STA. CLARA DE MONTEFALCO COLLEGE INC.

NCM 102
Malhacan, Meycauayan, Bulacan Gynecologic Nursing
Tel. No. ( 044) 695-29-78 Midterm Period

PREGNANCY INDUCED HYPERTENSION - prepare for possible delivery

-new arterial hypertension after 20wks AOG - Monitor fetal status
Etiology- unknown - Blood type & xmatch
- Exposure to chorionic villi, immunologic, genetic & - Postpartum – VS, seizure precautions
endocrine factors.
Risk Factors HYPEREMESIS GRAVIDARUM
- nulligravida, adolescence, 35 & up, multigravids with - Severe nausea and/or vomiting
multiple gestation, HPN, DM, renal disease - Maybe due to ↑HCG, ↑Es & Pr, ↓gastric motility, immune
response to chorionic villi & to “foreign” fetus
Assessment
1. Transient HPN w/o proteinuria or edema Complications – dehydration, ketosis
2. Preeclampsia, mild – - Nutritional
- 140/90 mmHg or increase of 30/15 mmHg - Acid-base imbalance
- 2+ to 3+ proteinuria - Altered sense of taste
- begins past 20th wks - Fetal distress, disease, DM, psychologic disorders
- slight anazarca, weight gain
2. Preeclampsia, severe – Dx: - rule out bulimia
- 150-160/110 mmHg - HCG measurement
- +4 proteinuria - rule out other cause [AP, gastritis, hepatitis, infection]
- headache, epigastric pain, extreme irritability
- hyperreflexia Tx: - antiemetics, hydration, bland diet, eating before arising,
- HELLP syndrome Trace = 5-20 mg/dL ginger ale for nausea.
3. Eclampsia – +1 = 30 mg/dL
- hypertension +2 = 100 mg/dL ECTOPIC PREGNANCIES
- proteinuria +3 = 300 mg/dL - any extrauterine gestation
+4 = > 2000 mg/dL
- convulsion - major cause of maternal mortality
- coma
4. Post delivery – Etiology
- DIC – monitor BP for 48h, anticoagulant therapy - Structural factors
6. No prior incidence - Functional factors
S/Sx: - abdominal pain
Diagnoses – - Scanty, dark, vaginal spotting
- Altered tissue perfusion - Abdominal tenderness
- Knowledge & compliance deficits
- Risk of injury Dx: - culdoscopy , ultrasound
- Anxiety & powerlessness
Mgt: preservation of maternal life,
Mgt: removal of pregnancy &
1. Preeclampsia, mild [home] reconstruction of tube if possible.
- bedrest, left lateral pos
- diet
- Weigh daily, keep daily log Ndx: - fluid volume deficit
- diversions - Pain
- support systems - Anxiety r/t uncertainty

2. Preeclampsia, severe [in hospital]

- bedrest
- VS, FHT
- I/O
- seizure precaution
- meds Nursing Mgt:
- Fluid replacement, VS
3. eclampsia [obstetric emergency] - Blood typing & xmatch
- maintain patent IV line, monitor I/O - Relieve pain and anxiety
- minimize stimuli - Bed rest, health education / expectation setting
- have airway & O2 available
NCM 102 GYNECOLOGIC NURSING BY HARLY S. SABATER, RN 2009
 STA. CLARA DE MONTEFALCO COLLEGE INC. NCM 102
Malhacan, Meycauayan, Bulacan Gynecologic Nursing
Tel. No. ( 044) 695-29-78 Midterm Period

GESTATIONAL THROPHOBLASTIC DISEASE N/Mgt: monitor pt for premature labor

- Hydatidiform mole / molar pregnancy - avoid physical activity for 3-5days
- fetus may or may not be present - ff/up checks of cerclage

Etiology: Complications:
- unknown, maybe genetics - cervical dystocia
S/Sx: - fundus large for gestational age - infection
- bleeding, PIH - PROM
- passage of vesicles in vagina - premature labor

Dx:- ultrasound
- PIH before 20wks
- HCG status
- vesicles [HCG]

Mgt: - evacuation of the mole

- ff/up for malignant changes
N/Mgt: - VS esp BP
- blood typing & xmatch
- prepare at least 2-4 units
- decrease anxiety
- avoid pregnancy for 1 yr

SPONTANEOUS ABORTION
-etiology unknown
- 50% genetics
Risks:
- incompetent cervix
- teratogens
- postmature sperm/ova
S/Sx:
INCOMPETENT CERVIX - dark spotting leading to frank bleeding
- too weak to stay close during a pregnancy.
- major cause of 2nd trimester pregnancy loss Classification:
- premature opening w/o labor or contraction a. threatened – vaginal bleeding or spotting, mild cramps,
Dx: - manual examination tenderness over uterus, cervix slightly dilated [vaginal
- sonography [> 2.5cm open or shortened to 20mm] examination, bed rest, pad count]
- funnelling b. inevitable – profuse bleeding, membranes ruptured, cervix
Risks: - DES dilated, painful uterine contraction [ embryo delivered, D&C]
- Cervical trauma c. habitual – spontaneous abortion of 3 or more times [D&C, tx of
- Congenital causes, rule out abnormalities, cerclage]
- Uterine anomalies d. incomplete – fetus expelled, placenta & membranes retained
[D&C]
Not eligible if: - hyperirritability of cervix e. missed – fetus dies in utero but retained, maceration, no
- Baby has already died symptoms of abortion but pregnancy regression symptoms
- > 4cm dilated present eg uterine size & breast changes [ real-time
- Water is broken ultrasound to determine if fetus is dead, oxytocin induction
for labor]
Mcdonald Cerclage – purse stitching, upper part of cervix
Shirodkar Cerclage – more technical, permanent General N/Mgt:
- maintain fluid balance
- do not give false reassurance
NCM 102 GYNECOLOGIC NURSING BY HARLY S. SABATER, RN 2009
 STA. CLARA DE MONTEFALCO COLLEGE INC. NCM 102
Malhacan, Meycauayan, Bulacan Gynecologic Nursing
Tel. No. ( 044) 695-29-78 Midterm Period

- if abortus is intact, allow parents to view if desired

- instruct on perineal care
-monitor for infection
- blood typing & xmatch

ABRUPTIO PLACENTA
- premature separation of placenta
PLACENTA PREVIA
- low lying placenta Two Types- concealed hemorrhage & external hemorrhage
- may cover cervical os
Risks: - HPN, short umbilical cord, tumor, uterine anomaly,
S/Sx: - painless vaginal bleeding alcohol consumption
Dx: - ultrasound will show location of placenta
S/Sx:
Assessment: 1.Concealed: no signs of bleeding, VS changes occurs
- determine amount & type of bleeding 2. External: visible hemorrhage occurs
- monitor maternal & fetal VS 3. fetal HR drops
- inquire presence of pain 4. abdominal pain present
- palpate for contraction
- evaluate hematologic lab data Dx: ultrasound

N/Mgt: - monitor HTc, HGb Mgt: preserve maternal and fetal life if possible
- establish & maintain IV LINE N/Mgt: - determine amount and type of bleeding, presence
- side lying position of pain, measure fundal ht to detect concealed bleeding,
- blood typing & xmatch
- CBR w/o BP
- instruct on perineal care

NCM 102 GYNECOLOGIC NURSING BY HARLY S. SABATER, RN 2009