1. PREECLAMPSIA (Toxemia)
- Increased blood pressure and proteinuria
- Usually begins after 20 weeks of pregnancy in
women whose blood pressure had been normal
- Normal Urine output 2000cc
Causes:
- Multiple pregnancies 5 or more
- Overproduction of amniotic fluid
- Underlying disease
Symptoms
1. Preeclampsia with Severe Features
- Proteinuria (increased protein in urine)
- Weight gain
- Mild edema in upper extremities or face
- BP is 140/90 mmHg
Management:
- Bed rest
- Good nutrition (less sodium)
- Emotional Support
- Antiplatelet Therapy (low dose of aspirin)
2. Preeclampsia without Severe Features
- BP is 160/110 mmHg
- Increased protein in the urine (3+ 4+)
- Oliguria (500ml or less in 24 hrs)
- Cerebral or Visual disturbances
- Pulmonary or cardiac involvement,
extensive peripheral edema
- Hepatic dysfunction, thrombocytopenia
- Epigastric pain, nausea, or vomiting
Management
- Bedrest (w/o bathroom)
- Monitor fetal well-being (check bp every 4hrs)
- Diet (high protein, moderate sodium)
Medication to prevent Eclampsia:
- Magnesium Sulfate IV
- Hydralazine (Apresoline) IV
- Diazepam (Valium) IV (lessen stress and anxiety)
- Calcium Gluconate IV (antidote for magnesium
sulfate intoxication)
If left untreated, it may progress to eclampsia that
may lead to maternal and fetal death.
MYOMA/ Uterine Fibroids
- Most common benign tumors in the reproductive
organ.
- Undetectable by the human eye
- Noncancerous growth that develops around the
womb
3 types of myoma
1. Intramural
- Grow within the muscular uterine walls.
2. Submucosal
- Can block or distort the fallopian tube which
makes it difficult for sperm to enter
3. Subserosal
- Most common type of fibroid
- Severe pain and anemia
Risk factors
- Older woman (a woman grows, reproductive
organs change; overproduction of estrogen,
menopausal)
- Obesity
- No history of pregnancy
- Race (due to stress)
- Heredity and Genetic factors
- Vitamin D deficiency
- Birth control
- Alcohol and Diet low in fruits and vegetables
Symptoms:
- Heavy menstrual bleeding
- Menstrual periods lasting more than a week
- Pelvic pressure (as fibroids grow larger, it presses
the pelvic organ)
- Frequent and Difficulty Urination and (As fibroids
grow larger, It compresses bladder)
- Constipation
- Backache or leg pains
Diagnostic Test:
1. Pelvic exam (for physician to feel the size)
2. MRI (Magnetic Resonance Images)
3. Transvaginal Ultrasonography (to see the
size of fibroid)
Medical Management:
1. Non-steroidal drugs, Anti-inflammatory
Drugs (NSAIDs)
- reduce the pain sensation as well as
minimize the blood loss
2. Tranexamic acid
- suffering from excessive blood loss
Surgical Management:
1. Oophorectomy (Surgical removal of both
ovaries)
2. Myomectomy (surgical removal of fibroids)
3. Laparoscope (Telescope to view the inside
of the reproductive organs; destroys
fibroids)
4. Hysterectomy (Removal of the uterus)
5. Vaginal hysterectomy (Removal of uterus
in Vagina; includes cervix, uterus, ovaries,
and fallopian tube)
- It is possible for single women to have
myoma since it depends on its
size.(irregular menstruation)
- If myoma has already been removed,
there’s a possibility that it will occur again
depending on one’s lifestyle.
Difference between OB and GYNE
1. OB - pregnant matter (normal or
complications)
2. GYNECOLOGY - disorders of the
reproductive system
2. VITAL SIGNS TAKING AND RECORDING
MIO- Measure Intake and Output
- Measure every 1-2 hours
ML - Unit of Vomit per kidney basin
- Ask client about the amount of stool
- Total all output
- Write your initial at the bottom part of the
TPR to be signed by CI.
Taking BP
- Hand of patient should be aligned with her heart
- Dial should be clipped on top
Medications
- Dosage of a child depends on its weight.
- Macro drop set (1ml) = 15 drops/ min
- Micro drop set (1ml) = 60 drops/ min
- IV is only good for 24 hours
- GTTS (drops per min)
- KVO (Keep Vein Open)
Solving Medication
Desired Dose
----------------------------------------------
Available Dose x Volume = Dose
IVF Calculation
Flow Rate =
Total volume of fluid (ml) x Drop factor
----------------------------------------------------
Total time of infusion (in mins)
PELVIC INFLAMMATORY DISEASE
Cause: STD/STI
- Sexually transmitted disease or infection
Risk Factors:
- STD/STI
- Multiple sexual partners
- Previous PID
- Sexually active less than 25 years of age.
- Douche
- Use of IUD
Vaginal Douche
Disrupts the vaginal wall or normal flora. If it is
distracted, microbes or bacteria will be introduced.
Symptoms of PID:
- Pain in the lower abdomen or pelvis
- Heavy vaginal discharge with an unpleasant odor
- Irregular menstrual bleeding
- Pain during intercourse (Dyspareunia)
- Low back pain
- Fever, fatigue, diarrhea, or vomiting
- Painful or difficult urination (Suria)
Diagnosis:
- Based on signs and symptoms
- Pelvic exam (Gram Staining - culture and
sensitivity)
- Pelvic laparoscopy
Complications:
- Scar formation leading to tubal blockage
- Ectopic pregnancy
- Infertility
- Long-term pelvic or abdominal pain
Treatment:
- Antibiotics
SPONTANEOUS MISCARRIAGE
- the loss of pregnancy before the fetus reaches the
age of viability 20 to 24 weeks of gestation or
weighing 500 grams or less.
Common Cause:
- Abnormal delta development
( teratogenic factor or chromosoml aberration)
- Abnormal Implantation
- Alcohol Intake
- Urinary Tract Infectiion
- Systemic infetions (rubella, syphilis, poliomylitis)
Symptomns:
- Heavy spotting
- Vaginal bleeding
- Discharge of tissue or fluid from the vagina
- Severe abdominal pain or cramping
- Mild to severe back pain
- Feeling fain ot light-headedness
Types of Sponteous Miscarriage:
1. Threatened Miscarriage
- abnromal bleeding and abdominal pain that
occurs while the pregnancy continues.
Total Bed rest
- patient is not allowed to get up from bed
Management:
- Bed rest or limited activity
- Medication that supports pregnancy.
(progesterone supplementation)
2. Imminent (Inevitable) Miscarriage
- Comes afer a threatened miscarriage.
- If uterine contractions and cervical dilation occur,
cervix opens.
- May experience more vaginal bleeding.
3. Complete Miscarriage
