25/11/2024

Obstetric Nursing
Romeo T. Papa, DMD RN

Anatomy and Physiology

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Male Reproductive
System: External

• Scrotum
• Testes
• Seminiferous tubules
• Leydig’s cells
• Penis

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Male Reproductive System: Internal

• Internal Structure
• Epididymis
• (20 ft)
• 5% semen production
• Vas Deferens (Ductus Deferens)
• (final maturation of sperm occur)
• Seminal Vesicles
• 30% semen production
• Ejaculatory Ducts
• Prostate Gland
• 60% semen production
• Bulbourethral (Cowper’s) Glands
• Urethra
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Female Reproductive System: External

• Mons Veneris
• Labia Minora
• Labia Majora
• Other External Organs
• Hymen
• Vestibule
• Two Skene’s glands
• Front of vaginal opening
• Bartholin’s Glands
• Back part of vaginal opening
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Female Reproductive System: Ovaries

• Ovaries
• Female gonad
• Function is to produce,
mature, and discharge
ova (the egg cells)
• produce estrogen and
progesterone and initiate
and regulate menstrual
cycles

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Female Reproductive System: Fallopian Tube

• Fallopian Tubes
• approximately 10 cm long
• Parts:
• Interstitial portion
• Isthmus
• This is the portion of the tube that is cut
or sealed in a tubal ligation
• Ampulla
• portion that fertilization of an ovum
usually occurs
• Indundibulum
• funnel shaped
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Female Reproductive System: Uterus

• Functions:
• receive the ovum from the fallopian
tube
• for implantation and nourishment of
fetus
• Fundus
• Expands during pregnancy
• Isthmus
• Enlarges to accommodate growing fetus
• Portion cut during C-section
• Cervix
• lowest portion of the uterus
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Female Reproductive System:

Vagina
• lined with stratified squamous epithelium
similar to that covering the cervix
• contain many folds or rugae
• Bulbocavernosus
• at the external opening of the vagina acts as
a voluntary sphincter
• mucus produced in lining has a rich glycogen
content
• When this glycogen is broken down by the
lactose-fermenting bacteria that frequent the
vagina (Döderlein’s bacillus), lactic acid is
formed
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QUESTION

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Prolapse

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Breasts

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Sexual Response Cycle

By Masters and Johnson

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Excitement: occurs with physical and psychological stimulation

causing parasympathetic nerve stimulation causing vasocongestion in
genitals

Women Men
• clitoris increases in size • penile erection occurs
• vaginal walls lubrication • scrotal thickening and
elevation of the testes
• The vagina widens in
• increase in increase VS
diameter and increases in
length.
• Nipples become erect
• increase in increase VS

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Plateau is reached just before orgasm

Women Men
• clitoris is drawn forward and • vasocongestion leads to
retracts under the clitoral distention of the penis.
prepuce • Heart rate increases to 100 to
• the lower part of the vagina 175 beats per minute and
becomes extremely congested respiratory rate to approximately
(formation of the orgasmic 40 respirations per minute.
platform)
• increased nipple elevation.

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Orgasm occurs when stimulation proceeds through the

plateau stage, sudden discharges accumulated sexual tension

Women Men
• A vigorous contraction of • muscle contractions
muscles in the pelvic area surrounding the seminal
• Expels or dissipates blood and vessels and prostate project
fluid from the area of semen into the proximal
congestion. urethra.
• propulsive ejaculatory
contractions

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Resolution is a 30-minute period during which the external

and internal genital organs return to an unaroused state

Women Men
• do not go through this • a refractory period occurs
refractory period during which further orgasm is
• possible for women who are impossible.
interested and properly
stimulated to have additional
orgasms immediately after the
first.

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Infertility/Subfertility
• Subfertility investigation is
usually limited to three
assessments:
• Semen analysis
• Ovulation monitoring
• Tubal patency
• Ultrasound

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Management
• Therapeutic insemination
• deposition of sperm into a woman’s cervix or uterus
• In-vitro fertilization (IVF)
• the union of sperm and ovum under laboratory conditions
• Gamete intrafallopian transfer (GIFT)
• uses multiple eggs collected from the ovaries
• eggs are placed into a thin flexible tube (catheter) along with the sperm to
be used
• The gametes (both eggs and sperm) are then injected into the fallopian
tubes using a surgical procedure called laparoscopy

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Stages of Fetal Development

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Fetal growth and development

•Three periods:
• preembryonic (first 2 weeks, beginning with
fertilization)
• embryonic (weeks 3 through 8)
• fetal (from week 8 through birth)

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Fertilization
• AKA conception
• the union of an ovum and a
spermatozoa
• OVA life span = 24 hours
• Sperm 48 -72 hours
• ovum and spermatozoon fuse
to form a zygote

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Implantation
• zygote migrates over the
next 3 to 4 days toward the
body of the uterus
• mitotic cell division, or
cleavage,begins
• zygote reaches the body of
the uterus, it consists of 16
to 50 cells
• it is termed a morula

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EMBRYONIC STRUCTURES: The Decidua

• After fertilization, the corpus luteum in
the ovary continues to function rather
than atrophying, because of the influence
of human chorionic gonadotropin (hCG)
• Decidua is the thickened endometrial
lining
• Three parts:
• 1. Decidua basalis
• 2. Decidua capsularis
• 3. Decidua vera

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EMBRYONIC
STRUCTURES:
Chorionic Villi
• As early as the 11th or
12th day, Chorionic
villi is formed
• It reach out from the
single layer of cells
into the uterine
endometrium to begin
formation of the
placenta.
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EMBRYONIC STRUCTURES: The Placenta

• At 4 weeks, the blastocyst is
splitting into an embryo and
placenta
• At week 10 - 12 placenta takes
over from a structure known
as the corpus luteum

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EMBRYONIC STRUCTURES: Amniotic Membranes

• smooth chorion eventually

becomes the chorionic
membrane
• form the sac that contains the
amniotic fluid
• Hydramnios
• Increased amniotic fluid
• Oligohydramnios
• reduction in the amount of
amniotic fluid
• Slightly alkaline
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EMBRYONIC STRUCTURES: The Umbilical Cord

• transport oxygen and nutrients to

the fetus from the placenta and to
return waste products from the
fetus to the placenta.
• The bulk of the cord is a gelatinous
mucopolysaccharide called
Wharton’s jelly
• AVA
• one vein (carrying blood from the
placental villi to the fetus)
• two arteries (carrying blood from the fetus
back to the placental villi)

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Cardiovascular System
• first systems to become functional in intrauterine life.
• Formation starts as early as 16th day
• Heart beats as early as the 24th day
• Can be heard in doppler = 10th to 12th week
• End of 16th week = FHT is audible using Stethoscope
• 28th week of pregnancy, when the sympathetic nervous
• system has matured, the heart rate begins to show a baseline
variability of about 5 BPM
• Normal FHT = 120-160 bpm

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Fetal
Circulation

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Respiratory System
• Alveoli and capillaries
• begin to form between the 24th and 28th weeks
• Surfactant
• a phospholipid substance, is formed and excreted by the alveolar cells at
about the 24th week of pregnancy.
• Surfactant has two components:
• lecithin (L)
• Sphingomyelin (S)
• At about 35 weeks, a surge in the production of lecithin
• becomes the chief component by a ratio of 2:1

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Nervous System
• Develop during 3rd and 4th weeks of IUL
• A neural plate (a thickened portion of the
ectoderm) is apparent by the third week of
gestation.
1. neural tube, which will form the central nervous
system (brain and spinal cord)
2. neural crest, which will develop into the peripheral
nervous system

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Neural tube defects

• also known as spinal dysraphisms
• are a category of neurological disorders related to malformations of the spinal
cord such as:
• spina bifida
• Anencephaly
• Meningocele
• Myelomeningocele
• Cause:
• Lack of folic acid
• Genetics
• Encourage intake of folic acid (contained in green leafy vegetables and
pregnancy vitamins)

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Determination of Estimated Birth Date

• EDD or EDC = 38 to 42 weeks
• Naegel’s Rule:
• LMP
• Jan to Mar = +9(mos.), +7(days)
• Apr – Dec = -3(mos.),+7(days), +1(yr)
• McDonald’s rule:
• symphysis-fundal height measurement
• method of determining during midpregnancy
• Uterine fundus to Symphysis pubis
• 1cm = 1week AOG between the 20th and 31st weeks of pregnancy.
• Easy milestone:
• Symphysis pubis = 12 weeks
• umbilicus = 20 weeks,
• xiphoid process = 36 weeks

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Fetal Movement
• Fetal movement that can be felt by the mother (quickening)
• 18 to 20 weeks of pregnancy
• at least 10 times a day
• 28 to 38 weeks
• 10–12 times an hour

• assure a woman that fetal movements do vary, especially in

relation to sleep cycles

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Fetal Heart Rate/Tone

• Fetal hearts beat at 120 to 160 beats per minute
• Rhythm Strip Testing
• Attach an external fetal heart rate monitor abdominally
• Record for 20 mins
• Baseline reading refers to the average rate of the fetal heartbeat per
minute.
• Variability refers to small changes in rate
• absent (none apparent)
• minimal (extremely small fluctuations)
• moderate (amplitude range of 6–25 beats per minute)
• marked (amplitude range over 25 beats per minute)

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Nonstress Testing
• A nonstress test measures the response of the fetal heart rate to
fetal movement.
• attach both a fetal heart rate and a uterine contraction monitor.
• Usually done for 10 – 20 mins
• Instruct a woman to push a button whenever she feels the fetus
move.
• When the fetus moves, the fetal heart rate should increase about
15 beats per minute and remain elevated for 15 seconds.
• If no increase in beats per minute is noticeable on fetal movement, poor
oxygen perfusion

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Contraction Stress Testing

• fetal heart rate is analyzed in conjunction with contractions
• Before it was initiated with intravenous infusion of oxytocin
• Nowadays source of oxytocin for contraction stress testing
currently is achieved by nipple stimulation.
• baseline fetal heart rate is obtained
• Next, the woman stimulates nipple until uterine contractions
begin, which are recorded by a uterine monitor.
• Three contractions with a duration of 40 seconds or longer
must be present in a 10-minute window

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Contraction Stress Testing

• Negative (normal)
• if no fetal heart rate decelerations are present with
contractions.
• Positive (abnormal)
• if 50% or more of contractions cause a late deceleration

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Ultrasonography
• Diagnose pregnancy as early as 6 weeks’ AOG
• Confirm the presence, size, and location of the placenta and
amniotic fluid
• Establish sex if a penis is revealed
• Establish the presentation and position of the fetus
• Predict maturity by measurement of the biparietal diameter of the
head
• discover complications of pregnancy

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Ultrasonography
• Encourage to drink a full glass of water every 15 minutes beginning
90 minutes before the procedure
• Do not void until after the procedure
• place a towel under her right buttock
• To prevent supine hypotension syndrome
• Be certain that the gel is at room temperature or even slightly
warmer
• To prevent uncomfortable uterine cramping.

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Amniocentesis
• aspiration of amniotic fluid
• scheduled between the 14th and 16th weeks of pregnancy
• ask the woman to void
• (to reduce the size of the bladder and prevent an inadvertent puncture)
• Do not suggest that she take a deep breath and hold
• this lowers the diaphragm against the uterus and shifts intrauterine contents.
• Increased alpha-Fetoprotein = anencephaly, myelomeningocele
• If the woman has Rh-negative blood, Rho(D) immune globulin (RhIG;
RhoGAM) is administered after the procedure
• to prevent fetal isoimmunization.

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Pregnancy:
Presumptive (Subjective) Signs
• Nausea, vomiting
• Amenorrhea
• Quickening
• Fetal movement felt by woman

• Linea nigra
• Line of dark pigment on the abdomen
• Melasma
• Dark pigment on face

• Striae gravidarum
• Red streaks on abdomen

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Pregnancy: Probable Signs

objective documented by an examiner
• Serum laboratory test
• Chadwick’s sign
• Color change of the vagina from pink to violet
• Goodell’s sign
• Softening of the cervix
• Hegar’s sign
• Softening of the lower uterine segment
• Ballottement
• lower uterine segment is tapped on a bimanual
examination, the fetus can be felt to rise against
abdominal wall
• Braxton Hicks
• Periodic uterine tightening occurs

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Pregnancy: Positive Signs

•FHT
•Fetal movements felt by an examiner
•Visualization of the fetus by ultrasound

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Obstetric History
• Term
• Gravida • Number of full-term infants born
(infants born at 37 weeks or after)
• number of pregnancies
including present • Preterm
pregnancy • Number of preterm infants born
(infants born before 37 weeks)
• Para • Abortion
• Number of pregnancies • Number of spontaneous
miscarriages or therapeutic
that have reached abortions
viability, regardless of
whether the infants were
• Living
born alive • Number of living children
• Multiple
• Multiple pregnancies
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SIGNS INDICATING
COMPLICATIONS OF
PREGNANCY

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SIGNS INDICATING COMPLICATIONS

• Vaginal Bleeding
• Persistent Vomiting
• Chills and Fever
• Sudden Escape of Clear Fluid From the Vagina
• Pregnancy-Induced Hypertension
• Increase or Decrease in Fetal Movement

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HEALTH PROMOTION DURING

PREGNANCY

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HEALTH PROMOTION DURING PREGNANCY

• Self-Care Needs • Sexual Activity

• help separating fact from fiction
• Hx of spontaneous miscarriage
• Bathing • have ruptured or vaginal spotting
• Tub baths are restricted • side-by-side position
• Dental Care • Love on top
• Routine OP
• Exercise
• Perineal Hygiene • walking is best
• Prevent douching • Swimming
• Clothing
• Recommend loose-fitting,
comfortable garments
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Discomforts of Early Pregnancy:

The First Trimester
• Breast Tenderness
• Palmar Erythema
• Constipation
• Nausea, Vomiting, and Pyrosis
• Muscle Cramps

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Discomforts of Early Pregnancy:

The First Trimester
• Hypotension
• Varicosities
• Hemorrhoids
• Frequent Urination
• Kegel Exercises
• strengthen the
pubococcygeal
muscles

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Discomforts of Middle to Late Pregnancy

•Backache
• lumbar lordosis
develops
• Pelvic rocking or tilting
• Dyspnea
• uterus places pressure
on the diaphragm

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Discomforts of Middle to Late Pregnancy

• Ankle Edema
• normal occurrence in pregnancy so long as no
proteinuria
• Braxton Hicks Contractions
• 8th to 12th week AOG
• Non pathological uterine contractions

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Teratogenic Maternal Infections

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Toxoplasmosis
• protozoan infection
• spread most commonly with
uncooked meat
• through handling cat stool in soil or
cat litter
• S/Sx: (almost no symptoms)
• few days of malaise and posterior
cervical lymphadenopathy
• if the infection crosses the placenta = could lead to CNS damage
• Tx: sulfonamides or Pyrimethamine
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Rubella
• causes only a mild rash and mild systemic illness in a woman
• but the teratogenic effects on a fetus can be devastating
• hearing impairment, cognitive and motor challenges, cataracts, cardiac
defects
• woman who is not immunized before pregnancy cannot be
immunized during pregnancy
• If planning to get pregnant have immunization
• After a rubella immunization, a woman is advised not to become
pregnant for 3 months

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Cytomegalovirus
• member of the herpes virus family, is another teratogen that can
cause extensive damage to a fetus
• infant may be born severe neurologically challenged
(hydrocephalus, microcephaly, spasticity) or with eye damage
(optic atrophy)
• no treatment for the even if it presents in the mother with enough
symptoms to allow detection

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Herpes Simplex Virus (Genital Herpes

Infection)
• virus spreads into the bloodstream (viremia) and crosses the placenta
to a fetus posing substantial fetal risk
• first trimester:
• severe congenital anomalies or spontaneous miscarriage
• second or third trimester:
• premature birth
• intrauterine growth restriction
• infection of the newborn at birth
• Treatment: Intravenous or oral acyclovir (Zovirax) can be administered
to women during pregnancy
• If genital lesions at time of birth= C-section is advised

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Syphilis
• fetus at risk for intrauterine or congenital syphilis
• If treated with benzathine penicillin in the first
trimester
• a fetus is rarely affected.
• If left untreated beyond the 18th week of gestation
• hearing impairment, cognitive challenge,
osteochondritis, and fetal death are possible.

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Nutritional Health During

Pregnancy
A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is recommended
as an average weight gain in pregnancy.

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Energy (Calorie) Needs

• The DRI of calories for women of childbearing age is 2200.
• An additional 300 calories, or a total caloric intake of 2500
calories, is recommended.

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Protein Needs
• The DRI for protein in women is 46 g/d.
• During pregnancy, the need for protein increases to 71 g daily.

Vitamin Needs
• Requirements for both fat-soluble and water-soluble vitamins
increase during pregnancy
• Most vitamins comes with Folic Acid which is essential for fetal
health

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Mineral Needs and Fluid

•Calcium and • Extra amounts of water
Phosphorus are needed during
pregnancy
•Iodine
• Promote kidney
•Iron function
•Zinc

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Preparing a Family for Childbirth

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Perineal and Abdominal Exercises

Tailor Sitting
• 15 minutes every day
• stretches perineal muscles
without occluding blood
supply to the lower legs
• By 3rd trimester a woman’s
perineum should be so supple
that when she tailor sits, her
knees will almost touch the
floor if pushed.

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Perineal and Abdominal Exercises

Squatting
• also stretches perineal muscles
• useful position for second-stage
labor
• Practice 15 minutes a day
• For pelvic muscles to stretch, a
woman should keep her feet flat on
the floor.
• Incorporating squatting into daily
activities such as picking up toys
reduces the amount of time a
woman must devote to daily
exercises.

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Perineal and Abdominal Exercises

Kegel Exercises
tighten the muscles of perineum
strengthen the pubococcygeal muscles
and bulbocavernosus
1. Hold for 3 seconds. Relax. Repeat this
sequence 10 times.
2. Contract and relax the muscles
surrounding the vagina as rapidly as
possible 10 to 25 times.
3. Imagine that you are sitting in a bathtub
of water and squeeze muscles as if
sucking water into the vagina. Hold for
3 seconds. Relax. Repeat this action 10
times.
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Perineal and Abdominal Exercises

Pelvic Rocking
• helps relieve backache during
• pregnancy and early labor
• making the lumbar spine more flexible.
• increases flexibility and helps relieve
back pain
• Holds the position for 1 minute, then
hollows her back.
• Do it five times a day

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Perineal and Abdominal Exercises

Water exercise
• is the best for maintaining
cardiovascular fitness without
stressing the body since the buoyancy
of the water lessens the impact on
joints and ligaments.
• Water's mild resistance helps to
increase muscle strength and
flexibility.
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PREPARATION FOR LABOR

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Preliminary Signs of Labor

Lightening Show
• Lightening is the settling of the fetal • Show is the common term
head into the inlet of the true pelvis. used to describe the release of
• It occurs approximately 2 weeks the cervical plug (operculum)
before labor in primiparas but at • It consists of a mucous, often
unpredictable times in multiparas. blood-streaked vaginal
• A woman notices she is not as short discharge and indicates the
of breath beginning of cervical
• frequency of urination or sciatic dilatation.
pain (pain across a buttock radiating • Keep monitoring until there is
down her leg) regular contraction
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Preliminary Signs of Labor

Excess Energy Ripening of the Cervix
It occurs as part of the body’s • Internal examination
physiologic preparation for labor.
• Goodell’s sign
If she can recognize she can • Earlobe consistency throughout
conserve energy in preparation for pregnancy
labor.
• Ripened Cervix
If not recognize she may use this • Cervix becomes softer (“butter-soft”)
burst of energy in chores and
• Indicating true labor is close
exhaust herself before labor
begins.

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Preliminary Signs of Labor

Braxton Hicks Contractions
In the last week or days:
May feel extremely strong Braxton Hicks contractions
These are false contractions and doesn’t require admission
Keep on monitoring until true labor contractions occur

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Signs of TRUE Labor

Show
• Show is the common term used to describe the release of the
cervical plug (operculum)
• It consists of a mucous, often blood-streaked vaginal discharge
and indicates the beginning of cervical dilatation.
• Keep monitoring until there is regular contraction

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Signs of TRUE Labor

Uterine Contractions
• surest sign that labor has begun is productive uterine
contractions.
• contractions last about 30 to 70 seconds and come about 5 to 10
minutes apart

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Signs of TRUE Labor

Rupture of the Membranes
• A sudden gush of clear fluid
(amniotic fluid) from the vagina

• Rush to the primary care

provider immediately

• Possible danger of cord

prolapse and uterine infection.
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COMPONENTS OF LABOR

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1. Passage
• A woman’s pelvis (the passage) is of
adequate size and contour.
• Two measurements:
• diagonal conjugate (anteroposterior)
• transverse diameter

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2. Passenger
• The passenger (the fetus) is of
appropriate size and in an
advantageous position and
presentation.
• Fetal Biparietal diameter should present in
maternal anteroposterior diameter to allow
engagement
• Degree of flexion
• Suboccipitobregmatic
• Occipitofrontal
• occipitomental

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Passenger: Fetal Attitude

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83

Passenger: Station
• refers to the relationship of the
presenting part of a fetus to the
level of the ischial spines

• 0 station
• (synonymous with engagement)
• “floating”
• presenting part that is not engaged
is said to be
• “dipping”
• One that is descending but has not
yet reached the ischial spines

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84

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Passenger: Fetal Lie

• Lie • Presentation
• relationship between the • Cephalic
long (cephalocaudal) axis of • Needs continuous Valsalva
the fetal body and the long during delivery
(cephalocaudal) axis of a • Breach
woman’s body • buttocks or feet
• Horizontal (transverse) • Shoulder
• Vertical (longitudinal) • If small fetus
• manual rotation
• If normal or big
• Consider C-section

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85

3. The powers of labor

• Uterine Contractions • Dilatation
• effective uterine contractions is • enlargement or widening of the
rhythmicity and progressive cervical canal
lengthening and intensity. • few millimeters wide to full
• Cervical Changes dilatation (approximately 10 cm)
• Effacement
• shortening and thinning of the
cervical canal
• Approx 1 – 2 cm dilatation
• In primi effacement before
dilatation
• In multi possible dilatation may
proceed before effacement

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86

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4. Psyche
• Refers to the psychological • Feeling of apprehension or
state or feelings fright
• Excitement or awe • without adequate support can
have an experience so
• strong sense of self-esteem and frightening and stressful
a meaningful support person
• can develop a posttraumatic
stress syndrome

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87

STAGES OF LABOR

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88

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First Stage
• TRUE LABOR to Full dilatation
• Lumbar epidural block may be administered
• Latent phase
• onset of regularly uterine contractions and ends when rapid cervical
dilatation
• Active phase
• cervical dilatation 4 to 7 cm
• Contractions 40 to 60 seconds, 3 to 5 mins interval
• Transition phase
• cervical (full) dilatation 9 to 10 cm
• Full effacement
• Contractions 60 to 90 seconds, 2 to 3 mins interval

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89

Second Stage
• from full dilatation and
cervical effacement to
birth of the infant
• Pudendal block may be
administered
• Crowning takes place
• episiotomy
• Midline
• Mideolateral
WOF signs of uterine Tetany!!!

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90

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Third Stage
• the placental stage • Signs of Placental Separation
• approximately 5 minutes • Lengthening of the cord
after the birth of the infant • Sudden gush of blood
• Change in the shape of the uterus
• birth of the infant to • Firm contraction of the uterus
delivery of the placenta • Appearance of the placenta at the
vaginal opening
• Two phases: • Schultze
• placental separation • Separate at center first
• placental expulsion • Duncan
• Valsalva or by Crede’s • Separate from edge first
• Manual evacuation

oxytocin
21/11/2024is usually ordered to be administered
rtpapadmdrn intramuscularly or intravenously
91

91

Fourth Stage
• first few hours after birth
• Perineal Repair

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92

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Phases of the Puerperium

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93

Taking-In Phase
• time of reflection
• 2- to 3-day period
• Mother is passive
• Dependency in activity
• usually wants to talk about her pregnancy rather than new role
• Expressed little interest in caring for her child
• holds her new child with a sense of wonder

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94

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Taking-Hold and Letting Go

Taking-Hold Phase Letting-Go Phase

• begins to initiate action • woman finally redefines her
• begins to take a strong interest new role
for her child

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95

Pregnancy
Complication

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96

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Diabetes Mellitus
• Patient with DM
• Decrease insulin need in early pregnancy
• Increase insulin as pregnancy progresses (24th week)
• Type 1 is of higher risk of birth defects

• GDM
• Midpoint of pregnancy there is occurrence insulin resistance and degradation
• Due to Hormone human placental lactogen (chorionic somatomammotropin)
and high levels of cortisol, estrogen, progesterone, and catecholamines.
• Placental Insulinase may cause increased breakdown or degradation of insulin.
• symptoms fade again at the completion of pregnancy
• risk of developing type 2 diabetes later in life

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97

Bleeding During Pregnancy

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98

49
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21/11/2024 rtpapadmdrn 99

99

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100

50
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101

Ectopic Pregnancy
• 2nd most frequent cause of bleeding early
in pregnancy
• Sites:
• Fallopian tube – most common
• Surface of uterus
• Cervix
• S/Sx:
• sharp, stabbing pain in one of her lower
abdominal quadrants at the time of rupture
• scant vaginal spotting.

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102

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Ectopic Pregnancy
• If raptured early
• No treatment required as it will be reabsorbed
• If raptured late
• WOF for signs of shock
• Hemorrhage management
• Laparoscopy and ligation of bleeding site
• If failed to rupture
• Methotrexate
• folic acid antagonist chemotherapeutic agent
• Mifepristone, an abortifacient
• If Rh(-) mother: give Rhogam
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103

Placenta Previa
• is a condition of pregnancy in which the placenta is implanted
abnormally in the uterus.
• most common cause of painless bleeding in the third 3rd of
pregnancy

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104

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Placenta Previa
• cautioned to avoid coitus
• to get adequate rest
• Report any sign of vaginal bleeding
Management:
• Side lying
• Bed rest
• Preterm labor is apparent due to bleeding

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105

Abruptio Placenta
• primary cause: unknown
• Predisposing factors:
• high parity
• advanced maternal age,
• short umbilical cord
• chronic hypertensive
disease
• pregnancy-induced
hypertension
• direct trauma

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106

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Abruptio Placenta
• S/Sx:
• sharp, stabbing pain .
• high in the uterine fundus
• Heavy bleeding
• If blood infiltrates the uterine musculature Couvelaire uterus or
uteroplacental apoplexy, forming a hard, boardlike uterus
• DIC syndrome can occur

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107

PREGNANCY-INDUCED
HYPERTENSION

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108

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PIH
• is a condition in which vasospasm occurs during pregnancy in
both small and large arteries
• Cause: Unknown
• Maybe related to antiphospholipid syndrome or the presence of
antiphospholipid antibodies
• CLASSIC SIGNS:
•hypertension, proteinuria, and edema

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109

PIH
Risk Factor:
• occur most frequently in women of color
• Multiple pregnancy
• primiparas younger than 20 years or older than 40 years
• women from low socioeconomic backgrounds
• those who have had five or more pregnancies

21/11/2024 rtpapadmdrn 110

110

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PIH Classification
• Gestational hypertension
• elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema
• Preeclampsia
• Classic signs are present
• Eclampsia
• Classic signs + seizure
• cerebral edema is so acute that a grand-mal seizure (tonic-clonic) or
coma occurs

21/11/2024 rtpapadmdrn 111

111

PIH management
• Low dose aspirin and monitor Antiplatelet Therapy
• Promote Bed Rest
• Monitor Fetal Well-being
• Support a Nutritious Diet
• Medication:
• hydralazine (Apresoline), labetalol, nifedipine
• Magnesium sulfate - Muscle relaxant via piggyback infusion over 15–30
min
• Diazepam (Valium)

21/11/2024 rtpapadmdrn 112

112

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113

57