obstetrics perfusion issues student-3
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Obstetrics Perfusion IssuesF. Thomas, PhD, RN
Placenta Previa
• Implantation of the placenta I the lower uterus
Classifications
• Marginal• Partial• Total
In what group is previa more common!
Classic Sign
Collaborative Management
• 1. Evaluate the amount of hemorrhage• 2. Electronic fetal monitoring to evaluate fetus• 3. Fetal gestational age
• Conservative management if• Mother’s CV status is stable• Fetus is immature• Reassuring pattern
• What are the advantages to delaying birth?
Home Care Considerations
• No evidence of active bleeding• Maintain bed rest at home• Home location is reasonable distance form hospital• Woman and family can verbalize understanding of risks
Inpatient Care
• Assessment of bleeding• Signs of preterm labor• Periodic electronic fetal mentoring
Excessive Bleeding
• Delivery of fetus• How??
Abruption
• Separation of the Placenta before delivery
Causes
• Cocaine Use• Maternal HTN• Cigarette smoking• Short umbilical cord• Trauma• PROM• History of previous separation
Manifestations
• Bleeding Types• Uterine tenderness• Uterine irritability• Low back or abd. Pain• High uterine resting tone• Other
Major Concerns
• Woman feels powerless and frightened• Fetal hypoxia
Assessment
• Nature of bleeding• Pain• Maternal and fetal vital signs• Condition of fetus• Contractions• Obstetric history• Length of gestation• Lab data• Ultrsasound
Management
• Emergency: need to go to ER and admitted• Focus on CV status of Mother and condition of fetus• Mild condition• Delivery
Interventions
• Monitor for hypovolemic shock• Monitor fetus• Promote tissue oxygenation• Collaborate with health care provider for fluid replacement• Prepare woman for surgery• Emotional support
Critical to remember!
Ectopic Pregnancy
• Called disaster of reproduction
Causes
• Scarring from pelvic infections• Failed tubal ligation• History of previous ectopic pregnancy• Assisted reproduction• IUDs• 40% of EP occur with no identified risk• Delayed or premature ovulation
Manifestations
• Classic• Subtle• Rupture
Diagnosis
• Transvaginal Ultrasound• Beta-hCG is at low levels than expected• Gestational sac cannot be seen• Maternal serum progesterone levels• High resolution transvaginal US • Laproscopy
Management
• Goal• Improve future fertility and preserve the tube
• Medical• If tube is unruptured• Use Methotrexate inhibits cell division
• Surgical• Unruptured involves a linear incision (salphingostomy)• Ruptured requires salpingectomy
Nursing
• Prevention or early identification of hypovolemic shock• Monitor for S/S of rupture• Pelvic and shoulder pain**• Neck pain• Dizziness• Vag bleeding
• Analgesics• Teach SE of Methrotrexate• Emotional support
Hemorrhagic Conditions of Late Pregnancy• Assessment Data
Planning
Monitor for S/S of hypovolemic shock
Interventions
• Monitor for S/S for shock: You know these already!!• Fetal monitoring• Promote tissue Oxygenation• Collaborate with practitioner to replace volume• Prepare for surgery• Emotional Support
• Evaluation