
Nursing Care:




Counseling about the procedures and alternatives
Provide nonjudgmental care
Allow the client to express her feelings
Preparation for the procedures:


Surgery-D&C or hysterotomy (rarely used)
Medications:
 “Morning –after pill” –RU-482
 Oxytocin
 Prostaglandins-ProstinE2
 Misoprotol (Cytotec)
Post –procedure care
 Administer RhoGam if the client is Rh-negative
 Discharge Instructions

 INCOMPETENT
CERVIX is where there is painless
effacement and dilation of the cervical os that is
not associated with contractions
 It often occurs in the second trimester
 Risk Factor:





Congenital uterine anomalies
Diethylstilbestrol (DES) exposure
Cervical operations
Cervical Trauma
Cervical Inflammation
 Clinical





manifestations:
Lower abdominal pain
Urinary frequency in the second trimester
Effacement and Dilation of the cervix
Protrusion of membranes through the cervix
Rupture of the membranes in second trimester
 Treatment:






Bedrest- Position client so there is pressure off
cervix Initially the Trendelenburg position may be
used until after surgery
Serial cervical ultrasound assessment
No vaginal exams
Administer tocolytic agents
Surgical intervention- Cerclage is a band of
nonabsorbable suture placed around the cervix.
Monitor for uterine contractions, fetal well
being, and vital signs
 Discharge




planning:
Teach the client the clinical manifestations of
preterm labor , rupture of membranes, and
infection. And to report them to health care
provider immediately.
Teach the client to return(to hospital) if uterine
contraction begin , because the suture will need
to be removed to prevent damage to cervix and
allow birth
Keep follow up visits with the health care
provider
Do Fetal Movement Counts
 PLACENTA
PREVIA is the improper implantation of
the placenta in the lower uterine segment.
 It is classified according to the degree to which the
placenta covers the cervical os.:




Low-laying
Marginal
Partial
Complete or Total

Risk factors:
Endometrial scarring
 Impede Endometrial vasculation related to:






Hypertension
Diabetes mellitus
Uterine tumor
Drug abuse
Smoking
Increase placenta mass
 Closely spaced pregnancies
 Multiple gestation
 Multiparity

 Clinical



Manifestations:
Episodic painless vaginal bleeding after 20 weeks
gestation
Bright Red Bleeding without uterine contractions
Ultrasound:

Reveals the malpositioned placenta
 Complications




of placenta previa:
Preterm delivery
Hypovolemia
Altered tissue perfusion
Deterioration in fetal status

NURSING CARE:




Perform a complete assessment on any pregnant client that
presents with painless bright red vaginal bleeding except:
NO VAGINAL EXAMS
Insert large bore catheter(18 or greater) and maintain IV
infusion
Monitor:




Vital signs
Continuous Fetal monitoring
I&O-pad count/weight them
Notify:

Physician, charge nurse, ICN, and anesthesia personnel
 Nurse

Obtain laboratory specimens:






CBC, Type & Rh, Type & Crossmatch
Be prepared to deliver client:


Care:
Vaginally for the low-lying placenta-have Double set up in the
Delivery room
Cesarean section for partial and complete placenta previahave Hysterectomy tray in the delivery room
Provide emotional support
Strict Bedrest- Position client so pressure is not on the
placenta
If client is stable and has diet order make sure it is well
balance
Prenatal vitamins and iron will be continue
 ABRUPTIO
PLACENTA is a premature separation,
either partial or total of a normally implanted
placenta from the decidual lining of the uterus
after 20 weeks’ gestation.
 Classifications of Abruptio Placenta:

Types: See next slide




Marginal-A
Central/Concealed/Covert-B
Complete-C
Degrees of placental separation:

Grades-0-3
 RISK









FACTORS:
Preeclampsia
Eclampsia
Chronic Hypertension
Multiparty
Abdominal Trauma
Uterine Anomalies
Smoking
Cocaine Abuse
Premature Rupture Of Membranes-PROM
 Complications








of Abruptio Placenta:
Risk of depleting clotting factors
DIC
Hypovolemia
Multiorgan failure
Maternal Death
Uterine Placenta insuffiency
Fetal Hypoxia
Fetal Death
 Clinical






manifestations:
Sudden Dark Red Vaginal Bleeding
Unremitting pain
Firm-to boardlike uterine
Shock greater than blood loss
Ultrasound will show abruption
EFM:


Uterine irritability
Nonreassuring Fetal Heart pattern- Loss of variability
and late decelerations
 NURSING

CARE:
Assess and Monitor:
Amount of Vaginal Bleeding
 Vital Signs
 I&O
 Measure abdominal girth
 Uterine characteristics and activity
 EFM-Continuously
 For development of coagulation problems
Review lab values:
CBC, Coagulation studies, PT,PTT

 Nursing
Care:
 Insert large IV Catheter(18-gauge or bigger)
and maintain IV infusion
 Provide O@ at 8-12L/min
 Anticipate Transfusion Therapy:





RBC’s
FFP
PLT’s
Crypopreciate
Albumin
 Nursing

Anticipate Expedited Delivery:






Care:
Vaginally
Cesarean section
Have Hysterectomy Tray in room
Provide emotional support
Instruct client and family on disease process and
procedures and possible surgery
Contact-Physician, Charge nurse, Anesthesia
personnel, ICN unit
DISSEMINATED INTRAVASCULAR COAGULATION
(DIC) is a complex coagulopathy condition
which occurs secondary to another underlying
disease process
 Risk Factor:








Preeclampsia/Eclampsia
Sepsis
Abruptio Placenta
Prolonged IUFD
Excessive Blood
Uterine inversion or rupture
Amniotic Fluid embolism (AFE)
 Complications:





Hypovolemia
Alt. Tissue Perfusion
Multiorgan failure
Maternal death
Fetal death

Clinical Manifestations:
Shocklike state
 Overwhelming and diffuse hemorrhage:





Petechia, ecchymosis, hematomas
Oozing of blood from puncture sites, IV sites, and /or
surgery incisions. Bleeding gums.
Blood in urine
Laboratory valves:
 Decreased Hg and Hct
 Prolonged PTT and PT
 Decreased fibrinogen
 Decrease PLT’s
 D-Dimer
 NURSING




Care for this client is for the critically ill client.
Identify Risk factors predisposing to DIC. Early
detection is extremely important
Maintain IV site- Central line maybe placed.
Anticipated Transfusion therapy:




CARE:
Fresh Whole Blood
Fresh Frozen plasma
Cryoprecipate
Monitor VS, I&O, perfusion status*,bleeding,
cardiopulmonary status
 Nursing



Care:
Educate the client and family concerning disease
process, procedures.
Provide support to the client and family.
No Heparin is given to the client who has DIC and
who is pregnant or has been delivered
 HYPEREMESIS
GRAVIDARUM is a disorder with
intractable vomiting associated with pregnancy
with significant electrolyte imbalance and fluid
deficit and possible starvation.
 Etiology is unknown/PREGNANCY
 Risk Factors:






High levels of hCG
Gestational Trophoblastic Disease
Multigestation
Psychopathologic and emotional factors
Stress
Other pathophysiology