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TOPICS: 2. Premature Separation of the Placenta

1. Bleeding during pregnancy (Abruption Placentae)
 Spontaneous Miscarriage 3. Preterm Labor
Threatened Miscarriage S/S OF HYPOVOLEMIC SHOCK
Imminent Miscarriage  Pallor
Complete Miscarriage  Confusion
Incomplete Miscarriage  Decreased BP
Missed Miscarriage  Increased Resp rate and pulse rate
 Gestational Trophoblastic Disease  Cold clammy hands
(Hydatidiform Mole)  Decreased urine output
 Cervical Insufficiency (Premature Cervical  Peripheral vasoconstriction (placental
Dilatation) insufficiency will occur)
 Placenta Previa  Fetal bradycardia
 Premature Separation of the Placenta EMERGENCY INTERVENTIONS FOR
(Abruptio Placenta) BLEEDING
 Disseminated Intravascular Coagulation  Place on side, flat in bed
 Premature Rupture of Membranes  IV Ringer's lactate with 16-18 gauge
2. Hypertensive Disorders  Oxygen 6-10L/min
 Gestational Hypertension  No oral fluids or vaginal exams
3. HELLP Syndrome  Order type and cross match of blood
4. Multiple Pregnancy  Measure/weigh pads to assess blood loss
5. Polyhydramnios (saturating more than 1/hour is heavy loss)
6. Oligohydramnios ABORTION - Interruption of a pregnancy
7. Postterm Pregnancy before fetus is viable (less than 20-24 weeks , under
8. Isoimmunization 500grams)
MISCARRIAGE - fetus born before viability.
BLEEDING DURING PREGNANCY Early: before week 16
o Never normal, more blood loss may be hidden. Late: 16-24 weeks
o Hypovolemic shock occurs with 10% or 2 units of CAUSES:
blood are lost.  Chromosomal aberrations, immunologic factors
o Fetal distress occurs when 25% of blood volume is  Implantation issues
lost.  Symp:
o May occur at any point - frightening.  Vaginal spotting
o Bleeding may be innocent, but any degree of  Slight cramping
bleeding should be evaluated. Tx:
CAUSES: (refer to page 527, table. 21.1)  Avoid strenuous activity for 1-2 days
A. First and Second Trimester  Gradually resume activity
1. Threatened Spontaneous Miscarriage  Restrict coitus for 2 weeks
2. Imminent Miscarriage BLEEDING AND MISCARRIAGE (Page 529)
3. Missed Miscarriage Week 6: not severe
4. Incomplete Spontaneous Miscarriage Week 12: severe. Placenta has implanted deeply.
5. Complete Spontaneous Miscarriage TYPES OF MISCARRIAGE (Page 530-531)
6. Ectopic (Tubal) Pregnancy  Spontaneous: Pregnancy ends b/c of natural causes.
B. Second Trimester Early miscarriage = before 16 weeks
1. Gestational Trophoblastic Disease Late miscarriage = 16-24 weeks
(Hydatidiform mole)  Induced: Elective reasons exist for terminating.
2. Premature Cervical Dilatation  Threatened: Spotting or cramping without cervical
C. Third Trimester change occur. Mom should avoid strenuous activity
1. Placenta previa for 24-48 hours. 50% result in miscarriage
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 Inevitable: Spotting and cramping occur and cervix  Isoimmunization
begins to dilate and efface  Powerlessness or anxiety
 Incomplete: Loss of some products of conception
occurs, with part of the products retained (most ECTOPIC PREGNANCY
often placenta). D & C procedure may be Pregnancy that occurs in a site other than a
necessary to remove retained tissue uterine site, with implantation usually occurring in the
 Complete: Loss of all products of conception fallopian tube.
occurs. ASSESSMENT/DATA COLLECTION OF
 Missed: Products of conception are retained in ECTOPIC
utero after fetal death. Patient may still experience  Missed period
pregnancy symptoms and hormones.  Seems normal in early pregnancy.
 Habitual: Recurrent pregnancy losses that occur in RISK FACTORS
3 or more successions  Damage to the fallopian tube causing blockage or
Signs and Symptoms narrowing so the eggs cannot move into the uterus.
 Vaginal spotting.  Previous pelvic infection.
 Vaginal bleeding. Bleeding is a serious occurrence  Damage to the fallopian tube causing blockage or
during pregnancy because it might indicate that the narrowing so the eggs cannot move into the uterus.
cervix has opened, and products of conception  Previous pelvic infection.
might be expelled.  Chlamydia.
 Cramping/sharp/dull pain in the symphysis  Previous appendicitis.
pubis.  Women with a history of infertility (Stabile, 1996);
 Uterine contractions felt by the mother. Can be  Caesarean section.
false or true, but either of the two could be  Women aged 35 or older.
alarming during the early stages of pregnancy  Smoking
because it could expel the contents of the uterus S/S ECTOPIC
thereby leading to abortion.  The zygote will grow large enough that it ruptures
NURSING INTERVENTIONS FOR ABORTION the fallopian tube.
1. Maintain bed rest.  This will cause sharp abdominal pain with vaginal
2. Monitor vs cramping and bleeding. spotting.
3. Count perineal pads to evaluate. Save expelled  By the time a woman arrives at the hospital or
tissue and clots. PCPs office, she may already be in shock with
4. Maintain IV fluids as prescribed. Monitor for signs rapid pulse and respirations, falling BP.
of hemorrhage or shock.  If a woman waits before seeking help, she will
5. Prepare the client for D & C, as prescribed, for notice a rigid abdomen, pain in her shoulders, and
incomplete abortion.  Cullen-sign - umbilicus will turn blueish hue.
6. Prepare to administer Rh (D) immune globulin INTERVENTIONS FOR ECTOPIC
(RhoGAM) to a Rh-negative woman.  If ruptured ectopic prepare for surgery via
SURGICAL MANAGEMENT laparoscopy to ligate the bleeding vessels and
 Dilatation and evacuation. This is to make sure remove/repair the fallopian tube.
that all products of conception would be removed  Obtain blood for Hgb level, type and cross match.
from the uterus.  Start (16 gauge - pink) large bore IV for fluids and
 Dilation and curettage. This is most performed for blood administration.
incomplete abortions to remove the remainder of  Monitor VS, bleeding and for shock.
the products of conception from the uterus.  An ectopic pregnancy can be visualized via
COMPLICATIONS OF MISCARRIAGE (Page 532- ultrasound and caught before any serious
533) complications.
 Hemorrhage  After agreement with mom that therapy could be
 Infection life saving, Methotrexate is given. (Chemo drug
 Septic abortion that will destroy cells)
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 Tube is left intact, no surgery needed. defects of the cervix. Process is usually painless; first
 Pls refer to Figure 21.2 Page 534 for possible sign is pink stained vaginal discharge or show or
sites of ectopic. Maternal and Child Health increased pressure.
Nursing, Eight edition volume 1. CAUSES:
GESTATIONAL THROMBOPLASTIC DISEASE 1. Abnormally formed uterus or cervix.
(HYDATIDIFORM MOLE) (Page 535) 2. Previous cervix surgery.
 Occurs when there is abnormal growth and then 3. Short cervix.
degeneration of the trophoblastic villi. 4. Damaged uterus from previous miscarriage or
 As the cells degenerate, they become filled with childbirth.
fluid and appear as fluid filled grape-like clusters. 5. Exposure to diethylstilbestrol (DES), a synthetic
The embryo fails to develop beyond a primitive (human-made) hormone given to some women in the
start. past to help them have successful pregnancies.
 Abnormal trophoblast cells must be identified b/c
they are associated with choriocarcinoma, a rapidly CERVICAL INSUFFICIENCY TX:
metastasizing malignancy. (high risk for CA)  Surgical placement of a cervical cerclage at weeks
ASSESSMENT/DATE COLLECTION 12-14 once ultrasound confirms fetus is healthy.
 No FHR Sutures are placed in the cervix to strengthen it and
 Vaginal bleeding prevent it from opening.
 Signs of gestational HTN  Sutures are removed at weeks 37-38 so the fetus
 Fundal height greater than expected. can be born vaginally.
 Elevated HCG levels INTERVENTIONS FOR INCOMPETENT CERVIX
 US shows dense growth but no fetal growth -  Remain on bed rest for a few days after cerclage to
"clumps of abnormal cells." decrease pressure on the new sutures.
RISK FACTORS OF GTD  Avoid prolonged standing or heavy lifting.
 Low protein intake  Usual activity and sexual relations can continue
 Women older than 35 yrs old. after this rest period.
 Asian women  Instruct her to report post vaginal bleeding/ctx.
 Women with a blood group of A who marry men  The prognosis is favorable - success rate is 80-
with blood group O. 90%.
NURSING INTERVENTIONS FOR NURSING CARE
GESTATIONAL TROPHOBLASTIC DISEASE  Maintain bed rest for 24 hours after cerclage.
 Suction curettage to evacuate the abnormal cells.  Monitor for rupture of membranes or bleeding.
 HCG is analyzed every 2 wks until levels are PLACENTA PREVIA (page 537-540)
normal again, then every 4 weeks for the next 6-12 The placenta is improperly implanted in the
months. lower uterine segment near or over the internal cervical
 *If the level plateaus or increases during this os. Management depends on the classification of the
period, it suggests a malignancy. placenta previa and gestational age of the fetus.
 A woman should use reliable contraception for this There are 4 degrees of Placenta Previa (see page 538,
12 month period of evaluation then after this period Figure 21.6)
of time may plan for another pregnancy. This is to  Low-lying Placenta = implantation in the lower
rule out malignancy. rather than upper portion of the uterus.
 Women may experience grief/loss - they thought  Marginal Implantation = the placenta edge
they were going to have a baby. May have anger approaches the cervical os.
and sense of unfairness.  Partial Placenta Previa = Implantation that
CERVICAL INSUFFICIENCY (PREMATURE occludes a portion of the cervical os.
CERVICAL DILATATION) (Page 537)  Total Placenta Previa = Implantation that totally
Premature dilation of the cervix (incompetent obstructs the cervical os.
cervix) occurs most often during the 4th or 5th month of ASSESSMENT/DATA COLLECTION
pregnancy and is associated with structural or functional
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 Placenta Previa is usually detected during  Heavy dark red bleeding usually occurs (if placenta
pregnancy through routine ultrasound. separates at the edges). If it separates at the center,
 The placenta is unable to stretch because of the blood may not be evident.
cervical opening, so a small portion loosens, and  Hypovolemic shock follows quickly.
damaged blood vessels begin to bleed.  Uterus becomes tense/rigid and tender.
 Woman will have sudden onset of painless bright  Assess when bleeding started, if pain is present,
red vaginal bleeding during the last half of and trauma could have led to placental separation.
pregnancy. For pics of types of placental separation see
 Bleeding can create an emergency situation page 540.
because the placenta is loosened - fetal oxygen and NURSING INTERVENTIONS
nutrient supply are compromised and mom is at  THIS IS AN EMERGENCY SITUATION for mom
risk for hemorrhage. and fetus. Monitor VS and FHR.
 May also cause pre-term labor.  Need large bore IV (20 gauge) for fluids and
NURSING INTERVENTIONS FOR PLACENTA oxygen by mask
PREVIA  Keep woman in lateral position
 Inspect perineum for bleeding, estimate blood loss.  Do not perform any abdominal, vaginal or pelvic
 Obtain VS and determine if hypovolemia is examination if abruptio placentae is suspected.
present.  If vaginal birth is not imminent, C-section is birth
 **Monitor BP every 5-15 mins** method of choice.
 *Vaginal exams or any other activity that would  Monitor for DIC (bleeding disorder)in the
stimulate the uterus or further damage placenta are postpartum period
AVOIDED.***  If a woman has bleeding before birth, she is more
 Maintain bedrest on the left side prone to infection after birth.
 Attach external monitors to record FHR and uterine DISSEMINATED INTRAVASCULAR
contraction. COAGULATION
 Obtain labs for H & H, type and cross match. DIC is an acquired disorder of blood clotting in
 Monitor urinary output, administer IV fluids. which the fibrinogen level falls to below effective limits.
 Obtain US to determine if vaginal delivery is May notice easy bruising or bleeding from an IV site.
possible. Complete placenta previa = C-SECTION CAUSES OF DIC
CARE MEASURES  Abruptio placentae
 If labor has begun or bleeding is continuous, or  Amniotic fluid embolism
fetus is compromised, birth MUST OCCUR  Gestational hypertension
regardless of gestational age.  Placental retention
 If bleeding has stopped, and fetus and VS are  Intrauterine fetal death
stable, a woman is monitored for 24-48 hours in the  Septic abortion
hospital. She is sent home on bed rest. DIC CREATES A PARADOX
 Betamethasone may be given to encourage fetal  One part of the circulatory system may experience
lung maturity if fetus is less than 34 weeks increased coagulation.
gestation.  The other part may experience a bleeding defect.
 After delivery, mom is more prone to postpartum ASSESSMENT/DATA COLLECTION FOR DIC
hemorrhage b/c the lower uterine segment does not Draw blood for:
contract as well.  Platelet count
ABRUPTIO PLACENTAE (PREMATURE  Prothrombin
SEPARATION OF THE PLACENTA) page 540-541  Thrombin Time
Premature separation of the placenta from the  Fibrinogen
uterine wall after 20 weeks gestation and before the birth  Uncontrolled; bleeding, bruising,
of the baby. petechiae/ecchymosis
ASSESSMENT/ DATA COLLECTION  Occult blood in excretions (stool)
 Hematuria/hematemesis/vaginal bleeding
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 Decrease in fibrinogen level, platelet count and hct  Administer fluids per physicians orders for
level. hydration
 Increase PT PTT, clotting time and fibrin  Obtain clean catch urine to rule out UTI/infection
degradation products. KNOW PRE-TERM LABOR MEDICATIONS
NURSING INTERVENTIONS FOR DIC Terbutaline (brethine)
 Treat underlying cause of DIC  Most common. Causes tachycardia.
 Approved to treat bronchospasm but may be used
 Increased coagulation must be stopped so normal off label as a tocolytic (an agent to halt labor)
clotting function can be restored - give heparin.  Cannot be used more than 48-72 hours of therapy
 Heparin must be given cautiously close to birth d/t/ d/t serious potential for maternal heart problems
risk of postpartum hemorrhage. and death.
 Kidneys can be affected - monitor for appropriate  If woman is 4-5 cm or membranes have ruptured,
urinary output - 30 mL/hr terbutaline CANNOT BE USED.
 Monitor labs to determine if blood coagulation Mag Sulfate
studies are returning to normal.  DOC for gestational hypertension but can be used
PRE-TERM LABOR to reduce uterine ctx.
Labor that occurs after 20 weeks but before end  Administered IV until contractions have
of the 37th wk of gestation. Is potentially serious since slowed/dilation has stopped. Mom needs monitored
the infant will be immature. Occurs in approx 9-11% of for respiratory depression!!
pregnancies and accounts for up to 2/3 of neonatal  *Also used for seizure prevention
deaths. Even if contractions are mild and widely spaced,
she can be in labor if 80% effacement and dilatation Betamethasone
over 1 cm has occurred.  Is used in 2 doses, 24 hours apart to help surfactant
PRECURSORS: production if pregnancy is less than 34 weeks.
 Dehydration PRE-TERM RUPTURE OF MEMBRANES
 UTI (PROM)
 Periodontal disease Spontaneous rupture of fetal membranes with
 Chorioamnionitis loss of amniotic fluid before 37 weeks of pregnancy.
 Being adolescent or African-Amer. Gestational age determines the plan and intervention.
 Lack of prental care  When rupture of membranes is before term and
 Past OB conditions delivery will be delayed, infection becomes a risk.
 Substance abuse  Another complication could be increased pressure
PRE-TERM LABOR SYMPTOMS on the umbilical cord or cord prolapse, which
 Persistent dull and low backache interferes with fetal nutrition supply and
 Vaginal spotting circulation.
 Pelvic pressure ASSESSMENT/DATA COLLECTION
 Menstrual like cramping  Sudden gush of clear fluid from the vagina with
 Increased vaginal discharge continued minimal leakage is reported.
 Uterine cramping  If fluid pools in the vagina, this is an indication of
 Intestinal cramping ROM. The Nitrazine test or Fern test positive to
 Rupture of membranes confirm.
NURSING INTERVENTIONS FOR PRE-TERM  Amount/color/consistency/odor of fluid needs to be
LABOR assessed.
 Focus on stopping labor if membranes are still  **Preterm rupture is associated with infection, so
intact, fetal distress, no bleeding and cervix is not cultures are obtained vaginally for gonorrhea,
dilated more than 4-5 cm. group b strep and chlamydia.
 Maintain bed rest on left side  **FHR - tachycardia may indicate infection
 Monitor fetal activity and FHR, and contractions NURSING INTERVENTION FOR PREMATURE
ROM
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 Assist with tests to assess gestational age.  Further BP evaluation: a systolic increase of 30
 If labor does not begin within 24 hours and the mmHG or diastolic increase of 15 mmHG above
fetus is mature enough to survive, oxytocin will pre-pregnancy level = gestational hypertension.
be administered IV to start labor. NURSING INTERVENTIONS FOR
 If the fetus is not viable, a woman is placed on GESTATIONAL HTN
bedrest and administered corticosteroid Monitor BP
(betamethasone).  Fetal activity and growth
 Prophylactic ATB will be given to delay labor and  Perinatal mortality is not increased with simple
reduce risk of infection. gestational hypertension, so observe carefully, and
 If contractions begin and no infection is present, no drug therapy is necessary.
mom will be given a tocolytic agent to stop labor. MILD PREECLAMPSIA
 Avoid vaginal exam because of risk of infection.  Occurs after 20 weeks of gestation and is
 Age of viability is 24 but if ruptured membranes determined by gestational HTN plus proteinuria
hold off as long as possible.  BP increases to 140/90 (or parameters given
 Bed rest. previously), taken on 2 occasions at least 6 hrs
GESTATIONAL HYPERTENSION apart
Vasospasm occurs in both small and large  Proteinuria: random urine sample shows +1 to 2+
arteries during pregnancy, causing increased BP, protein on a reagent strip (dip stick)
proteinuria and edema.  Wt gain of over 2 lbs/wk in second trimester and
WHO IS AT RISK FOR GESTATIONAL over 1 lb/wk in the third trimester.
HYPERTENSION?  Mild edema begins to accumulate in the upper
 Women of color extremities or face
 Multiple pregnancies MILD PRE-ECLAMPSIA - NURSING
 Primiparas under 20 years old or older than 40 INTERVENTIONS
 Low socioeconomic backgrounds  Monitor antiplatelet therapy - increased risk for
 Those who has had 5 pregnancies or more platelet aggregation - OTC baby aspirin may be
 Those with underlying disease such as heart recommended by PCP
disease, DM or primary HTN  Promote bed rest - this helps secrete sodium. Left
COMPLICATIONS side best position.
 Abruptio placentae PRE-ECLAMPSIA NURSING INTERVENTIONS
 DIC  Provide emotional support - women have several
 Thrombocytopenia responsibilities in the home, work and with their
 Placental insufficiency other children. If mom is on bed rest, who will be
 Intrauterine growth restriction there to help her?
 Intrauterine fetal death  Monitor BP, weight, and urine for protein as is
CLASSIFICATIONS routine for every visit.
 Gestational HTN
 Mild pre-eclampsia
 Severe pre-eclampsia
 Eclampsia SEVERE PRE-ECLAMPSIA
 HELLP  A woman goes from mild to severe pre-eclampsia
 Gestational Hypertension when BP rises to 160/110 or above on 2 occasions
 BP elevation is detected for the first time after a 6 hours apart after a woman has been on bed rest.
woman has REACHED 20 WEEKS of pregnancy =  Proteinuria is present +3 to 4+ on a random urine
mid pregnancy sample or more than 5 g in a 24 hour urine
ASSESSMENT FOR GESTATIONAL HTN sample.
 BP 140/90 with no proteinuria or edema  Oliguria - less than 500 mL urine in 24 hours or
altered renal function tests - elevated serum
creatinine more than 1.2 mg/dL
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 Cerebral edema - severe headache, blurred vision,  Blood levels should be maintained at 5-8 mg/dL.
seeing spots, confusion. May have pulmonary Higher than 8 is toxicity.
edema (will feel short of breath) MONITOR SIGNS OF MAG TOXICITY:
S/S severe epigastric or RUQ pain, N/V due to ischemia  Flushing
of liver/pancreas  Sweating
**KEY ASSESSMENT  Hypotension
 Severe Pre-eclampsia Additional Assessment  Depressed tendon reflexes
 Assess the extent of edema - 1+, 2+, 3+, 4+  Decreased resp
 Cerebral edema causes marked hyper reflexia and  Decreased urine output
possible ankle clonus.  Reduce consciousness
 Check patellar reflex - place mom in supine and Antidote for toxicity: Calcium gluconate
have her bend her knee. Use reflex hammer to ECLAMPSIA
strike patellar tendon. Reflex is scored as 0  Cerebral edema that is so severe that either a
(none), 1+ (diminished), 2+ (normal), 3+ 9brisker seizure or coma has occurred.
than average, 4+ (hyperreactive) - stronger than  It can happen in late pregnancy or up to 2 weeks
normal after birth.
** KNOW RANGES ***  With eclampsia one can have tonic clinic seizures
 Check ankle clonus by dorsiflexing the feet x3.  Body becomes rigid in a state of tonic muscular
Once you take your hand away, observe foot. contractions that last 15-20 seconds.
 No motion - no clonus  Facial muscles and then all body muscles
 Mild = 2 movements alternately contract and relax in rapid succession
 Moderate = 3-5 (clonic phase may last about 1 minute)
 Severe = over 6 movements  Respirations ceases during seizure b/c diaphragm
NURSING INTERVENTIONS FOR SEVERE PRE- tends to remain fixed; resumes shortly after it is
ECLAMPSIA over
 If a woman has reached 39 weeks, labor is  Postictal sleep occurs
induced/C-section performed. NURSING INTERVENTIONS FOR ECLAMPSIA
 If less than 39 weeks:  Remain with client and call for help
 Maintain bed rest, room is darkened, stress should  Ensure open airway, turn the client onto left side,
be decreased. adminster oxygen using a faskmask (8-10 L)
 Take BP frequently, q 4 h.  Assist in administering medications for seizures -
 Obtain blood studies: CBC, platelets, liver mag sulfate or diazepam (Valium) IV
function, obtain daily weights and strict I & O  Interventions for eclampsia con't
 24 hour urine - check for protein and creatinine  Assess uterine contractions, check for vaginal
clearance. bleeding - postictal sleep: woman cannot tell you if
 Monitor fetal well being - Doppler q 4 h, she is in labor.
nonstress test or biophysical profile. "Cure" for eclampsia - baby needs delivered after
 Support nutritious intake - high protein and patient has become stable. Labor is induced if fetus has
moderate sodium. reached viability.
 Provide emotional support because of possibly Monitor BP for 2 weeks postpartum.
changing birthing plans. HELLP Syndrome
ADMINISTER MEDICATIONS TO PREVENT A variation of gestational hypertension that is
ECLAMPSIA (SEIZURE) named for common symptoms that occur. It is serious -
 Hydralazine (Apresoline), labetalol (Normodyne), maternal mortality rate 24%, fate rate 35%.
or nifidipine may be given to reduce hypertension.  Hemolysis that leads to anemia.
 May cause tachycardia, so assess pulse as wellas  Increased liver enzyme levels that lead to epigastric
BP before administration. pain.
 Mag Sulfate may be ordered to prevent seizures.  Low platelet count that lead to abnormal
bleeding/clotting
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 Petechiae - red dots Tx:
TREATMENT FOR HELLP  Careful inspection of infant at birth to rule out
 Transfusion of fresh frozen plasma or platelets; if kidney disease and compromised lung
hypoglycemic (glucose). development.
 Infant needs to be born as soon as feasible. -breast tenderness
 Have to monitor platelets. ISOIMMUNIZATION (RH INCOMPATIBILITY)
MULTIPLE GESTATION Patho: Rh- mother carries a Rh+ fetus. Maternal
Occurs with fertilization of two ova AB are formed 72 hours after first birth, can cross
(fraternal/dizygotic) or splitting of one of the fertilized placenta in the second pregnancy, and destroy fetal
ovum (identical/monozygotic). RBCs causing hemolytic disease of the newborn.
COMPLICATIONS DX:
 Spontaneous abortion  Anti-D titer at 1st visit and week 28.
 Anemia  Titier is 1:16 or greater.
 Congenital anomalies  Doppler velocity is high in fetal middle cerebral
 Hyperemesis gravidarum artery
 Intrauterine growth restriction
 Gestational HTN
 Polyhydramnios TX:
 Postpartum hemorrhage  At 28 weeks: RhoGaM given, and 72 after birth in
 Premature rupture of membranes event of positive Coombs test
 Preterm labor/delivery  In utero blood transfusion
MULTIPLE GESTATION: ASSESSMENT AND  Phototherapy for fetus to reduce bilirubin released
DATA COLLECTION from injured RBC's
 Excessive fetal activity - uterus large gestational WHAT IS THE FUNCTION OF RHOGAM?
age  Given at 28 weeks and 72 hours after birth.
 Palpation of 3-4 fetal arts in the uterus  Within 2 weeks - 2 months, will destroy passive
 Auscultate more than one FHR antibodies.
 Excessive weight gain WHAT IS THE MEANING OF A NEGATIVE
 Ultrasound reveals multiple sacs early in COOMBS TEST?
pregnancy.  Cord blood sample from fetus is Rh+. thus the
HYDRAMNIOS RhoGAM injection is given to the mother.
Patho: Amniotic fluid is 2000ml or more. Occurs HOW IS FETAL MATURITY DETERMINED?
because fetus has issues swallowing (transesophageal  Mature lecithin/sphingomyelin ratio has been
fistula) or absorbing fluid, or has excess UO (ie fetus of reached.
diabetic) FETAL DEATH
SYMP: CAUSES: chromosomal abnormalities, congenital, Hep
 Rapid enlargement of uterus B, immunologic, complications of maternal disease
 Extreme SOB Symp:
 Weight gain, hemorrhoids.  Painless spotting
TX:  Lack of fetal movement
 Bed rest to prevent preterm labor, increase  Confirmation by Ultrasound
circulation Tx:
 High fiber diet and stool softener  Misoprostol (Cytotec) to being uterine contractions
 Amniocentesis removes extra fluid if labor does not begin spontaneously.
 Needled membrane rupture Nsg:
OLIGOHYDRAMNIOS  Observe for excess bleeding (sign of DIC)
Patho: Less than normal (less than 500ml-  Swaddle as if it were a newborn.
1000ml) amniotic fluid. Caused by growth restriction or  Wait 6 months before starting another pregnancy.
fetus not voiding as usual (bladder or renal disorder)
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