Prelim - MCN Lec
Prelim - MCN Lec
Prelim - MCN Lec
➔ Philippines maternal mortality rate for 2012 MOST MATERNAL DEATHS AND DISABILITIES
was 126.00, a 0.79% decline from 2011. WOULD BE AVERTED IF…
- All pregnancies are wanted and planned - All
pregnancies are adequately managed throughout its
course
- All births are attended by skilled health professionals
(ideally facility-based)
- All complications are managed in adequately staffed
and equipped facilities offering emergency obstetric
care
● Physical assessment
● Diagnostic testing LEGAL AND ETHICAL ASPECTS OF GENETIC
SCREENING AND COUNSELING
DIAGNOSTIC TEST
KARYOTYPING
● Visual presentation of the chromosome pattern of an
individual
● Specimen: venous blood/cells from buccal membrane
● Metaphase (stage of mitosis)
● Stained, place under microscope and photographed
ENVIRONMENTAL FACTORS
● Exposure to Teratogens due to employment
● Environmental contaminants at home
● Poor Housing
ASSESSMENT
● Provide enough time for thorough health history.
● Problems such as headache, blurred vision, vaginal
spotting should be discovered and investigated
thoroughly
IMPLEMENTATION
● Interventions for woman experiencing a complication
of pregnancy include measures to maintain number of
different areas:
● Continued healthy fetal growth
● A woman's and family's psychological health
● Continuation of the pregnancy as long as possible
EVALUATION
● Client's BP is maintained within acceptable
parameters
● Couple state they feel able to cope with anxiety
associated with the pregnancy complication
● Client accurately verbalizes crucial signs and
symptoms to report to the health care provider
immediately.
ABORTION
- Medical term for any interruption of a pregnancy
before a fetus is viable
SPONTANEOUS MISCARRIAGE
- Early miscarriage if it occurs before 16th week
- Late between 16-24 weeks
CAUSES:
● Teratogenic factor
● Chromosomal aberrations/abnormal fetal
development
● Implantation abnormalities
● Failure to produce enough progesterone
● Infection
PRESENTING SYMPTOM
● Vaginal bleeding/spotting
➔ Should consult attending Obstetrician so that
instructions may be given
THREATENED MISCARRIAGE
● Vaginal bleeding, scant, bright red usually, slight
cramping
● No cervical dilatation
MANAGEMENT:
● Fetal heart assessment
● Utz
● hCG determination
● Avoid strenuous activity
● Coitus usually restricted for 2 weeks
● Spotting usually stops within 24-48 hours
COMPLETE MISCARRIAGE
- Entire products of conception are expelled
spontaneously without assistance
INCOMPLETE MISCARRIAGE
- Part of the conceptus is expelled, but the membrane
or placenta is retained
MANAGEMENT:
● Dilatation and curettage or suction curettage
COMPLICATIONS OF MISCARRIAGE
SHOW
● Hemorrhage
- Cervix is Less than 4cm dilated and the membranes ● Infection
are still intact ● Risk for isoimmunization
PROPHYLAXIS
● Methotrexate
● Dactinomycin
ASSESSMENT
● Uterus tends to expand faster
● Strong (+) result of hCG-1 to 2 M IU compared to a
normal of 400, 000 IU)
OCCURS IN 4 DEGREES
PREDISPOSING FACTORS:
● Low lying - implantation in the lower rather than in the
● High parity
upper portion of the uterus
● Advanced maternal age
● Marginal - the placenta edge approaches that of the
● Short umbilical cord
cervical os
● Chronic hypertensive disease
● Partial - implantation that partially obstructs the
● Pregnancy induced hypertension
cervical os
● Direct trauma
● Total placenta previa - totally obstructs the cervical os
● Vasoconstriction
● Autoimmune antibodies
ASSESSMENT ● Chorioamnionitis
● Bleeding is abrupt, painless, bright red and sudden
● Immediate care measures: ASSESSMENT:
● Place the woman immediately on bedrest in a side
● Sharp stabbing pain high in the uterine fundus
lying position
● If labor begins, each contraction will be accompanied
by pain over and above the pain of contraction
ASSOCIATED WITH: ● Heavy bleeding - evident if separation occurs at the
● Increased parity edges
● Advanced maternal age ● Couvelaire uterus (uteroplacental apoplexy) - hard
● Past CS board like uterus with no apparent or minimally
● Past uterine curettage apparent bleedingDisseminated Intravascular
● Multiple gestation Coagulation (DIC) may occur
● Male fetus
THERAPEUTIC MANAGEMENT:
ASSESS: ● Emergency situation
● Duration of pregnancy ● Large gauge IV catheter
● Time the bleeding began ● Oxygen by mask
● Estimate amount of blood loss ● FHT and maternal VS monitoring
● Accompanying pain ● Lateral position
● Color of the blood ● No abdominal, pelvic or vaginal examination
● What has she done ● Unless separation is minimal, pregnancy must be
● Prior episodes of bleeding TERMINATED
● Prior cervical surgery
PRETERM LABOR
● Labor that occurs before the end of the 37 weeks of
gestation
● Persistent uterine contractions, cervical effacement
over 80% and dilation over 1 cm
● Unknown cause
CONDITIONS ASSOCIATED:
● Dehydration
● UTI
● Periodontal disease
● Chorioamnionitis
● Inadequate prenatal care
ASSESSMENT:
● Persistent, dull, low backache
● Vaginal spotting
● Pelvic pressure or abdominal tightening
● Menstrual like cramping
MANAGEMENT OF ECLAMPSIA:
● Tonic-clonic seizures
● Maintain patent airway
● Administer oxygen
● Turn to side
● Administer Magnesium sulfate (Antidote: Calcium
Gluconate) or Diazepam (Valium)
● Assess FHT
● Check for vaginal bleeding
HELLP SYNDROME
● Variation of PIH
● H-emolysis (lysis of RBC)
● E-levated L-iver enzymes
● L-ow P-latelet count
● Increased BP. edema, proteinuria+
● Nausea, epigastric pain, general malaise, RUQ
tenderness
MANAGEMENT:
● Bed rest
● Assess VS and edema
● NSAID (Non-Steroidal Anti-inflammatory Drugs)
● Amniocentesis- almost daily
OLIGOHYDRAMNIOS
● Pregnancy with less than the average amount of
amniotic fluid
● Caused by bladder or renal disorder
● Fetus is cramped for space
● Uterus fails to meet expected growth rate
● Mgt: Amnio Transfusion
ISOIMMUNIZATION
● Occur when an Rh negative mother carries a fetus
with an Rh positive blood (D antigen)
THERAPEUTIC MANAGEMENT:
● Passive Rh (D) antibodies against the Rh factor is
administered to women who are Rh-negative at 28
weeks
● Given in the 1 st 72 hours after birth
● Cord blood is tested if Rh positive (Coombs' negative)
large amount of antibodies are not present in the
mother, mother will receive RhIG injection
● If Rh negative injection not necessary
INTRAUTERINE TRANSFUSION
● Injection of RBC directly into the vessel of the fetal
cord or depositing them in the fetal abdomen
FETAL DEATH
● If labor does not begin, it will be induced by a
combination of prostaglandin gel such as misoprostol
(Cytotec) and oxytocin
● Cytotec should not be given to pregnant women
because it can trigger abortion; it is meant for ulcer
● Severe dyspnea prior to stage of pressure on the DECREASE WORKLOAD OF THE HEART
diaphragm ● Adequate rest and sleep
● Treat early anemia
SIGNS OF CARDIAC DECOMPENSATION ● Prevent exhaustion, fatigue, stress
● Moist cough
● Pedal edema AVOID ACTIVITIES THAT DECREASE OXYGENATION
● Dyspnea ● Smoking
● Tachycardia ● Overcrowded place
● Tachypnea
● Chest pain on exertion AVOID CONSTIPATION
● Cyanosis
● Persistent heart murmur ● Daily fruits
● Vegetables
MATERNAL EFFECTS ● Regular bowel movement
● Regular exercise
● Patients with valvular problems causing atrial
fibrillation-susceptible to embolic episodes PROPER NUTRITION
● Cyanotic heart disease-increase the maternal
mortality by 50% ● Well balanced diet
● Adequate protein
FETAL AND NEONATAL EFFECTS ● Low sodium, fats and carbohydrates
● No junk foods and stimulants
● Compromised maternal circulation- uterine blood flow
will be reduced INTRAPARTUM PERIOD GOALS
● Spontaneous abortion- Growth retardation and Mental
retardation ● Minimize changes in pulse and blood pressure:
● Fetal Distress- Preterm delivery and fetal ● Lateral position
morbidity/fetal death ● Adequate pain relief
● Avoidance of hemorrhage
USUAL MEDICAL MANAGEMENT AND PROTOCOLS ● Avoidance of infection
● Oxygen per mask
FOR NURSE PRACTITIONERS ● Forceps or vacuum extraction
● GENERAL MANAGEMENT ● Elective CS
○ Team approach
○ Adjust cardiac medications PRIMARY GOAL:
○ Bed rest/restricted activity
● Reduce risks for complications
○ Prophylactic antibiotic
○ Careful titration of fluid volume
○ Advance planning for route of delivery ACHIEVED BY:
● DRUG THERAPY ● Education
○ Heparin – anticoagulant ● Routine assessment
○ Warfarin - pulmonary embolism/prosthetic ● Proper referral
valves ● Facilitation of patient participation in decision
○ Furosemide - diuretic ● Being an advocate and coordinator for the
○ Digitalis - crosses placental barrier multidisciplinary team approach
○ Tocolytics
○ Beta blockers - treat hypertension
NURSING IMPLEMENTATIONS
● Encourage early, frequent and regular prenatal visits
● Encourage compliance with therapeutic regimen
PREVENTION / MANAGEMENT
● Prenatal vitamins containing iron supplement of 60
mg elemental iron
● Diet high in iron such as green leafy vegetables,
meat, legumes (beans) and fruits
● If with deficiency : 120-200 mg/day
● Severe anemia- IV iron dextran (substitute for blood MAY RESULT TO:
plasma or transfusion) ● Blockage to placental circulation
● Low birth weight
NURSING IMPLEMENTATIONS ● Fetal death
● Promote a balance of activity and rest with avoidance
of fatigue THERAPEUTIC MANAGEMENT
● Provide dietary instructions ● Exchange transfusion
● Encourage regular intake of ordered hematinics ● Administering oxygen
(ferrous sulfate) ● Controlling pain
● Increasing fluid volume
FOLIC ACID DEFICIENCY ● The chances of passing it to the offspring depends on
genetic composition of the parents
● Folic acid-B vitamin necessary for the normal
formation of red blood cells
● Leads to megaloblastic anemia (abnormally large, RENAL AND URINARY DISORDERS
immature and dysfunctional red blood cell) ● Urinary tract Infection (UTI)
● Becomes apparent in the 2nd trimester of pregnancy ● Chronic Renal Failure
● More common in multiple pregnancy
INCIDENCE
CAUSES ● Infection - 1-5% of pregnancies
● Alcohol abuse (alcohol prevents absorption of several ● Chronic kidney disease - 6 to 12 cases per 10,000
nutrients especially the B vitamins) pregnancies
● Poor diets (common in alcoholics, the elderly, those
living alone or in poverty, and infants especially those KIDNEYS
with infections or diarrhea) ● Excrete water, electrolytes and nitrogenous waste
● Impaired absorption because of intestinal dysfunction product
● Bacteria competing for available folic acid ● Acid-base balance
● Overcooking of food, destroying valuable ● Secretes erythropoietin - kidney hormone that
water-soluble nutrients, including a high percentage of increases the number of RBC in cases of anemia
folic acid ● Renin - angiotensin - aldosterone system Renin -
● Limited storage capacity in infants hormone released in the kidney in response to either
● Prolonged drug therapy, especially from decrease BP or plasma sodium concentration
anticonvulsants and estrogens ● Accounts 20-25 % of the cardiac output
● Not addressing increased folic acid needs of certain
age groups URINARY TRACT INFECTION
● Ureters dilate from the effect of progesterone - urine
MAY CONTRIBUTE stasis/stagnation
● Early miscarriage ● Minimal glucosuria - growth of microorganisms
● Early separation of placenta
ASCENDING INFECTION
PREVENTION / MANAGEMENT - Caused by Escherichia coli
● 400 ug of folic acid daily before getting pregnant
● Folacin rich food: green leafy vegetables, oranges, DESCENDING INFECTION
dried beans - Streptococcus B
● During pregnancy: 600 ug/day
MATERNAL EFFECTS
● May lead to preterm labor
● Bacteremia causing septic shock
THERAPEUTIC MGT
● Urine C & S
● Administration of antibiotics
● Amoxicillin and ampicillin are safe to administer
TRIMETHOPRIM
● Antibiotic used mainly in the prevention and treatment
of urinary tract infections
● Folic acid antagonist (neutralizes the effect of another
drug)
● Must not be given on the first trimester
PREVENTION OF UTI
● Void frequently
● Wiping perineal area from front to back
● Wearing cotton underwear
● Voiding immediately after sexual intercourse
NURSING IMPLEMENTATIONS
● Advise 3-4L of water/day
● Knee chest position - to promote urine drainage
● Compliance to medications
MEDICAL MANAGEMENT
● ACE inhibitor-preserves kidney function but fetotoxic
● Low dose aspirin
● Urine output monitoring
● Ultrasound every 2 weeks from 24 wks of gestation
● Non stress test
NURSING INTERVENTIONS
● Monitor I and O
● Evaluate degree of edema
● Make referral to a dietician
● Teach home blood pressure monitoring
● Teach pt signs and symptoms of preterm labor
● Educate on the importance of drinking variety of fluids