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Mchn midterm notes

Nursing (Western Mindanao State University)

Studocu is not sponsored or endorsed by any college or university

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13. Low birth weight babies.
TOPIC 2: FRAMEWORK OF MATERNAL AND 14. Women often lack Access to relevant information trained
CHILD NURSING FOCUSING ON AT RISK, HIGH providers and suppliers emergency transport and other
RISK, AND SICK CLIENTS essential services

15. Cultural attitudes and practices impede women’s use of

Maternal and Child Health- is the health service provided services that are available.
to mothers (women in their child bearing years) and
children. The targets of MCH are all women in their • Given the magnitude of these problems and
reproductive age groups, 15-49 years of age, children, interventions available much has not been done.
school age population and adolescents. Maternal and child health programme should focus
and address these problems to reduce maternal and
JUSTIFICATION FOR THE PROVISION OF MCH child morbidity and mortality
ARE

1. Mothers and children make up to 2/3 of the whole

population. STATISTICAL TERMS AND CURRENT
STATISTICS USED TO REPORT MATERNAL AND
2. Maternal mortality is an adverse outcome of many CHILD HEALTH
pregnancies.
Birth Rate: The number of births per 1000 population.
3. Most pregnant women receive insufficient or no prenatal
care and delivery without help from appropriately trained Fertility Rate: The number of pregnancies per 1k women
health care providers. of child bearing age.

4. Poorly timed unwanted pregnancies carry high risks of Fetal death rate: The number of fetal deaths (over 500g)
morbidity and mortality as well as social economic costs per 1k live births
particularly to the adolescents and many unwanted ends in
unsafe abortion. Neonatal: The number of deaths per 1k live births
occurring at births in the first 28 days of life.
5. Large number of women suffer severe chronic illnesses that
can be exacerbated by pregnancy. Perinatal death rates: The number of deaths during the
perinatal time period. It is the beginning when the fetus
6. Infectious diseases like malaria are more prevalent in reaches 500g about week 20 of pregnancies and ending
pregnant women than in non-pregnant women. about 4-6 weeks after birth. It is the sum of fetal and
neonatal rates.
7. Many women suffer pregnancy related disabilities like
uterine prolapse long after delivery due to early marriage Maternal mortality rate: The number of maternal deaths
and childbearing high fertility. per 100,000 live births that occur as a direct result of the
reproductive process.
8. Nutritional problems are severe among pregnant mothers
and 60-70% of pregnant women are estimated to be anemic. Infant mortality rate: The number of deaths per 1k live
births occurring at birth or in the first 12 months of life.
9. Majority of perinatal deaths are associated with maternal
complications, poor management techniques during labor Childhood mortality rate: The number of deaths per 1k
and delivery and nutritional status before and during population in children aged 1-10 years old.
delivery.
GENETICS AND GENETIC COUNSELING
10. Majority of pregnancies end in maternal deaths and also
fetal or perinatal death. Genetics- study of the way such disorders occur.

11. Antepartum complications are associated with a large Genetic abnormalities are conditions that can be passed
number of perinatal deaths. from one generation to the next. They result from some
disorders in the genes. It occurs at the moment there’s ovum
12. Development impairments among children due to poor and sperm fusion.
management during labor and delivery.

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Genes are the basic units of heredity that determine both 3. Miscarriage
physical and mental characteristics of people.
4. Other complications
Genetic counseling- A communication process to help
individuals or couples as well as the family to understand WEIGHT: Obesity,
and adapt to the medical, psychological, familial and Undereight
reproductive implications of the genetic contribution to
specific health conditions.

2. PARITY
• Gravity and parity are the number of
times a woman is or has been pregnant and
carried to the pregnancies to a viable
gestational age
• Gravity- Indicates the number of times a
woman is or has been pregnant regardless
TOPIC 3: NURSING CARE OF PREGNANT of the pregnancy outcome.
CLIENT • Multiple pregnancies - delivered multiple
times
A. Risk factors affecting pregnancy • Multiple-Birth pregnancies - number of
a. Age baby growing inside the womb (e.g twins,
b. Parity triplets, quadruplets)
c. Pre-existing Disease
d. Social Profile (use of tobacco, alcohol, and drug
consumption; violence)
B. Laboratory and diagnostic exams – urinalysis,
blood serum studies (CBC, genetic screen, VDRL 3. PRE-EXISTING DISEASE
(serologic screen for syphilis,) serum antibody titer for
hepatitis, rubella and varicella, HIV screening, •
ultrasonography .

4. SOCIAL PROFILE
1. AGE • Prenatal exposure to smoking & alcohol
• Women under age 20 and women over age increases the risk for SUDDEN INFANT
35 have higher risk of serious medical DEATH SYNDROME (SIDS)
complications related to pregnancy. • Drinking alcohol can reduce your ability to
conceive, can lead to miscarriage. It can
Some Risk factors connected to young age lead to premature weight and low birth
(below 20) weight
•
o Underdeveloped pelvis
o Nutritional deficiencies - because
B. LABORATORY AND DIAGNOSTIC EXAMS
of poor eating habits
o High Blood pressure - this can
a. AMNIOCENTESIS
trigger premature labor
• A procedure used to take out a small
amount of the amniotic fluid for testing.
RISK FACTORS over age 35
• Amniotic fluid is the fluid that surrounds
1. Underlying conditions - such as the fetus in a pregnant woman. It is a clear,
HBP, Diabetes/ Gestational diabetes; CV pale yellow fluid that protects the fetus
disease from injury. It also protects against
infection.
2. Chromosomal problems - e.g. • It is done to check if the baby has a
down syndrome genetic or chromosomal condition such

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as Down’s syndrome or Edward’s villi is then suctioned through a tube for
syndrome. diagnostic study.
• This procedure is usually not painful but
may experience pressure when the needle ii. TRANSABDOMINAL CVS -
is taken out. Amniocentesis is an accurate inserting a thin needle into the abdomen. The client
way to determine the baby’s gender will lie tummy-up. Ultrasound is used to determine
before birth. the location of the placenta and to see the uterine
• It also determines the baby’s lungs, if it walls. A needle is inserted through the abdomen &
is matured enough when an early delivery the uterine wall to the edge of the placenta and the
may be warranted. sample is drawn up through a needle.

Risks of having amniocentesis: c. FETAL BLOOD SAMPLING

• also known as CORDOCENTESIS or
1. miscarriage PERCUTANEOUS UMBILICAL
CORD SAMPLING.
2. infection in the uterus • A diagnostic prenatal test.
• The fetal blood sample is withdrawn from
3. cramping, spotting or leaking amniotic the umbilical cord for testing.
fluid
This procedure is done to:
4. passing infection to the baby
1. determine blood type
5. RH problems
2. diagnose genetic/chromosomal
b. CHORIONIC VILLUS SAMPLING (CVS) abnormalities
• recommended when the client is over 35
years old and at risk of carrying a baby 3. diagnose fetal infections
with chromosomal disorder.
• If the family history of a known carrier of 4. Identify fetal anemia
a genetic disease.
• CVS testing is entirely optional. 5. identify low platelet count
• Both amniocentesis and cvs are diagnostic
tests aimed at detecting chromosomal d. FETAL ECHOCARDIOGRAM
disorders. • It detects fetal heart abnormalities
before birth.
ADVANTAGES OF CVS • This is done in a darkened room while
lying down.
• It is performed earlier than amniocentesis, • A gel is put on the belly to help sound
done in the 10th-13th weeks of pregnancy waves travel from the echocardiogram
- (CVS) while amniocentesis is done on wand (Transducer) to the baby’s heart
the 16th-18th weeks of (before week 22). and back again.
•
How is CVS done? e. FETAL MAGNETIC RESONANCE
IMAGING (MRI)
Both procedures take about 30 minutes to • Uses a magnetic field and radio waves to
finish. Depending on the placenta, a placenta cell create detailed pictures of an unborn baby.
will be taken: f. GENETIC TESTING
• A type of medical test that identifies
i. TRANSCERVICAL CVS -, thru the changes in the genes/chromosomes. The
vagina/cervix. The patient will lie on her result of the test can confirm or rule out a
back while a long thin tube is inserted suspected genetic condition or help a
through the vagina into the uterus. Guided person’s chance of developing or passing
by ultrasound imaging. The doctor on a genetic disorder.
positions the tube between the uterine g. ULTRASOUND / DOPPLER ULTRASOUND
lining & the chorion (Chorion is the fetal • Sound of the baby’s heartbeat is heard
membrane that forms on the baby’s side using the doppler.
of the placenta). A sample of the chorionic

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M: 13.8-18 g/dl

LABORATORY TESTS F: 12-16 g/dl

BLOOD TEST Normal: 12-18g/dL

Venipuncture- Puncture of vein done by Increased: Polycythemia vera

Phlebotomist/Nurse (Trained)
Decreased: blood loss, Bone Marrow Suppression,
Position: Descendent position (arm)- to increase blood Anemia-iron deficiency anemia
flow to the art

Selection of vein: Visible

If not visible: 3. Hematocrit

• Percentage of RBC in the plasma
A- Apply warmth
Blood- Formed elements: (RBC, Platelets, CBC)
T- Tourniquet/Tap gently
Plasma: (Water, electrolytes, plasma, albumin, substances,
O- Open close fist acids, clotting factor, waste)

S- Stroke arm (Proximal to distal) Increased Plasma = Decreased RBC- Blood loss,
overhydration, fluid overload, Dietary deficiency
Apply pressure to site 2-3 minutes—----- vein puncture (decreased iron, vit b6,b9, and Blood Pressure Decreased)

Decreased Plasma= Increased RBC- Polycythemia vera,

SHN, Burns

1. CBC Male: 33-49 %

• RBC Count (Erythrocytes)- No. of RBCs per cubic
millimeter Female: 36-46 %

Male: 4.5-5.3 million/mm Normal: 33-52 %

Female: 4.1-5.2 million/mm 4. White Blood Cells

• The number of WBC in cubic mm. (4500-11,000 /
Normal: 4-6 million/mm mm)

Increased: Oxygen Demand ex. COPD, Polycythemia vera Increased (Leukocytosis)

Decreased: Destruction of RBC (BT Rxn, Hemoglobin Decreased (Leukopenia, autoimmune disease, bone
Rxn), Hormonal changes, Erythropoietin (Kidneys) renal marrow suppression, corticosteroid)
failure.
Basophils- formed element. If increased (Leukemia), If
Bone Marrow Suppression: Blood Cells, chemotherapy, decreased (Corticosteroid)
radiation (affects rapidly dividing cells- normal and
abnormal). Eosinophils- Increased (Allergic Rxn, parasitic
Infection) If decreased (Corticosteroid)
2. Hemoglobin
Neutrophils- Increased (Infections, Stress) If decreased
Hemo: pigmented part of the Hgb (iron) (Corticosteroid)

Globin: Protein part of Hgb Monocytes- Increased (TB, Protozoan infection, ulcerative
colitis) Decreased (chemotherapy/radiation)
Components of RBC— gives color (O2 + Iron)= red color.
It carries O2(oxygen)

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Lymphocytes- Increased (B-cells, bone marrow, Humoral Risk factors:
immunity); Decreased (Thymus is infected which is
responsible for cellular immunity) 1. Obesity
2. Age over 25 years
3. Hx of large babies (10 lbs or more)
4. Hx of unexplained fetal perinatal loss
Urinalysis- Pregnancy test 5. Hx of congenital anomalies in previous pregnancy
6. Family Hx
• HCG hormones about a week after you've missed a
period. The hormone can be detected 10 days after Problem Placenta
conception.
• Human Chorionic Gonadotropin (HCG) urine a. Promotes flow of nutrients from the mother to the
test is a pregnancy test. A pregnant woman’s fetus.
placenta produces HCG, also called pregnancy b. Diabetogenic hormone
hormone. c. Increase during 34th-28th weeks of pregnancy
• Urine tests for sugar, proteins, ketones, bacteria,
blood cells, UTI are done in urinalysis, even SIGNS AND SYMPTOMS
gestational diabetes or pre eclampsia.
Glycosuria
Blood Serum Studies
Recurrent monilial vaginitis- infection to increase glucose
• VDRL- is a screening test for syphilis. It measures
substances (proteins) called antibodies which our • Macrosomia of the fetus
body may produce if you have come in contact with
the bacteria that cause syphilis. Blood is drawn Polyhydramnios- excessive accumulation of amniotic
from a vein, venipuncture usually from the inside fluid. The fluid that surrounds the baby in the uterus during
of the elbow of the back hand. pregnancy.

Why is the test performed? In gestational diabetes, the glucose circulates the
bloodstream. It binds to a portion of the total hemoglobin
-The bacteria that cause syphilis is called treponema in the blood. Glycosylated hemoglobin would be a very
pallidum. The health care provider may order this test if you good diagnostic test. It measures glucose level over the past
have signs and symptoms of a sexually transmitted disease. 4-6 weeks (The time the RBCs were picking up the
glucose).
-A negative test is normal. No antibodies to syphilis seen.
Gestational Diabetes- is a high blood sugar that develops
Serum Antibody titer for hepatitis during pregnancy and usually disappears after giving birth.
Common in the second and third trimester of pregnancy.
1. HBsAg- Hepatitis B surface Antigen- a positive or
reactive test result means that the person is infected
with Hepatitis B. The result means that the patient
is infected and can spread the hep B virus to others WARNING SIGNS
through the blood.
2. HBsAb- Hepatitis B surface antibody- positive - 1. Unusual thirst
protected against hepa B virus. Perhaps through 2. Frequent Urination
vaccines. The patient is not infected and cannot 3. Skin Infections
spread hepatitis B to others. 4. Vision
3. HBcAb- hepatitis B core antibody- Positive- 5. Vaginal Bladder and skin infections.
indicates a past or current hepa B infection.
Causes in Pregnancy
Pre gestational Conditions
• During pregnancy, the placenta makes hormones
that cause glucose to build up in the blood.
• Gestational Diabetes can cause the fetus to be
larger than normal. Delivery of the baby may be
1. Gestational diabetes mellitus more complicated as a result. The baby is also at

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risk for developing low blood glucose • Multiple gestation-multiple placenta
(Hypoglycemia) immediately after birth.
• Following a nutrition plan is the typical risk of Normal BP: 120/80
gestational diabetes.
• Maintaining a health weight and following a In pre-eclampsia, increased BP which will lead to decreased
healthy eating plan may be able to help prevent or flow to kidney damage (Proteinuria- protein in the urine)
minimize the risks of gestational diabetes,
• Women with gestational diabetes have an increased -HCG- leads ot triggers to vasospasm which is (decreased
risk of developing diabetes after the pregnancy. blood supply)

How can it affect the baby?

• With GD who receive proper care deliver healthy

babies. However, if you have elevated blood a. Liver
glucose levels, the fetus can also have it.
• The baby is at risk for having low blood glucose -Increased Ammonia
(Hypoglycemia) immediately after birth.
• Greater risk of Jaundice -Decreased Albumin
• Increased risk for respiratory distress syndrome
• A higher chance of dying before or following birth -Decreased clotting factor
• Risk of becoming overweight and developing type
2 diabetes later in life. -Increased Cellular Injury
• If Diabetes is present in earlier pregnancy there is
an increased risk of birth defects and miscarriage. -Pressure

PREGNANCY INDUCED HYPERTENSION (PIH)

• A form of high blood pressure in pregnancy. It

occurs in about 7 to 10 % of all pregnancies. b. Kidney
ANother type of High blood pressure is chronic
-Increased cell destruction
hypertension- which is a high bp that is present
before pregnancy.
-Proteinuria
SYMPTOMS:
-Edmea
a. Headache that doesn't go away.
-Cerebral edema
b. Edema
c. Sudden weight gain -Seizure
d. Vision changes
e. Nausea or vomiting c. Brain
f. Pain in the upper right side of the belly or around • Increased ICP
the stomach • Headache
g. Making small amounts of urine • Blurring vision
• Dizziness
Is pre eclampsia the same as PIH?

-Pre-eclampsia is sometimes called as PIH or called as

toxemia.
d. Spleen
1. Preeclampsia- after 20 weeks of gestation • Increased workload
2. Eclampsia
• Splenomegaly- enlargement of the spleen
• Increased intraabdominal pressure
Etiology (Cause)
• Abdominal pain
• Unknown
• Occurs for primigravida patients aged younger than
18 or older than 35

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MILD PRE ECLAMPSIA 3. Thyroid Gland- Calcitonin

• Presence of protein (+1, +2 3– mg/24 hrs urine 4. Parathyroid Gland – Posterior of thyroid; regulates
• Edema (lower and upper extremities) calcium
• Liver Enzymes (Slightly elevated)
• Weight pattern (2nd trimester- 2lbs/week 3rd 5. Thymus Gland - Immunity
trimester(1lb/week)
• Urine output (less than 120 ml in 4 hours 6. Adrenal Gland –Suprarenal (above the kidney, bilateral,
• Baby (No intrauterine, growth retardation unilateral
• Reflex (+3)
• Pain (No abdominal Pain) 7. Pancreas –Exocrine (Enzymes- amylase, (CHO),
Trypsin (CHON), Lipase (FATS)
Management for Mild Pre eclampsia
ENDOCRINE –Islet of Langerhans (B-Beta, I- Insulin, G-
• Home management Glucagon, A- Alpha
• Moderate to high protein
• Low moderate Sodium 8. Gonads –Gonadotropin hormones- ovaries, teste
• Bed rest
• Emotional Support

Pre eclampsia

Protein +3, +4 5g/24 hrs urine

Edema Anasarca

Liver Enzyme HYPERTHYROIDISM AND PREGNANCY

Liver enzyme markedly elevated

Weight Pattern Rapid weight gain Thyroid functions:

1. Oxygen consumption
Urine Output 500 ml/24 hrs 2. Body heat production
3. CHO,CHON,FAT Metabolism
Baby 4.
With intrauterine growth retardation Metabolic rate of all cells

Reflex +4 hyperreflexia Goiter- Thyroid Gland hypertrophy (Enlargement of the

thyroid gland). Iodide deficiency anemia is the main cause
Pain RUQ pain (Aura of seizure) of goiter.

ENDOCRINE SYSTEM Hypothyroidism is also called “graves disease” which

occurs when your thyroid produces more thyroid hormone
ENDOCRINE SYSTEM – Is composed of ductless glands (thyroxine) than normal. (autoimmune disorder)
(Produces HORMONES and directly releases to the
bloodstream.

HORMONES- are chemical substances affecting body HYPERTHYROIDISM (OVERACTIVE THYROID)

functions.
• Occurs when the thyroid gland produces too much
GLANDS thyroxine hormone. This can accelerate the body’s
metabolism causing unintentional weight loss and
1. Pineal Gland – Function: Unknown, sleep pattern rapid irregular heart beat (palpitations).

2. Pituitary Gland- “Master Gland'', a butterfly –shaped Treatment: Doctors used anti-thyroid medications
gland. (Hypothalamus-releasing factor in the pituitary (TAPAZOLE) and radioactive iodine to slow the
gland) production of thyroid hormones. Sometimes it involves
surgery.

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High levels of HCG, seen in severe forms of morning
sickness (hyperemesis gravidarum), may cause transient
Findings: hypothyroidism in early pregnancy.

1. Irritability, agitation, hyperactive movements, RISK of HYPERTHYROIDISM TO THE MOTHER

tremor, sweating and insomnia
2. Increased appetite, hyperphagia, weight loss, Hyperthyroidism/Graves’ disease may present initially
diarrhea and intolerance to heat. during the first trimester. Inadequately treated maternal
3. Diagnostic Test- elevated T3 and t4 levels hyperthyroidism can result in early labor and a serious
4. Exophthalmos (Protrusion of the eyeballs) complication known as pre-eclampsia. Additionally,
5. warm skin, fine soft hair women with active Graves’ disease during pregnancy are at
6. Tachycardia, increased systolic blood pressure, higher risk of developing very severe hyperthyroidism
palpitations known as thyroid storm. Graves’ disease often improves
during the third trimester of pregnancy and may worsen
The thyroid gland produces 2 main hormones that during the postpartum period.
influence every cell in the body:
• Pre-eclampsia
1. Thyroxine (T4) • Graves Diseases (3rd trimester- worsen postpartum
2. Triiodothyronine (T3) period)
• Thyroid storm
NURSING RESPONSIBILITIES
RISK OF GRAVES DISEASE TO THE BABY
1. Monitor V/S, daily weights
• Uncontrolled maternal hyperthyroidism- has
2. Administer antithyroid meds as ordered. been associated with tachycardia, small for
gestational age babies, prematurity, stillbirths,
3. encourage bed rest congenital malformations, birth defects.
• Extremely High Levels of Thyroid Stimulating
4. Provide a cool environment Immunoglobulins (TSI)- These antibodies do
cross the placenta and can interact with the baby’s
5. Minimize stress in the environment thyroid. High levels of maternal TSI’s have been
known to cause fetal or neonatal hyperthyroidism.
6. Provide a diet high in carbohydrates, protein, calories, • Antithyroid Drug Therapy (ATD)- Methimazole
vitamins and minerals with supplemental feedings between (Tapazole) or propylthiouracil (PTU). Both of
meals and at bedtime ; these drugs cross the placenta and can potentially
impair the baby’s thyroid function and cause fetal
7. Protect eyes with dark glasses goiter. Use of either drug in the first trimester of
pregnancy has been associated with birth defects.
8. Provide tachings and discharge planning. The benefits to the baby of treating a mother with
hyperthyroidism during pregnancy outweigh the
What is the interaction between the thyroid function of
risks if therapy is carefully monitored
the mother and the baby?
ABORTIONS
• For the first 18-20 weeks of pregnancy, the baby is
completely dependent on the mother for the • Loss of pregnancy before viability of the fetus; may
production of thyroid hormone. be spontaneous, therapeutic or elective. (Clients
• By mild pregnancy, the body’s thyroid begins to may use miscarriage for spontaneous abortion).
produce thyroid hormone on its own.
• The baby, however, remains dependent on the How does abortion affect future pregnancy?In most
mother for ingestion of adequate amounts of iodine cases, an abortion does not affect fertility or future
which is essential to make thyroid hormones. pregnancies. It is possible to ovulate and become pregnant
• Women who are planning pregnancy should take within 2 weeks of an abortion. In rare cases, surgical
daily supplements that contain iodine. abortion can cause scarring of the uterine wall or damage to
• The World Health Organization (WHO) the cervix. These complications may make it more difficult
recommends iodine intake of 250 to get pregnant again.
micrograms/day during pregnancy to maintain
adequate thyroid hormone production.

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When is a fetus considered a baby? After the embryonic 3. Arrange for blood typing & Cross matching.
period has ended at the end of the 10th week of pregnancy,
the embryo is now considered a fetus. A fetus is a 4. Administer RHOGAM – prevent antibodies against RH,
developing baby beginning in the 11th week of pregnancy. administer within 72 hours of bleeding, chorionic villi
sampling----RH of baby, det. Compatibility of baby
Findings:
HYPEREMESIS GRAVIDARUM
1. Vaginal bleeding (observing carefully for accurate
determination of amount, saving all perineal pad. • Excessive nausea and vomiting of early pregnancy
2. Contractions, pelvic cramping backache leads to dehydration and electrolyte disturbances,
3. Lowered hemoglobin if blood loss is significant especially acidosis.
4. Passage of fetus or tissue
Causes: Possible severe reaction to HCG, not
Nursing Interventions: psychological. Greater risk to conditions where HCG levels
increased. HCG levels peak around 6 weeks after
1. Save all tissue pads. conception, then begin to decline after 12th weeks.
2. Keep clients at rest/bed rest. Symptoms often improve later in pregnancy but may last
3. Increase fluid PO or IV the entire etime.
4. Prepare client for surgical intervention (Incomplete
abortion) Findings:
5. Provide discharge teaching about limited activities
and coitus after bleeding ceases. 1. Nausea and vomiting progressing to itching
6. Provide emotional support to mother, allow between meals.
expression of feelings of grief and lost. 2. Weight loss

NURSING RESPONSIBILITIES

TYPES OF ABORTION 1. Begin NPO and IV fluids and electrolyte

replacement. (NPO will rest the stomach).
1. Threatened abortion- Cervix is closed, some 2. Monitor I & O- record the intake of the patient.
bleedinga and contractions Calibrated glass recorded
2. Inevitable/imminent- Open cervix, heavy 3. Gradually re introduce PO intake, monitor amounts
bleeding and stronger contractions, loss of fetus, taken and retained,
unavoidable. 4. Provide mouth care
3. Complete- All products of conception expelled. 5. Offer emotional support- very demoralizing and
4. Incomplete- Expulsion of fetus incomplete, depressing to client
membranes of placenta retained. (procedure: 6. Monitor TPN (Total Parenteral nutrition) and
dilatation and curettage) central line replacement if unable to eat.
5. Habitual- 3 or more miscarriages culminating in
spontaneous abortion, may need to determine HYDATIDIFORM MOLE (H-MOLE)
underlying causes.
6. Missed- fetal death in utero (sepsis, DIC- GESTATIONAL TROPHOBLASTIC DISEASE
disseminated intravascular coagulation)
7. Septic- Fever, complication of extreme infection 1. Proliferation of trophoblasts; embryo dies. Unusual
chromosomal patterns seen. (Either no genetic
MANAGEMENT OF ABORTION material in ovum- ultrasound). The chorionic villi
change into a mass of clear, fluid-filled grapelik
D AND C - Dilatation and Curettage vessels.
2. Common women among 40
1. General management for bleeding disorders 3. Cause unknown
a. V/S Fist sign of bleeding: Tachycardia and
Hypotension Findings
b. Late Sign: Cold clammy, decreased RR, BP, and
PR. 1. Size of the uterus disproportionate to length of
pregnancy.
2. . Insert a large IV catheter. 2. High levels of HCG with excessive nausea and
vomiting

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3. Dark red to brownish vaginal bleeding after 12th • Causes painful vesicles on genitals both external
week and internal
4. Anemia often accompanies bleeding • There is no cure
5. Symptoms of pre eclampsia before unusual time of • Treatment is symptomatic
onset • Acyclovir (Zovirax)- reduces severity and
6. No fetal heart sounds or palpation of fetal parts duration of exacerbation.
7. Ultrasound shows no fetal skeleton • Recurrences of conditions may be caused by
infection, stress
Nursing responsibilities

1. Provide pre and postoperative care for evacuation

of uterus (procedure D & C) CHLAMYDIA
2. Teach contraceptive use so that pregnancy is
delayed for at least one year. • Most common STD
3. Teach client need to follow up lab work to detect • Symptoms similar to gonorrhea (cervical/vaginal
rising HCG levels indicative of choriocarcinoma- discharge)
( fast growing cancer in the womb) • Can be transmitted to fetus at birth causes neonatal
4. Provide emotional support for loss of pregnancy ophthalmia
5. Teach about the risk for future pregnancies if • Treated with Erythromycin, prophylactic
indicated treatment of neonate eyes
• If untreated it can lead to pelvic inflammatory
SEXUALLY TRANSMITTED DISEASES (STD) disease.

INFECTIONS OCCURING PREDOMINANTLY IN GONORRHEA

THE GENITAL AREA AND SPREAD BY SEXUAL
RELATIONS • Caused by N. gonorrhoeae
• Symptoms may include heavy purulent vagibal
Assessment: discharge, but often asymptomatic in females.
• May be passed to the fetus at time of birth, causing
1. Sexual history/sexual practices ophthalmia neonatorum and sepsis.
2. Physical examinations for signs and symptoms of • Treatment in Penicillin, allergic clients may be
std. treated with Erythromycin (or if not pregnant)
the cephalosporins
PLANNING AND IMPLEMENTATION • All sexual contacts must be treated as well and
prevent recurrence.
a. Goals.
1. Disease process will SYPHILIS

B. Interventions • Caused by Treponema Pallidum (spirochete)

• Crosses placenta after 16 weeks of pregnancy to
1. Collect specimens for testing. infect the fetus
2. Isolation technique • Initial symptoms are canker and lymphadenopathy
3. Teach transmission and prevention technique and may disappear without treatment in 4 to 6
4. Assist in case findings weeks.
• Secondary symptoms: rash, Malaise, Alopecia
C. Evaluation
Tertiary syphilis- recur later in life affecting organ system
1. Client demonstrate knowledge about the disease especially cardiovascular and neurologic
process and transmission
2. Affected others identified and treated. • Diagnosis- dark field eczema and serologic test
• Treatment- Penicillin And erythromycin
SPECIFIC DISORDERS STD
Other genital infections- trichomonas vaginalis
HERPES DISORDERS- STD
• Caused by protozoan
• Caused by herpes simplex virus type 2 • Major symptom is profuse foamy white to greenish
discharge that is irritating genitalia

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• Treatment of metronidazole (Flagyl) for women right atrium, where it mixes with oxygen-poor
and all sexal partners blood and increases the total amount of blood that
• Treatment ;asts seven days, during which time a flows toward the lungs.
condom should be used for intercurse
• Alcohol ingestion with flagyl causes severe ii. Tetralogy of Fallot is a combination of four congenital
gastrointestinal upset. heart defects. The four defects are a ventricular septal defect
(VSD), pulmonary stenosis, a misplaced aorta and a
HIV thickened right ventricular wall (right ventricular
hypertrophy). They usually result in a lack of oxygen-rich
• Pregnant women should be given counseling and blood reaching the body.
should be offered HIV screening as a part of
prenatal care. See a physician so that medications b. Obstructive Heart Lesions
can be given. No over the counter drugs, because it
may harm the baby. Such as aortic or mitral valve stenosis, which limits cardiac
• Prone to transmit HIV to the fetus. output and particularly compromised during pregnancy.
• Antiretroviral therapy- medication.
• 8% rate….. d. Cyanotic heart disease
• Cesarean Delivery- to minimize the transmission of
HIV. refers to a group of many different heart defects that are
• After birth, the infants usually are positive as HIV present at birth (congenital). They result in a low blood
because of antibody tests. Usually 18 months only. oxygen level. Cyanosis refers to a bluish color of the skin
• Breastfeeding is contraindicated because the virus and mucous membranes.
can be transmitted via breast milk.
e. Complex congenital heart disease
Effect: Unclear.
refers to a group of heart defects present at birth. These
defects occur when the heart doesn't develop properly in the
womb. Our surgeons would try to treat all types of
CARDIOVASCULAR DISEASE & PREGNANCY congenital heart defects, from common and mild to rare and
severe.
What are the main cardiac disorders in pregnancy?
How does Congenital Heart Disease Affect Pregnancy?
Congenital heart defects are the most common heart
problems that affect women of childbearing age. These u The congenital heart disease of the Mother can
include shunt lesions, obstructive lesions, complex lesions affect the baby. The baby may be smaller if the
and cyanotic heart disease heart does not pump as efficiently as it should and
delivers less oxygen and nutrients to the placenta
a. Congenital Shunt Lesions and the developing baby. Babies may be born
prematurely.
Shunts include atrial septal defect (ASD), which is a hole
between the upper chambers of the heart; ventricular septal
defect (VSD), which is a hole between the lower chambers
of the heart; and patent ductus arteriosus (PDA), which IDENTIFYING GESTATIONAL CONDITIONS
means there is abnormal blood flow between the aorta and
pulmonary artery 1. Preterm Labor

i. ATRIAL SEPTAL DEFECT (ASD) General Information:

u Opening between atria; It is a birth defect of the 1. Labor that occurs before the end of the 37th
heart in which there is a hole in the wall week of pregnancy.
(septum) that divides the upper chambers (atria)
of the heart. A hole can vary in size and may close 2. Cause is frequently unknown. But the
on its own or may require surgery. An atrial septal following conditions are associated with
defect is one type of congenital heart defect. premature labor (cervical incompetence, pre-
eclampsia/eclampsia, maternal injury,
u As a result, some oxygenated blood from the left infection, multiple births, placental disorders).
atrium flows through the hole in the septum into the

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Prevention: - Decrease the effect of calcium on muscle
activation to slow or stop uterine
· Minimize/stop smoking- a major contractions.
factor in preterm labor and birth.

· Minimize/stop substance abuse,

chemical dependency. - Initially given IV then p.o brethin
(terbutaline) for maintenance.
· Early and consistent prenatal care.

· Appropriate diet and weight gain

Terbutaline (1-8mg/min x 8-12 hours ) ( 2.5-5mg p.o q 4-
· Minimize psychological stressors – 8 hours)
Stress increases CORTICOTROPIN –
releasing hormones and may result uterine
contractility.
Ritodrine (0.05-1.0mg/min until contractions stop) (10-
· Minimize/prevent infections in 20mg q 2 hours for 24 hours)
order to increase uterine contractility.
- Side effects: Increased heart rate,
· Learn to recognize signs/symptoms nervousness, tremors, nausea and
of preterm labor vomiting, decrease in serum k, cardiac
arrhythmias, pulmonary edema.
Medical Management:
NIFEDIPINE channnel blocker—1, Calcium channel
1. Unless labor is irreversible, the usual medical blocker, 10-30mg loading dose, oral or sublingual, second
intervention is to attempt to arrest the premature labor dose may be given in 30 mins if contractions persist, 10-
(Tocolysis). 20mg orally q 4-6 hour for maintenance

TOCOLYSIS- an obstetrical procedure carried Side effects: Facial flushing, mild hypotension,
out with use of medications for purposes of reflex tachycardia, headache and nausea.
delaying the delivery of the fetus.
INDOMETHACINE
2. Medications used in the treatment of premature labor
Prostaglandine synthetase inhibitor
A. Magnesium sulphate - Stops uterine
contractions with fewer side effects than beta-adrenergic Side effects: Nausea, vomiting, dyspepsia (When
drugs. Interferes with muscle contractility premature labor cannot be arrested and fetal lung maturity
needs to be improved, the use of betamethasone (Celestone)
B. Adminster IV for 12-24 hours PO. Form of can improve the L/S Ratio of lung surfactants. It is
magnesium may be used for maintainance. administered to the mother, usually q 12 hours times 2, then
weekly until 34 weeks gestation.
Loading dose of 4-6 grams IV over 20-30 mins.
Nursing Intervention:
1-4gms dose IV (2-3g/hour)
1. Keep the client at rest, side-lying position.
3. Must monitor patient for magnesium toxicity
2. Hydrate the patient and maintain IV or PO fluids.
Calcium Gluconate--- Antidote for magnesium
sulfate 3. Maintain maternal/fetal monitoring ( Maternal-
fetal V/S q 10 minutes; be alert for abrupt changes.
4. Few serious side effects, initially patients feel hot, Monitor I&0.
flushed. Headache, nausea and diarrhea, dizziness and
lethargy. 4. Monitor urine for glucose and ketones.

BETA-ADRENERGIC DRUGS -----TERBUTALINE 5. Watch cardiac and respiratory status carefully

AND RITODRINE

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6. Evaluate lab test result carefully 4. Observe and record color, odor, amount of amniotic
fluid.
7. Administer Drugs as ordered/indicated
5. Examine mother for signs of prolapsed cord.
A. Terbutaline ( position client on side as
much as possible, apply external fetal 6. Provide explanations of procedures, findings and
monitor., Complete fetal assessment) support to mother and family.

B. keep client informed of all 3. INFECTIONS

progress/changes
- Infection can be dangerous during pregnancy as it can
C. Identify side effects/ complications as cause problems for unborn babies, such as hearing loss,
early as possible. visual impairment or blindness, learning difficulties and
epilepsy.
D. carry out activities designed to keep client
comfortable Common Infections During Pregnancy

- During pregnancy, some common

infections that may occur are the flu,
2. PREMATURE RUPTURE OF MEMBRANES vaginal yeast infections, uterine infections,
(PROM) group B streptococcus, bacterial vaginosis.
Changes in immune function may cause
General Information: this increased risk of infection, and if left
untreated, may lead to serious
1. Loss of amniotic fluid prior to term, unconnected complications.
with labor.
What Causes Infection in the Womb when pregnant?
2. Dangers associated with this event are prolapsed
cord, infection and the potential need for premature The most common cause is bacteria moving up through the
delivery. vagina and cervix. It can also come through the maternal
bloodstream through the placenta. Infection may also be a
complication of invasive procedures such as amniocentesis
or fetoscopy.

What are fetal infections?

Assessment Findings:
Fetal infections are a potentially preventable cause of
1. Report from mother/ Family of discharge fluid. perinatal morbidity and mortality. Viruses such as rubella,
cytomegalovirus, parvovirus, varicella-zoster virus and
2. pH of vaginal fluid will differentiate between parasites like Toxoplasma gondii can be transmitted from a
amniotic fluid (Alkaline) and urine or purulent pregnant woman to her fetus via the placenta and can affect
discharge ( acidic). fetal development.
Nursing Intervention: The following infections may also increase the risk for
miscarriage.
1. Monitor maternal/fetal v/s on continuous basis,
especially maternal temperature. · rubella (german measles)
2. Calculate gestational age. · cytomegalovirus.
3. Observe for signs of infection and for signs of onset · bacterial vaginosis.
of labor. (If signs of infection present, administer
antibiotics as ordered and prepare for immediate · HIV.
delivery. If no maternal infection, induction of labor
may be delayed). · chlamydia.

· gonorrhea.

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· syphilis. urine. feeling the urge to urinate more often than usual.
urinating before you reach the toilet ('leaking' or
· malaria. incontinence)

Infections that may cause birth defects: Can UTIs cause miscarriage?

Toxoplasmosis, cytomegalovirus (CMV), varicella, Urinary Tract Infections: A UTI alone doesn't cause
rubella, and lymphocytic choriomeningitis virus a miscarriage, but complications might. "If [a UTI] is not
(LCMV) are among the agents that are recognized to treated and the infection ascends into the kidneys, it can
have the potential to cause birth defects in a developing cause a very serious full-body infection called sepsis which
fetus. can cause a miscarriage

Infections that can cause stillbirth include: How long does it take for a UTI to go away while
pregnant?
Cytomegalovirus (also called CMV). This is a kind of
herpes virus that you can get by coming in contact with Your symptoms should go away in 3 days. Take all
body fluid (like saliva, semen, mucus, urine or blood) from of your medication on schedule anyway. Don't stop it early,
a person who carries the virus. even if your symptoms fade. Many common antibiotics --
amoxicillin, erythromycin, and penicillin, for example --
What causes birth defects? are considered safe for pregnant women

· Genetics. One or more genes might have Can a UTI go away on its own?
a change or mutation that prevents them from
working properly. ... Many times a UTI will go away on its own. In
fact, in several studies of women with UTI symptoms, 25%
· Chromosomal problems. ... to 50% got better within a week — without antibiotics.

· Exposures to medicines, chemicals, or How do I know if my UTI is getting worse?

other toxic substances. ...
If the infection has worsened and travels to the
· Infections during pregnancy. . kidneys, symptoms can include the following: Pain
in the upper back and sides. Fever.
· Lack of certain nutrients.

5. ABO – INCOMPATIBILITY
4. UTI – During Pregnancy
- ABO incompatibility happens when a mother's
When you're pregnant, your pee has more sugar, blood type is O, and her baby's blood type is A or B. The
protein, and hormones in it. These changes also mother's immune system may react and make antibodies
put you at higher risk for a UTI. Because you're against her baby's red blood cells.
pregnant, your growing uterus presses on your
bladder. That makes it hard for you to let out all the What happens with ABO incompatibility?
urine in your bladder.
ABO incompatibility results when the fetal blood
How can a pregnant woman get rid of a UTI? type is different from the mother's blood type. When the
blood types differ, the mother creates antibodies against the
Most UTIs during pregnancy are treated with a fetus' incompatible blood type. These antibodies enter the
course of antibiotics. Your doctor will prescribe placenta and begin to destroy the fetus' blood cells
an antibiotic that is pregnancy-safe but still
effective in killing off bacteria in your body. How long is ABO incompatibility jaundice?

What does a UTI feel like when pregnant? This type of jaundice starts at 4 to 7 days
of age. It may last 3 to 10 weeks. It is not harmful.
- Common symptoms of a UTI during pregnancy Blood group incompatibility (Rh or ABO
are similar to those that you might experience at any other problems): If a baby and mother have different
time, and include: a burning sensation when you pass blood types, sometimes the mother produces

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antibodies that destroy the newborn's red blood Spotting or bleeding may occur shortly after
cells. conception, this is known as an implantation bleed. It is
caused by the fertilised egg embedding itself in the lining
Do Babies always have the father's blood type? of the womb. This bleeding is often mistaken for a period,
and it may occur around the time your period is due.
Our blood type is inherited from our parents.
Each biological parent donates one of two ABO genes to Does bed rest help bleeding pregnancy?
their child. The A and B genes are dominant and the O gene
is recessive. For example, if an O gene is paired with an A Work, activity, lifting, or exercise may worsen or
gene, the blood type will be A. provoke certain situations, so bed rest may be prescribed to
reduce vaginal bleeding or decrease the chance of
How do you prevent ABO incompatibility? premature labor. Bed rest may also be necessary to help
increase blood flow to the placenta.
In order to prevent ABO-incompatible transfusion,
it is important to establish a management system In which monthly periods stops in pregnancy?
of blood transfusion in the hospital, including a
hospital transfusion committee and a responsible Once your body starts producing the pregnancy
medical doctor. hormone human chorionic gonadotrophin (hCG), your
periods will stop. However, you may be pregnant and have
light bleeding at about the time that your period would have
been due.
6. BLEEDING TENDENCIES IN PREGNANCY

Bleeding during early pregnancy is common, and it TOPIC 4: NURSING CARE OF THE CLIENT
often is not a cause for concern. Bleeding during DURING LABOR AND DELIVERY
the second and third trimester is less common and
can indicate a health problem. In some cases, late 5 factors of labor ( 5’Ps)
pregnancy bleeding is caused by a problem with the 1. Passenger – or fetus, adjust to the size and shape of the
placenta. pelvis.
2. Passageway- composed of the pelvis, bony canal through
What causes bleeding tendency? which the fetus must pass, as well as the soft tissues of the
cervix, vagina and perineum.
BLEEDING TENDENCIES 3. Powers –may be positive or negative. The positive
powers of labor, the uterine contractions and the use of
A bleeding tendency can be caused mainly by a abdominal muscles for the pushing stage, must overcome
blood platelet defect (thrombocytopenia) or blood the negative powers, the resistance of the soft tissues.
coagulation defect (anticoagulant drugs, 4. Placenta
haemophilia, von Willebrand disease). 5. Psychological response – Personality of the laboring
woman influences her response to labor
How much bleeding is normal in early pregnancy?

About 20% of women have some bleeding during

the first 12 weeks of pregnancy. Possible causes of first
trimester bleeding include: Implantation bleeding. You may PASSENGER
experience some normal spotting within the first six to 12
days after you conceive as the fertilized egg implants itself
in the lining of the uterus. 1. Fetal malposition
2. Malpresentation
What is bleeding disorder in pregnancy? 3. Cord coil
4. Cord prolapse
Bleeding disorders, also known as coagulopathy, 5. SGA
are conditions that affect your body's ability to clot 6. LGA
normally at the site of an injury, resulting in 7. Fetal distress
bleeding that can range from mild to severe. The 8. Multiple pregnancy
bleeding can be inside or outside the body.

Is pregnancy bleeding like a period?

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• An umbilical cord that is wrapped around a baby’s Malpresentation can mean the baby’s face, brow,
neck in utero is called a nuchal cord, and usually is buttocks, foot, shoulder, arms, legs or the umbilical cord are
harmless. An umbilical cord is a lifeline for a baby against the cervix.
in the womb. Running the baby’s abdomen to the
placenta, the umbilical cord usually contains three It’s best for the baby’s head to come out first as it is the
blood vessels. largest and least flexible part of the body. If any other body
• Umbilical cord contains AVA- 2 arteries, 1 vein. part goes down the birth canal first, there’s a danger the
• Cord coil is visible during ultrasound, making the head will get stuck or there will be an umbilical cord
baby move less in the last weeks of pregnancy. prolapse (when the umbilical cord comes down in front of
the baby, cutting off the supply of oxygen).
The baby may also be more likely to get a nuchal cord if:
DIFFERENT TYPES OF MALPRESENTATION

1. The mother is having twins or multiples.

2. Have excessive amniotic fluid. 1. Breech presentation: A breech presentation is
3. The mother has a long cord. when the baby is lying with their bottom or feet
4. The structure of the cord is poor down. Sometimes one foot may enter the birth
5. There is no way to avoid the nuchal cord and they're canal first (called a ‘footling presentation’).
never caused anything the mother has done. 2. Transverse lie: The baby’s back, shoulders, arms
or legs may be the first to enter the birth canal.
Management: No way to be treated. Nothing can be done 3. Oblique lie: The baby is high above the birth canal.
until delivery. Simply slip off the cord from the neck of the No particular part of the baby’s body is against the
baby so that it won't tighten at the baby’s neck and for a cervix.
good supply of oxygenation. 4. Unstable lie: The baby is continually changing the
position around and no particular part of their body
Cesarean is against the cervix. cord presentation: This is
• Other type of delivery when the umbilical cord is against the cervix. It’s
• Assisted birth- with forceps usually caused by oblique or unstable lies.

FETAL MALPRESENTATION/MALPOSITION What are the causes of malpresentation?

Fetal malpresentation and fetal malposition are Malpresentation may be caused by:
frequently interchanged; however, fetal malpresentation 1. having a low-lying placenta
refers to a fetus with a fetal part other than the head 2. having too much or too little amniotic fluid
engaging the maternal pelvis. Fetal malposition in labor 3. an abnormally shaped uterus
includes occiput posterior and occiput transverse 4. problems with the uterus, such as large fibroids
positions.
How is malpresentation diagnosed?
Malpresentation refers to when your baby is in an unusual
position as the birth approaches. Sometimes it’s possible to Malpresentation is normally diagnosed when your doctor
move the baby, but often it’s safer for you and the baby if or midwife feels your tummy. Sometimes it can be
you have a cesarean diagnosed with an ultrasound.

Babies often change position through the pregnancy, but

this becomes much less likely after 37 weeks because there
isn’t enough room for the baby to move around.
What is presentation and malpresentation?
What are the risks involved with malpresentation?
The ideal presentation is with the crown of the baby’s
head against the cervix, face towards the mother’s back, 1. An assisted delivery, or instrumental delivery, is when
with the chin tucked into the baby’s chest. This is called your doctor uses forceps.
‘vertex presentation’. If the baby is in any other position, 2. The techniques can cause a bit of swelling or leave a mark
it’s called malpresentation. on your baby’s head, but these will fade quickly.

There is also a chance that the baby could suffer a more

serious birth injury, such as a fracture, nerve damage or

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brain damage. Although very upsetting, your medical team
will treat and monitor your baby in special care. At risk: Infant with low birth weight; mothers with multiple
gestation; pregnancy with high station of fetal presenting
Having an assisted delivery can also result in birth injury to part; malpresentation- fetal part is transverse or in footling
the mother. Some injuries will be temporary and will heal position.
over time, but occasionally the injury can be more long-
lasting and may require treatment. 5. Small gestational Age (SGA)

Small for gestational- a baby who is smaller than the usual

amount for the number of weeks of pregnancy. SGA babies
Passenger- Cord Prolapse- yung umbilical cord una usually have low birth weights.
lumabas
What is the difference of Small for gestational age and
low birth weight?
• Umbilical cord prolapse occurs when the cord
drops through the open cervix into the vagina
before the baby moves into the birth canal. •Small for gestational age (SGA) newborns are
• Umbilical cord prolapse is an uncommon but those who are smaller in size than normal for
potentially fatal obstetric emergency. When this gestational age.
occurs during labor or delivery the prolapsed cord CAUSES:
is compressed between the fetal presenting art and 1. Genetic diseases
the cervix. This can result in a loss of oxygen of the 2. Inherited Metabolic Diseases
fetus, and may even result in a stillbirth. 3. Chromosome Anomalies
4. Multiple gestations
Diagnosis: IE; vaginal exam 5. A developing baby with intrauterine growth
restriction will be small in size and may have
Signs and symptoms: problems such as:
• Increased red blood cells
• Low blood sugar
• The most obvious symptom of a prolapsed • Low body temperature
umbilical cord is seeing or feeling the cord before
the baby is delivered. Fetal distress from lack of TREATMENT:
oxygen and prolonged fetal heart rate
deceleration on the fetal monitor (bradycardia).
1. Temperature controlled beds (INCUBATOR)
Cord compression- death of the baby/ stillbirth 2. Tube feedings

What causes cord prolapse in pregnancy? What are SGA babies at risk for?
- The most common cause of cord prolapse is premature
rupture of the membranes, which is when a mom's water
breaks before she's actually in labor and her baby's head has • A baby who is SGA has a lower weight than normal
begun to "engage," or settle into, the birth canal. for the number of weeks of pregnancy sometimes
raises the risk of early birth, LBW, miscarriages.
Can a baby survive cord prolapse?
• For most babies, there is no long-term harm from Other problems: Perinatal asphyxia, meconium aspiration,
cord prolapse. However, even with the best care, polycythemia, and hypoglycemia.
some babies can suffer brain damage if there is a
severe lack of oxygen (birth asphyxia). Rarely, a Gestational age- the primary determinant of organ
baby can die. maturity.

Management: Apply upward pressure to relieve the Complications:

compression. Remain applying pressure until the baby is 1. Low oxygen levels
delivered. 2. Low apgar score
Place the woman in niche’s/ tenderburg?? 3. Low Blood sugar
Position ??? Position to relieve cord compression. 4. Too many RBC
Administer oxygen. 5. Trouble in keeping body temperature

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to the baby's breathing amniotic fluid containing
meconium.
• Described when the fetus does not receive adequate
6. Large for Gestational AGe (LGA) amounts of oxygen during pregnancy.
• Fetus who are larger expected that their age and
gender. Signs of Fetal Distress:
• Can be detected by leoplod’s

Risk: 1. Abnormal heart rates

2. Decrease in Fetal movement
3. Maternal Weight gain
• If the baby is too large to fit the birth canal easily,
birth can be difficult.
• Long time for delivery Treatment:
• Difficult birth 1. Changing the mother’s position.
• Injury to the aby 2. Ensuring the mother is well- hydrated.
• Brachial plexus- damage nerve, broken collar bone 3. Ensuring the mother has adequate oxygen.
• Increased need for Cesarean delivery. 4. Tocolysis- used to stop contractions/ delay preterm
labor.
Complications:
Conditions behind Fetal Distress:

1. Respiratory distress syndrome: Risk for Anemia- (the most prevalent obstetric condition seen
breathing meconium into the lungs around the time behind non-reassuring fetal status)
of birth.
2. Birth Injuries such as a broken collar bone or Oligohydraminos- (a condition in which there is a lower
damaged nerves in the arm (brachial plexus) are level of amniotic fluid around the fetus)
more common in babies who are very large for
gestational age. These babies also may need to stay Pregnancy Induced Hypertension (PIH)- Post-term
in neonatal intensive care because of breathing pregnancies (42 weeks or more)
problems, low blood sugar (hypoglycemia), or
both. Post term pregnancy (42 weeks or more)-
3. More likely to have an excessive amount of RBC
or polycythemia. Intrauterine Growth Retardation (IUGR)

Causes: Meconium stained amniotic fluid- Meconium-stained

amniotic fluid (a condition in which meconium, a baby’s
first stool, is present in the amniotic fluid which can block
1. Some babies ar enlarge because parents ar enlarge fetal airways)
2. Amount of weight a mother gains during pregnancy
3. Diabetes 8. Multiple Pregnancy

Prevention:
• Pregnancy where you’re carrying more than 1
baby at a time. If you're carrying two babies, they
1. Regular prenatal care are called twins. Three babies that are carried
2. Regular check ups during one pregnancy are called triplets. You can
also carry more than three babies at one time (high-
order multiples)
7. Fetal Distress
How do multiple pregnancies happen?

• A sign that the bay is not well. It happens when the Two main ways:
baby isn't receiving enough oxygen through the
placenta. If not treated, then fetal distress can lead

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1. Fertilized eggs splits before it implants in the weeks) than a woman carrying only one baby. The
uterine lining goal for many moms of multiples is to complete 37
2. Two or more eggs were fertilized by a different weeks. This is considered term in a twin pregnancy
sperm at the same time. and reaching this week of gestation increases the
chance the babies will be born healthy and at a good
Identical baby/twins/triplets- single egg is fertilized, then weight. Babies that are born prematurely are at risk
later splits. Newly derived embryos are identical. Children of another complication of multiple births — low
that are identical multiples will look like each other and be birth weight.
the same sex. 2. Pre eclampsia or gestational hypertension (high
Fraternal babies/twins/triplets- develop from separate blood pressure)- High blood pressure is called
eggs that are fertilized by a different sperm. Because these hypertension. This can lead to a dangerous
are different eggs and different sperm, the genetic material condition called preeclampsia. Complications
is varied. These children won't look identical and can be related to high blood pressure happen at twice the
different sexes from each other. rate in women carrying multiples compared to
women pregnant with only one baby. This
In pregnancy with triplets or more, the babies could all be complication also tends to happen earlier in
identical , all fraternal or a mixture of both. This can happen pregnancy and be more severe in multiple
if your body releases multiple eggs and more than one is pregnancies than single pregnancies.
fertilized. In cases where you have both identical and
fraternal multiples, more than one egg is fertilized and at
least one of the eggs also split for fertilization.
Gestational Diabetes: This can happen because of the
Are identical twins or triplets always the same sex? increased amount of hormones in the placenta. Two
placentas- increase resistance to insulin.
Identical twins/Triplets- always sex, because one egg is
fertilized. Because identical twins or triplets share genetic Abruptio placenta- This condition happens when the
material, they are always the same sex. The sex of a baby is placenta detaches (separates) from the wall of your uterus
determined by the particular sperm cell that fertilizes the before delivery. This is an emergency situation. Placenta
egg at conception. There are two kinds of sperm cells — abruption is more common in women who are carrying
those carrying an X chromosome or Y chromosome. The multiples.
mother’s egg carries an X chromosome. If a sperm cell
carrying an X chromosome fertilizes the egg, it will make a Fetal Growth Restriction:
XX combination (female). If the sperm cell is carrying a Y
chromosome, you end up with an XY pairing (male).
1. IUGR or SGA- This condition happens when one
or more of your babies is not growing at the proper
• Identical multiples start as one egg and then split, rate. This condition might cause the babies to be
so whatever chromosome combination is present at born prematurely or at a low birth-weight. Nearly
fertilization is the sex of all multiples. half of pregnancies with more than one baby have
this problem.
What increases the chance of a multiple pregnancy? 2. Identical twins- may have one placenta (70% of
the cases) or two placentas (30% of the cases). The
risks of identical twins with two placentas are
• Are older (women in their 30s are at higher risk of similar to those listed above for fraternal twins.
multiples because the body starts to release Identical twins with one placenta (called
multiple eggs at one time when they get older. monochorionic) have risks that are unique to them.
• Are a twin yourself or have twins in your family. 3. Fraternal twins- always have two placentas. The
• Are using fertility drugs. risks of pregnancies with fraternal twins are similar
to those of pregnancies with only one baby.
Complications: However, the number of possible risks are
increased when compared to pregnancies with one
baby.
1. Premature labor and birth: The most common
complication of multiple births is premature Passageway- CPD Cephalopelvic Disproportion
labor. If you’re pregnant for multiples, you are • CPD is a medical issue that can arise during
more likely to go into premature labor (before 37 childbirth. It occurs when a baby is having trouble

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getting through the birth canal. The baby may be 5. The baby is not moving down.
very large or the mom’s pelvis may be too small for
the baby to pass safely. It can lead to obstructed • The labor is prolonged or lasting longer than
labor. expected.

Risk Factors for CPD • Uterine contractions are not strong enough to keep
the labor moving forward.
For the baby
1. Size: Baby too big. When a baby is much bigger • The thinning and dilation of the cervix is happening
than average, so is his head. The risk of CPD goes slowly or not at all.
up when the baby is over 8 lbs 13 oz (4000 g), and
it’s even higher when the baby is over 9 lbs 15 oz • The baby’s head is not engaging or entering the
(4500 g). pelvis.

2. Position: If the baby is breech or lying sideways, it • The baby is not moving down through the pelvic
will affect labor and delivery. stations.

3. Presentation: Delivery is easier when the smallest Treatment/Management:

part of the head leads the way. But, when a larger •
part of the baby’s head such as the forehead or face Cesarean section. The treatment for CPD is to
is heading out first, it can be challenging to make it continue with labor or move on to a cesarean
through the pelvis. section. The goal of treatment is to have a safe
delivery, so the doctors will decide how to treat the
4. Health: Hydrocephalus. Certain health conditions condition based on how the delivery is going.
in the baby, such as hydrocephalus, can cause the
baby’s head to be larger than average. Trial of labor:
1. Close monitoring of contractions, dilation, and the
baby’s progression down the birth canal.
2. Close monitoring of the baby’s movement and
5. Gender: Boys tend to be larger than girls, so the heart rate.
risk of CPD with boys is a little higher. 3. Confirmation of baby’s position, heart rate and
presentation.
For the mother 4. Other tests, such as x ray, ultrasound, MRI to
visualize the baby’s head and your pelvis.

1. History of pelvic history

2. Pelvis that is narrow or has genetic variation in • If labor continues, forceps or a vacuum may be
shape needed to help deliver the baby. But, if problems
3. First pregnancy arise such as ineffective contractions, slow dilation
4. Diabetes and gestational diabetes and effacement, no descent, or fetal distress, the
5. Polyhydramnios doctors will end the trial, and a c-section will be
6. Obesity necessary.
7. Malnutrition
8. History of fertility treatments
9. Overdue dates
10. Previous Cesarean Section • If you've already been through a pregnancy and had
11. Hispanic heritage a difficult labor or a c-section due to CPD, the
12. Short stature standard treatment for the next pregnancy is an
elective c-section. The c-section should be
The doctor will suspect CPD if: scheduled when your baby is as close to full-term
1. Labor is prolonged or lasting longer than expected. as possible. If the doctor is not sure of the dates,
2. Uterine contractions are not strong you may have to wait until your labor begins to
3. The thinning and dilation of the cervix is happening have the c-section to prevent the problems
slowly or not at all. associated with prematurity.
4. The baby’s head is not engaging or entering the
pelvis.

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Complications Etiology/Cause

• Premature rupture of membranes Uterine overdistension and overuse as seen in multifetal

• Dystocia gestation, fetal macrosomia, polyhydramnios and grand-
• Extreme molding of the head multiparity
• Umbilical cord prolapses
• Fetal distress
• Damage to the mom's perineum Mechanical disruption of myometrial function from
• Injury to the baby’s head myoma or distension of the bladder or bowel
• Uterine rupture
• Cesarean birth
Malpositioning and malpresentation of the fetus, where
there is absent reflex in uterine contraction, due to
PASSAGEWAY-INEFFECTIVE CERVICAL inadequate contact of the presenting part onto the lower
DILATATION, EFFACEMENT uterine segment

Treatment / Management
Abnormal uterine axis as seen in a pendulous abdomen.
• Supportive Measures
There is an exaggerated anteversion of the uterus.
• Continuous reassurance to keep the mother calm.
• Maternal stress increases endogenous adrenaline,
which can inhibit uterine contractions.
Uterine deformities or myometrial disorganization as
• Encourage ambulation and avoid supine position.
seen with developmental uterine hypoplasia and extensive
• Although these are not proven to improve
myomectomy.
contractions or prolonged labor due to hypo
contractility, they may improve the comfort of the Prematurity below 30weeks gestation where oxytocin
parturient. receptors are not fairly established
• Empty bladder, consider catheterization.
Other general/systemic causes may include maternal
• Maintain adequate hydration.
anemia, maternal exhaustion, and improper use of analgesia
• Adequate pain relief.
in labor.
Active Measures
POWER
Amniotomy- Amniotomy should be attempted when
• Uterine dysfunction/disorder vaginal delivery is probable; where cervical dilatation > 4
cm, there is adequate fetal descent (station -2 or lower), and
the presenting part is well-applied to the lower uterine
• Hypotonic labor is an abnormal labor pattern, segment.
notable especially during the active phase of labor,
characterized by poor and inadequate uterine
contractions that are ineffective to cause cervical Oxytocin
dilation, effacement, and fetal descent, leading to a
prolonged or protracted delivery.
Oxytocin is the medication of choice for augmenting
contractions. combination of amniotomy and oxytocin
• Hypotonic labor is primarily a dysfunction of augmentation is effective in the management of
power. There is inadequate propulsive power to hypocontractile labor than amniotomy alone when
cause fetal descent, cervical dilatation, and instituted early in the active phase.
eventual expulsion of the fetus(es) and placenta. Surgical management: Cesarean Section

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Operative delivery by cesarean section should be
considered early when the assessment indicates a CPD or
fetal mispositioning/malpresentation. NURSING CARE OF THE POSTPARTUM CLIENT

1. Postpartum Hemorrhage

-Also called PPH

-When a woman has heavy bleeding after giving birth.
- Serious but rare condition.
- It usually happens 1 day after giving birth but it can
Complications happen up to 12 weeks after having a baby.
-Losing lots of blood quickly can cause a severe drop in
• Complications of hypotonic labor may be maternal,
your blood pressure. It may lead to shock and death if not
fetal, or both. treated.
• Arrest of labor -The most common cause is when the uterus does not
• Maternal anxiety and exhaustion contract enough after delivery.
• Postpartum hemorrhage due to uterine atony
Common Causes of postpartum Hemorrhage

Retained placenta due to ineffective myometrial retraction

1. Placental abruption- The early detachment of the
placenta from the uterus.

Increased risk of instrumental delivery and possible injuries Uterine atony - refers to the failure of the uterus to contract
to mother and baby sufficiently during and after childbirth. It can occur during
both vaginal and cesarean delivery. The uterus is
anatomically divided into 3 regions; the fundus (uppermost
Cesarean section risk with the attending surgical and part), the body (main part), and the cervix (lower part).
2. Placenta previa- The placenta covers or is near the
anesthetic complications
cervical opening.
3. Over distended uterus- This is when the uterus is
larger than normal because of too much amniotic fluid or a
Fetal distress and birth asphyxia large baby.
4. Multiple pregnancy-
5. Gestational hypertension or preeclampsia or
PHYSIOLOGICAL STATE INFLUENCING LABOR PIH-
AND DELIVERY 6. Having many previous births-
7. Prolonged labor-
8. Infections-
• Pregnant women express worries and fears in
relation to their pregnancy of upcoming childbirth. Who is at risk for PPH?
Fears may get to be strong to be clinically relevant.
• The physiological aspects of fear and anxiety
include responses such as palpitations, • The risk factors for PPH were maternal age <18
hyperventilation, dizziness, etc. years, a previous CS, history of PPH, conception
• There is substantial evidence that anxiety, through IVF, pre-delivery anemia, stillbirth,
depression, and stress in pregnancy are risk factors prolonged labor, placenta previa, placental
for adverse outcomes for mothers and children. abruption PAS and macrosomia
Most specifically, anxiety in pregnancy is
associated with shorter gestation and has adverse How do you recover from postpartum Hemorrhage?
implications for fetal neurodevelopment and child
outcomes. • Traditionally, postpartum hemorrhage (PPH) has
been defined as greater than 500 mL estimated
Ambivalence- the state of having mixed feelings or blood loss associated with vaginal delivery or
contradictory ideas about something or someone.

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greater than 1000 mL estimated blood loss 1. Treated with oral antibiotics. (Clindamycin or
associated with cesarean delivery. gentamycin)
2. Maintaining hygiene

• Depending on how much blood was lost, recovery

may vary for each woman. Typically, will develop 3. Uterine Atony
anemia and will need time to recover after delivery
with plenty of fluids and rest. To restore your
health, you'll most likely be prescribed prenatal • Refers to the failure of the uterus contract
vitamins and iron supplements. sufficiently during and after birth.

2. Puerperal Infection
4. Hematomas

• Occurs when bacteria infect the uterus and

surrounding areas after a woman gives birth. • Usually associated with severe perineal pain.
• Known as postpartum infections. • Parang pasa sa perineum during delivery omg that
pain
What causes Puerperal infections? • Blood clots
• Swelling, irritated tissue, bulging

• Physiologic and teratogenic trauma to the

abdominal wall and reproductive genital and 5. DIC- Disseminated Intravascular Coagulation
urinary tracts that occur during childbirth or
abortion which allows the introduction of bacteria
into these normally sterile environments. • Excessive postpartum bleeding

Endometritis- most common infection in the postpartum —---------------------------------

period.

Puerperal sepsis Signs and Symptoms 6. Thrombophlebitis- Inflammation process that

causes a blood clot to form and block one or more veins,
usually in the legs.
1. Fever • The affected vein might be near the skin
2. Pelvic Pain (SUperficial thrombophlebitis) or deep vein
3. Vaginal Discharge; presence of pus thrombosis or DVT- Deep within a muscle.
4. Abnormal smell • There is an increased risk of thrombophlebitis in
5. Delay of the rate of reduction of the size of the postpartum.
uterus. • This can progress to thromboembolism- which tis
the blood clot will be divided into small particles
and could run through the blood flow.

Causes of Infections/Sepsis Signs and Symptoms: redness, tenderness in the affected

leg, pain in the calf while walking.

1. Retained products of conception

2. Chorioamnionitis 7. Mastitis- Is an inflammation of breast tissue that
3. Pelvic Abscess sometimes involves infection.
Signs and Symptoms:
Can cause long term health problems such as chronic pelvic Breast Pain, swelling, warmth, and redness, fever and chills
inflammatory diseases and infertility in females
Causes:
Treatment 1. Accumulation of breastmilk- Blocked milk duct- if
the breast does not completely empty at feedings.
2. Bacteria entering the breast. Bacteria from the skin
surface and baby's mouth that can enter the milk

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duct through a crack in the skin of the nipple or disease. Men with fertility problems may have a
through milk duct opening, can lead to infection. low sperm count or low testosterone. The risk of
Risk factors: infertility increases as you age.
1. Sore/cracked nipples- although mastitis can
develop without broken skin. Types of Infertility
2. Wearing a tight fitting bra or putting pressure on the
breast when using a seat belt/carrying a heavy bag
which may restrict milk flow. 1. Primary- who were never pregnant and who can't
3. Becoming overtired or stressed. conceive after one year or not using birth control.
4. Poor nutrition 2. Secondary- when a woman cannot get pregnant
5. Smoking again after having at least one successful
pregnancy.
Complication: It can cause collection of pus (abscess)
usually requiring surgical drainage. Risk Factors:
Age over 35 for women or over 40 for men
Prevention:
Female:
1. Diabetes
1. Fully drain the milk from the breast while 2. Eating disorders, including anorexia nervosa and
breastfeeding bulimia
2. Allow the baby to completely empty one breast 3. Excessive alcohol use
before switching to the other breast during feeding. 4. Exposure to environmental toxins, such as lead and
3. Change the position to breastfeed from one feeding pesticides.
to the next. 5. Over exercising
6. Radiation therapy or other cancer treatments.
8. Postpartum psychosis- a mental illness that can affect 7. Sexually transmitted diseases (STDs)
someone soon after having a baby. Many who have given 8. Smoking
birth will experience mild mood changes after having a 9. Stress
baby known as “baby blues”. This is normal and usually 10. Substance abuse
lasts only for a few days. 11. Weight problems (obesity or underweight)

Symptoms:
1. Hallucination- hearing, seeing, smelling, feeling Male:
things that are not there. 1. Enlarge veins in the scrotum (varicocele) the sac
2. Delusions- thoughts or beliefs that are unlikely to that holds the testitces.
be true. 2. Cystic fibrosis
3. Manic mood- feeling high 3. High heat exposure to testicles from tight clothing
4. Low mood- showing signs of depression; low or frequent use of hot tubs and saunas.
appetite; anxiety 4. Injury to the scrotum of testicles
Treatments: 5. Low sperm count or low testosterone
1. Antipsychotics- helps with manic and psychotic (hypogonadism)
symptoms (Delusions/hallucinations) 6. Misuse of anabolic steroids
2. Mood stabilizers- to stabilize mood and prevent 7. Premature ejaculation or retrograde ejaculation
symptoms from recur. (semen flows back into the bladder)
3. Antidepressants- to help ease symptoms of 8. Testicular cancer and treatments
depression. 9. Undescended testicles.

TOPIC 6: NURSING CARE OF MALE AND How is female infertility diagnoses?

FEMALE CLIENTS WITH PROBLEMS IN
REPRODUCTIVE AND SEXUALITY
1. Basal body temperture and cervical mucus
Test:
1. Infertility- a condition where you cannot get
pregnant after one year of trying to conceive. In
women, causes of infertility can include 1. Pelvic exam- it includes pap smear to check for
endometriosis, uterine fibroids, and thyroid problems or signs of disease.

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2. Blood test- for hormone levels. Causes:
3. Transvaginal ultrasound Imbalance in one or more hormones.
4. Hysteroscopy- to examine the uterus
5. Saline sonohysterogram (SIS)- it is when the
provider fills uterus with saline and conducts a 1. Gonadotropic hormones
transvaginal ultrasound. 2. Follicle stimulating hormone
6. Hysterosalpingogram (HSH)- xray capture an 3. Luteinizing hormone
injecible dye as it travels to the fallopian tube.
7. Laparoscopy- to identify problems in the uterine Diagnosis:
walls/uterus

How is male infertility diagnoses? 1. Irregular periods.

Tests:
1. Blood progesterone levels
1. Semen analysis- for sperm count 2. Blood thyroid levels
2. Blood test- to check testosterone, thyroid, and 3. Blood prolactin levels
other hormone levels. 4. Ultrasound exam of pelvic organs
3. Scrotal ultrasound- identifies varicoceles or other Treatment:
testicular problems.

Management and treatment • Depends on the hormonal imbalance that causes it

• Managing stress
Female: • Managing weight
• FSH injections
Medications: fertility drugs and hormone stimulation • GnRH injections

Surgery: Surgery can be done in blocked open tubes, and Endometriosis- often a painful disorder in which tissue
remove uterine fibroids and polyps. Surgical treatment can similar to the tissue that normally lines inside the uterus- the
be done to endometriosis. endometrium- which grows inside the uterus. It is most
commonly involved in the ovaries, fallopian tubes, and the
Male: tissue lining in the pelvis.

Surgery: Varicocele surgery Symptoms: Dysmenorrhea; pelvic pain; backpain;

menstrual cramps; painful sex;
Sterility vs Impotence
Complications: risk for adenocarcinoma/ ovarian cancer
Impotence (erectile dysfunction)- difficulty getting an
erection. Endometriosis is the leading cause of infertility.

Infertility- body is unable to produce good sperm Diagnosis:

1. Pelvic exam
An ovulation happens when an egg does not release from 2. Imaging tests (CT scan, MRI)
the ovary during menstrual cycle. Chronic anovulation is a 3. Laparoscopy
common cause of infertility. 4. Biopsy- sample tissue

Signs and Symptoms: STAGES IN ENDOMETRIOSIS

1. Having irregular periods Stage 1: Minimal;- No scar tissue

2. Having very heavy or light periods Stage 2: Mild; more lesions but no scar
3. Lack of period (amenorrhea) Stage 2: Moderate; scar tissue
4. Lack of cervical mucus Stage 4: Severe; Large cysts, lesions, scar
5. Irregular Basal body temperature

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