Hight Risk Pregnancy Concepts

8/6/2019 Hight Risk Pregnancy Concepts

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Termination of pregnancy before 20 weeks

ABORTION


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TYPES OF ABORTIONySpontaneous

yInducedyThreatened

yHabitual

yIncomplete

yCompleteyMissed


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EtiologyEtiology

Fetal factorsFetal factors Placental factorsPlacental factors

Maternal factorsMaternal factors


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Q. Which of this is true about abortion?

A. Inevitable abortion can be saved

B. It occurs when fetus reaches age ofviability

C. Threatened abortion has no cervical

dilation

D. Complete abortion needs D and C

E. No sex during active signs of abortion

F. Bed rest is needed


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ASSESSMENT OF CLIENTS WITH ABORTION

yVaginal bleeding

yPassage of clots or tissueyCramping/contractions

yShock


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INTERVENTIONSyAssess

y

Uterus, bleeding, pads, clots, shockyBed rest and no sex

yAdminister

yIVfluids and Rhogam if necesary

yAssisst with D&C


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Q. A pregnant mother will receive Rhogam,if:

A. Rh negative mother, Rh positive fetus, +Coombs testB. Rh postive mother, Rh positive fetus, -

Coombs test

C. Rh negative mother, Rh positive fetus, -Coombs testD. Rh negative mother, Rh positive fetus, -

Coombs test


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Pregnancy outside uterus

ECTOPIC PREGNANCY


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EtiologyEtiology

Problems in the fallopian tubesProblems in the fallopian tubesUse ofIUDUse ofIUD


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ASSESSMENT OF CLIENTS WITH ECTOPIC

PREGNANCY

yTiming of signsyAbdominal pain

yVaginal spotting

ySigns of rupture


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Diagnostic

CBC

Pregnancy test

UTZ

Culdocentesis


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INTERVENTIONSyAssess

yVS, pain, and rupture, shockyAdminister medications

yPrepare for surgery

yProvide emotional support


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Q. A client is suspected of ectopic

pregnancy. Which one supports the

diagnosis?A. 3rd trimester pregnancy

B. Dark vaginal bleeding

C. Painless vaginal bleeding

D. Sudden/sharp upper abdominal pain

E. Spotting in before 20 weeks

F. Signs and symptoms of shock

G.Blood aspirated on the pelvis (cul-de

sac)


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Thropoblastic proliferation of grapelike vesicles

HYDATIDIFORM MOLE


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Diagnostic

HCG

UTZ


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ASSESSMENT OF CLIENTS WITH H-MOLE

yOnset of signs

yNo growing fetus

yVaginal bleeding

yIncreased fundal height

y


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Q. Which one does not support

the diagnosis ofH-mole?

A. Severe edema of face and hands

B.Abnormal fundal height

C.Absent FH tone

D.Elevate HCG

E. Sudden pain in the lowerabdomen

F. UTZ no fetus


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INTERVENTONSyAssist with uterine evacuation

yTissues for analysis

yMonitor for complications

yMonitor HCG levels

yNo pregnancy for 1 year


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Q. A client with H-mole is for

discharge. Which one is

emphasized on teaching?

A. Use contraception for 1 year

B. Monitor HCG for 6 months until

normal C.Report fever or sore throat

when on methotrexate

D. Supplement methotrexate with

folic acid for prevention and

treatment of choriocarcinoma


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Premature dilation of cervix

INCOMPETENTCERVIX


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Etiology

History of traumatic birth

Anatomical anomaly


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ASSESSMENT OF CLIENTS WITH

INCOMPETENT CERVIX

yCommon 20th

weekyVaginal bleeding

yFetal membranes visible throughthe cervix


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INTERVENTIONSyBed rest and tocolytic agents

yPrepare for cervical cerclage

yReport these after cerclage

ybleeding and contractions

yInfection and bag of water


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Low implantation of placenta

PLACENTAPREVIA


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EtiologyEtiology

Maternal factorsMaternal factors

History of placenta previaHistory of placenta previa


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TYPES OF PLACENTA PREEVIA

y

Total placenta previayPartial placenta previa

yMarginal placenta previa

yLow-lying placenta previa


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Diagnostic

UTZ


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yQ. Partial placenta previa is:

yLow lying placenta

yPlacenta covers some of the vcervical os

yEntire placenta covers the cervical os

yPlacenta covers the cervical os duringdilatation

yPregnancy outside the uterus


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ASSESSMENT OF CLIENTS WITH PLACENTA

PREVIA

yVaginal bleedingyUterus is soft, relax and non-tender


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INTERVENTIONSyMonitorVS and FHT

yBed rest

yPrepare UTZ

yNo IE

yMonitor bleeding

yCS for heavy bleeding

yRhogam is needed


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yQ. Care for a client with placenta previainclude:

yA. IE to measure cervix dialtion

yB. Complete bed rest lying on back

yC. Double set up during internal exam

yD. Monitoring for shock

yE. UTZ to confirm diagnosis

yF. Weight saturated pads


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PREMATURE SEPARATION OF THEPLACENTA

ABRUPTIO PLACENTAE


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EtiologyEtiology

Anatomical anomalyAnatomical anomaly

Underlying disease conditionUnderlying disease condition

Previous CSPrevious CS

Trauma to the abdomenTrauma to the abdomen


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ASSESSMENT OF CLIENTS WITH ABRUPTIO

PLACENTAE

yVaginal bleeding

yUterine rigidity and tenderness

ySevere abdominal pain

yFetal distress

ySigns of complication


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INTERVENTIONSyMonitor

yVS, bleeding, uterus, fundus, pads

yBed rest

yAdminister O2, IVF, BT

yEmergency delivery of the fetus

yRhogam is needed

yProvide emotional support


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yAssessment technique to determineblood loss on a client with abruptio

placentae include the following except:yA. Measure fundal height

yB. Measure abdominal girth

yC. Check VS and Hgb and Hct

yD. Monitor for saturated pads


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ACUTE HYPERTENSIVE STATE THATDEVELOPS AFTER THE 20TH WEEK OF

GESTATION

PREGNANY-INDUCED HYPERTENSION


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EtiologyEtiology

Risk factorsRisk factors

Genetic

Genetic

PrimigravidaPrimigravida

AgeAge

Underlying disease/conditionUnderlying disease/condition


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Diagnostic

UA

CBC

Renal Function

Liver Function

Roll over test


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PREGNANCY-INDUCED HYPERTENSION (PIH)

yMILD

ySEVERE

yClassic signs of PIH

yProteinuriayEdema

yHypertension


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ASSESSMENTMILD SEVERE

yP

yE

yH

yP

yE

yH


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Q. Mild PIH is: SATAQ. Mild PIH is: SATA

A.A.BP of at least 160/110BP of at least 160/110B.B.ProteinuriaProteinuria is more than 5 g/dl in 24is more than 5 g/dl in 24hour urine collectionhour urine collection

C.C.Having increased liver enzymes andHaving increased liver enzymes and

seizuresseizuresD.D.Presence of HELLPPresence of HELLP

E.E.Systole increases to 30, and diastole toSystole increases to 30, and diastole to

1515F.F.SevereSevere epigastricepigastric painpain

G.G.BP 140/90BP 140/90


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Warning signs of Worsening PIH

yWorsening PEH

y Increasing weight gain

yCerebral signs

yRenal signs

yGI signs

yHELLP syndrome


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INTERVENTIONS FOR MILD AND

SEVERE PIHyAssessVS, CNS, edema and weight

yBed rest and limit stimulation

yProvide safety

yModify diet

yAdminister medications


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Q. Before Mg SO4 administration, the

nurse checks:

A.Respiration

B.Uterine contractions

C.Visual acuityD.Platelet count


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Premature rupture ofPremature rupture of

membrane (PROM)membrane (PROM)Rupture of amniotic sac beforeRupture of amniotic sac before

onset of laboronset of labor


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PROM

Diagnostic

Ferning test

Nitrazine test


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InterventionsInterventions

Confirm ruptureConfirm rupture

AssessAssess

Fetal and maternal statusFetal and maternal status

Maintain on bed rest if fetal head isMaintain on bed rest if fetal head is

not engagednot engaged Position if with cordPosition if with cord prolapseprolapse

NSD is possibleNSD is possible


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AssessmentAssessment

Signs of true labor between 20S

igns of true labor between 20weeks to 37 weeks gestationweeks to 37 weeks gestation


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AssessAssess

VS, bleeding, contractions andVS, bleeding, contractions andFHTFHT

Bed restBed rest

Diagnostic proceduresDiagnostic proceduresUTZ and amniocentesisUTZ and amniocentesis

MedicationsMedications


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Cord ProlapseCord ProlapseDescent of the cord that myDescent of the cord that my

stop placental and fetalstop placental and fetalperfusionperfusion


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EtiologyEtiology

Preterm laborPreterm labor

Rupture of membraneRupture of membrane


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Feeling the cord within the vaginaFeeling the cord within the vagina

Cord seen or felt on IECord seen or felt on IE

Cord prolapsed maybe occultCord prolapsed maybe occult

DecelerationDeceleration


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Identify prolapsed cord and provideIdentify prolapsed cord and provide

immediate interventionimmediate intervention

Assess FHR, especially right after theAssess FHR, especially right after therupture of membrane and again in 5rupture of membrane and again in 5--1010

minutesminutes

If cord prolapse is identified, prepare forIf cord prolapse is identified, prepare forCS deliveryCS delivery


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If client is fully dilated, NSD isIf client is fully dilated, NSD is

possible:possible:

Proper positioningProper positioning

OxygenationOxygenation

Relieve pressure form the cordRelieve pressure form the cord

Prevent drying of the cordPrevent drying of the cord


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Dysfunctional LaborDysfunctional LaborDifficult, painful, prolonged laborDifficult, painful, prolonged labor

due to mechanical factorsdue to mechanical factors


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EtiologyyFetal factors

yUterine factorsyPelvic factors

yPsyche factors


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Assessment

yIrregular uterine contractionsyIneffective uterine contractions


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Uterine RuptureUterine RuptureComplete or incomplete tearing ofComplete or incomplete tearing of

uterine walluterine wall


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EtiologyEtiology

Obstetric interventionsObstetric interventions

Grand

Grand multiparitymultiparity

Fetal factorsFetal factors


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Abdominal painAbdominal pain

Fetal parts under the skinFetal parts under the skin Fetal distressFetal distress

Signs of shockSigns of shock


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Assess forAssess for

UterusUterus

Prepare forCS and surgeryPrepare forCS and surgery

Prevent and treat shockPrevent and treat shock


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END

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Hight Risk Pregnancy Concepts

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