QUIZ TOMORROW (02/23/24)

• Abruptio Placenta:

  • Usually happens in the 2nd or 3rd trimester of pregnancy
  • Premature separation of the placenta that occurs late in pregnancy
  • Signs of internal bleeding include distended, rigid, and tender abdomen
  • Signs of placental separation: sudden gush of blood, lengthening of the cord, and globular shape of the uterus
• Types of Placental Separation:

  • Fetal anoxia: inadequate oxygenation of the mother, low maternal blood pressure, or abnormalities in the uterus, placenta, or umbilical cord
  • Risk factors include high parity, short umbilical cord, advanced maternal age, direct trauma, and chorioamnionitis (maternal infection)
• Medical Management of Abruptio Placenta:

  • Intravenous therapy
  • Oxygen inhalation administered via face mask to prevent fetal anoxia
  • Fibrinogen determination test to detect disseminated intravascular coagulation
• Surgical Management of Abruptio Placenta:

  • Cesarean delivery
  • Hysterectomy (removal of the uterus)
• Nursing Interventions for Abruptio Placenta:

  • Place the patient in a lateral position
  • Monitor fetal heart sounds
  • Monitor vital signs
• Preterm Labor:

  • Occurs before the end of the 37th week of gestation
  • Precursors include dehydration, urinary tract infection, periodontal disease, and lack of prenatal care
  • Symptoms include persistent backache, vaginal spotting, and uterine contractions
• Therapeutic Management of Preterm Labor:

  • Bed rest to relieve pressure on the cervix
  • Intravenous fluid therapy to stop contractions
  • Tocolytic agents like Terbutaline to halt labor
• Medications for Preterm Labor:

  • Betamethasone and Dexamethasone for lung maturation
  • Magnesium sulfate to prevent cerebral palsy
  • Tocolytics to prevent contractions
• Premature Rupture of Membrane (PPROM):

  • Rupture of fetal membrane with loss of amniotic fluid before 37 weeks
  • Risk factors include chorioamnionitis, vaginal infections, cervical abnormalities, and smoking
• Complications of PPROM:

  • Maternal and neonatal infections
  • Cord prolapse
  • Potter-like syndrome with distorted facial features and pulmonary hypoplasia
• Pregnancy-Induced Hypertension (PIH) or Gestational Hypertension:

  • Vasospasm occurs in both small and large arteries during pregnancy
  • Most common medical problem encountered during pregnancy (8% of pregnancies)
  • Form of high blood pressure in pregnancy leading to increased resistance in blood vessels, hindering blood flow in various organ systems
• In multiple pregnancies, more than one fetus can develop simultaneously in the uterus

  • Twin pregnancy is the simultaneous development of two fetuses
  • Rarely, three (triplets), four (quadruplets), or five (quintuplets) fetuses may develop
• Twin Pregnancy:

  • Commonest variety of multiple pregnancy
  • Two types: Dizygotic twins (fraternal) and Monozygotic twins (identical)
• Risk factors for multiple pregnancies:

  • Increasing maternal age (30-35 y/o)
  • Increasing parity (5 gravida onwards)
  • Nutritional factors
  • Pituitary gonadotropin
  • Infertility therapy
  • Assisted reproductive therapy
  • Genetic, hereditary factors (Race, black > white)
• Dizygotic Twins:

  • Result from fertilization of two ova by two sperms during a single ovarian cycle
  • Two placentas, each fetus surrounded by a separate amnion and chorion
  • Genetic features may differ between twins
• Monozygotic Twins:

  • Constant incidence of 1:250 births
  • Single ovum twins usually have one placenta, one chorion, two amnions, and two umbilical cords
  • Twinning may occur at different periods after fertilization
• Assessment of multiple pregnancies includes:

  • History of ovulation inducing drugs
  • Family history of twinning
  • Symptoms like increased nausea, vomiting, palpitations, shortness of breath
  • General examination for anemia, unusual weight gain, evidence of preeclampsia
  • Abdominal examination for barrel shape, unduly enlarged uterus, palpation of fetal parts
• Complications of multiple pregnancies:

  • Maternal complications during pregnancy, labor, and puerperium
  • Fetal complications including miscarriage, prematurity, growth problems, and more
• Amniotic Fluid Volume:

  • Hydramnios: Excess amniotic fluid volume, can cause fetal malpresentation and other risks
  • Oligohydramnios: Less than average amount of amniotic fluid, can lead to fetal complications
• Isoimmunization (Rh Incompatibility) can occur in multiple pregnancies
• Dystocia:

  • Difficult labor that can arise from issues related to power, passenger, passageway, and psyche