complete, fran7 or footling Shoul"er) lying hori>ontally 01:1 hand, elbow, iliac crest Trans(erse) perpendicular POSITION Relationship of the presenting part to a specific =uadrant of the womanIs pelvis ?ost common is L+A L+PGR+P is painful due to the pressure at the sacral nerves causing sharp bac7 pains 'mportant in labor because it influences the process and efficiency of labor MEC$ANISMS O' %A-OR

10

E A engagement,settling of the presenting part of the fetus far enough to the pelvis to be at the level of ischial spines 0) descent, donward movement of the biparietal dm of the fetal head to with in the pelvic inlet '- fle%ion, head bend forward onto the chest Ir) internal rotation E)e%tension, bac7 of the nec7 stops beneath the pubic arch & acts as a pivot for the rest of the head E) e%ternal rotationG Restitution E) e%pulsion POWERS O' %A-OR Chara3teristi3s of Uterine Contra3tion 'nvoluntary- /ot within the control of parturient a" 'ntermittent- alternate contraction and rela%ation b" 'nvolves discomfort- labor pains )ausesE a" compression of the nerve ganglia b" (tretching of the cervi% during dilatation c" stretching of the peritoneum overlying the uterus d" hypo%ia of the concentrated myometrium e" (tretching of ligaments

P$ASES O' UTERINE CONTRACTION *+ In3rement OR Cresen"o) contraction is starting and intensity is building up, longest phase /+ A3me or A!eC) pea7 of contraction 2+ 0e3rement or 0e3resen"o) when muscles start to rela% 'ntensity- strength of the uterine contraction ?ild contraction- slightly tense fundus that is easy to indent with fingertips ?oderate- firm fundus that is difficult to indent with fingertips (trong contraction- rigid board li7e fundus that is almost impossible to indent with fingertips @re=uency- rate at which contraction are occuring, from beginning of a contraction to the beginning of the ne%t contraction -uration- Length of contraction" @rom beginning of one contraction to the end of same contraction 'nterval- ?easured from the end of a contraction to the beginning of one contraction

11

Ph5siolo1i3 Retra3tion Rin1) upper portion becomes thic7er and active, lower segment becomes thin walled, passive so fetus can be pushed out easily, boundery between the ! portions becomes mar7ed by a ridge on the inner surface Patholo1i3 Retra3tion Rin1) in difficult labor, if fetus is larger than the birth canal, the round ligaments of the uterus becomes tense during dilatation and e%pulsion and maybe palpable on the abdomen" 't becomes prominent and observable as an abdominal indention" 't may signify possible rupture of the lower uterine segment if obstruction is not relieve" Cer(i3al Chan1es Effa3ement) shortening and thinning of the cervical canal 0ilatation) enlargement of the cervical canal from an opening a few millimeters wide to one large enough to permit the passage of the fetus STAGES O' %A-OR @'R(T (TA*4 B from onset of true labor pains to the full dilatation of the cervi% 1! hours B primi 1"!cmGhr < hours - multi 1"#cmGhour mild 0.)1, !$- $ sec 0duration1, #-1$ min" 0interval1, $- cm 0)-1, , hr for nullipara, 8"# hr multi Pt"Is behavior- smiling, tal7ative or mute, tense or calm, ambulatory, controls the pain well, follows instruction readily A3ti(e Phase) labor is established, best time for admission, moderate to strong 0.)1, 8$-#$ sec", -#min", 8-< cm, hr for nullipara, !hr for multi Pt"Is behavior- apprehensive, doubtful in the control of pain, has some difficulty following instruction Transitional !hase) strong 0.)1, ,$-<$ sec, !- min, C-1$ cm F Pt"Is behavior- loss of control, restless, irritable, 7nees are sha7ing, vomiting, perspiring, 5+6 usually ruptures, urge to push, anus is spouting and perineum is bulging Nursing ManagementE *ather data for evaluation 2istory Physical 4%amination Abdominal 4%amination !" Assess Rupture of ?embranes " J( Temp" N <"! report to physician, chec7 temp" every 8 hr & every !hr if 5+6 is ruptured PR & RRE every 8 hr" tachycardia indicates hemorrhage or dehydration 5PE every 8hr, if with analgesia, chec7 5P every 1# min, decrease 5P suggest hemorrhage

12

2+ Che34 %ab+ ECamination 7+ Che34 Uterine Contra3tion -uration, intensity, fre=uency, interval After each contraction, chec7 the fundus if it becomes soft to touch" 't means that uterus has time to rela% and able to refill o%ygen for the placenta to the fetus" >+ Che34 fetal 8ell bein1- @2T 1!$-1,$ bpm Latent phase- = ,$ min, active = $ min", transitional = 1#min", second stage = # min Normal '$T !attern 5aseline rate- 1!$-1,$ bpm 5aseline variability- # to 1# bpm fluctuation = min" 5eat to beat variability- There is difference between successive heart beats 4arly deceleration- rate of @2T decreases at onset of uterine contraction but return to normal before the end of contraction as a response of the fetus to head compression during contraction Acceleration- when the fetus moves, it is normal for the @2T to increase

Abnormal '$T !attern -ra"53ar"ia= 1$$-11& bpm- mo"erate below 1$$bpm B mar4e" Cause= @etal hypo%ia as a result of analgesia and anesthesia, maternal hypotension and prolonged umbilical cord compression Mana1ement= Place the mother on the left side, assess for cord prolapse, administer o%ygen Ta3h53ar"ia= 1,1 to 1C$ bpm- moderate, above 1C$ bpm- mar7ed Cause= ?aternal fever, dehydration and drugs 0atrophine, vistaril, ritrodrine and terbutaline1, fetal distress Mana1ement= Reduce maternal fever, increase fluids, monitor for chorioamionitis

%ate "e3eleration A rate of @2Tdecreases during uterine contraction and do not return to normal even after the said contraction is a sign of uteroplacental insufficiency Cause= 'ndicative of uteroplacental insufficiency caused by uterine tetany from o%ytocin administration, maternal supine hypotension, hypertensive disorder, -? and other chronic disorders Mana1ement= -iscontinue o%ytocin, position on the left side, o%ygen administration O C-1C Lpm, prepare for birth if no improvement

13

&ariable !attern) deceleration at unpridictable times of uterine contraction Cause= cord compression Mana1ement= Relieve pressure on the cord, 7nee-chest, e%agerated sims, lateral position and o%ygen administration, prepare for )(

," Pro(i"e Comfort Apply sacral pressure to minimi>e bac7ache +ffer ice chips to prevent crac7ing of the lips and drying of the mouth *ive perineal care and use sanitary pads to 7eep her dry <" Promote bla""er 3are @ull bladder can impede fetal descent 4ncourage to void = !-8 hour C" A"minister 3leansin1 enema as or"ere" In"i3ations= to improve the =uality of uterine contraction To prevent contamination To minimi>e discomfort Contrain"i3ations= Ruptured 5+6 Possible placenta previa Premature labor ?alpresentation )ervical dilatation 8cm if the head is not engage &" En3oura1e ambulation )ontraindicationE P'2, (ame as enema 1$" Pro(i"e emotional su!!ort 'nform her about the progress of labor Allow husband to stay with her" -o not leave her alone 11" En3oura1e the 8oman to assume left sims !osition in be" To prevent vena cava compression Prevent supine hypotensive syndrome @avors internal rotation of the fetal head 1!" En3oura1e breathin1 eCer3ises 8ith uterine 3ontra3tion to !re(ent !remature !ushin1 %e(el I= if .) are mild, breathing e%ercise must be slow and shallow %e(el II= if .) are moderate, breathing e%ercise must be rapid but shallow %e(el III= if .) are strong & e%pulsive, and there is urge to push, breathing techni=ue is pant blow %e(el I&= if .c are strong & e%pulsive, cervi% is 1$cm, breath in with .) and push

'f woman is hyperventilating to increase Pa)+!, minimi>e fetal acidosis and relieve symptoms of vertigo and syncope 5reathe into paper bag

14

5reathe into cupped hands +ffer support, encouragement and praise as appropriate -iscourage bearing down effort if cervi% is not fully dilated

*2+ Assist in the a"ministration of anal1esia Me!eri"ine $3l A 0-emerol1 'J route bet #-, cm, 0anti spasmodic, )/( depression1 )hec7 5P and @2T before and immediately after the administration, monitor the =uality of contraction AntedoteE /alo%one 0/arcan1 4piduralE O L -L8, it relieves pain contraction and numbs vagina and perineum painless pushless delivery" ?ay cause hypotension but do not cause headache PudendalE .sed at !nd stage of labor of labor" Relieves perineal comfort and numbs area for episiotomy *7+ Status of -OW 'f 5+6 rupture and the woman is wal7ing- P.T 24R '/ 54 'f woman is in bed and 5+6 ruptures, )24)K @2T 'f 5+6 ruptures and the woman remain undelivered for more than , hour ?+/'T+R T4?P" @+R ('*/( +@ (4P('( *>+ Obser(e if the 8oman is enterin1 the /n" sta1e Progressive increase in the amount of (2+6 .rge to push Anus is spouting Perineum is bulging SECON0 STAGE) full cervical dilatation to the e%pulsion of the fetus C$ min in primi- needs !$ strong contraction with the delivery of the baby $ min in multi- 1$ strong contraction to push the baby out Mana1ement= 4ncourage pushing only with uterine contraction 5ring her to -R if fully dilated in primi, C-1$cm in multi Assist her to assume dorsal lithotomy position (tirrups must be padded to prevent trauma to the veins resulting to thrombophlebitis Legs must be placed O the same level to prevent damage to the uterine ligament resulting to prolapse of uterus 8" 'f fetal head is crowning, instruct the mother to pant blow to prevent s#" *et sterile towel to support the perineum 0?odified RitgenIs ?aneuver1 ," As soon as the baby is out, wipe mucus, clear airway to prevent aspiration " )hec7 nec7 for cord coil 0slip the cord over the shoulder or over the head, delay clamping to prevent blood loss1 <" -eliver the shoulder only after e%ternal rotation of &$ degrees

15

sudden e%pulsion of the fetal head resulting to laceration C" As soon as the baby is out E )lear airway -ry him immediately Place head lower than the body Place over the motherIs s abdomen to promote .) and placental separation )lamp the cord only when the pulsation stops &" (how the baby to the mother to initiate bonding through eye to eye contact, tell her the se% of the baby, time of delivery and start breastfeeding 0 $ min" /(-, 8hour )(1 T$IR0 STAGE) from delivery of the baby and ends in the delivery of the placenta 0uration A #-!$ min SIGNS= )al7inIs sign C$: sudden gush of blood lengthening of the cord Management -eliver the placenta" )hec7 for completeness, AJA, !$ cotelydons .se 5rantIs AndrewIs ?aneuver to E Prevent placental fragments 'nversion of the uterus " )hec7 the fundus, must be firm at the midline 8" )hec7 5P #" Administer medication as orderedE a+ Meth5ler1ono(ine Malaete '? or 'JP- sustain .) for , hour )ontraindicationE 2P/, 2eart -isease b+ OC5to3in) if given 'm or 'J, can sustain .) for $ min <" )hec7 perineum for laceration 5right red vaginal bleeding- blood originated from artery -ar7 red vaginal bleeding- blood originated at placental site Prepare for repair C" Apply ice caps at the placental site, empty the bladder, massage gently the uterus &" )hange her gown and bring her to the new born to same room to facilitate rooming-in and encourage breastfeeding 'OURT$ STAGE) 1-! hours post delivery ?ost critical stage for the mother J( are stable Management:

16

)hec7 J( = 1# min in the first hour and = $ min on the ne%t hour until

stable 5PE increased within 8C hours TempE elevated in the first !8 hours PRE normally decreased- P2;('+L+*') 5RA-;)AR-'A RRE unchanged )hec7 the fundus, firm O the midline and normally palpable O the level of umbilicus 4ncourage early ambulation for 8 hours post delivery /(-, C-1! hour post )( )hec7 perineum for bleeding and swelling" Apply cold compress only for first !8 hour )hec7 for lochia R.5RA- mainly blood , days PP (4R+(A- blood and mucus, 8-& days PP AL5A- mainly mucus, yellowish to white, 1$th to !!nd PP days

SIGNS TO REPORT .terine cramping 'ncrease vaginal bleeding, passage of large clots /ausea and vomiting COMMON COMP%ICATION POST PARTUM Post Partum $emorrha1e) loss of #$$ml of blood or more during the first !8 hour 0/(-1, 1$$$ml 0)(1 Causes: .terine Atony & laceration Retained placenta & -') 0dessiminated intravascular coagulation defects1 Danger: (heehan (yndrome- necrosis of the pituitary gland Amenorrhea Loss of pubic hair 5reast shrin7 Loss of libido 2ypovolemia B decrease 5P, PR tachy, thready, RR increase depth, temp" decreased Renal failure Causes: Uterine Aton5) loss of ability to maintain uterine contraction

17

Causes= uterine over distension 0multipregnancy, polyhydramios, fetal macrosomia1, multiparity, prolonged or precipitate labor, anesthesia, o%ytocin, distended bladder SS & Sx: @undus- soft, boggy, flabby 5P decrease, PR increase Placenta 'ncomplete -ar7 red vaginal bleeding Management ?assage fundus gently 4mpty the bladder Apply ice cap Administer methergine as ordered /+ %a3eration of the 3er(iC (a1inal 8all an" Perineum Causes= !nd degree laceration, forceps delivery, large fetus, rapid delivery SS D SC= a" @undus firm b" Perineal pain c" 5right red vaginal bleeding Mana1ement= Prepare for repair Apply ice cap first !8 hours 4ncourage 7egelIs e%ercise 2+ Retaine" Pla3ental !arts) Causes= ?ismanagement of the third stage, abnormally adherent placenta SS D SC= fundus rela% Jaginal bleeding Placenta is incomplete Mana1ement= Prepare for -&) Assist in the administration of Pitocin drip )hec7 fundus and J( = $ in first !8 hours 7+ 0essiminate" Intra(as3ular Coa1ulation A inability of the plasma clotting factor 0fibrin1 to form a permanent clot in the wound after !8 hours )ausesE 2ypofibrinogenemia SS D SC= @undus firm Jaginal bleeding- dar7 red 5lood test- hyperfibrogenemia

18

Management: Assist in the administration CRYOPRECIPITATE ?ust be thawed O room temp" -o not sha7e )onsumed within $ min

of

fro>en

clotting

factor-

Puer!erual Se!sis 'nfection of the genital tract within , w7s after delivery Causes= e%isting vaginitis, poor aseptic techni=ue, infected personnel, PR+?, precipitate delivery SS & Sx: @ever after !8 hours 5ody malaise )hills Anore%ia Types *+En"ometritis) infection in the lining of the uterus SC= foul odor lochia, sub- involuted uterus, abdominal tenderness Management: 2igh fowlerIs position to facilitate drainage Jaginal discharge -iet, increase )2+/, Jit" ), iron, moderate calorie Antibiotic theraphy /+ Thrombo!hlebitis) inflamed wall of veins due to clot formation Causes= delayed ambulation, trauma to veins, varicosities SS & Sx: 4dematous, pale & shiny leg- PhlegmasiaGAlbadolensG ?il7y leg Pelvic pain A 2omanIs signManagement: 4levate the affected leg -o not massage Assist in heparin therapy 2+ Mastitis) infected mammary gland Causes= crac7led nipple, infected mouth of /5, poor breastfeeding techni=ue, poor breast hygiene Management: Postponed breastfeeding on the affected breast 4mpty the breast regularly for continuous lactation 4%posed breast to heat lump 1#- $ minGday 2eatGcold application .se protective bra PSYC$O%OGICA% C$ANGES in POST PARTUM PERIO0

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RU-IN@S POSTPARTUM P$ASE Ta4in1) In Phase +ccurs !- days postpartum The woman focused on her own needs for rest , sleep, and dependent on others /+ Ta4in1 A $ol" Phase) 2r" A / 8ee4s @ocused on the ability to control body functions and ability to assume mothering role @atigue and e%haustion is common at this phase 2+ %ettin1 A Go Phase) ?other thin7s that the infant is a separate individual and not part of herself 4%periences a feeling of loss Nursin1 Inter(entions Ta4in1 A In Phase 4ncourage verbali>ation of labor or birth e%perience )omplement parents on how well they did 4%plore feelings of disappoinment if any ?eet dependency needs, comment on appearance, grooming 4ncourage rooming in /+ Ta4in1 A $ol" Phase -iscuss self-care, psychologicalGphysiological changes -emonstrate infant care Let the mother to do return demonstration -IO%OGICA% 'OUN0ATION O' POSTPARTA% PERIO0

Uterine In(olution) uterus returns to pre-pregnant state a" Contra3tions) Gafter !ainsH @re=uency, intensity and discomforts after !8 hours )ommon in multipara, after birth of large baby, breastfeeding women b" @ormation of new endometrium 8-, wee7s until placental site is healed 3+ Cer(iC 'mmediately after birth- bruised, small tears, admit 1 hand +ne w7 PP- admit ! fingers /ever return to pre-pregnant state 'un"us Located midway between the umbilicus and symphisis pubis after delivery After 1! hours rises at the level of the umbilicus -escends 1 cmG day At 1$th day, it cannot be palpated

20

%OC$IA Perineum +bserve for signs of infection 4ncourage perineal hygiene 'ce pac7s for the first !8 hours- vasoconstriction and lessen edema (it> bath- application of heat to the perineum after !8 hours for vasodilation *iven -8%Gday not more than !$ minutes Perineal lamp- 1! inches away, !$ minutes Menstruation) non-lactating <-&wee7s PP, ovulates at 1$th w7

$IG$ RISF PREGNANCY Premature Ru!ture of Membranes (pontaneous rupture of the fetal membranes before the onset of labor whether term or preterm Causes: 'nfection Amniocentesis Complications: Preterm labor 'nfections )ord compression causing hypo%ia, prolapse cord Signs and symptoms Lea7age of fluids )onstant wetness in underwear Passage of fluid with signs of labor Labor should occur within !8 hours Preterm- delayed up to a wee7 after PR+? Management Prenatal 'nstruction 2ospitali>ation based on fetal lung maturity- L( ratio !E1 5ubble sha7e test @oam stability test /itra>ine test- determine the amount of amniotic fluid Pin7-blue- al7aline @erning pattern upon microscopic e%am " 'f PR+? occurred at term- induction of labor if labor does not occur within !8 hours To deliver the baby and to prevent infection

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Nursing nter!ention 1" 5ed rest- 7nee chest, sims or left lateral Ris7 for in9ury !" ?onitor J( = !-8 hour if normal condition, @2T = 1, monitor the character of amniotic fluid, uterine contraction Ris7 for infection " Alleviate fears- inform progress of labor, let her listen to @2T An%iety rGt outcome of pregnancy 8" Provide comfort (acral pressure, bac7 rub, fre=uent changes in position #" Administer prescribe medication and monitor patients response ," -iscourage bearing down until cervi% is fully dilated Premature %abor 5etween !$ w7s B < w7s A+* characteri>ed by regular contraction more than $ seconds that results in cervical dilatation and effacement *reatest cause of neonatal mortality and morbidity Low birth wt infants- less than !#$$ g Jery low- less than 1#$$ g 4%tremely low- less than 1$$$ g L*A- more than &$th : ran7 (*A- below 1$th : ran7

"is# o$ premature birth to in$ants Respiratory distress syndrome Pathologic apnea 'nfection )ongenital heart defects Thermoregulation problems @eeding difficulties /eurological disorders Paundice 'ncrease susceptability to infection Causes% etiology 2istory of premature labor 2istory of spontaneous abortion 4pidemiological factors- low socio economic,Q1C-N8$ yGo, smo7ing, cocaine, stressful living condition ?ultiparity .terine abnormalities ?aternal infections- (T22

)hronic 2P/, -? Poor nutrition PR+? )ongenital malformation of fetus and placenta

Management Regular prenatal chec7-up = !w7s if at ris7 Life style modification 'f preterm labor occurs, stop uterine contractions if Q ! w7s bedrest- Left lateral 2ydration /on-stress test Tocolytics- if Q 8cm, intact membranes, fetus !#$$g )ontraindication- A" placenta, fetal distress, 2P/ eclampsia, chorioamionitis 8" /o coitus T+)+L;T') -R.*( Ritrodine 2)L B ;utopar 2P/,tachycardia, arrythmia Antidote- Propanolol !" ?g (+8- effective in delaying delivery " Terbutaline- 5rethine )ontraindicated to pt" with -?, cardiac disorder Tachycardia, hypotension, chest pain, dysrrythmias, nervousness, /&J, headache 8" Prostaglandin 'nhibitors 'ndomethacin- decrease concentration of )a 'so%suprine 2)l- Jasodilan, -uvadilan (albutamol POST TERM PREGNANCY Management Assess fetal well being ?ethod of delivery based on fetal well being Nursing nter!ention: ?onitor fetus for signs of hypo%ia and distress )olor of amniotic fluid After delivery of Post ?ature infantE (uctioning Assess for hypoglycemia Provide warm blan7et $5"ramio N !$$$ ml Causes:
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1"@etal abnormality anencephaly- absence of fetal s7ull, increase transudation of fluid from meninges and e%cessive urination of fetus 4sophageal atresia- inability to swallow amniotic fluid (pinal bifida 2eart failure )ongenital infection /+ Maternal 'a3tors ?ultiple pregnancy -? Signs and symptoms: 'ncrease uterine si>e out of proportion of A+* (+5 5ac7pain, varicosities, constipation, fre=uent urination, hemorrhoids .T3- increase amount of amniotic fluid Management Complication Premature delivery Abruptio placenta Post partum hemorrhage )ord prolapse ?alpresentation +L'*+2;-RA?'+(

Less than #$$ ml

Causes: Renal anomalies of fetus and renal agenesis 0absence of 7idney1 PR+? 4%posure to A)4 inhibitors '.*R Post term Signs and Symptoms: Lea7ing amniotic fluid -ecrease amount of amniotic fluid on ultrasound (mall uterus Management Assess fetal well being +bserve for complication- abortion, still birth, a" placenta, fetal growth retardation -uring labor and delivery )ord compression @etal hypo%ia Prolonged labor
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-%EE0ING IN PREGNANCY A-ORTION) termination of pregnancy before the fetus sufficiently develop to survive before !$th w7 or less than #$$g &tiology: A5 >ygote developmentG defective >ygote01st trimester1 'ncompetent cervi% 0!nd trimester1 Types Threatene" Abortion) closed cervi%, slight vaginal bleeding, mild abdominal cramps )5R for 8C hours (ave all pads for evaluation ?onitor J( Progesterone supplement to maintain decidua /o '4, no coitus /+ Ine(itable) cervi% open, vaginal bleeding moderate, bac7ache, uterine cramps Prepare for - & ) 4motional support G S!ontaneous abortion is natures safe1uar" to !re(ent the birth of babies 8ith multi!le anomaliesH >+ $abitual) or more successive abortion %ea"in1 Cause= 'ncompetent cervi% B dilates before the !$th w7 of pregnancy Parity of more than # )ervical laceration )ongenital Signs and symptoms: Presence of show 5+6 ruptures .terine contraction 4)T+P') PR4*/A/); 4%tra uterine gestation ('T.E tubal0 ampulla-common, interstitial1, cervical, ovarian Causes Tumor in fallopian tube (car Adhesion 4ndometriosis- growth of endometrium in the tube '. P'F The tube ruptures between &-1!th w7 of pregnancy

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Signs and symptoms: Fehr@s si1n) sharp stabbing pain on the lower outer =uadrant of the abdomen, radiates on shoulder Culler@s si1n) bluish umbilical area of the mother Rigid uterusG 'ncrease 65), temp /ormal, decreased 5P, rapid pulse '4 reveals presence of culdesac mass Management: )ontrol of bleeding- laparotomy to ligate bleeders 5T T-berg position Provide warmth to decrease the demand for o%ygen $Y0ATI0I'ORM MO%E -egeneration of chorionic villi resulting to proliferation forming a cluster of vessels containing fluids, grape-li7e, maybe non-malignant or may cause cancer 4tiologyE .n7nown, age 1C below, low socioeconomic status0 decrease )2+/ inta7e1 Signs and Symptoms: A preg" Test 2)*- millions .ndue enlargement of uterus 4arly P'2 before !$th w7s 2yperemesis gravidarum Jaginal bleeding before or 8th month, 1!th w7s Absence of fetal parts, outline and movements Management: 4vacuation of 2-?ole Jaccuim aspiration -&) (ample of 2-mole is sent to laboratory for biopsy 'f benign, the woman must undergo methotre%ate thepary to prevent the growth of )A cells 'f malignant, must undergo hysterectomy !" Pregnancy is contraindicated After 8$ days, 2)* must be absent to her urine )ontraception is necessary P%ACENTA PRE&IA Low lying placenta Types: ?arginal- edge of placenta reaches the margin of the cervi% Partial- part of placenta covers cervical os
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)omplete or total- center of placenta covers cervical os

Signs and Symptoms: Painless uterine bleeding after !$th w7 .terus remain soft- not always accompanied with fetal distress Nursing Care .pon admission, )5R 8C hour, high fowlers ?onitor J( and @2T /o '4, enemas Prepare for sonogram to locate placenta @acilitate double set up, preparation for )( is completed before '4 at +R ?anage bleeding episodes ?aintain /P+ 'f bleeding stops, pregnancy is allowed upto Cw7s A-RUPTIO P%ACENTA Premature separation of the implanted placenta Causes: -ecrease blood supply to placenta P'2 -? (hort umbilical cord Tetanic contraction -isparity between placenta and its site 0PR+?Gbirth of the 1 st twin1 Management Respond to symptoms Treat shoc7 symptoms Administer +%ygen by tight mas7 O ,-1$ LGmin 'ncrease 'J@ rate Administer blood- properly type and cross matched J( = 1#, @2R .rine output " +bserve (s & (% of coagulation defects 8" ?easure abdominal girth #" Remain with the client ," )ontinually monitor labor pattern if labor is allowed to continue <" Prepare for )( $YPERTENSI&E 0ISOR0ERS O' PREGNANCY $5!ertension- a 5P reading in two occasions of at least 18$G&$ or a rise $G1#mm Pre1nan35 In"u3e" $PN- developed after !$th w7 Pree3lam!sia- 2P/, proteinuria,edema
27

Gestational $PN- 2P/ developed during pregnancy or after delivery which is not accompanied with edema, proteinuria and convulsions and disappears within 1$ days after delivery Chroni3 $PN- presence of 2P/ or developed before the !$th w7 gestation in the absence of 2-mole and persist beyond post partum 'redisposing Factors: Primipara Q!$ yGo, N8$ yGo Low socio-economic status Previous 2P/ of pregnancy, 2-mole, polyhydramios, renal disease, heart disease 2eriditary Classi$ication: Gestational $PN- 5P 18$G&$, no protienuria, no edema Mil" !ree3lam!sia- 5P 18$G&$0 ta7en in ! occasion O , hours apart1, protienuria A1A! 01gGl1, A edema Se(ere !ree3lam!sia- 5P 1,$G11$, protienuria A A8 0#gGl1, A edema edema- puffiness face and hands, pitting edema Rings are tight or eyes are swollen at am -ecreased urine output (evere epigastric pain, /&J (+5 5lurred vision, severe headache ?ar7ed hyper refle%ia and muscle clonus 7+ E3lam!sia- sei>ure A all signs of severe preeclampsia

-?,

multiple

pregnancy,

Complication: )erebral hemorrhage Renal failure @etal hypo%ia Abruptio placenta Premature labor

Nursing Diagnosis: 'neffective Tissue Perfusion rGt vasoconstriction of blood vessels @luid volume deficit rGt fluid loss to subcutaneous tissue Ris7 for in9ury rGt placental perfusion !nd to vasospasm (ocial isolation rGt prescribe bed rest Nursing nter!ention: 'or Mil" Pree3lam!sia= Promote best rest- lateral position
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Promote good nutrition, decreased /a in the diet Provide emotional support- verbali>ation of feelings Se(ere Pree3lam!sia 5est rest Provide =uite environment, limit visitor, avoid stress ?onitor fetal well being -iet- moderate ti high )2+/, moderate /a Administer medication as ordered

$5"rala6ine (A!resoline# decreases 5P, can cause tachycardia M1SO7) bloc7s peripheral neuromascular transmission- lessen possibility of sei>ure, reduces edema )hec7 urine output $-,$ mlG hr RR Q 1! bpm -TR Classi$ication: $EART 0ISEASE Pregnant women with heart disease should avoid infection, e%cessive wt" gain, edema and anemia because this conditions increase the wor7load of the heart

Signs and Symptoms: -+5- dyspnea, orthopnea, nocturnal dyspnea cyanosis (yncope )hest pain )lubbing of fingers /ec7 vein distention ?urmurs )ardiomegaly Arrythmia Pulmonary 2P/ Complications: 2eart failure Abortion Premature labor '.*R Management: Class 1" &

Rest" C hours sleep and fre=uent rest period during the day" Lie down for $ min" after each meal" Light wor7 only, no climbing of stairs and no e%haustion

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!" " 8" #" ,"

-iet" 2igh 'ron, )2+/, minerals and vitamins, limit /a inta7e" ?onitor wt" *ain Avoid high altitudes, smo7ing areas, planes and crowded areas" Prevent infections Provide instructions on danger signs of heart failure- cough with rales, increasing dyspnea, tachycardia, rales, edema ?edicationsE 'ron -igitalis to strengthen myocardial contraction and slow down heart rate /itroglycerine Antibiotics -iuretics mayb e prescribed in case of heart failure

ntrapartal Care

4arly hospitali>ation to promote rest and closed supervision (emi fowlerIs or lateral recumbent position"Lo lithotomy J( = 1# min 4pidural anesthesia- painless" /o pushing Poor candidate for )( due to increased ris7 for hemorrhage, infection and throboembolism 'ostpartum Care

?onitor J( Promote rest" Limit visitors until cardiac status has estabili>ed 4arly but gradual ambulation to prevent thrombophlebitis ?edicationsE Antibiotics & (tool softeners 5reastfeeding is allowed if there are no signs of decompensation during pregnancy, labor and puerperium PREGESTATIONA% 0IA-ETES -ue to problems in the pancreatic 5eta cells Gestational 0M) due to carbohydrate intolerance pregnancy Si1ns= 4%cessive thirstG hunger 4%cessive fatigue @re=uent urination Recurrent monilial infections 'ncreased fundic ht" Polyhydramnios and suspected macrosomia 4levated blood sugar level, proteinuria detected

cardiac

during

30

&$$ects o$ Diabetes: *+ Mother preeclampsiaG eclampsia, .T', candidiasis -ystocia Postpartum hemorrhage 2ydramnios ?aternal mortality Retinopathy, nephrophathy Preterm delivery /+ 'etus ?acrosomia Prematurity '.*R 2ypoglycemia and hypocalcemia Predisposition of -? in later life Respiratory distress Classi$ications:()hite*s Classi$ication+ Class A +nset is at pregnancy )ontrolled by diet, insulin not re=uired 'nfant Large for *estational age Class +nset at age !$, has the disease for less than 1$ yrs 'nsulin dependent during pregnancy Class C +nset between 1$-1& yGo 'nsulin dependent before pregancy, insulin re=uirements increase during pregnancy )omplication of preeclampsia and '.@Class 0 +nset before 1$ yGo 6ith benign retinopathy, insulin dependent, (*A infants 'renatal Management -iagnosis- 2% of -?, une%plained repeated abortions, stillbirth, with glycosuria, obese, 2% of large infants and congenital anomaly (creening test @5(- /P+ ,-C hours +*TT /P+ ,-C, fasting specimen in A? bloodG urine Administer 1$$ gm of glucose dissolved 1 glass fruit 9uice or $$ gm )2+ 1, !, , collection of blood sample 'nterpretationE

31

5lood rise after 1 *radually decrease at ! Almost normal at

-ene"i3ts Test- # ml of benedictIs soln", warm and add C-1$ gtts of urine, boil then let it cool nterpretation: 5lue -$ 5lue green - A1 ;ellow - A! +range -A 5ric7 red - A8 Aci test- aci test tablet )lini test- 1$ gtts of 2!+, # gtts of urine, clini test tablet0corrosive1 'nterpretation- 5, 5*, *, ;*, ;+, +range " -iet- #$: )2+, $: @ats, !$: )2+/ )omple% )2+ Proper e%ercise 8" 'nsulin therapy 'ncreased 'nsulin re=uirement at !nd & rd trimester +ral hypoglycemic drugs are contraindicated 2umulin- drug of choice #" ?onitor glucose level- <$ to 1!$mgGdL

TYPE O' MU%TIP%E PREGNANCY

Mono651oti3 or I"enti3al T8ins) develop from one ovum and one sperm that undergo rapid cell division that resulted into ! or more individuals" 2ave the same genetic traits and same se% 'f twining occurs after <! hours, ! amnions, ! chorions and ! embyos After 8th B Cth day, ! amnions, 1 chorion, ! embryos After Cth days, 1 amnion, 1 chorion, ! embryos 'f twining occurred after the ebbryonic disc is formed, con9oined twins will develop Anterior- Thoracopagus 0 most common1 Posterior- pyopagus )ephalic- craniopagus )audal- 'schiopagus +ccur in every !#$ pregnancy, not influenced by race, heredity, parity, maternal age /+ 0i651oti3 T8ins or fraternal t8ins) ! or more ova and sperm cells that fertili>ed at the same time, may have different genetic traits, may not be the same se% and always have ! placentas, ! chorions, ! amnions Race
32

2eredity- more common on maternal side 2igh parity and advance maternal age .se of fertility drugs

Complications: Abortion -eath of one fetus Perinatal mortality Preterm labor Low birth wt" )ongenital malformation 2ydramnios ?aternal 2P/ Placenta previa and abruptio placenta '.*R )ord enlargement, prolapse, compression ?aternal anemia Management: /utrition- additional $$ Kcal, 'ron ,$-1$$ mg, Jit", (i% small mealsGday Rest- more rest period to avoid premature labor ?anage discomforts Labor and -elivery 'nstruct to come to the hospital if labor begins ?onitor J(, @2R, P+L The cord is cut right after delivery of the first infant -etect presentation of the second infant by leopoldIs or ultrasound /ormal interval is $ min of the second twin #" 6atch for post partum hemorrhage

n$ections in 'regnancy Tuber3ulosis) ,th cause of mortality and morbidity 0-+2 1&&C1 Rifampicin, '/2", P3A, 4thambutol 5reastfeeding is not affected by the medications for T /+ MalariaA Cth cause of morbidity 'ncreased ris7 for anemia, death, spontaneous abortions, stillbirth, premature delivery and low birth wt" Pro!h5laCis= ! tab )hloro=uine phosphate !#$mgGtab = w7 for the duration of pregnancy 2+ -reastfee"in1 is contraindicated 7+ $e!atitis 1" 2epa 5 immuneglobulin at birth !" 2epa 5 vaccine at 1 w7, 1 month, , months after delivery >+ $I&) transmission thru placenta 0greatest near term1, birth canal during delivery, breast mil7 " @ocus of care is to treat infections and reduce the ris7 of perinatal transmission
33

8" II0O&U0INE initiated at 18- 8w7s A+* throughout the pregnancy, 'J during labor and delivery, and neonatal dose after delivery #" 5athe the neonate as soon as possible after delivery ," All needle procedure is done after bath :+ RU-E%%A ( German Measles# <" Jirus crosses the placenta C" Affects the fetus #$-&$: 1st trimester 0 deafness, psychomotor problems, microcephaly1 &" day rash which disappear upon pressure on the s7in, fever and lymphadenopathy 1$" Rubella immuni6ation) the woman should not get pregnant !months after vaccination 11"'mmune serum globulin for maternal symptoms 1!"(trict isolation during the disease 1 "?ay breastfed after the disease

Nonstress Test) interprets the @2R reactivity as response to fetal movements" 6hen heart rate pea7s at 1#bpm above baseline lasting for 1# sec or more on two accelerations, this is highly predictive of fetal survival within < days Contra3tion Stress Test) the fetal heart rate response to hypo%ia during uterine contraction induced either by nipple stimulation or 'J infusion of o%ytocin, should be negative result 'etal mo(ement) aless than 1$ calls for further evaluation 7+ Amnio3entesis) transabdominal aspiration of 1$-!$ ml amniotic fluid 18"At 1!-18 w7s A+*- detects genitic abnormalities but carries the ris7s of infection and Rh isoimmuni>ation0Rh B mother1 1#"$" -$"# : fetal loss 1,"At rd trimester- detects lung maturity Nursing "esponsibilities: 'nformed consent PositionE (upine with roll towel or pillow at right buttoc7s to decrease the pressure on vena cava and aorta Abdominal preparation J(- maternal 5P and @2R before and after the procedure Provide bed rest 1-! days after the procedure

Administer Rho*am as ordered

1<")omplicationsE placental, cord and bladder puncture 1C"Advise client to void before the procedure >+ Per3utaneous Umbili3al Cor" Sam!lin1 1&"PurposeE removal of blood from umbilical vein using an amniocentesis techni=ue for analysis !$"Administer Rho*am to Rh negative women

34

!1"?onitor fetal well being :+ Chorioni3 &illi Sam!lin1) a thin catheter is inserted into the uterus to detect genetic abberations !!"'nstruct the client to drin7 water to fill the bladder to aid in the attainment of the desired position of the uterus ! "4%plain the ris7 involveE spontaneous abortion, infection, hematoma, intrauterine fetal death

35