OB-abnormal
Lecture
Prof. Toni Notario RN MAN
Hemorrhagic Disorders in
Pregnancy
1. ABORTION
*Viable Fetus:
Types of ABORTION:
a. Spontaneous Abortion b. Induced Abortion
Types: Types:
2. Ectopic Pregnancy- outside the uterine wall
Site: Tubal in Nature (90%)----------AMPULLARY
(80%)
-Most common Predisposing factor for PID
-Other Factors: 1. Presence of IUD
2. Hx of Previous Ectopic Pregnancy
Triad Manifestation:
Clinical Manifestation of Ectopic Pregnancy
Diagnosis:
Culdocentesis- extraction of fluid
from the recto-uterine pouch posterior
to the vagina through a needle.
Management:
Methotrexate
-a sclerosing agent
-a folic-acid antagonist chemotherapeutic agents
attacks and destroys fast-growing cells
-it shrinks and absorb products of conception
-given IM if the size is less than 3cm.
Surgical Management
Salpingotomy
Salpingectomy
Hydatidiform Mole
Abnormal proliferation and then degeneration
of the trophoblastic villi
Vesicle-like structure is formed instead of
placenta
CAUSE: Unknown
Manifestations of H-mole
Management
1. Dilatation and Curettage
2. Monitor HCG Titer
3. Mandatory follow-up
4. Monitor level of HCG every 2 weeks until normal
5. No pregnancy for 1 year
Premature Cervical
Dilatation
AKA: Incompetent Cervix
Most Common Cause: Habitual Abortion
1st symptom: pink vaginal discharge
Predisposing Factors:
1. Developmental Factors
2. Repeated trauma to the cervix
3. Repeated D and C
Management
MCDONALD’s Rule
-Purse string suture applied to cervical opening
-The purpose is to make the cervix tense
-Done if the product of conception is less than 12
weeks old
-Sutures are removed 37 to 38 weeks of pregnancy
Shirodkar/Barter Procedure
-Sterile tape is threaded in a purse-string manner
under the submucous layer of the cervix and
sutured in place to achieve a closed cervix.
-Cervix is closed but menstrual blood is allowed to
come out
-Sutures are placed by a trans-abdominal route
-Delivery is Cesarean Section
Important Concepts:
1. Bed rest
2. Modified Trendelenburg
3. Lumbar area is elevated; feet lowered
4. TOCOLYTIC therapy- if there is contraction
5. Ritodrin (Yutopar) and Terbutaline
(Brethine) are administered to stop
contraction. These drugs relax uterine muscle.
Placenta Previa
Placenta is implanted abnormally in the uterus
Common cause of Painless Bleeding in 3rd
Trimester
Predisposing Factor:
1. Multiparity
2. Tumor or mass in the uterus
3. Developmental Anomaly in the Uterus
Types:
Clinical Assessment
-Bleeding that occurs is usually abrupt, painless,
and bright red
-Uterine consistency: soft
Management
1. Bed Rest
2. Position: Side-Lying
3. Assess the following:
a. Duration of pregnancy
b. Time the bleeding began
c. Woman’s estimation of the amount of blood
d. Whether there was accompanying
e. Color of Blood
4. Never attempt a pelvic or rectal examination
5. Obtain vital signs
6. IV therapy
7. Attach external monitoring equipment
8. Have oxygen equipment available in case of
fetal distress
9. If bleeding stops the woman can go home
Abruptio Placenta
Early separation of the placenta prior to delivery
of the fetus
Normal: placenta separates on the 3rd stage
labor
In Abruptio Placenta, the abnormal separation
occurs on the second stage of labor
CAUSE: Unknown
Clinical Assessment
1. Sharp, stabbing pain in uterine fundus
2. Heavy bleeding but may not be readily
apparent
3. Rigidity of the uterus
4. Fetal heart tone may not be heard
Management
1. Fluid replacement
2. Provide oxygenation to limit fetal anoxia
3. Monitor fetal heart sounds
4. Monitor V/S
5. Position: Lateral Position----- avoid supine
position to prevent pressure on the vena cava
6. Do not perform any abdominal, vaginal or
pelvic examination
Pre-term Rupture of
Membranes (PROM)
-Rupture of fetal membranes with loss of amniotic
fluid during pregnancy before 37 weeks.
Cause: Unknown
COMPLICATION:
1. Infection
- GOLD STANDARD is 24 hours
- If more than 24 hours, there will be sepsis
2. Cord Prolapse
Management
1. Bed Rest
2. Corticosteroid such as Betamethasone to
hasten fetal lung maturity
3. Do not reinsert the cord
4. Moisten gauze with NSS and cover the cord
5. Provide Oxygenation
6. Get fetal heart tone
7. Outright delivery must be initiated
Premature Labor
- Labor that occurs before the end of week 37 of
gestation
- Responsible for almost 2/3 of all infant deaths in
the neonatal period
- Preventable
CAUSE: Unknown, Dehydration, UTI,
Chorioamnionitis
Management
1. Bed Rest
2. Intravenous therapy
3. Tocolytic Agents
4. Coitus Restriction
Post Term Pregnancy
-Pregnancy that exceeds 42 weeks long
-Also termed as PostMature/Postdate
-Post term pregnancy occurs in 3% to 12% of all
pregnancies
Complications:
1. Meconium Aspiration
2. Fetal Macrosomia
3. Decreased fetal circulation due to calcium
deposits leading to fetal hypoxia
Management
1. Prostaglandin gel or Misoprotol may be applied
to the cervix to initiate ripening
2. Oxytocin administration to begin labor
3. Monitor fetal heart rate closely during labor
Breech Delivery
- Either the buttocks of the feet are the 1st body
parts that will contact the cervix
- Occur in approximately 3% of births and are
affected by the fetal attitude.
Types:
1. COMPLETE
2. FRANK
3. FOOTLING
Problems Associated with
Breech Delivery
CORD PROLAPSE
HEAD ENTRAPMENT
SHOULDER DYSTOCIA
KEY CONCEPT: look for possible meconium stain
Pregnancy Induced
Hypertension (P.I.H)
- A condition in which vasospasm occurs during
pregnancy in both small and large arteries
- CAUSE: Unknown
CLASSIC SIGN:
General Classifications
1. Gestational Hypertension
- Elevated BP (140/90 mmHg)
- No Proteinuria
- No Edema
- Blood pressure returns to normal after
birth
2. Mild Pre-Eclampsia
-(1+ or 2+) Proteinuria
-BP (140/90 mmHg)
-Diastolic is very important indicator for peripheral
arterial spasm
-Weight gain 2 lbs per week on 2nd Trimester
-Weight gain of 1 lb per week in 3rd Trimester
Management Mild Pre-
Eclampsia
1. Bed Rest- to conserve oxygen
2. Limit intake of salty foods (at least 2-3
grams/day)
3. Weekly check-up/ follow-up
3. Severe Pre-Eclampsia
-(160-110 mmHg)
-Marked proteinuria (3+ or 4+)
-Protein of more than 5g in a 24-hour sample
-Extensive EDEMA
-Hepatic Dysfucntion
Management of Severe
Pre-eclampsia
1. Prevention of Seizures
2. Give MgS04
- Can cause a marked decrease in BP
- Check deep tendon reflex
- Check respiratory rate as this causes respiratory
depression
- Check urine output
- ANTIDOTE: Calcium Gluconate
4. Eclampsia- most severe
classification of PIH
- Grand-mal seizure
occurs or comma occurs
- Accompanied by signs
and symptoms of pre-eclampsia
Management
1. MgS04
2. Diuretics
3. Digitalis (Digoxin)
4. Vitamin K
5. Barbiturates- fast acting sedatives; arrest
seizures
6. Hydralazine
Important Points
1. Provide dim lights
2. Limit visitors
3. Put up side rails
4. Suction Machine at the bedside
5. Don’t put anything in mouth if there is seizure
6. Open collar
7. Turn patient from side to side to promote
drainage of saliva
8. Promote safety
Gestational DM
Puerperium
Refers to the 6-week period after childbirth
Main Responsibility: -Achieve INVOLUTION
-Production of milk for
lactation, restoration of the normal menstrual
cycle and beginning of a parenting role.
Rubin's Phases of
Puerperium
1. Taking-in Phase
2. Taking-hold Phase
3. Letting-Go Phase
LOCHIA
1. RUBRA
2. SEROSA
3. ALBA
Important Concepts
*after 6 weeks, there should be no more Lochia
NORMAL Characteristics:
1. ODOR- musty but not foul smelling
2. COLOR- should not be yellowish/cloudy
3. Must be in order of appearance