ATIENZAR, ALEXANDRA YZOBEL I.

ANEMIA • smooth and shiny tongue

- hemoglobin value < 11mg/dl or • koilonychia
hematocrit <33% during the second or
third trimester NURSING INTERVENTION
➢ discuss iron supplements and
NORMAL: 13.5g/dl (non-pregnant) increasing dietary sources of iron as
indicated
MILD ANEMIA ➢ prepare for blood typing and
- Hemoglobin 11mg/dl crossmatching, and for administering
- poses no threat packed RBCs during labor if client has
- indicates less than optimum nutritional severe anemia
state ➢ instruct about the need for high fluid
intake/high fiber diet
IRON DEFICIENCY ANEMIA ➢ instruct about the need for
- Most common anemia in pregnancy supplemental Fe
- affect 15-50% of pregnant woman ➢ instruct that vit. c will increase
- identified as physiologic anemia in absorption
pregnancy. (Intervention: increase ➢ teach mother that iron will produce
plasma volume) black stool and may cause other
gastrointestinal symptoms
ETIOLOGY (gas/nausea)
Nutritional deficiency (iron deficiency ➢ it can be tolerated, Fe is best
or megaloblastic anemia which includes absorbed if taken in with empty
folic stomach
acid anemia and vitamin b12 deficiency) ➢ milks inhibit absorption
Acute and chronic loss
hemolysis (sickle cell anemia, thallasemia, VITAMIN C
or - enhances absorption of IRON
glucose-6-phosphate dehydrogenase
(g6pd)) increases destruction of RBCs

ASSESSMENT
Clients with hemoglobin 10.5 f/dl expects
complaints of:
CHEILOSIS is also known as CHEILITIS
indicates
painful inflammation and crackling of the
angles of the mouth it may involve one or
both sides of the mouth
• excessive fatigue
• headache
• tachycardia
• susceptibility of infection

SIGNS OF IRON DEFICIENCY ANEMIA

• hgb <10.5g/dl
• brittle nails
• cheilosis (severely chapped lips)
 ATIENZAR, ALEXANDRA YZOBEL I.

ABORTION 2. INEVITABLE ABORTION/IMMINENT

-the termination of pregnancy at any ABORTION
time before the fetus has attained - Cervix is opened
viability - bleeding more profuse and
VIABILITY: 20 wks of gestation or fetal cramping become more severe
weight of 500 gm (1.1 lb) - membranes rupture
- products of conception
TYPES OF ABORTION expelled
1. SPONTANEOUS
- threatened abortion 3. COMPLETE ABORTION
- inevitable abortion - All products of conception are
- habitual abortion expelled within 24-48 hours
-incomplete abortion
-missed abortion 4. INCOMPLETE ABORTION
-expulsion of only part of the
2. THERAPEUTIC ABORTION products of conception (usually the
SPONTANEOUS ABORTION fetus)
ETIOLOGY
FETAL FACTORS 5. MISSED ABORTION
- Defective embryonic development - fetal intrauterine death without
- faulty ovum implantation expulsion of the products of
- projection of the ovum by the conception
endometrium - cervix is closed
- chromosomal abnormalities - dark brown vaginal bleeding
- (-) pregnancy test
PLACENTAL FACTORS
- premature separation of the normal 6. RECURRENT HABITUAL ABORTION
implanted placenta - spontaneous abortion of 3 or more
- abnormal placental implantation consecutive pregnancies
-abnormal placental function
-chromosomal abnormalities VACUUM ASPIRATION OR CURETTAGE

MATERNAL FACTORS VACUUM ASPIRATION ABORTION

- infection -13 weeks of gestation
- reproductive system abnormalities -cervix is dilated with metal rods
(incompetent cervix) - uterine cavity is aspirated with
- endocrine problems (thyroid negative pressure
dysfunction)
- trauma DILATION AND CURETTAGE
- drug ingestion -dilation (widening/opening) of the
cervix and surgical removal of part of
1. THREATENED ABORTION the lining of the uterus and/or contents
- cervix is close or slightly dilated of the uterus by scraping and
- some bleeding, mild cramping, scooping (curettage)
and persistent backache with
feeling of pelvic pressure
- symptoms subside or develop
into inevitable abortion
 ATIENZAR, ALEXANDRA YZOBEL I.

ASSESSMENT FINDINGS FIRST TRIMESTER

- Vaginal bleeding in the first 20 weeks Incompetent cervix
of pregnancy - characterized by painless dilation and
- complaints of cramping in the lower effacement of the cervical os without
abdomen contractions of the uterus in the early
- fever, malaise, or other symptoms of trimester resulting in expulsion of the
infection products of conception
- commonly occurs at about 20th weeks of
LABORATORY AND DIAGNOSTIC pregnancy
FINDINGS
- Serum beta hCG levels are ETIOLOGY
quantitatively low - History of traumatic birth
- U/S reveals absence of viable fetus - repeated D&C
- clients mother treated with
NURSING CARE FOR CLIENTS WITH diethylstilbestrol (DES) when pregnant
ABORTION -congenital short cervix
- monitor amount and type of bleeding. -uterine anomalies
save and count number of pads -unknown etiology
- monitor fundus for firmness after -
products of conception are expelled
-monitor VS for hypovolemia, shock, ASSESSMENT
and infection, monitor CBC, COMMON CLINICAL MANIFESTATION
hematocrit, hemoglobin and prepare - Appreciable cervical dilation with
bt if indicated prolapse of the membrane through
- administer oxygen if indicated. the cervix without contractions
measure and record IV fluids - painless contractions in midtrimester
- prepare for D&C if indicated - birth of dead or nonviable fetus
- prepare for RhoGAM administration to
an Rh (-) mother as prescribed THERAPEUTIC INTERVENTIONS
- recommend iron supplements and ✓ cerclage procedure during 14th to
increased dietary iron as indicated to 16th
help prevent anemia weeks of gestation or before next
- offer anticipatory guidance relative to pregnancy
expected recovery, the need for rest - suture or ribbon placed beneath the
and delay of another pregnancy until cervical mucosa to close the cervix
client fully recovers
- suggest avoiding intercourse until a. permanent suture (Shirodkar
after the next menses or using procedure)
condoms when engaging in - subsequent delivery by
intercourse cesarean

b. temporary purse string (mc

donald procedure)
- suture removed at term with
vaginal delivery
 ATIENZAR, ALEXANDRA YZOBEL I.

MEDICAL MANAGEMENT
NURSING INTERVENTIONS conservative treatment
- describe problems that must be • woman is monitored for signs of
reported immediately infections and the of spontaneous
o pinked tinged vaginal labor
discharge, increased pelvic • hospitalization with bed rest after 37
pressure and rupture of the weeks of gestation
membranes • amnioinfusion of isotonic saline in some
- prepare for cervical cerclage if cases to allow for fetal movement and
appropriate lessen danger of cord compression
- maintain activity restriction as
prescribed Tocolytic and corticosteroid
- discuss the need for vaginal rest (no • tocolytic therapy is used until fetal
intercourse or orgasm) lungs have matured
- address emotional and physiological • 2 doses of betamethasone(celestone)
needs mare given 24-48 hours before birth, if
- prepare for immediate delivery if births appear inevitable
membranes have ruptures • ACTIONS: reduces incidence of RDS if
preterm infants, enhances formation of
PREMATURE RUPTURE OF surfactant
MEMBRANES (PROM) • if the infant is born within the next 7
- Spontaneous rupture of membranes days, the incidence of respiratory
before of onset of labor distress may be decreased
- dangers associated with this event are
prolapsed cord, infection, and NURSING MANAGEMENT
potential need for premature delivery • Monitor maternal/fetal vital signs on
- the leading cause of death continuous basis especially maternal
associated with prom is infection temperature
• calculate gestation age
ASSESSMENT • observe for sign of infection and for
- mark by amniotic fluid gushing from signs of onset of labor
the vagina in the absence of o if signs of infection is present,
contraction administer antibiotics as
- pooling of amniotic fluid in the will be ordered
visualized during a speculum o if no maternal infection,
examination induction of labor may be
- maternal fever, fetal tachycardia, and delayed
malodorous discharge may indicate • observed and record color, odor,
infection amount of amniotic fluid
• examine mother for signs of prolapsed
LABORATORY AND DIAGNOSTIC cord
STUDIES • prepare mother/family for early birth if
Rupture of membranes is confirmed by the indicated
following:
- ferning is evident
- nitrazine test tape turns blue-green
color
 ATIENZAR, ALEXANDRA YZOBEL I.

ECTOPIC PREGNANCY c) Sharp abdominal pain and referred

-refers to any gestation located outside shoulder pain
the uterine cavity most frequent site is d) Vaginal bleeding (scanty and dark in
middle portion of fallopian tube, other color)
sites are abdomen, ovaries, or cervix. e) Pelvic exams reveal pelvic mass,
posterior to the uterus and cervical
ETIOLOGY pain on movement
-results from conditions that hinder
ovum passage through the fallopian NURSING ASSESSMENT FOR:
tube and into the uterine cavity such
as: 1. TUBAL ERUPTION
a) salphingitis a. Faintness – shock
b) diverticula b. Pain radiating to shoulder, and
c) tumors neck
d) adhesion from previous surgery c. Nausea and vomiting
e) transmigration of the ovum from one
ovary to the opposite fallopian tube 2. ABDOMINAL BLEEDING
f) congenital anomalies COMPLICATIONS
g) history of PID (pelvic inflammatory a) Hemorrhage
diseases) b) Shock
h) endometriosis c) Peritonitis

SITES OF ECTOPIC PREGNANCY DIAGNOSTIC EVALUATION

a) Ampulla
b) Isthmus 1. CULDOCENTESIS
c) Fimbria - Aspiration of fluid from cul-de-sac of
d) Tuboovarian ligament douglas, (+) presence of bloody fluids
e) Interstitium indicates peritoneal bleeding
f) Ovary
g) Cervix (external os) 2. CULDOSCOPY
h) Abdominal cavity - Visualization of the pelvic organs
through the punctured posterior formix
ASSOCIATED FINDINGS
• Suspect ectopic pregnancy in client 3. ULTRASOUND
whose history including: - Confirm extra uterine pregnancy
a) Missed menstrual period
b) Pelvic or shoulder pain 4. RADIOIMMUNOASSAY OF
c) Pelvic infections (PID) ELEVATED
d) Previous ectopic pregnancy SERUM QUANTITATIVE BETA- hCG
e) History of multiple induced abortions
f) Spotting or bleeding 5. BLOOD EXAMPLES FOR Hgb and
g) Use of IUD Hct:
h) Tubal surgery blood type and group
HYSTEROSALPHINGOGRAM
COMMON CLINICAL S/S • Hysterosalphingogram (xray study)
a) May or may have no symptoms of showing blockage of the left fallopian
pregnancy tube
b) Dizziness and syncope (faintness)
 ATIENZAR, ALEXANDRA YZOBEL I.

THERAPEUTIC INTERVENTION of the chorion

• Diagnosis confirmed by the ultrasound o Spontaneous eruption occurs
examination, laparoscopy, or between 16th and 18th week
culdocentesis
• Immediate blood replacement if TYPES OF H. MOLE
blood loss is severe 1. COMPLETE MOLE
• Surgical repair or removal of ruptured • Chromosomes are either 46xx or 46xy
fallopian tube may be attempted but are contributed by only one
• Chemical therapies to salvage parent and the chromosome material
fallopian tube (e.g. methotrexate, duplicated
leucovorin)ctto this only serves as • This type usually leads to
reviewer choriocarcinoma
2. PARTIAL MOLE
NURSING INTERVENTION •Has 69 chromosomes. There are 3
• Assess continuously for signs of shock chromosomes for every pair instead of
• Administer blood transfusion if ordered 2
for excessive blood loss • This type rarely leads choriocarcinoma
•Administer analgesics as ordered for
pain NURSING MANAGEMENT
•Provide emotional support •Prepare for suction curettage
•Administer RhoGAM to Rh negative evacuation of the fetus, induction of
client oxytocic agents prostaglandins
• Frequent physical and pelvic
HYDATIDIFORM MOLE examination for 1 year to monitor
-Or molar pregnancy results from over recurrence and progression of disease
production of the tissue that is •hCG levels monitored for one year to
supposed to develop into the rule out metastasis from
placenta. choriocarcinoma, (continued
elevation may require hysterectomy
TWO TYPES: and chemotherapy)
1. PARTIAL MOLAR PREGNANCY • Pregnancy is discourage for 1 year
- There is abnormal placental and some • Oral contraceptives and IUD are not
fetal movement recommended
2. COMPLETE MOLAR PREGNANCY • Report the following s/s immediately:
- There is an abnormal placenta but no irregular vaginal bleeding, persistent
fetus secretion from the breast, hemoptysis,
and persistent headaches (spreads to
HYDATIDIFORM MOLE (Gestational other organs
trophoblastic disease) • Address physiological and emotional
o An alternation of embryonic needs
growth
o Causing placental disruption, ASSESSMENT FOR H. MOLE
o Rapid proliferation of abnormal • Vaginal bleeding (may contain
cells, and some of the edematous villi,
o Destruction of the embryo brownish, prune juice) containing
o An abnormal pregnancy in grapelike tissue
which there is a benign growth • Uterus larger than expected for the
duration of the pregnancy
 ATIENZAR, ALEXANDRA YZOBEL I.

• Abdominal cramping from uterine CLINICAL MANIFESTATION

distention • Unremitting N/V
• s/s of preeclampsia before 20 • Vomitus initially containing undigested
weeks of gestation (BP elevated food, bile, and mucus: later containing
earlier than 24 weeks’ gestation) blood and material that resembles
• severe nausea and vomiting coffee grounds
• absence of fetal heart tones
OTHER S/S
LABORATORY AND DIAGNOSTIC • Pale, dry skin
FINDINGS • Rapid pulse
• hcg serum levels are abnormally • Fetid, fruity breath odor (acetone
high breath)
• ultrasounds reveal characteristic • CNS effects: confusion, delirium,
appearance of molar growthctto this only headache, lethargy, stupor or coma
serves as reviewer
NURSING INTERVENTION
HYPEREMESIS GRAVIDARUM • NPO until cessation of vomiting (rest
- severe and excessive nausea and stomach)
vomiting during pregnancy which lead • IV and electrolyte replacement as
to electrolyte, metabolic and prescribed. May be given on an
nutritional imbalances in the absence ambulatory basis if dehydration is mild
of medical problems. • Measure and record I/O
- Persistent N/V • Gradually re introduce intake, monitor
- Leads to dehydration and F/E intake and amount tolerated.
imbalance • Encourage small frequent feedings.
- Causes: possible severe reaction to Provide bland solid foods
HCG • Avoid greasy, gassy, and spicy foods
• Keep emesis pan handy but out of
INTERVENTIONS: sight
• NPO, F/E replacement • Provide mouth care
• Monitor I/O • Administer antiemetic as prescribed
• Gradually introduce PO intake • Offer emotional support
• If given TPN, monitor central line, • Refer to home health care as
provide mouth care appropriate for continued IV or TPN
• Offer emotional support therapy

ETIOLOGY
• High levels of Hcg in early pregnancy
• Metabolic or nutritional deficiencies
• Ambivalence toward pregnancy or
family-related stress
• Thyroid dysfunction

ASSESSMENT
• S/S occur during the first 16th weeks of
pregnancy
 ATIENZAR, ALEXANDRA YZOBEL I.

PLACENTA PREVIA • FHR stable and within normal limits

- Implantation of the placenta in the unless maternal shock is present
lower uterine segment • Signs of infection

Placenta previa is classified according DIAGNOSIS

to the • Transabdominal ultrasound shows
placement of placenta location of the placenta and confirms
1. TYPE I or low lying the suspicion of placenta previa
- The placenta encroaches the lower
segment of the uterus but does not NURSING INTERVENTION
infringe on the cervical os • No admission vaginal examination; if a
2. TYPE II or marginal vaginal examination is to be
- The placenta touches, but does niot performed double set ups (vaginal
cover the top of the cervix and cesarean) must be provided
3. Type III or partial • Take and record VS, assess bleeding,
- The placenta partially covers the top and maintain a perineal pad count
of the cervix weight perineal pads before and after
4. TYPE IV or complete use to estimate blood loss
- The placenta completely covers the • Assess for shock and administer
top of the cervix oxygen as indicated
• Monitor FHR continuously
CLASSIFICATIONS • Enforce strict bedrest to minimize risk of
1. TOTAL PLACENTA PREVIA fetus (side lying)
- Occurs when the placenta • Monitor Hgb and Hct: prepare for
immediately covers the internal OS cesarean if bleeding persists
2. PARTIAL PLACENTA PREVIA • Administer IV therapy and/or blood
- Occurs when the placenta partially replacement
covers the internal os • Prepare client for ambulation and
3. LOW LYING OR LOW discharge (may be within 48 hours of
IMPLACENTATION last bleeding episode)
PLACENTA • Instruct client to return to hospital if
- Occurs when the placental border bleeding recurs and to avoid
reaches the border of internal os intercourse until after birth
• Proper handwashing and toileting to
PREDISPOSING prevent infection
• Multiparity (80%)
• Advanced maternal age (older than
35 yrs. old in 33% cases)
• Multiple gestation ABRUPTIO PLACENTA
• Previous cesarean section - Premature separation of a normally
• Uterine incision implanted placenta after the 20th
• Prior placenta previa (12 times greater weeks of pregnancy, typically with
severe hemorrhage
ASSESSMENT
• Painless, bright red vaginal bleeding ETIOLOGY
after 7th month of pregnancy - Cause is UNKNOWN
• Soft, non-tender abdomen: relaxes
between contraction
 ATIENZAR, ALEXANDRA YZOBEL I.

RISK FACTORS
• Uterine anomalies LABORATORY AND DIAGNOSTIC
• Multiparity FINDINGS
• Preeclampsia • ULTRASOUND may be able to identify
• Previous CS the extent of abruptio
• Renal or vascular disease
• Trauma to abdomen TREATMENT
• Previous trimester bleeding • Replacement of blood loss
• Abnormally large placenta • With moderate or severe separation or
maternal/fetal distress: EMERGENCY
TYPES OF ABRUPTION PLACENTA CESAREAN BIRTH
• With mild separation without fetal
• CONCEALED (CENTRAL) distress and in the presence of some
HEMORRHAGE cervical effacement and dilation:
- Placenta separates centrally INDUCTION OR LABOR MAY BE
- Large amount of blood accumulates ATTEMPTED
under the placenta
NURSING INTERVENTION
• EXTERNAL (MARGINAL) • Continuously evaluate maternal and
HEMORRHAGE fetal physiologic status particularly
- Placenta separates marginally a) Vital signs
- Blood flows under the membrane and b) bleeding
through the cervix c) Electronic fetal and
maternal monitoring
ASSESSMENT tracing
• Intense, localized uterine pain, with or d) Decreasing urine output
without vaginal bleeding • Never perform vaginal or rectal exam
• Concealed if center of the placenta or take any action that would
separates and margins are intact; stimulate uterine activity
dark-red blood may/may not be • If bleeding could not be stopped with
evident with partially detached bedrest, emergency C- section is
placenta at margins indicated
• Uterus firm to board line, with severe • Maintain in bedrest in left lateral
continuous pain recumbent
• Uterine contraction • Assess for shock
• Uterine outline possibly enlarged or • Assess abdominal pain, tonicity of
changing shape abdomen, perineal pads if bleeding
• FHR present or absent (hyperactivity evident, Hgb & Hct levels
then cessation of fetal movements) • Administer IV therapy and/or blood
• Fetal presenting part may be replacement
engaged • Observes for signs of DIC such as
seepage of blood from IV site or
ASSOCIATED FINDINGS incisional are
• Renal failure
• Maternal and fetal death
• Disseminated intravascular
coagulation
• Hypofibrinogenemia