NURSING MATERNAL

1. HYDATIDIFORM MOLE
h-mole
A benign disorder characterized by
degeneration of the chorion and death of the
embryo. The chorionic villi rapidly proliferate
and become grape like vesicles that produce
large amount of HCG.
Gestational trophoblastic disease – group of
pregnancy related tumor
Cause essentially unknown

3. Risk factors:
•A molar pregnancy creates a 20-40 times higher risk
of having it again.
•Increased incidence with advanced maternal age.
•Unusual chromosomal patterns seen.
( either no genetic material in ovum or 69
chromosomes)
When the gametes join they form a cell called a
zygote. Human sperm and eggs
contain 23 chromosomes. Human zygotes
contain 46 chromosomes.

4. Diagnostics:
•Ultrasonography reveals no fetal
skeleton
•Elevated HCG level
Assessment
The uterus tends to expand faster than
usual - proliferation of the abnormal
trophoblast cells grow so rapidly

5. Signs and symptoms
•excessive vomiting due to elevated HCG
levels
•passage of grape like vesicles around the 4th
month (dark red to brownish vaginal
bleeding)
•rapid increase of uterine size which is out of
proportion to the actual age of gestation.
•absence of FHT and fetal skeleton
•ultrasound reveal a mass of fluid filled
vesicles instead of a developing fetus.

6. Management:
•D and C to remove the mole. If the woman is more
than 40 years old, hysterectomy since she has a
higher chance of developing choriocarcinoma
•Anticancer drug prescribed to the woman for one
year to prevent development of malignant or cancer
cells in the uterus.
Nursing responsibilities:
•Provide pre-postoperative care for evacuation of uterus
(usually suction curettage).
•Teach contraceptive use so that pregnancy is delayed for
at least a year.
•Teach client’s need for follow-up lab work to detect rising
HCG levels indicative of choriocarcinoma.

7. Hyper emesis gravidarum
Hyper emesis gravidarum -is intractable
vomiting during pregnancy that results in dehydration and
electrolyte imbalance.
It occurs in one of every 1000 pregnancies; the cause is
uncertain
Sign and symptoms:
1. Severe, persistent vomiting that leads to
dehydration or nutritional deficiency
2. Progresses to fluid electrolyte imbalance and
alkalosis from loss of hydrochloric acid.

8. Management:
•Medical: replacement of fluids, electrolytes,
and vitamins, along with tranquilizer or
antiemetic
•NPO for 48 hours, after condition improves,
six small feedings are alternated with liquid
nourishment in small amount every 1-2 hours.
•If vomiting recurs, NPO status is resumed and
administration of IV is restarted.

9. PLACENTA PREVIA
Placenta previa is the abnormal implantation of placental
near or over the internal os.
It is the most common bleeding disorder of the third
trimester.

11. Causes of Placenta previa:
•Multiparity
•Multiple pregnancy
•Advance maternal age- over 35 years old
•Smoking
•Previous cesarean section and abortion
•Sign and symptoms:
•Painless bright red vaginal bleeding is the most
significant sign near the end of early of the 3rd
trimester.
•Ultrasound revealed placenta implanted over or near
the cervix.

12. Nursing intervention:
•Ensure complete bed rest.
•Maintain sterile conditions for any invasive
procedure.
•Make provisions for emergency cesarean birth
•Continue to monitor maternal/fetal vital signs
Management:
•Cesarian is the delivery of choice for all kinds of placenta
previa.
•Manage bleeding episodes
•Watchful waiting- delay delivery until fetus is mature
enough (corticosteroid)
•No IE is performed in diagnosed placenta previa

13. ABRUPTIO PLACENTA
Abruptio placenta is the premature
separation of placenta from part or all normal
implantation site, usually accompanied by
pain.
Usually occurs after 20 weeks of gestation
and before delivery of the fetus

16. Types of Placental Separation

17. Grading of Placental Separation

18. Causes of abruptio placenta:
•Maternal hypertension
•Advance maternal age
•Multiparity
•Trauma to the uterus
•Short umbilical cord
•Cigarette smoking and cocaine abuse
Signs and symptoms:
•Painful Vaginal bleeding
•Board-like abdomen caused by accumulation of blood
behind the placenta with fetal parts hard to palpate
•Sharp pain over the fundus as the placenta separates
•Signs of shock and fetal distress if bleeding is severe.

19. Nursing interventions:
•Ensure bed rest
•Check maternal/fetal vital signs frequently
•Vaginal delivery if there is no sign of fetal distress, CS
if bleeding is severe and fetus cannot be delivered
with vaginal method.
Incompetent cervix
•Premature dilation of the cervix
•Is a defect related trauma of the
cervix or a congenitally short cervix,
which leads to habitual abortion and
premature labor.

20. Risk factors: cervical trauma related to D&C, cervical
lacerations from previous deliveries
Sign & symptoms:
•Dilated cervix without painful uterine contractions.
•Rupture membranes, labor begins and premature fetus is
delivered.
Surgical treatment:
•Reinforcement of the weakened cervix by a purse
string suture, which encircles the internal os.
•Shidorkar-barter cerclage; permanent suture that
allows the cervix to remain closed for all
pregnancies; cesarian delivery is required.
•McDonald cerclage; left in place until term, then
remove before labor.

22. hydramnios
Polyhydramnios: (More than 2L of fluid).
Excess of amniotic fluid.
For the first 16 weeks, fluid is produced
mainly by the
Corpus luteum.
functions of amniotic fluid-
Protection
Equalization of pressure
Maintains temperature
Allows movement
Lung maturity

24. Causes:
•Fetal abnormalities- excessive urination of fetus
•Esophageal atresia- fetus cannot swallow amniotic
fluid.
•Multiple pregnancy
•Diabetes mellitus
Complications:
•Premature labor & delivery
•Abruptio placenta
•Postpartum hemorrhage due to over distension of uterus
•Cord prolapsed
•malpresentation