MATERNAL AND CHILD HEALTH NURSING

• PREMATURE RUPTURE OF MEMBRANES (PROM)


  Rupture of the chorion and amnion on hour or more before the onset of labor
• Infection 


  Leading causes of death associated with PROM
• SIGNS AND SYMPTOMS OF PROM

  •Gushing of amniotic fluid from vagina in the absence of contraction

  •Maternal fever, fetal tachycardia, malodorous discharge may indicate infection
• What is the Dx in PROM?

  • FERNING is evident

  • Nitrazine test tape turns blue-green color
• What is your nursing mngt for PROM?

  • maintain the pt bed rest if the fetal head is not engage to prevent CORD PROLAPSE
• It is the case where the uterus turns completely or partially inside out

  Uterine Inversion
• When does the uterine inversion occur?

  It occurs immediately following the delivery of the placenta
• What is the cause of forced inversion??

  Caused by excessive pulling of the cord
• What is the cause of Spontaneous Inversion

  It is due to increased abdominal pressure from bearing down, coughing, or sudden abdominal muscle contraction.
• It is where the top of the uterus has collapsed but the uterus hasn't come through the cervix?

  Incomplete Inversion
• The uterus is inside out and coming out through the cervix?

  Complete Inversion
• The fundus of the uterus is coming out of the vagina?

  Prolapsed Inversion
• What are the s/s of UTERINE INVERSION?

  • Excruciating pelvic pain with a sensation of extreme fullness extending into vagina

  •Vaginal Bleeding & signs of hypovolemia

  •Extrusion of the inner uterine lining into the vagina
• What are your nursing responsibility in UTERINE INVERSION?

  • Immediate manual replacement of the uterus at the time of inversion will prevent CERVICAL INTRAPMENT of the uterus. This prevent rapid band extreme blood loss that may cause hypovolemic shock
• Labor that begins after 20 weeks of gestation and before 37 weeks of gestation?


  PRETERM LABOR
• What are the causes of PRETERM LABOR?

  • PROM

  • Pre-eclampsia

  • Hydramnios

  • Placenta Previa

  • Incompetent cervix

  • Fetal Death
• What are the clinical manifestations of PRETERM LABOR?

  • Bloody show

  • Lower back pain

  • Suprapubic pressure

  • Vaginal pressure

  • Expulsion of cervical mucus plug
• What are the actions will you perform to stop PRETERM LABOR?

  • Bed rest in side lying position

  • UTZ

  • Administer TOCOLYTIC DRUG as ordered
• What are the TOCOLYTIC DRUG that you will administer during PRETERM LABOR?

  • Ritodrine Sulfate (Yutopar)

  • Terbutaline Sulfate (Brithine)
• It is difficult, painful, and prolonged labor due to mechanical factors?

  Dysfunctional labor
• What are the causes of dysfunctional labor?

  • Fetal factor

  • Uterine factor

  • Pelvic factor

  • Psyche factor
• Include unusual large fetus, malpresentation, fetal anomaly, and malposition,

  Fetal Factor (Passenger)
• Include hypotonic labor, hypertonic labor, precipitous labor, and prolonged labor

  Uterine Factor (Power)
• Include inlet contracture, midpelvis contracture , and outlet contracture

  Pelvic Factor (Passage)
• Include maternal anxiety and fear and lack of preparation?

  Psyche Factor
• Midpelvis Contracture - The baby's head cannot pass through the pelvis easily because there is an obstruction at the level of the sacrum.
• What are your nursing mngt for Dysfunctional labor?

  • monitor uterine contractions

  • assess FHR, activity, and color of amniotic fluid

  •provide physical and emotional support
• The anterior should of the baby is unable to pass under maternal pubic arch?

  • shoulder dystocia
• This happen when external rotation doesn't occur

  Shoulder dystocia
• It's a case where the fetal head retracts against the mother's perineum

  Turtle sign
• What are the causes of shoulder dystocia?

  • DM

  • Obesity

  • Macrosomia

  • Multiparity
• Nursing mngt for SHOULDER DYSTOCIA?

  • place the pt into MC Robert's position

  •apply suprapubic pressure
• It is a position where the thighs pulled up against the abdomen with hips abducted?

  MC Robert's position
• Tearing of the uterus, either complete or incomplete?

  Uterine Rupture
• It is where the tear goes through all 3 layers of the uterine wall

  Complete uterine rupture
• The tear doesn't go through all 3 layers of the uterine wall

  Incomplete uterine rupture
• Causes of uterine rupture

  • injury from obstetric instrument

  • excessive fundal pressure

  • violent bearing down

  • after previous uterine surgery
• Most likely to occur after previous uterine surgery, and multiparity given with oxytocic agent?

  Spontaneous uterine rupture
• Placental chorionic villi adhere to the superficial layer of the uterine myometrium?

  Placenta Accreta
• Placental chorionic villi invade deeply into the uterine myometrium?

  Placenta Increta