LECTURE 3 : DISORDERS

• Placental Abruption


  is a complication of pregnancy that happens when the placenta separates from the uterus before delivery. It is most likely to occur in the last trimester of pregnancy, especially in the last few weeks before birth.
• Placental Abruption


  the placenta may completely detach or partially detach. This can decrease the amount of oxygen and nutrients to the fetus and cause heavy bleeding in the mother.
• Types of Placental Abruption

  1. Revealed abruption

  2. Concealed abruption
• Revealed abruption

  visible vaginal bleeding
• Revealed abruption

  internal hemorrhage
• Concealed abruption


  don't have visible vaginal bleeding
• Concealed abruption

  infection (abdominal pain)
• Pathophysiology of Placental Abruption

  Separation of the placenta is initiated by bleeding into the decidua basalis. The bleeding splits the decidua and spreads beneath the placenta, shearing it off. A thin layer of the decidua basalis often remains attached to the placenta after separation. However, as hematoma forms due to vessel rupture, it causes additional separation of the placenta from the uterine wall with destruction and compression of adjacent placental tissue. The bleeding can also track into the myometrium causing a couvelaire uterus, which is when the bleeding goes into the peritoneal cavity.
• Signs and Symptoms of Placental Abruption


  • Vaginal bleeding, although there might not be any

  • Abdominal pain

  • Back pain

  • Uterine tenderness or rigidity

  • Uterine contractions, often coming one right after another

  • Fetal distress
• Treatment for Placental Abruption

  Treatments highly depends on the on the physiologic status of both the mother and baby:

  1. Intravenous fluids and blood products

  2. Monitor pregnancy closely

  3. Hemodynamic support until safe delivery

  4. Emergency caesarean delivery
• Nursing Intervention for Placental Abruption

  • Continuously evaluate maternal and fetal physiologic

  • Position the client in a lateral or left side-lying position

  • Monitor for persistent or heavy fluid or blood loss.

  • Provide comfort measures and a quiet environment to allow the patient to rest properly.
• Placental Abruption


  In — — it is not advisable to give tocolytic drugs because the focus is in the cervical os and not in the placenta
• Placenta Previa


  obstruction in the cervical os/uterus
• Placenta Previa


  scanning of uterine wall lining
• Signs and Symptoms of Placenta Previa

  • tonic abdominal pain

  • lower back pain

  • uterine bleeding
• 3 Categories of Placenta Previa

  C1 - 40%

  C2 - 50%

  C3 - 80-100%
• Treatment for Placenta Previa

  cesarean section delivery
• Nursing Intervention for Placenta Previa

  • decrease level of pain by administering medications

  • decrease movement

  • deep breathing exercise

  • divertional activity (listening to music, TV)

  • placing in a left lateral position
• Premature or Preterm Labor


  is labor that occurs after 20 weeks and before the end of the 37th week of pregnancy.
• Premature or Preterm Labor


  A woman is said to be in — — when she experiencing uterine contractions every 10 minutes for 1 hour and cervical dilatation begins.
• clean catch urine

  getting the midstream urine
• Pathophysiology of Premature or Preterm Labor

  It is associated, however, with multiple distention, dehydration, stress, and infection/ inflammation. Women who continue to work at strenuous jobs during pregnancy or perform shift work that leads to extreme fatigue and stress may trigger the labor. Chronic stress causes long-term changes in the body's vascular system, hormone levels, and the ability to fight infection. With the increased stress, the cortisol hormone appears to cross the placenta and affect the fetus, disrupting ongoing processes. These changes could all potentially influence labor to start before the baby is full-term. These chemicals pass through the placenta into the fetus and have detrimental effects on proper fetal growth. The overproduction of prostaglandins caused by the inflammation associated with an infection could lead to uterine contractions.
• Signs and Symptoms of Premature or Preterm Labor

  • Persistent, dull, and low backache;

  • Vaginal spotting;

  • A feeling of pelvic pressure or abdominal tightening;

  • Menstrual-like cramping;

  • Increased vaginal discharge;

  • Uterine contractions;

  • Intestinal cramping.
• Medical Intervention for Premature or Preterm Labor

  • Admit first to the hospital and placed on bed rest to relieve the pressure of the fetus on the cervix. External fetal and uterine contraction monitors are attached to monitor FHR and the intensity of contractions.

  • Intravenous fluid therapy to keep her well-hydrated is begun.

  • Vaginal and cervical cultures and a clean-catch urine sample are prescribed to rule out infection.

  • Terbutaline, a drug approved to prevent and treat bronchospasm (narrowing of airways) but may be used, off-label, as a tocolytic agent (an agent to halt labor).

  • Magnesium sulfate, given intravenously, is used primarily to treat preeclampsia and prevent eclamptic seizures.
• Nursing Intervention for Premature or Preterm Labor

  • Assess the patient's vital signs.

  • Monitor the patient for any signs of bleeding.

  • Place the patient in a side-lying lateral position.

  • Administer tocolytics with caution.

  • The nurse should educate the pregnant woman to avoid stress and always keep hydrated.
• Post Term Pregnancy


  - is a pregnancy that lasts longer or exceeds the term pregnancy.

  -the term pregnancy lasts 38-42 weeks

  - complications of this disorder includes fetus being too large, meconium aspiration syndrome, hypoglycemia & umbilical cord compression for the baby.
• Anatomy and Physiology of Post Term Pregnancy

  • fetus grows too large in size

  • Placenta deteriorates with age, while acquiring calcified deposists

  • Uterus become too expanded, altering capability for normal uterine contraction

  • Amniotic Fluid is reduced
• Pathophysiology of Post Term Pregnancy

  • The reasons why there is post term pregnancy may be of miscalculation of estimated date of delivery (EDD). For those who experience this with accurate EDD's, the reason is unknown, but may be of high doses of salicylates taken, which reduce synthesis of prostaglandins needed for labor initiation.

  • Fetus continues to grow in size inside the womb beyond term, while placenta starts to lose function as it ages beyond the term pregnancy. This leads to deprivation of oxygen & nutrients for the fetus. Lack of nutrients may cause the fetus to lose weight. Meconium may be aspirated by the fetus, which may cause respiratory distress to the fetus.

  • Placenta plays a major role in the production of amniotic fluid, and because it starts to deteriorate, amniotic fluid may be reduced critically (oligohydramnios), which may lead to cord compression. Cord compression blocks the blood flow between mother & fetus, that puts the fetus at risk of perinatal asphyxia.
• Signs and Symptoms of Post Term Pregnancy

  • Reduced amniotic fluid

  • Calcified placenta

  • Amniotic fluid is stained with meconium

  
  

  Determining a post term pregnancy can be done by observing the characteristics of a post term infant.

  Characteristics of a post term is infant:

  • Dry, loose, peeling skin

  • Overgrown nails

  • Abundant scalp hair

  • Visible creases on palms and soles of feet

  • Minimal fat deposits

  • Green, brown, or yellow coloring of skin from meconium staining the first stool passed during pregnancy into the amniotic fluid)

  • More alert and "wide-eyed"
• Medical Intervention for Post Term Pregnancy


  - first thing needed to do is to determine accurately the gestational age of the fetus. nonstress test/biophysical profile is done to document placental perfusion and amount amniotic fluid. If it is normal, the EDD is miscalculated, and if its abnormal whre the term baby is already in term size, labor induction will be conducted.
• Labor Induction for Normal spontaneous delivery.

  Prostaglandin gel or misoprostol (Cytotec) applied to the vagina to initiate cervical ripening followed by an oxytocin infusion are common methods used to begin labor
• Cesarean Section.


  this is done if cervix is unfavorable for normal labor.
• Nursing Intervention for Post Term Pregnancy

  The nurse's role may include:

  • Teaching about procedures such as antepartum testing or induction of labor

  • Support for the woman's psychological and physical fatigue

  • Nursing care related to specific procedures such as induction of labor