OB Final Notes Essay

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Complications of Pregnancy
Abortion
Loss of pregnancy before viably of fetus; may be spontaneous, therapeutic, or elective
Types:
Threatened abortion: cervix closed, some bleeding and contractions, fetus not expelled
Inevitable: cervix open, heavier bleeding and stronger contractions, loss of fetus usually not avoidable
Assessment Findings
Vaginal bleeding (saving all pads and amount)
Contractions, pelvic cramping, backache
Lowered hemoglobin in blood loss significant
Passage of fetus/tissue
Nursing Interventions
Save all tissue passed
Keep client at rest and teach reason for bed rest
Increase fluids PO or IV
Prepare client for surgical intervention (D&C or suction evac or termination)
Provide discharge teaching about limited activity and coitus after bleeding ceases
Emotional support to mom
Administer RhoGAM if mother is Rh negative
Incompetent Cervical OS (Premature Dilation of Cervix)
Ectopic Pregnancy: Any gestation outside the uterine cavity. Most common fallopian tube
Assessment Findings
History of missed periods and symptoms of early pregnancy
Abdominal pain, may be localized to one side
Rigid, tender abdomen; sometimes abnormal pelvic mass
Bleeding; if severe may lead to shock
Low hemoglobin and hematocrit, rising WBC count
HCG titers usually lower than in intrauterine pregnancy
Nursing Interventions
Prepare client for surgery
Institute measures to control/treat shock if hemorrhage severe; continue to monitor postoperatively
Allow pt to express feelings about loss and concerns about future pregnancies
Treatment: involves laparoscopic removal of ruptured tube and administering Methrexate (stops division of embryo)
Follow-up hCG levels
Hydatidiform Mole (gestational Trophoblastic Disease)
Embryo dies, fluid-filled grapelike vessels, snowy white on ultrasound
Assessment Findings
Increased size of uterus disproportionate to length of pregnancy
High levels of HCG with excessive nausea and vomiting
Dark red to brownish vaginal bleeding after 12 weeks
Anemia often accompanies bleeding
Symptoms of preeclampsia before usual time of onset
No fetal heart sounds or palpation of fetal parts
Nursing Interventions
Teach contraceptive use so that pregnancy is delayed for at least one year
Flow up HCG levels
Emotional support
Take out
Second Trimester Bleeding Complications: few unique ones but absorptions or incompetent cervical is in first trimester
Third Trimester Bleeding Complications
Placenta Previa
Low implantation of the placenta so that it overlays some or all of the internal cervical os. Complete Previa requires cesarean delivery. Partial may deliver vaginally if fetus in vertex prevention
Assessment:
Bright red, painless vaginal bleeding after seventh month of pregnancy is cardinal indication. Bleeding may be intermittent, in gushes, or continues
Uterus remains soft
FHR usually stable unless maternal shock present
Nursing Interventions:
Ensure complete bed rest
Maintain sterile conditions for any invasive produces
Measure blood loss and V/S
Assesse uterine tone
Don’t put anything in vagina!
Vaginal exams only with standby, c-section for complete
Abruptio Placentae
Separation of placea form part or all of normal implantation site, usually accompanied by pain
Increased risk of abruption with maternal hypertension, previous abruption, cigarette smoking, multiparty, hs of abortion, cocine use, abdominal trauma
Assessment Findings
Painful vaginal bleeding, rigid board-like abdomen with or without vaginal bleeding
Absences of fetal heart tones, brady and late decels
Nursing Interventions
Ensure bed rest
Check maternal/fetal v/s frequently
Prepare for IV infusion of fluids/blood as indicated
Monitor urinary output
Support and surgerie if needed
Hpyeremesis Gravidarum
Excess n/v of early pregnancy leads to dehydration and electrolyte disturbances, especially acidosis
Weight loss-monitor
Nursing
Begin NPO and IV fluids and electrolyte replacement
Monitor I&O
Decrease floods with meals, don’t eat and drink
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