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6.

Inversion of the Uterus – uterus is turned inside


out
Clinical manifestation
1. Sudden gush of blood
2. Unpalpable fundus
3. Signs of shock
Management
1. Never attempt to replace the inversion w/o good pelvic
relaxation
2. Never attempt to remove the placenta if it is still attached
3. Administer tocolytic agent or anesthesia
4. BT
7. Prolapse of the Umbilical Cord – a loop of
umbilical cord slips down in front of the presenting fetal
part
Clinical manifestations
1. Fetal distress
2. Cord is felt as presenting part during vaginal examination
or visible in the vulva
3. Deceleration
Management
1. Manual elevation of the fetal head
2. Trendelenberg position
3. O2 @ 10L/min via mask
4. Tocolytic agent
5. Do not push back exposed cord
6. Cover exposed cord w/ saline compress
8. Multiple Pregnancy – twinning mostly occur 1 in q
99
- considered complication of pregnancy bec the
woman’s body must adjust to the effects of more than 1
fetus
Types:
a. monozygote – identical, same sex, same features
- 1 ovum + 1 spermatozoa
b. dizygote – each has its own placenta, cord, amnion
- 2 ova + 2 spermatozoa (possibly not from same
sex partners)
Risk Factors
1. Genetic
2. Age: the higher the age, the greater the tendency
3. Parity: the higher the parity, the greater the tendency
Clinical Manifestations
1. ↑ size of uterus @ faster rate than usual
2. Multiple gestational sac @ USD
3. Elevated alpha-fetoprotein
4. Flurries of axns @ different portion of the abd during
quickening
5. 2 sets of FHT
6. Marked wt inc not associated w/ PIH
7. Difficulty in sleeping bec of greater discomfort by many
fetal activities
8. Extreme fatigue & backache
Nsg care Mgt
1. Eat small 6 meals to compensate nutrition
2. Advise to rest during the last 3 mons
3. Advise to refrain from coitus during the last 2 mons bec
cervix may dilate prematurely
9. Hydramnios – excessive amniotic fluid prod’n usually
up to 2000ml
- suggests difficulty w/ fetus’ ability to swallow or absorb
excessive urine prod’n (anencephalic, TEF, intestinal
obstruction)
Clinical manifestations
1. Rapid enlargement of the uterus
2. FHT is difficult to auscultate
3. Shortness of breath
4. Lower extremities varicosities & hemorrhoids
Nsg Care Mgt
1. Bedrest to help inc utero-placental circ
2. Educate women to report signs of ruptured membrane
3. Advise to ↑ fiber diet to avoid constipation
4. Suggest for stool softeners
5. Assess VS & lower extremities edema q 4°
10. Dystocia – difficulty in labor & delivery most
commonly due to CPD or large baby
11. Malpresentation
a. Occipitoposterior Position – the occiput is
directed diagonally & posteriorly rather than
anteriorly
b. Breech Presentation
Complete feet & legs are flexed on thighs; thighs
are flexed on abd; buttocks & feet are
the presenting part
Frank legs are extended & lie against the abd
& chest; feet are @ the level of
shoulder, buttocks are the presenting
part
Double footling Legs are unflexed & extended; feet are
the presenting part
Single footling One leg is unflexed & extended; 1 foot
is the presenting part
c. Face Presentation (chin/mentum) – rare
- presenting part is too large for the canal for the birth
to proceed
12. Forceps Delivery – method of delivering infants
through the use of forceps extraction
- 2 double-crossed, spoonlike articulated blades that are
used to assist in delivery of fetal head
- may cause damage on the facial nerve of the baby
13. Vacuum Delivery – method of delivering an infant
using a vacuum applied over the scalp of the baby
- may cause caput succedaneum
14. Cesarean Section – incision is done on the abd of
the pregnant woman to deliver the fetus primarily bec of
CPD.
3 types
a. Low Segment CS –
method os choice since
lower segment is thinner,
fewer bld vessels,
passive during labor
b. Classical CS –
indicated for transverse
lie, placenta previa,
adhesion of tissues
c. Pffannenstiel or bikini
POSTPARTUM COMPLICATIONS
1. HEMORRHAGE - 1-3 hrs postpartum is the most
critical stage
Causes:
a. Laceration
b. Placental retention
c. Uterine rupture
d. Uterine inversion
e. Uterine atony
2. INFECTIONS
a. Endometritis – endometriosis is the growth of
endometrial tissue outside the uterus. When infected, it
is called endometritis.
clinical manifestations
foul smelling vaginal discharge
fever & chills
profuse bleeding
b. Episiotomy Infection

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