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The Antepartal Period


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The Antepartal Period

  1. 1. THE ANTEPARTAL PERIOD<br />BY:<br />Zosi Farah w. Fernandez, RN<br />
  2. 2. Anatomy and Physiology<br />Uterus<br /><ul><li>Serves as an organ of implantation for the fertilized ovum that becomes the fetus
  3. 3. Responsible for expulsion of the fetus during childbirth from the strong muscle contractions as well as menstruation
  4. 4. Fundal height </li></ul> a. At the level of the sypmphysis at 12-14 weeks<br /> b. Rises at 1 cm/week until 36 weeks of gestation<br /> c. At the level of umbilicus at 20 weeks<br />
  5. 5. b. Cervix<br /><ul><li>Goodell’s Sign
  6. 6. Chadwick’s sign</li></ul>c. Vagina<br /><ul><li>Slight acidic pH (4-5) to decrease risk of infections
  7. 7. Functions include out passage for menstrual flow from the endometrium of the uterus, the female organ for intercourse, and a passageway for vaginal childbirth
  8. 8. During pregnancy the mucosa of the vagina may have a bluish violet color, has increased vascularity, and increase vaginal mucus discharge</li></ul>d. External structure<br /><ul><li>External genitals organs, or vulva, include all the structure found externally between the pubis and the perineum
  9. 9. Structures include the mons pubis, labia majora, labia minora, prepuce, frenulum, fourchette, clitoris and vestibule</li></ul>e. Ovaries<br />Photograph of the vulva. 1. Pubic hair (shaved), 2.Clitoral hood, 3. Clitoris, 4. Labia majora, 5. Labia minora (enclosing the Vaginal Opening), 6. Perineum.<br />
  10. 10. e. Placenta<br /><ul><li>Chorionic villi form and invade the lining of the uterus where endometrial arteries fill with blood.
  11. 11. Earliest function is as an endocrine gland to excrete:</li></ul> a. hCG<br /> b. hPL<br /><ul><li>Metabolic function of placenta:</li></ul> a. Respiration<br /> b. Nutrition<br /> c. Excretion<br /><ul><li>Fetal blood cells can leak into maternal circulation from occasional breaks in the placenta membrane and the mother may develop antibodies to the fetal blood cells.
  12. 12. Interference with the circulation to the placenta, such as maternal vasoconstriction from hypertension or cocaine or decreased maternal blood pressure or decreased maternal cardiac output, impedes the blood supply to the fetus.</li></li></ul><li>g. Membrane<br />h. Umbilical cord<br /><ul><li>Two arteries
  13. 13. One vein
  14. 14. Wharton’s jelly
  15. 15. Usually located centrally as the placenta develops from the chorionic villi</li></ul>Amniotic fluid<br /><ul><li>Functions include fetal lung development, protection of the cord, and allows for normal limb development and development of GI and renal System</li></ul>j. Cardiovascular System<br /><ul><li>Vena caval syndrome
  16. 16. Blood volume increases 30-50% during pregnancy</li></ul>k. Gastrointestinal system<br />- Constipation and gastroesophageal reflux<br />
  17. 17. l. Urinary System<br /><ul><li>Similar relaxation of the urinary tract places the pregnant client at risk for UTI or pyelonephritis from bacteria ascending from perineum</li></ul>m. Endocrine system<br />Pancreas<br />Thyroid<br />Pituitary<br />n. Respiratory system<br /><ul><li>Increased BMR requires more oxygen for the pregnant body
  18. 18. Tidal volume and minute ventilation increase until the third trimester when the large uterus may impede lung expansion
  19. 19. CO2 output increases, resulting in slight respiratory alkalosis</li></li></ul><li>o. Hematologic system<br /><ul><li>RBC increased by one-third
  20. 20. Plasma volume increase is greater, resulting in physiologic anemia of pregnancy
  21. 21. Clotting factors increase in pregnancy, which increase the client’s risk for blood clots</li></ul>p. Breast<br />q. Skin<br /><ul><li>Increased pigmentation
  22. 22. Chloasma
  23. 23. Linea nigra
  24. 24. Striaegravidarum</li></li></ul><li>Chloasma<br />Linea nigra<br />
  25. 25. Striaegravidarum<br />
  26. 26. r. Fetal development<br />Fertilization<br />Implantation<br />Placental development<br />Developmental landmarks<br /> a. Fetal heart tones<br /> b. Quickening<br />5. Infants at genetic risk of abnormalities<br />a. African American: sickle cell disease<br />b. Jewish ethnicity of Northern European descent: Tay-sachs disease<br />c. Mediterranean: Thalassemia<br />d. Family history of hereditary condition such as cystiic fibrosis or cleft lip palate<br />e. Born to a woman of advanced maternal age<br />f. Parents are closely related blood relatives<br />
  27. 27. 6. Chromosomal abnormalities<br />a. Types of transmission to the fetus:<br />1. Autosomal dominant<br />2. Autosomal recessive<br />3. Sex-linked transmission<br />b. Down syndrome<br /><ul><li>Risk increases in women over 35 years old and continues to increases with each year of age
  28. 28. Characteristics:</li></ul> Low-set ears, large fat pads at the nape of a short neck, protruding tongue, small mouth and high palate, epicanthal folds and slanted eyes, small rounded head with flattened occiput, hypotonic muscle with hypermonility of joints, simian crease across the palm of hand and mental retardation<br />
  29. 29. c. Turner’s syndrome<br />Characteristics:<br /><ul><li>Usually infertile
  30. 30. Small stature
  31. 31. Cognitive functions unimpaired</li></li></ul><li>d. Klinefelter’s syndrome<br />Characteristics:<br /> * usually infetrille<br /> * cognitive functions vary from unimpaired to mild mental retardation<br />
  32. 32. e. Inborn errors of metabolism<br />Phenylketonuria (PKU)<br />Tay-sachs disease<br />Cystic fibrosis<br />Congenital adrenal hyperplasia<br />Congenital hypothyroidism<br />
  33. 33. Assessment<br />Prenatal care<br />Assessment of positive pregnancy<br />
  34. 34. 2. Naegele’s rule<br /><ul><li>To determine the estimated date of confinement or estimated date of delivery, count back 3 months from the first day of the last menstrual cycle and then add1 year and 7 days</li></ul>3. Obstetrical classification<br />Grvida<br />Para or parity<br />G-T-P-A-L<br />4. Frequency and elements of maternal and fetal assessment<br />Initial visit<br />a.1 Intake assessment<br />a.2 Lab evaluation<br />a.3 Client education<br />b. Period specific evaluation in pregnancy<br />b.1 Every 4 weeks until 28 weeks AOG<br />b.2 5-20 weeks of gestation:<br />Maternal alpha-feto protein, begin preterm birth prevention education and review warning signs<br />b.3 20-24 weeks of gestation:<br />Preterm prevention education<br />
  35. 35. b.4 24-28 weeks of gestation:<br />1 hour glucose tolerance test, cervical exam, begin education and treatment if diabetic, and review preterm birth prevention and warning signs<br />b.5 every 2 weeks from 28 to 36 weeks of gestation<br />b.6 28-36 weeks of gestation:<br />CBC, blood group antibody screen if Rh negative, give Rh immune globulin; cervical examination, follow up with a dietician if diabetic, breast assessment and education preparation for breastfeeding, review of warning sign, and begin parenting class<br />b.7 35-37 weeks of gestation:<br />Vaginal and rectal group B beta strep culture<br />b.8 weekly visits from 36 weeks of gestation until delivery<br />b.9 36-40 weeks of gestation:<br />CBC, repeat gonorrhea, chlamydia, RPR,HIV, hepatitis B screen if indicated, educate about sign of labor and begin childbirth preparation<br />
  36. 36. Assessment of psychosocial aspect of pregnancy<br />Economic status<br />Marital status<br />Age<br />Perceived support<br />Self-esteem<br />Culture<br />Religion and importance of faith beliefs<br />Stability of living condition<br />Assess mood<br /> i.1 ambivalence<br /> i.2 Increased sensitivity and irritability<br /> i.3 sense of vulnerability<br /> i.4 fear<br />
  37. 37. j. Assess developmental task of pregnancy<br /> 1. Pregnancy validation<br /> 2. Fetal embodiment<br /> 3. Fetal distinction<br /> 4. role transition<br />
  38. 38. B. Assessment of High-Risk Pregnancy<br />Health history<br />Social history<br />Problems with pregnancy<br />Physical exam<br />Inspection<br />Auscultation<br />Palpitation<br />Vital signs<br />
  39. 39. Diagnostic Studies<br />a. Sterile Speculum Exam<br /><ul><li>Indicated for suspected ruptured membranes
  40. 40. Amniotic fluid will turn Nitrazine paper blue because of the alkaline pH
  41. 41. Free flow of fluid may be seen coming through the cervix when the clients is asked to cough or perform a valsalva maneuver</li></ul>Preprocedure:<br />Client is assisted into the lithotomy position<br />Gather supplies<br />
  42. 42. b. Urinalysis with reagent strips<br /><ul><li>Urine is tested with a reagent strip to test for the presence of components in the urine such as WBC, blood, protein, bilirubin, leukocytes, ketones, glucose, specific gravity, pH, urobilinogen and nitrite.</li></ul>Preprocedure<br />Instruct the client not to discard urine<br />Postprocedure<br />Compare the result with the legend on the side of the bottle to determine normal or abnormal findings<br />Discard the urine and record the result<br />c. 24 hour Urine<br /><ul><li>The clients total urine output for 24 hours is collected and analyzed for amount, specific gravity, pH, presence and amount of protein and creatinine clearance.</li></ul>Preprocedure<br />Instruct the client not to discard any urine for 24 hours<br />Obtain specimen on ice for the duration of the test<br />Have the client empty the bladder and record the start time<br />Post sign in the bathroom to remind the client, family, and all staff that the test is in progress<br />
  43. 43. Postprocedure:<br />Send the entire specimen to the lab<br />Record the end time<br />d. Urinalysis and culture<br /><ul><li>They are useful in determining the presence of a UTI, which during pregnancy can result in preterm labor</li></ul>Preprocedure<br />Obtain the specimen as ordered<br />Lable the specimen and send it to the lab<br />e. Laboratory Serum Evaluation<br />CBC<br />Metabolic panel<br />Liver proofile<br />D-dimer and fibrinogen<br />Kleinhauer-Betke<br />C-reactive protein (CRP)<br />Beta hCG<br />Maternal serum alpha-fetoprotein (AFP or MS-AFP)<br />OB panel<br />TORCH<br />
  44. 44. f. Fetal Fibronectin<br /><ul><li>A protein found in amniotic fluid, the placental tissue itself and following injury to membranes-either mechanical or inflammatory
  45. 45. Used to gauge the risk of preterm birth for client hospitalized with PTL</li></ul>Preprocedure:<br />1. Assist the client in assuming the lithotomy position <br />2. Gather the equipments<br />g. Oral glucose tolerance test (OGTT or GTT)<br /><ul><li>Blood glucose greater than or equal to 140 indicates an abnormal screen, and the 3 hour GTT is indicated
  46. 46. 3-hour GTT: 100 grams of glucose is given to the client to drink in a liquid form in 5 minutes; fasting is now required for 12 hours before the test as well as for 3 hours after, serum glucose levels are evaluated at 1,2, and 3 hours after drinking the glucose solution</li></ul>Preprocedure:<br />Obtain the glucose solution and arrange for the blood draw on schedule<br />
  47. 47. h. Daily Fetal Movement count<br /><ul><li>Advised to do daily or twice daily in high-risk client
  48. 48. Counting 10 movements in 1hour is reassuring kick count</li></ul>i. Electronic fetal monitoring (EFM)<br />j. Ultrasound<br /><ul><li>Ultrasound scanning can be either transvaginally or transabdominally
  49. 49. Indication for antepartum care include estimation of fetal age, fetal weight and fetal presentation, placenta position and integrity, or a follow-up of fetal anomalies or well being</li></li></ul><li>k. Biophysical Profile (BPP)<br />
  50. 50. l. Umbilical artery dopplerVelocimerty<br /><ul><li>Noninvasive test is done via ultrasound, examining the umbilical artery
  51. 51. Test is done when placenta/fetal perfusion compromise is suspected</li></ul>m. Amniocentesis<br /><ul><li>Amniotic fluid is then removed for the following indicators:</li></ul> *genetic screening<br /> * diagnostic for isoimmunization<br /> *follow-up after an abnormal ultrasound<br /> * to evaluate fetal lung maturity<br /> * to evaluate for subclinical infection<br /> * or to aspirate amniotic fluid to reduce volume<br />Preprocedure<br />Written consent discussion must take place between the client and the physician<br />Educate the client about the procedure<br />Postprocedure<br />EFM for minimum of 30 minutes<br />Give Rh immune globulin for women who are Rh negative<br />
  52. 52. n. Group B Beta Streptococcus (GSBBS) Culture <br /><ul><li>Universal screening at 35-37 weeks of gestation
  53. 53. Indicated for clients hospitalized preterm with high-risk pregnancy condition</li></li></ul><li>Nursing Diagnosis<br />Deficient Knowledge<br />Acute pain<br />Risk for constipation<br />Disturbed body image<br />Ineffective coping<br />Risk for deficient fluid volume<br />Noncompliance<br />Anxiety<br />Imbalanced nutrition: less than body requirements<br />
  54. 54. Normal pregnancy<br />40 lunar weeks gestation<br />Term pregnancy is from the beginning of the 38th weeks until the completion of 42 weeks.<br /> Normal concerns of pregnancy<br />Nausea and vomiting<br />Breast tenderness<br />Urinary frequency<br />Constipation and hemorrhoids<br />Light headedness or dizziness<br />Leg cramps<br />Fatigue<br />Heartburn<br />Backaches<br />Emotional reactions<br />Sexuality and intimacy<br />
  55. 55. High Risk Pregnancy Condition<br />I. Preterm labor<br /><ul><li>Progressive dilatation or effacement of the cervix with uterine contraction or cervical dilatation greater than or equal to 2 cm or cervical effacement of greater than 80% between 20 and 37 weeks of gestation with intact membranes.
  56. 56. Risk factors for PTL:
  57. 57. African-American race
  58. 58. Young or advanced maternal age
  59. 59. Low socioeconomic status
  60. 60. History of previous PTB
  61. 61. Multiple pregnancy losses or abortion
  62. 62. Uterine or cervical anomalies
  63. 63. Infection
  64. 64. Incompetent cervix
  65. 65. Bleeding during pregnancy
  66. 66. Multiple pregnancy
  67. 67. PROM
  68. 68. Smoking or substance abuse </li></li></ul><li><ul><li>Assessment</li></ul>a. Careful history<br />b. Uterine contractions<br />c. Feeling that the baby is balling up and relaxing<br />d. Rhythmic backpain, thigh pain and change in vaginal mucus<br /><ul><li>Diagnostic test</li></ul>EFM<br />Vaginal ultrasound<br />Fetal fibronectin<br /><ul><li>Medical-surgical management</li></ul>Hospitalization<br />Antenatal glucocorticoids for promotion of fetal lung maturity<br />Tocolytic therapy<br />Prophylactic IV antibiotics<br />
  69. 69. <ul><li>Nursing interventions</li></ul>Encourage hydration<br />Monitor for contractions with EFM and by hand palpation<br />Monitor maternal vital signs<br />Provide comfort measures and emotional support<br />Report the changes to the physician<br />Obtain lab specimen as ordered<br />Encourage bed rest and side-lying position<br />Prepare the client and family for possible diagnostic procedures and tests<br />Instruct the client about early clinical manifestation <br />Perform kick counts for contraction<br />Perform a digital cervical exam<br />
  70. 70. II. Incompetent cervix<br /><ul><li>May result in spontaneous abortion or preterm delivery
  71. 71. Complications include PTB, PROM and intrauterine infection or chorioamnionitis</li></ul>Assessment<br /><ul><li>Effacement and dilatation of the cervix not associated with pain or uterine contraction</li></ul>Diagnostic tests<br /><ul><li>Similar to PTL, excluding fetal fibronectin</li></ul>Medical-surgical management<br /><ul><li>Cervical cerclage</li></ul>Nursing intervention<br /><ul><li>Evaluate for contractions
  72. 72. Evaluate cervical changes through a digital rectal exam or vaginal sonogram
  73. 73. Assess lab values and clinical picture for infectious process</li></li></ul><li>III. Premature Rupture of Membrane<br />Complications include risks to the mother and risks to the fetus;<br />Risk to the mother include sepsis secondary to chorioaminionitis, postpartum endometritis, placental abruption and death<br />Risk to the fetus include umbilical cord prolapse, meconium aspiration, infection or sepsis, skeletal compression deformities, abruption, death, onset of labor/prematurity and possibly cerebral palsy secondary to chrorioamnimitis<br />Diagnostic test<br />Ultrasound<br />BPP<br />Serial lab test<br />Amniocentesis<br />
  74. 74. Medical-surgical management<br />Prophhylactic antibiotic<br />Antenatal glucocorticoids<br />Induction of labor<br />Emergency CS <br />Close observation for complication<br />Nursing intervention<br />Medicate as prescribe<br />Encourage bed rest<br />Encourage hydration<br />Monitor maternal vital sign<br />Monitor intake and output<br />Provide comfort measures and support<br />Encourage side-lying position<br />Assess for contraction<br />Palpate the abdomen and uterus for tenderness<br />Ask the client about pain<br />Monitor FHR pattern<br />
  75. 75. IV. Diabetes in Pregnancy<br /><ul><li>Oral hypoglcemia are contraindicated in pregnancy
  76. 76. Maternal complication include increased risk for the mother developing DM later in life if GDM and fetal complications include risk to pregnancy such as macrosomia, stillbirth, organ malformation,pre-eclampsia, and increased chance of operative delivery</li></ul>Diagnostic test<br />OGTT<br />Screen at first prenatal if client has any risk<br />Nursing intervention<br />Provide the client with an appropriate diet<br />Instruct the nature of disease<br />Encourage hydration<br />Encourage side-lying<br />Blood glucose reading<br />Administer insulin<br />Encourage the client to monitor fetal movement<br />Ask about risk factors<br />
  77. 77. V. Vaginal bleeding from abruptio placenta<br /><ul><li>Is premature separation of the normally implanted placenta from the uterine wall
  78. 78. Associated causes and risk include cocaine, trauma, sudden decompression of the uterine cavity as in PROM, maternal hypertension, cigarette smoking, advanced maternal age and multiparity</li></ul>Assessment<br />Severe abdominal pain <br />Painful hard abdomen<br />Fetal distress<br />Diagnostic test<br />D-dimer and fibrinogen<br />Ultrasound<br />Nursing intervention<br />Monitor vital sign<br />Assess fetal status with EFM<br />Assess the clients blood type and Rh factors, gestational age, amount of bleeding, painful or painless bleeding, and presence of other medical conditions<br />
  79. 79. d. Obtain IV access<br />e. Prepare for emergency CS<br />f. Administer IV fluids bolus or blood transfusion as ordered<br />g. Provide lab specimen<br />h. Provide emotional support to the client and family<br />Clarify question s to help differentiate between previa and abruption; labor contraction<br />j. Avoid performing a vaginal exam<br />k. Palpate the abdomen for hard, board like texture<br />l. Estimate blood loss<br />
  80. 80. VI. Vaginal bleeding from Placenta Previa<br /><ul><li>Placenta is covering or encroaching on the internal os to varying degrees</li></ul>Total placenta previa or complete previa<br />Partial placenta previa<br />Marginal placenta previa<br />Low-lying placenta<br />
  81. 81. <ul><li>Risk factors include advanced maternal age, mutiparity, African or Asian ethnic background, prior placenta previa, smoking, one or more previous CS delivery and cocaine use.</li></ul>Assessment<br /><ul><li>Sudden onset of painless vaginal bleeding </li></ul>Nursing intervention<br />Prepare the client for an emergency CS<br />Place the client on bed rest<br />Perform intermittent EFM for onset of labor and fetal well being<br />Administer antenatal steroid<br />Encourage side-lying<br />Provide the client and family education<br />Maintain IV access<br />
  82. 82. VII. Pregnancy induced hypertension<br /><ul><li>Complex disease process with physiologic effects ranging from hypertension to multiorgan failure
  83. 83. May progress into HELLP syndrome with liver involvement and platelet destruction, which life is threatening, or seizure from cerebral edema
  84. 84. Risk factors for developing PIH include first preganancy, older than 40 years old, African-american race, DM, twin pregnancy, family history of PIH, antiphospholipids antibody syndrome, and chronic hypertension or renal problem</li></ul>Assessment<br /><ul><li>Headache
  85. 85. Visual changes
  86. 86. Right upper quadrant pain
  87. 87. Epigastric pain
  88. 88. Nausea and vomiting</li></li></ul><li>Diagnostic test<br />24 hour urine <br />CBC<br />Labs <br />Ultrasound <br />Biophysical profile<br />Umbilical artery doppler studies<br />Nursing Intervention<br />Promote bed rest<br />Perform frequent assessments of maternal hemodynamics, lung sounds, urine output, reflexes, symptoms or neurologic irritability and fetal well-being<br />Encourage hydration<br />Decrease stimulus <br />Monitor blood pressure<br />Test in urine<br />Inspect for edema<br />Perform deep tendon reflex<br />Palpate for liver tenderness<br />Auscultate lung sound<br />Measure intake and output<br />Administer magnesium sulfate<br />Prepare for dexamethasone<br />Provide steroid prophylaxis<br />Inform that surgical delivery is like<br />
  89. 89. VIII. HyperemesisGravidarum<br /><ul><li>Nausea and vomiting are common in pregnancy due to hormones of pregnancy
  90. 90. Criteria for the disorder are met with 5% weight loss along with dehydration, electrolyte imbalance, ketosis, and acetanuria
  91. 91. Risk factors include young maternal age, obese, nonsmoker, multifetal pregnancy and molar pregnancy
  92. 92. Maternal complication include decreased maternal weight gain and electrolyte imbalance, and fetal complications include decreased fetal weight with an increased mortality rate</li></ul>Nursing intervention<br />Provide small, frequent meals, as tolerated, after an intial period of NPO<br />Administer IV hydration<br />Monitor intake and output<br />Administer antiemetics as ordered<br />Provide parenteral nutrition via central line<br />Monitor daily weight<br />
  93. 93. IX. Heart disease<br /><ul><li>The cardiac disease is classified by the level of functional capacity
  94. 94. Most common complication is heart failure
  95. 95. The prognosis for the pregnancy and plan of care depend on the degree of cardiac compromise</li></ul>Assessment<br />Edema<br />Poor oxygenation<br />Tachycardia, murmurs, chest pain, and irregular pulse<br />Nursing Intervention<br />Monitor the client for sign of cardiac overload throughout pregnancy <br />Evaluate fetal well-being <br />Instruct the client as follow: avoid excessive weight gain and emotional stress, report any sign of infection promptly and avoid anemia with adequate nutrition and supplement<br />Avoid anemia<br />Administer prophylactic antibiotic<br />Administer prescribe diuretic<br />Treat dysrhythmias and use cardiac glycosides<br />
  96. 96. x. Substance Abuse<br /><ul><li>Substance include alcohol, tobacco, marijuana, cocaine, and heroin</li></ul>Diagnostic test<br />-toxicology screening of urine for drugs<br />Nursing intervention<br />Support all the clients efforts to decrease substance use<br />Monitor the fetal complication<br />Screen client for use of substance<br />Encourage the client to disclose all substance and amount used <br />Monitor for maternal complications<br />Promotes a slow withdrawal during pregnancy<br />
  97. 97. XI. HIV<br /><ul><li>AIDS is cause by HIV where the classic symptoms surround the severly impaired immune system and devastating opportunistic infections
  98. 98. Antiretroviral drugs that control replication of the virus are given to the client</li></ul>Assessment<br />Flu-like syndrome<br />Night sweats<br />Chronic diarrhea<br />Recurrent headaches<br />External fatigue<br />Oral hairy leukoplakia<br />Diagnostic test<br />ELISA<br />Western blot<br />
  99. 99. Nursing intervention:<br />Maintain a nonjudmental attitude<br />Offer emotional support and counselling as needed<br />Monitor the client for presence of infection<br />Implement universal precaution<br />Instruct the client about the need for antiretroviral medications<br />Prepare the client for the need to formula feed the infant<br />Monitor for fetal well-being<br />Evaluate for other sexually transmitted diseases and hepatitis B<br />Monitor the progress of vital status or disease state with lab test<br />
  100. 100. XII. Ectopic Pregnancy<br /><ul><li>Fertilized ovum implants outside the uterus
  101. 101. Risk factors include tubal sugery leading to scarring and narrowing, infections in the tubes, pelvic inflammation disease (PID) and IUD contraceptive device</li></ul>Assessment<br />Vaginal bleeding<br />Abdominal pain<br />Hypotension<br />Diagnostic Test<br />B-hCG<br />Ultrasound<br />Nursing Intervention<br />Monitor for sign of hemodynamic instability and shock<br />Start an 18 gauge IV, have oxygen available and prepare the client for surgery<br />Allow the client and her family <br />Administer RhoGAM for appropriate client<br />
  102. 102. XIII. Hydatiform Mole<br /><ul><li>Also called gestational trophoblastic disease
  103. 103. It can develop into choriocarcinoma or into malignant trophoblastic disease</li></ul>Assessment<br />Will have positive pregnancy clinical manifestation but abnormal lab values<br />Excessive nausea and vomiting<br />Ultrasound has classic “snowstorm” pattern<br />May have vaginal bleeding or pass parts of the mole<br />Diagnostic test<br />B-hCG and alpha-fetoprotein<br />Ultrasound<br />Nursing Intervention<br />Assess client with very high B-hCG level<br />Assist with the evacuation of the mole<br />Assist the evacuation of the mole<br />Allow the client and family to grieve<br />Administer RhoGAM for appropriate client<br />Instruct client on the importance of follow-up in the next year<br />Instruct the client on contraception for the next year<br />
  104. 104. XIV. Spontaneous Abortion<br /><ul><li>Unplanned pregnancy loss before 20 weeks of gestation
  105. 105. Also referred to as a miscarriage</li></li></ul><li>Assessment<br />Vaginal bleeding<br />Passage of clots or tissue<br />Uterine cramping<br />Declining B-hCG level<br />Absence of fetal heart tone or absence of fetal movement<br />Diagnostic test<br />FHR doppler<br />Possibly ultrasound<br />Lab values<br />B-hCG<br />Nursing interventions<br />Monitor for maternal blood loss and hemodynamic<br />Prepare the client for sugery<br />Medicate for pain<br />Allow the client and family to grieve<br />Administer RhoGAM to appropriate clients<br />Advice bed rest<br />Evacuate the uterus for incomplete and missed abortion<br />