This document discusses several high risk pregnancy complications that can cause bleeding. In the first trimester, abortion and ectopic pregnancy are risks. Second trimester risks include hydatidiform mole and incompetent cervix. Third trimester risks include placenta previa and abruption placenta. It then goes on to provide more detailed information about each complication, including causes, signs and symptoms, management, and nursing considerations.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Physiological Process that occur in a woman who has given birth up to 6wks postpartum, abnormal processes and their risk factors, clinical assessment and management
Lastly a brief review of anatomy of the breast
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Physiological Process that occur in a woman who has given birth up to 6wks postpartum, abnormal processes and their risk factors, clinical assessment and management
Lastly a brief review of anatomy of the breast
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
this slide helps a physician in understanding the basics of miscarriages(definition, types/classification, causes, clinical presentation, investigations and complications. In understanding the basics, this helps a physician to able to treat or manage abortions.
Postpartum Hemorrhage (PPH) and Ectopic Pregnancysosojammoly
what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is PPH and what is the management?
what is the ectopic pregnancy?
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Bleeding Disorders of
pregnancy
• First Trimester bleeding- Abortion
and ectopic pregnancy
• Second trimester bleeding-
Hydatidiform mole and incompetent
cervix
• Third trimester bleeding- Placenta
previa and abruption placenta
4. • Abortion- is the most common bleeding disorder of
early pregnancy. Abortion is the termination of
pregnancy before viability,that is, before 20 weeks.
• Abortus- a fetus that is aborted before it is 500
gms in weight.
• Blighted ovum- a small macerated fetus,
sometimes there is no fetus, surrounded by a fluid
inside the sac.
• Maceration- a dead fetus undergoing necrosis.
• Early abortion- termination of pregnancy before
16 weeks.
• Late abortion- abortion that occurs between 16 to
20 weeks.
5. Causes of abortion:
• FETAL CAUSES-
• The most common cause of early
spontaneous abortion is abnormal
development of the zygote, embryo,
and fetus.
• This abnormalities are incompatible
with life and would have resulted to
severe congenital anomalies if
pregnancy has not been aborted.
6. Causes of abortion:
• MATERNAL CAUSES-
• These are congenital or acquired
conditions of the mother and
environmental factors that had
adversely affected the pregnancy
outcome and led to abortion.
• Such conditions include DM,
incompetent cervix, exposure to
radiation and infection.
8. Threatened abortion- possible
loss of product of conception
• Light vaginal bleeding
• None to mild uterine cramping
• Vaginal examination at this
stage usually reveals a closed
cervix. 25% to 50% of
threatened abortion eventually
result in loss of the pregnancy.
9. The development of abortion is as follows:
continuing
pregnancy
• complete
inevitable abortion
abortion
incomplete
abortion
threatened
abortion
10. • Inevitable abortion- the loss of
the products of conception
cannot be prevented
• Moderate to profuse bleeding,
moderate to severe uterine
cramping
• Open cervix
• Rupture of membrane
11. • Complete abortion-
spontaneous expulsion of the
products of conception after the
fetus has died in utero
• Light bleeding
• Mild uterine cramping
• Passage of tissue
• Closed cervix
12. • Incomplete abortion- expulsion of
some parts and retention of other
parts of conceptus in uterus
• Heavy vaginal bleeding
• Severe uterine cramping
• Open cervix
• Passage of tissue
13. • Missed abortion- retention of all
products of conception after the
death of the fetus in the uterus
• No FHT
• Signs of pregnancy disappear
14. • Habitual abortion- abortion
occurring in 3 or more successive
pregnancies
• The most common cause is a
significant genetic abnormality of
the conceptus.
17. • Save all tissue passed
(histopathology examination)
• Strict bed rest and monitor bleeding
• Increased fluid PO or IV as ordered
• Prepare client for surgical
intervention (D & C or suction
evacuation) if needed
19. • Ectopic pregnancy is any gestation
located outside the uterine cavity.
• extra uterine pregnancy is the
second leading cause of bleeding in
early pregnancy.
20. Causes of Ectopic pregnancy
• Mechanical Factors- factors that delay
the passage of ovum in the oviducts
and prevent it from reaching the
uterus in time for implantation.
• Salphingitis
• Peritubal adhesions- kinking and
narrowing
• Previous ectopic pregnancy
• Tumors that distort the tube
21. Causes of Ectopic pregnancy
• Functional and failed
contraception factors
– External migration of the ovum
– IUD
– Oral contraception
– Tubal ligation- 15-50 %
– Hysterectomy
22. Causes of Ectopic pregnancy
• Assisted reproduction
– Ovulation induction- clomid
– Gamete intrafallopian transfer
– In vitro fertilization
– Ovum transfer
24. Most frequent site is in the fallopian tube,
so rupture of the site usually occurs
before 12 weeks
25. • Ectopic pregnancy usually occurs
99% of cases in the uterine tube. It
can be found in
• 1. The ampulla (64%)
• 2. The Isthmus (25%)
• 3. The infundibulum (9%)
• 4. The intramural junction (2%)
• 5. Ovarian (0.5%)
• 6. Cervical (0.4%)
• 7. Abdominal (0.1%)
• 8. Intraligamental (0.05%)
27. Assessment findings:
• History of missed periods & symptoms of
early pregnancy.
• Abdominal pain, may be localized on one
side
• Rigid. Tender abdomen; sometimes
abnormal pelvic mass
• Bleeding: if severe may lead to shock
• Low Hgb & Hct, rising white cell count
28. • Pelvic pain- sudden knife like pain is the
most common symptom when the tube
ruptures
• Signs of hemorrhage:
– Cullen’s sign- bluish discoloration of the
umbilicus due to the presence of blood in
the peritoneal cavity
– Hard rigid board like abdomen due to
presence of blood in the peritoneal cavity.
– Signs of shock- cyanosis, pallor, cold
clammy skin, rapid pulse, dec BP
29. Blood loss
dec. intravascular volume
dec. venous return, cardiac output & BP
Vasoconstriction of peripheral blood vessels & inc. respiratory rate.
Cold, clammy skin, dec. uterine perfusion
Reduced renal, uterine & brain perfusion
Lethargy, coma, dec. renal output
Renal failure
Matenal and fetal death
The
process of
shock due
to blood
loss
31. • If not yet ruptured, therapeutic
abortion is performed.
• If ruptured, removal or repair of
ruptured tube. Many physician
choose to remove the ruptured
tube because the presence of scar
if the tube repaired and left can
lead to another tubal pregnancy.
32. • Prevent and treat hemorrhage
which is the main danger of
ectopic pregnancy.
• Prevent infection as the woman
who lost so much blood is
susceptible to infection
33. • Prepare client for surgery
• Institute measures to control?
Treat shock if hemorrhage is
severe; continue to monitor
postoperatively.
• Allow client to express feelings
about loss of pregnancy &
concern about future pregnancies.
35. • 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
• Cause essentially unknown
36.
37. 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)
39. 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.
40. 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.
41. 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.
43. 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
44. • Risk factors: unknown
• Diagnostics: by symptoms
• 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.
45. 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.
47. • 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.
48.
49. Causes of Placenta previa:
• Multiparity
• Multiple pregnancy
• Advance maternal age- over 35
years old
• Smoking
• Previous cesarean section and
abortion
50. • 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.
51. 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
52. 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
• No IE is performed in diagnosed
placenta previa
54. • 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
55.
56.
57. Causes of abruptio placenta:
• Maternal hypertension
• Advance maternal age
• Multiparity
• Trauma to the uterus
• Short umbilical cord
• Cigarette smoking and cocaine
abuse
58. 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.
59. 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.
60. 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.
61. 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.
62. 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.
70. Causes:
• Fetal renal anomalies that
results in anuria
• Premature rupture of
membranes
71. Complications:
• Club foot
• Amputation- due to adhesion of
fetal parts to the amnion
• Abortion
• Stillbirth
• Fetal growth retardation
• Abruptio placenta
72. Complication during labor and
delivery
• Cord compression
• Fetal hypoxia as a result of
cord compression
• Prolonged labor
74. • Gestational hypertension replaces the
term PIH and is used for hypertensive
disorders that are specifically
associated with pregnancy,
preeclampsia, and eclampsia.
Incidence:
• Occur in 5-7% of all pregnancies
• Seen more often to primigravidas,
teenagers of low socioeconomic class.
75. • May be related to decreased production
of some vasodilating prostaglandins,
vasospasm occurs.
• Onset after 20th week of pregnancy,
may appear in labor or up to 48 hours
postpartum.
• Cause essentially unknown
76. vasospasm
Vascular effect Kidney effect Interstitial effects
vasoconstriction
Poor organ
perfusion
Inc. BP
Dec. glomeruli
filtration rate &
inc. permeability of
glomeruli
membranes
Inc. serum blood urea
nitrogen, uric acid, &
creatinine
Dec. urine output &
protenuria
Diffusion of
fluid from
blood stream
into interstitial
tissue
edema
77. –Danger Signs of Pregnancy-
Induced Hypertension
• Swelling of the face or fingers
• Flashes of light or dots
• Blurring of vision
• Severe continuous headache
78. Mild preeclampsia
• Bp of 140/90 or +30/+15 mmhg
on two consecutive occasions at
least 6 hours apart.
• Sudden weight gain
• Proteinuria of 300 mg/l in 24 hour
urine collection
79. Nursing intervention:
• Promote bed rest as long as signs of
edema or proteinuria are minimal,
preferably side lying.
• Provide well-balanced diet with
adequate protein.
• Explain need for close follow-up, weekly
or twice-weekly visits to physician.
80. Severe preeclampsia
• Headaches, epigastric pain, nausea
and vomiting, visual disturbances,
irritability
• Bp of 150-160/100-110 mmhg
• Increased edema and weight gain
• Proteinuria (5g/24hrs) 4+
81. Management:
• Magnesium sulfate- acts upon the
myoneural junction, diminishing
neuromuscular transmission
• It promotes maternal vasodilatation,
better tissue perfusion and has
anticonvulsant effect.
• Antidote: calcium gluconate
82. • Nursing responsibilities:
mgs04
• Monitor client’s respirations,
blood pressure and reflexes,
as well as urinary output
• Adm.med. Either IV or IM
83. Nursing interventions:
• Bed rest, side lying
• Carefully monitor maternal/fetal vital
signs
• Monitor I&O, results of laboratory
test
• Take daily weights
• Institute seizure precautions
• Continue to monitor 24-48 hours
post delivery
84. eclampsia
• Increased HPN precede convulsion
followed by hypotension and
collapse
• Coma may ensue
• Labor may begin, putting fetus in
great jeopardy
• Convulsion may occur
Medical mgt. same with severe
preeclampsia
85. Nursing intervention:
• Minimize all stimuli
• Have airway, oxygen and suction
equipment available
• Administer medication as ordered
• Prepare for C-section with seizures
stabilized
• Continue observations 24-48 hours
postpartum.
86. Complication of PIH:
• Maternal complications:
• Inc. intraocular pressure leading to
retinal detachment.
• HELLP (Hemolysis, Elevated Liver
function test, Low platelet count)
syndrome has been associated with
severe preeclampsia.
87. Fetal complications:
• Usually small for gestational age
• May be born prematurely
• Newborn maybe born over sedated
because of medications given to mother
• May have hypermagnesemia because
of maternal treatment with mgs04.
88. Danger signs of pregnancy
SIGN POSSIBLE CAUSE
Swelling of face, fingers & legs HPN of pregnancy
Headache, continuous & severe HPN of pregnancy
Abdominal/ chest pain Ectopic pregnancy, uterine rupture,
pulmonary embolism
Vaginal bleeding Placental problems , abortion
Vomiting, persistent Infection, hyperemesis gravidarum
Visual changes HPN of pregnancy
Escape of vaginal fluids PROM
90. • disorder of late gestation
• disorder induced by pregnancy:
from exaggerated physiological
changes in glucose metabolism
• Reversal after termination of
pregnancy with 20-50% chances of
developing type 2 diabetes later in
life.
91. RISK FACTORS
• Age over 30
• Family Hx of DM
• Prior macrosomic,
malformed or stillborn infant
• Obesity
• Hypertension
95. Assessment for gestational diabetes
• 3 P’s (polyphagia, polyuria, polydipsia)
• Dizziness, if hypoglycemic
• Confusion, if hyperglycemic
• Congenital anomalies
• Inc.risk of PIH
• Macrosomia
• Poor tissue perfusion of fetus
• Glycosoria
• Hyperglycemia
• Hydramios
• Possibility of inc. monilial infection
96. Diagnostic Tests for DM
Glycosylated hemoglobin
Provides information about blood
glucose level during the previous 3
months
because glucose in the
bloodstream attaches to some of
the hemoglobin and stay attached
during the 120-day lifespan of the
RBC
97. Diagnostic Tests for DM
Oral glucose challenge test values for
pregnancy:
Test type pregnancy glucose level
Fasting 95
1 hour 180
2 hours 155
3 hours 140
Following a 100g glucose load. Rate is
abnormal if two values are exceeded.
98. GDM - ADVERSE EFFECTS
MACROSOMIA
• Excessive fat deposition on
shoulders/trunk
• Predisposes to shoulder dystocia
• Maternal hyperglycemia transfer of
excess glucose to fetus stimulate fetal
insulin secretion which is a potent
growth factor
HYPOGLYCEMIA at birth
104. HEART DISEASE
Normal hemodynamic of pregnancy that
adversely affect the client with heart
disease
1. Oxygen consumption increased 10% to
20% ; related to needs of growing fetus
2. Plasma level and blood volume
increase; RBCs remain the same
(physiologic anemia)
105. Functional or therapeutic classification of heart
disease during pregnancy
1. Class I: no limitation of physical activity; no
symptoms of cardiac insufficiency or angina
2. Class II: slight limitation of physical activity;
may experience excessive fatigue,
palpitation, angina, or dyspnea; slight
limitation as indicated
3. Class III: moderate to marked limitation of
physical activity; dyspnea, angina, and fatigue
occur with slight activity, and bed rest is
indicated during most pregnancy
4. Class IV; marked limitation of physical
activity; angina, dyspnea, and discomfort
occur at rest; pregnancy should be avoided;
indication for termination of pregnancy
106. Prenatal period assessment:
• Evidenced of cardiac decompensation
especially when blood volume peaks (
weeks 28-32)
• Cough & dyspnea
• Edema
• Heart murmur
• Palpitations
• rales
107. Nursing intervention
prenatal period:
• Teach client to recognize & report signs
of infection, importance of prophylactic
antibiotics
• Compare vital signs to baseline
• Instruct in diet to limit weight gain to 15
lbs, low na+