Professional Documents
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Issues
F. Thomas, PhD, RN
Placenta Previa
Implantation of the placenta I the lower uterus
Classifications
Marginal
Partial
Total
Classic Sign
Collaborative Management
1. Evaluate the amount of hemorrhage
2. Electronic fetal monitoring to evaluate fetus
3. Fetal gestational age
Conservative management if
Mothers CV status is stable
Fetus is immature
Reassuring pattern
Inpatient Care
Assessment of bleeding
Signs of preterm labor
Periodic electronic fetal mentoring
Excessive Bleeding
Delivery of fetus
How??
Abruption
Separation of the Placenta before delivery
Causes
Cocaine Use
Maternal HTN
Cigarette smoking
Short umbilical cord
Trauma
PROM
History of previous separation
Manifestations
Bleeding Types
Uterine tenderness
Uterine irritability
Low back or abd. Pain
High uterine resting tone
Other
Major Concerns
Woman feels powerless and frightened
Fetal hypoxia
Assessment
Nature of bleeding
Pain
Maternal and fetal vital signs
Condition of fetus
Contractions
Obstetric history
Length of gestation
Lab data
Ultrsasound
Management
Emergency: need to go to ER and admitted
Focus on CV status of Mother and condition of fetus
Mild condition
Delivery
Interventions
Monitor for hypovolemic shock
Monitor fetus
Promote tissue oxygenation
Collaborate with health care provider for fluid
replacement
Prepare woman for surgery
Emotional support
Critical to remember!
Ectopic Pregnancy
Called disaster of reproduction
Causes
Scarring from pelvic infections
Failed tubal ligation
History of previous ectopic pregnancy
Assisted reproduction
IUDs
40% of EP occur with no identified risk
Delayed or premature ovulation
Classic
Subtle
Rupture
Manifestations
Diagnosis
Transvaginal Ultrasound
Beta-hCG is at low levels than expected
Gestational sac cannot be seen
Maternal serum progesterone levels
High resolution transvaginal US
Laproscopy
Management
Goal
Improve future fertility and preserve the tube
Medical
If tube is unruptured
Use Methotrexate inhibits cell division
Surgical
Unruptured involves a linear incision (salphingostomy)
Ruptured requires salpingectomy
Nursing
Prevention or early identification of hypovolemic shock
Monitor for S/S of rupture
Analgesics
Teach SE of Methrotrexate
Emotional support
Planning
Monitor for S/S of hypovolemic shock
Interventions
Monitor for S/S for shock: You know these already!!
Fetal monitoring
Promote tissue Oxygenation
Collaborate with practitioner to replace volume
Prepare for surgery
Emotional Support
Evaluation