OB-Gyne

Terratogenic Drugs:
A. Drugs
1. streptomycin- anti-TB and Quinine( antimalaria)- damaged to 8th cranial nerve
Effect:
> poor hearing and deafness
2. Tetracycline- staining tooth enamel, inhibit growth of long bone
3. Vitamin K- hemolysis( destruction of RBC), hyperbilirubenia or juandice
4. Iodides- enlargement of thyroid goiter
5. Thalidomides- amelia or phocomelia
6. Streoids- cleft lip or palate
B. Alcohol- lowered weight(vasoconstriction on mom) fetal alcohol withdrawal syn
drome and microcephaly
C. smoking- low birth rates
D. caffeine- low birth rate
E. Cocaine- Low birth rate and abruptio placenta
TORCH(terratogenic) infections- viruses
A group of infections caused by organism that can cross the placenta or ascend t
hrough birth canal and adversely affect fetal growth and development:
T- toxoplasmosis- mom takes care of cats feces. Cats feces can contaminate raw v
egetables or meat
O- others- Hepa A( oral/fecal)
Hepa B,blood and body fluids
Syphilis
R-Rubella- congenital heart disease( 1st month)
Don t get pregnant for 3 months after receiving vaccine.
Note: vaccine is terratogenic
C- cytomegalo virus
H- herpes simplex virus
Physiologic adaptation of the mother
Physiologic anemia
Iron deficiency anemia is the most common hematological disorder. It affects 20%
of pregnant women.
Nursing care:
> eat food reach in liver, red meat, green leafy vegetables( alugbati, kankong,
saluyot, malunggay,ampalaya.
> Parenteral Iron(inferon)- severe anemia, give IM z-tract
> Oral iron supplementtation- 30 mg 3 times a day-empty stomach 1 hr before or 2
hrs after meal, black stool and constipation
Edema-lower extremeties due to venous return is constricted due to large belly
Nsg care: elevate legs above hip level
Varicosities- pressure of uterus
Nsg care; use support stocking, avoid wearing knee high socks, use elastic banda
ge
Vulvar varecosities- painful pressure on gravid uterus to relieve position- side
lying with pillow under hips or modified knee chest position
Thrombophlebitis- presence of thrombus at inflammed blood vessel
> Increase fibrinogen
> Increase clotting factor
> Thrombus formation candidate
Outstanding sign
1.+ homan sign- pain on cuff during dorsiflexion
2. Milk leg- skinny white legs due to stretching of skin by inflammation or phla
gmasia albadolens
Management:
> Bed rest
> Never massage
> Assess homan sign once only
> Give anticougulant to prevent additional clotting
> Monitor APTT antidote for heparin therapy- protamine sulfate
> Avoid aspirin, might aggravate bleeding
Respiratory System- common problem SOB due to enlargement of uterus and increase
O2 demand
Position: Lateral expansion of lungs or side lying position
3. Gastrointestinal- 1st trimester change
a. Morning sickness- nausea and vomiting due to increase HCG.
Nsg. Intervention:
> Eat dry crackers or Dry CHO diet 30 mins before arising to bed
> Small frequent feeding
> Emesis gravidarum- replace fluid loss and monitor I and O
b. constipation- progesterone responsible for constipation.
Nsg. management:
> increase fluid intake
> Increase fiber diet
> Papaya,pineapple,watermelon,actaloupe,suha, apple except guava- has pectin tha
t s constipating
> exercise
c. flatulence- avoid gas forming food- cabbage
d. Heartburn or pyrosis- reflux of stomach content to esophagus
Nsg. Management:
> Small frequent feeding,
> avoid 3 full meals
> Avoid fatty and spicy food
> Sips of milk proper body mechanical
e. ptyalism- incraese salivation- mouth wash
4. Urinary system- frequency during 1st and 3 rd trimester
Acetic test- albumin
Benedict test- sugar in urine
5. Musculoskeletal
a. Lordosis- pride of pregnancy
b. Waddling gait- awkward walking due to relaxation- causes softening of joints
and bones
-Prone to accident falls- wear low healed shoes
c. Leg Cramps- prolonged standing, over fatigue, Ca and phosphorus imbalance( no
. causes in pregnant) chills, over sex, pressure in gravid uterus
Management:
> Increase Ca diet- Milk, cheese, yogurt, head of fish, dilis, sardines with bon
e, broccoli, seafood's tahong(mussels), lobster, crabs
> Vit. D increased calcium absorption
Local Changes
Vagina:
V- Chadwick's sign- blue violet discoloration of vagina
C-Goodels sign- change of consistency of cervix
I- hegar signs- change of consistency of isthmus( lower uterine segment)
> Leukorrhea- whitish gray, mousy odor discharge
> Estrogen- hormone, resp. for leukorrhea
> Operculum- mucus plug to seal out bacteria
> Progesterone- hormone responsible for operculum
Problem related to the change of vagina Environment:
a. Vaginitis- trichomonas vaginalis due to alkaline environment of vagina.
- Flagellated Protozoa- wants alkaline
Signs and symptoms:
Greenish cream colored frothy irritating itchy with foul smelling odor vaginal e
dema
Management:
> Flagyl( metronidazole-antiprotozoan.
> Carconogenic drugs so don t give at 1st trimester
> No alcohol- has antibuse effect
> Vaginal douche-IQ H2O: 1 Tbsp white vinegar
B. Monoliliasis or candidiasis due to candida albicans, fungal infection.
Signs and symptoms:
> Color- white cheese like patches adheres to wall of vagina.
Management:
> Antifungal- Nistatin, genshan violet, cotrimaxole, canesten
c. gonorrhea-Thick purulent discharges
d. Vagina warts- condifoma acuminata due to papilloma virus
Management: cauterization
1. Abdominal changes- striae gravidarum
Management:
> avoid scratching
> Use coconut oil
2.Breast changes- increase hormones, color of areola and nipples
> 3rd trimister- colostrum
Breast self exam- 7 days after mens
> Supine with pillow on back
> Quadrant-upper outer quadrant- common site of breast cancer
Test to determined breast cancer:
1. mammography- 35 to 49 yrs. Once every 1 to 2 years
50 yrs and above- 1 x a yr
Signs and symptoms of pregnancy:
a. Presumptive- signs and symptoms felt by the mother- subjective
Example:
> breast changes
> Urinary frequency
> Fatigue
> Morning sickness
> Chloasma
> Linea negra
> quickening
b. probable- signs observed by the examiner- Objectives
Example:
> Goodels
> Chadwicks
> Hegar
> Ballotment
> Elevated BBT
> Braxton hicks contraction
3. Positive: undeniable signs confirmed by the used of instrument
Example:
> ultrasound
> Fetal heart tone
> fetal movement
> Fetal part palpable
Pre- natal visit
1. Frequency of visit:
> 1st 7 months- 1x a month
> 8-9 months- 2 x a month
> 10- once a week
Important estimates:
1. Nageles Rule- use to determine expected date of delivery
> Get LMP= month -3+ date 7+ year 1 April- December
> LMP- Jan Feb March
+9 months + 7 date no year
2.Mc Donald Rule- used to calculate AOG
> Fundic height(cm) x 2/7= AOG in lunar months
> Fundic height(cm)x 8/7=AOG in weeks
3. Bartholomew's rule- to determine age of gestation by proper location of fundu
s at abdominal cavity
12 weeks- level of umbilicus
16 weeks- half way between umbilicus and symphysis
20 weeks- level of umbilicus
24 weeks- 2 fingers above umbilicus
Danger signs of pregnancy:
C- chills/fever- infection
cerebral disturbances( head ache- pre eclampsia)
A- abdominal pain( epigastric pain- aura of impending convulsion)
B- board like abdomen- abruptio placenta
B- blurred vision- preeclampsia
B- bleeding
> 1st trimister- abortion/ ectopic pregnancy
> 2nd trimester- H-mole, incompetent cervix
> 3rd trimester- placental anomalies
S- sudden gush of fluid- PROM( premature rupture of membrane) prone to infection
E- edema to upper extremities( preeclampsia)
Sexual desire:
a. 1st tri- decrease desire
b. 2nd tri- increased desire due to increases estrogen that enhances lubrication
c. 3rd tri- decrease desire
Best position: side lying or woman on top
Exercise
To strengthen muscles used during delivery process
> walking- best exercise
> Squatting- strengthen muscles of the perineum
> Tailor setting- Indian set
> Raise buttock 1st before head to prevent hypotension
> Shoulder circling- strengthen chest muscles
> Pelvic rocking- relieve low back pain and maintain good posture
> Kegels exercises- strengthen pulboccygeal muscles
Psychophysical
1. Bradley method- advocate active participation of husband in delivery process
2. Grantly Dick read method- fear leads to tension while tension leads to pain
> Classes include information as well as practice in relaxation and abdominal br
eathing techniques
3. Lamaze method- psycho prophylactic method
> Classes teach replacement of usual response to pain with new learned responses
( breathing, relaxation) in order to block recognition of pain and promote posit
ive sense of control
The 4 Ps in labor
1. Passenger- is the largest presenting part
Molding- the overlapping of the sutures of the skull to permit the passage way o
f the head to the pelvis
Fontanels:
> Anterior fontanels- diamond shape- 12 to 18 months after birth closed
> Posterior fontanels- triangular shape closes- 2- 3 months
Cord prolapsed- a complication when the umbilical cord falls or it washed throug
h the cervix into the vagina
Nursing management:
1. Cover cord with sterile gauze with saline to prevent drying and avoid from c
ord compression causing cerebral palsy
2. Slip cord away from the presenting part
3. Positioning: trendelenburg or knee chest position
Hemorrhagic disorder
1st trimester bleeding- abortion or ectopic
A. Abortion- termination of pregnancy before age of viability before 20 weeks
Causes:
> chromosomal alteration
> Blighted ovum
> Plasma germ cell
Classification:
1. threatened- pregnancy is jeopardized by bleeding and cramping but the cervix
is closed
2. Inevitable- moderate bleeding, cramping, tissue protrude from the cervix( cer
vical dilation)
Types:
a. complete- all products of conception are expelled. No management just emotion
al support
b. Incomplete- placenta and membranes retained: management D and C
3. habitual- 3 or more consecutive pregnancies result in abortion usually relate
d to incompetent cervix
4. Missed abortion- fetus died; product of conceptus remained in the uterus.
Management:
> Induced labor with oxytocin or vacuum extraction
Induced abortion- therapeutic abortion to save life of the pt. double effect cho
se lesser evil
Ectopic pregnacy:
occures when gestation is located outside the uterine cavity.
Common site: ampula or tubal
Dangerous site; interstitial
1. Unruptured ectopic:
> Missed period
> Abdominal pain within 3-5 weeks of missed period
> Scant, dark brown vaginal bleeding
Nursing care:
> V/S
> Administer IVF
> Monitor for vaginal bleeding
> Monitor I and O
2. Ruptured ectopic:
> sudden sharp, severe pain. Unilateral radiating to shoulder
> Shoulder pain indicatives of intraperitoneal bleeding that extends to diaphrag
m and phrenic nerve)
> Cullen signs- signs of intraperitoneal bleeding
> fainting
Management:
Surgery depending on site
Second trimester bleeding
Hydatidiform mole- bunch or grapes or gesta.tional tropoblastic disease.
> complete mole- sperm fertilizes empty egg
> Partial molar- 1 egg and 2 sperm 69 chromosomes
Management: methotrexate to prevent chariocarcinoma
Assessment early signs:
> vesicles passed thru the vagina
> Hyperemesis gravidarum
> Fundic height
> Vaginal bleeding
Late sign:
> Hypertension before 20 weeks
> Vesicles look like a snowstorm on sonogram
> Anemia
> Abdominal cramping
Nursing care:
> D and C
> teachings, return for pelvic exam as scheduled monitor HCG to assess charioca
rcinoma
> Avoid pregnancy for atleast 1 year
Third trimester
Placenta previa- it occurs when the placenta is improprely implanted in the lowe
r uterine segment, sometimes covering the cervical os. Abnormal lower implantati
on of the placenta
Candidates for CS
Signs:
> Bright red
> Painless bleeding
Diagnosis: Ultrasound
avoid:
> sex
> IE
> Enema
Double set up delivery
Surgeon in charged of signing of consent
Nurse as a witness
MD explain to the patient
Nursing care:
> NPO
> Bed rest
> Administer IV
B. Abruptio placenta- it is the premature separation of the placenta from the im
plantation. It usually occurs after the 20th weeks of pregnancy.
Signs:
> Dark red, painful bleeding, board like rigid uterus
Complication:
> sudden fetal blood loss
Nursing care:
> infuse IV
> Prepare to administer blood
> Monitor FHT
> Measure blood loss
> Monitor V/S
Thank you!!!