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