Obstetrics Perfusion Issues Student-3
description
Transcript of Obstetrics Perfusion Issues Student-3
![Page 1: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/1.jpg)
Obstetrics Perfusion IssuesF. Thomas, PhD, RN
![Page 2: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/2.jpg)
Placenta Previa
• Implantation of the placenta I the lower uterus
![Page 3: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/3.jpg)
Classifications
• Marginal• Partial• Total
![Page 4: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/4.jpg)
In what group is previa more common!
![Page 5: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/5.jpg)
Classic Sign
![Page 6: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/6.jpg)
![Page 7: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/7.jpg)
Collaborative Management
• 1. Evaluate the amount of hemorrhage• 2. Electronic fetal monitoring to evaluate fetus• 3. Fetal gestational age
![Page 8: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/8.jpg)
• Conservative management if• Mother’s CV status is stable• Fetus is immature• Reassuring pattern
![Page 9: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/9.jpg)
• What are the advantages to delaying birth?
![Page 10: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/10.jpg)
Home Care Considerations
• No evidence of active bleeding• Maintain bed rest at home• Home location is reasonable distance form hospital• Woman and family can verbalize understanding of risks
![Page 11: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/11.jpg)
Inpatient Care
• Assessment of bleeding• Signs of preterm labor• Periodic electronic fetal mentoring
![Page 12: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/12.jpg)
Excessive Bleeding
• Delivery of fetus• How??
![Page 13: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/13.jpg)
Abruption
• Separation of the Placenta before delivery
![Page 14: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/14.jpg)
Causes
• Cocaine Use• Maternal HTN• Cigarette smoking• Short umbilical cord• Trauma• PROM• History of previous separation
![Page 15: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/15.jpg)
Manifestations
• Bleeding Types• Uterine tenderness• Uterine irritability• Low back or abd. Pain• High uterine resting tone• Other
![Page 16: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/16.jpg)
Major Concerns
• Woman feels powerless and frightened• Fetal hypoxia
![Page 17: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/17.jpg)
Assessment
• Nature of bleeding• Pain• Maternal and fetal vital signs• Condition of fetus• Contractions• Obstetric history• Length of gestation• Lab data• Ultrsasound
![Page 18: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/18.jpg)
Management
• Emergency: need to go to ER and admitted• Focus on CV status of Mother and condition of fetus• Mild condition• Delivery
![Page 19: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/19.jpg)
Interventions
• Monitor for hypovolemic shock• Monitor fetus• Promote tissue oxygenation• Collaborate with health care provider for fluid replacement• Prepare woman for surgery• Emotional support
![Page 20: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/20.jpg)
Critical to remember!
![Page 21: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/21.jpg)
Ectopic Pregnancy
• Called disaster of reproduction
![Page 22: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/22.jpg)
Causes
• Scarring from pelvic infections• Failed tubal ligation• History of previous ectopic pregnancy• Assisted reproduction• IUDs• 40% of EP occur with no identified risk• Delayed or premature ovulation
![Page 23: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/23.jpg)
Manifestations
• Classic• Subtle• Rupture
![Page 24: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/24.jpg)
Diagnosis
• Transvaginal Ultrasound• Beta-hCG is at low levels than expected• Gestational sac cannot be seen• Maternal serum progesterone levels• High resolution transvaginal US • Laproscopy
![Page 25: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/25.jpg)
Management
• Goal• Improve future fertility and preserve the tube
• Medical• If tube is unruptured• Use Methotrexate inhibits cell division
• Surgical• Unruptured involves a linear incision (salphingostomy)• Ruptured requires salpingectomy
![Page 26: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/26.jpg)
Nursing
• Prevention or early identification of hypovolemic shock• Monitor for S/S of rupture• Pelvic and shoulder pain**• Neck pain• Dizziness• Vag bleeding
• Analgesics• Teach SE of Methrotrexate• Emotional support
![Page 27: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/27.jpg)
Hemorrhagic Conditions of Late Pregnancy• Assessment Data
![Page 28: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/28.jpg)
Planning
Monitor for S/S of hypovolemic shock
![Page 29: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/29.jpg)
Interventions
• Monitor for S/S for shock: You know these already!!• Fetal monitoring• Promote tissue Oxygenation• Collaborate with practitioner to replace volume• Prepare for surgery• Emotional Support
![Page 30: Obstetrics Perfusion Issues Student-3](https://reader035.fdocuments.in/reader035/viewer/2022062423/55cf8ede550346703b96748d/html5/thumbnails/30.jpg)
• Evaluation