to the mother and fetus, place the woman at

Placenta Previa bed rest in side-lying position.

b. Anticipate UTZ to localize the placenta
• The placenta implants in the lower uterine c. If the client of fetus deteriorates CS will be
segment, near the cervical os. required.
d. Prepare client for ambulation and dx 48 of last
Classifications: bleed
1. Total placneta previa e. Discuss the need of transportation to the
2. Partial placenta previa hospital available at all times.
3. Low-lying or low implantation placenta previa f. Instruct client to return to hospital if bleeding
recurs and to avoi intercourse until after birth
Incidence g. Proper hand washing and toileting
3 to 6 per 1,000 deliveries
Etiology 3. Address emotional and psychosocial needs.
1. Multiparity (80%) a. Offer emotional support to facilitate the
2. Advanced maternal age (older than age 35 in grieving process, if needed.
33% of cases) b. After birth of the newborn, provide frequent
3. Multiple gestation visits with the newborn so that mother can be
4. Previous CS birth certain of the infant’s condition.
5. Uterine incisions
6. Prior placenta previa (12x greater)
Abruptio Placenta
Pathophysiology
Pathologic process seems to be related to the Description:
conditions that alter the normal function of the Premature separation of a normally implanted
uterine decidua and its vascularization. placenta after the 20th week of pregnancy, typically
Bleeding which results from tearing of the placental with severe hemorrhage.
villi from the uterine wall as the lower uterine
segment contracts and dilates, can be slight or Etiology
profuse. 1. Unknown
2. Uterine anomalies
Assessment 3. Multiparity
1. In cases of suspected placenta previa, delay 4. Preeclampsia
vaginal exam until with UTZ result then 5. Previous CS
DOUBLE SET UP due to possible hemorrhage 6. Renal or vascular disease
2. Manifestations: 7. Trauma to the abdomen
1. Bright red, painless vaginal 8. Previous 3rd trimester bleeding
bleeding 9. Abnormally large placenta
2. Soft, non-tender abdomen that 10. Short umbilical cord
relaxes between contractions
3. FHR stable and within normal Pathophysiology
limits 1. The placenta detaches in whole or in part from
3. Laboratory and diagnostic the implantation site. This occurs in the area of
1. UTZ the decidua basalis.
2. hematology 2. Assessment.
1. Severe abruptio placenta may produce
Nursing Management complications:
1. Ensure the physiologic well-being of the client a. Renal failure
and fetus b. DIC
a. Monitor VS, assess for bleeding and c. Maternal and fetal death
maintain a perineal pad count. Weigh d.
perineal pads before and after use to Common clinical manifestations:
estimate blood loss. a. intense, localized uterine pain, with or
b. Observe for shock – rapid pulse, pallor, without vaginal bleeding
cold moist skin, low BP b. Concealed or external dark red bleeding
c. Moniotr FHR c. Uterus, firm to boardlike, with severe
d. Bed rest continuous pain
e. Observe for additional bleeding d. Uterine contractions
episodes. e. Uterine outline possibly enlarged or changing
2. Provide client and family teaching shape
a. Explain the condition and management f. FHR present or absent
options. To ensure an adequate blood supply g. Fetal presenting part may be engaged.

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 infection, known as chorioamnionitis, is
increased.
– Leading cause of death with PROM –
INFECTION!!
3. Laboratory and diagnostic findings: – When the latent period is less than 24
UTZ hours, INFECTION is LOW.
• Assessment findings
Nursing Management: •
1. Continuously evaluate maternal and fetal 1. Clinical manifestations
physiologic status particularly: a. PROM marked by amniotic
a. VS fluid gushing from the vagina
b. Bleeding in the absence of contractions
c. Electronic fetal and maternal b. Pooling of amniotic fluid in the
monitoring tracings vagina will be visualized during
d. Signs of shock a speculum examination
e. Low urine output 2. Laboratory and diagnostic Findings:
f. NEVER perform VAGINAL or RECTAL a. Ferning is evident
examination etc. that may stimulate b. Nitrazine test tape turns blue-
uterine activity. green

2. Assess the need for immediate delivery. If the client • Nursing Management
is in active labor and bleeding cannot be stopped with 1. Prevent infection and other
bed rest, emergency CS may be indicated. potential complications.
3. Provide appropriate management 2. Make an early and accurate
a. on admission, place the woman on bed evaluation of membrane
rest in a lateral position to prevent pressure on status, using sterile speculum
the vena cava. examination and
b. Insert a large gauge IV catheter into a large determination of ferning.
vein for fluid replacement. Obtain a blood  Minimize vaginal exam
sample for fibrinogen level 3. Obtain smear specimens from
vagina and rectum as
3. Monitor the FHR externally and measure maternal prescribed to test for
VS q 5 to 15 mins. betahemolytic streptococci,
c. administer O2 to the mother by mask. organisms that increases the
d. prepare for CS birth, which is the method of risk to the fetus.
choice. 4. Determine maternal and fetal
4. Provide client and family teaching. status including estimated
5. Address emotional and psychosocial needs. AOG.
Outcome for the mother and fetus depends on the
extent of the separation, amount of fetal hypoxia and • Nursing Management
amount of bleeding. d. Maintain the client on bed
rest if the fetal head is not
engaged. This method may
prevent cord prolapse if
Premature Rupture Of additional rupture and loss of
Membrane fluid occur.
- Once fetal head is engaged,
ambulation can be engaged.
• Is rupture of chorion and amnion before the
onset of labor. • Nursing Management
• The age of gestation of the fetus and estimates 2. Provide client and family
of viability affect management. education.
• Etiology a. Inform the client, if fetus is at
– UNKNOWN term, the chances of
spontaneous labor beginning
Pathophysiology are excellent; prepare couple
– Associated with malpresentation, for labor and delivery.
possible weak areas in the amnion and b. If labor does not begin or the
the chorion, subclinical infection, and fetus is judged to be preterm
possibly incompetent cervix. or at risk for infection, explain
– Basic and effective defense against the treatments that are likely to be
fetus contracting an infection is lost and needed.
the risk of ascending intrauterine

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 9. Severe nausea and vomiting

Clinical manifestations with severe preeclampsia

a. Blood pressure exceeding
160/110 mmHg noted on two
readings taken 6 hours apart
with the client on bed rest
b. Proteinuria exceeding 5g/24
Pregnancy Induced Hypertension hours
c. Oliguria (less than 400 ml/24
(PIH; Preeclampsia and eclampsia) hours)
d. Headache
Preeclampsia is hypertensive disorder of the e. Blurred vision, spots before
pregnancy developing after 20 weeks gestation and eyes and retinal edema
characterized by edema, hypertension and proteinuria. f. Pitting edema of the sacrum,
Eclampsia is an extension of preeclampsia and is face and upper extremities
characterized by the onset of seizure activity. g. Dyspnea
i. N/V
Etiology h. Epigastric pain
 Unknown j. hypereflexia
 Genetic or immunologic
 Primigravid status
 Conditions that create excess
trophoblastic tissue such as
multiple gestation, diabetes of
H-Mole.
 Age younger that 18 or older
that 35

Preeclampsia is a multisystem, vasospastic disease

coma
characterized by hemoconcentration, hypertension
and proteinuria.

Clinical manifestations of mild preeclampsia

a. BP exceeding 140/90 mmHg or
Inc. > baseline of 30 mmHg in
systolic pressure or 15 mmHg
in diastolic pressure on two
readings taken 6 hours apart SIGNIFICANT LABORATORY FINDINGS IN PIH
b. Generalized edema in the face,
hands and ankles (classic sign) Test Findings
c. Wt. gain of about 1.5 kg (3.3 lb) hct 37-47%
per month in the 2nd tri or S. UA 4.5-6 mg/dl > 10
more than 1.3 to 2.3 kg (3 to 5 mg/dl (severe PIH)
lb) per week in the 3rd tri Crea < 1 mg/dl 2-3
d. proteinuria 1+ to 2+ or 300 mg/dl (severe PIH)
mg/dl in a 24 hour sample Crea clearance >130-180 lm/min
BUN < 10 mg/dl 10-16
Warning signs of worsening preeclampsia
mg/dl (severe PIH)
1. Rapid rise in BP
2. Rapid weight gain APC < 150, 000 ml (severe
3. Generalized edema PIH)
4. Increased Proteinuria Fibrin degradation Absent
5. Epigastric pain, marked products
hypereflexia and severe
headache which usually
precede convulsions in Nursing Management
eclampsia 1. Monitor for, promote for the resolution of,
6. Visual disturbances complications
7. Oliguria (less than 120 ml in 4 a. Monitor VS and FHR
hours) b. Minimize external stimuli; promote rest
8. Irritability and relaxation

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 c. Measure and record urine output,
protein level and specific gravity
d. Assess for edema of face, arms, legs,
ankles and feet. Also pulmonary edema.
e. Weight pt. daily
f. Assess DTR every 4 hrs.
g. Assess for placental separation,
headache and visual disturbances, epi
pain and altered LOC

2. Treatment
a. Mild Preeclampsia - BED rest in L lateral
recumbent, balanced diet with
moderate to high CHON, low to
moderate Na and administer MgSO4
b. Severe Preeclampsia - BED rest in L
lateral recumbent, balanced diet with
high CHON, low to moderate Na , fluid
and electrolyte replacements, MgSO4
and anti hypertensive hydralazine.
c. Eclampsia – MgSO4, hydralazine as well
as anticonvulsants like diazepam,
phenobarbital or phenytoin.

Nursing Management
3. SEIZURE PRECAUTIONS.
- May occur up to 72 hours after delivery
4. The only ABSOLUTE treatment of preeclampsia and
eclampsia is the DELIVERY of the infant.
5. Address emotional and psychological needs.

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