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    SP 16 Week 5 Class 7 Bleeding in Late Pregnancy

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    Glory Mimi
    This document discusses various abnormalities that can occur in late pregnancy, including bleeding, cervical insufficiency, abruptio placenta, placenta previa, excessive or oligohydramnios, fetal growth restriction, and more. It describes the definition, incidence, risk factors, diagnosis, and collaborative nursing and medical management of each condition. For example, it states that bleeding in pregnancy occurs in about 6% of cases and is a leading cause of maternal mortality worldwide, and that all bleeding requires investigation to determine the etiology and guide management.

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    SP 16 Week 5 Class 7 Bleeding in Late Pregnancy

    Uploaded by

    Glory Mimi
    41 views33 pages
    This document discusses various abnormalities that can occur in late pregnancy, including bleeding, cervical insufficiency, abruptio placenta, placenta previa, excessive or oligohydramnios, fetal growth restriction, and more. It describes the definition, incidence, risk factors, diagnosis, and collaborative nursing and medical management of each condition. For example, it states that bleeding in pregnancy occurs in about 6% of cases and is a leading cause of maternal mortality worldwide, and that all bleeding requires investigation to determine the etiology and guide management.

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    Sp 16 Week 5 Class 7 Bleeding in late pregnancy (1).ppt

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    This document discusses various abnormalities that can occur in late pregnancy, including bleeding, cervical insufficiency, abruptio placenta, placenta previa, excessive or oligohydramnios, fetal growth restriction, and more. It describes the definition, incidence, risk factors, diagnosis, and collaborative nursing and medical management of each condition. For example, it states that bleeding in pregnancy occurs in about 6% of cases and is a leading cause of maternal mortality worldwide, and that all bleeding requires investigation to determine the etiology and guide management.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    41 views33 pages

    SP 16 Week 5 Class 7 Bleeding in Late Pregnancy

    Uploaded by

    Glory Mimi
    This document discusses various abnormalities that can occur in late pregnancy, including bleeding, cervical insufficiency, abruptio placenta, placenta previa, excessive or oligohydramnios, fetal growth restriction, and more. It describes the definition, incidence, risk factors, diagnosis, and collaborative nursing and medical management of each condition. For example, it states that bleeding in pregnancy occurs in about 6% of cases and is a leading cause of maternal mortality worldwide, and that all bleeding requires investigation to determine the etiology and guide management.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 33

    Late Pregnancy Bleeding and

    abnormalities in amniotic fluid


    Teri Stone Godena, RN, CNM,
    tsg 2016
    1
    MSN
    N 344 Spring, 2016

    Bleeding in Pregnancy
    Leading cause of maternal mortality worldwide (Bleeding after 20 weeks occurs
    about 6% of pregnancies)
    All bleeding requires investigation
    Contributors to mortality

    tsg 2016

    Etiology of Pregnancy Bleeding by trimester

    tsg 2016

    Cervical Insufficiency
    Definition: Painless dilatation of the
    cervix in the absence of uterine
    contractions. May be watery discharge.

    tsg 2016

    Cervical Insufficiency
    Incidence:
    Risks:
    Diagnosis by ultrasound
    Medical treatment

    tsg 2016

    Abruptio Placenta
    Premature detachment of the
    placenta from the wall of the uterus.
    Associated factors

    tsg 2016

    Nature of Bleeding

    tsg 2016

    Classification of abruption
    Abruption is classified by severity of
    symptoms not necessarily the amount of
    bleeding observed.
    Two systems: mild, moderate, severe
    Class 0,1,2,3

    tsg 2016

    Maternal

    Morbidity

    Fetal

    tsg 2016

    Establishing a Diagnosis
    Nurses role: Clinical History:
    Physical examination
    Maternal
    Fetal

    tsg 2016

    10

    Medical management
    Conservative
    Active

    tsg 2016

    11

    Clinical Application
    Keisha presents to triage at 32 weeks
    gestation with abdominal pain and
    moderate vaginal bleeding
    What are your 1st 5 actions?
    What is a likely diagnosis?

    tsg 2016

    12

    Clinical Application
    You confirm Keishas 18 week U/S showed a
    fundal placenta.
    VS are: BP 90/56, HR 110, RR 22, T 97.6. Her
    abdomen is rigid. The FHR baseline is 100
    bpm, with contractions every 6 minutes but no
    uterine relaxation between. You have notified
    the provider
    What are your next steps?
    How will you explain the plan to Keisha and her
    partner?
    tsg 2016

    13

    Placenta Previa
    Definition: Implantation of the placenta
    partially or wholly in the lower uterine
    segment.

    tsg 2016

    14

    Types of Placenta Previa


    Determined based on distance from
    internal os.

    tsg 2016

    15

    Placenta Previa
    Establishing a diagnosis
    Management

    tsg 2016

    16

    Major Sequelae Pl. previa


    Maternal Morbidity

    R.R.

    Neonatal Morbidity

    Antepartum
    hemorrhage/anemia
    hemorrhage

    10

    Prematurity/LBW.
    17% births prior to
    Prematurity
    34 weeks; 28% 34-37 weeks

    Need for hysterectomy

    33

    NICU stay

    Transfusion

    10

    Jaundice

    Septicemia

    5.5

    Anemia/isoimmunization

    Thrombophlebitis

    Abnormal presentation

    Endometritis

    6.6

    Growth restriction

    Morbidly adherent placenta


    (MAP) Accreta etc. *

    Neurodevelopmental delay
    Mortality

    *With a history of 2 prev. C/S and a current


    placenta previa, the risk of MAP Is
    tsg 2016
    40%

    17

    Clinical application
    Yasmin H. is a 38 year old G5 P2113 who
    presents at 35 weeks gestation with a
    small amount of painless, bright red vaginal
    bleeding. She has recently immigrated and
    had no
    prenatal care.
    What questions do you need
    to ask?
    What are the possible dx?

    tsg 2016

    18

    What would be your nursing management


    if she
    A. Had a placenta previa
    B. Had an abruption
    C. Was in preterm labor

    tsg 2016

    19

    Velamentous insertion of the cord


    Definition: The placental end of the cord consists
    of divergent umbilical vessels surrounded only by
    fetal membranes, with no Wharton's jelly

    Up to date

    tsg 2016

    20

    Vasa Previa Definition


    Definition: Fetal blood vessels present in
    the amniotic membranes covering the
    internal cervical os.
    .
    Implications

    Up to date

    tsg 2016

    21

    Vasa Previa

    tsg 2016

    22

    Uterine rupture

    tsg 2016

    23

    Disseminated Intravascular Coagulation


    overactivation of clotting cascade
    Platelets and clotting factors are used up
    RBCs are destroyed

    tsg 2016

    24

    Collaborative management of DIC


    Medical management:
    CORRECT the Cause
    Usually cured by delivery as
    source of coagulation
    resolves
    Delivery of dead fetus
    Treat infection
    Treat PEC
    Remove abrupted
    placenta

    tsg 2016

    Nursing Care
    EMOTIONAL SUPPORT
    Assess signs of bleeding( IV
    site, eyes, nose, ears)
    Administer:
    blood/plasma/platelets, IV fluid
    Cardiac monitoring
    Ins and Outs/Foley
    Side-lying tilt
    O2
    Protect from injury

    25

    Labor
    Term labor will be covered in depth in the
    Section on labor and birth

    tsg 2016

    26

    Amniotic fluid volume


    Amniotic fluid index (AFI) is the sum of the
    measurement of the vertical pockets of
    amniotic fluid at least .5 cm wide in 4
    quadrants of the uterus.

    tsg 2016

    27

    Excessive amniotic fluid

    tsg 2016

    28

    Collaborative management
    Nurses Role

    Medical Management
    US for fetal anomalies
    Observation (mild)
    Amnioreduction
    (therapeutic amniocentesis)

    Pharmacological
    treatment

    History for risk factors


    Coordinate lab work: GTT,
    TORCH
    Monitor maternal physical
    status and fetal status
    Physical exam: VS,
    Leopolds, fundal ht.
    Emotional support

    tsg 2016

    29

    Oligohydramnios
    Definition

    tsg 2016

    30

    Fetal Growth Restriction

    Definition
    Incidence
    Associated factors
    Diagnosis
    Asymmetric vs Symmetric
    Risks to fetus

    tsg 2016

    31

    Collaborative management
    Medical

    Nurses Role

    Establish diagnosis
    US to monitor fetal growth
    and fluid level Q2-3 weeks
    Fetal testing: NSTs twice
    weekly, BPPs weekly
    Determining appropriate
    timing for birth

    History
    Coordinate diagnostic studies
    Monitor maternal physical
    status and fetal status
    Physical exam: VS,
    Counseling: fetal movement
    Encourage fluid intake
    Emotional support
    Counsel re: modifiable risks
    Continuous EFM in labor

    tsg 2016

    32

    Clinical application
    Angie is a 17 year old smoker who
    weighed 93 pounds before pregnancy
    (height 52) and has had a total weight
    gain of 12 pounds at 36 weeks. Her fundal
    height 2 weeks ago was 32 cm. It is
    unchanged today. Her BP has been normal
    until today. It is now 142/92
    What are her risk factors for growth
    restriction?
    tsg 2016

    33

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