BLEEDING or

HEMORRHAGE
in
PREGNANCY
Bleeding in Pregnancy
ABORTION – any
interruption in pregnancy
before the age of viability
a. Spontaneous
Blighted ovum/ germ plasma defect= most
common cause
Following Trauma, infection (e.g.
rubella, influenza) or emotional
problems
 Types
1. Threatened
Symptom: bright red vaginal
bleeding which is moderate in
amount
Management
CBR for 24-48 hours
Coitus is restricted for 2 weeks after
bleeding has stopped
Advise the patient to save all pads,
clots and expelled tissues
2. Imminent/ Inevitable
Symptom:
Bright red vaginal bleeding
which is moderate in amount
and accompanied by uterine
contractions and cervical
dilatation.
Loss of the product of
conception is Inevitable.
Management- depends on
whether it is

Complete abortion- all products

of conception
are expelled;
bleeding is minimal
and self-limiting.
No intervention is
therefore needed.
Incomplete Abortion- part of
the conceptus ( usually
the fetus) expelled, but
membranes or
placental fragments
are retained.

D & C is indicated as
management
7 week old baby
8 week old fetus
3. Missed abortion
- fetus dies in utero but is not
expelled
-Usually discovered at a prenatal visit
when the fundic height is measured and
no increase is demonstrated or when
previously heard fetal heart tones are no
longer present.
-At 2 weeks time , signs of abortion
should occur ; otherwise, labor will have
to be induced to prevent
hypofibroginemia or sepsis.
b. Induced abortion
is never allowed in the Phils

Therapeutic
performed by a doctor in a controlled
hospital or clinic setting for a medical
or legal reason.
Also known as medical, planned or
legal abortion
Illegal
9 week old fetus
First trimester

First trimester
in womb photo
Second Trimester

Second trimester
in womb photo
Third Trimester

Third trimester
in womb photo
ECTOPIC
PREGNANCY
= any gestation located outside the
uterine cavity
Signs and symptoms
severe, sharp, knife-like stabbing pain in
either the right or left lower quadrant
Rigid abdomen
(+) Cullen’s sign- bluish umbilicus
Signs of shock: falling BP, PR
more than 100/min, rapid RR,
lightheadedness
Risk Factors
1.Pelvic inflammatory disease (PID),
gonorrhea, or chlamydia
(which may be symptomless) - Rate of ectopic
pregnancy in women withprevious known PID is
increased 6-10 times higher than in women with
no previous history of PID.
A published study of 745 women with one or
more
episodes of PID that attempted to conceive
showed that 16% were infertile from tubal
occlusion. Of those that conceived, 6.4% had
ectopic pregnancies.
2. You've had a previous ectopic pregnancy
3. You have an intrauterine device
(IUD) in place when you get
pregnant. (IUDs are about 99 percent
effective at preventing
pregnancy, but if you do get
pregnant while using one, the
pregnancy is likely to be ectopic.
Having used an IUD in the past
will not increase your risk for ectopic
pregnancy.)
4. Your tubes were damaged by a
previous infection or surgery.
Management
- ruptured ectopic pregnancy is an
emergency situation
Salpingostomy- if Fallopian Tube can still
be replaced and preserved; but the
pregnancy has to be terminated
Salpingectomy- removal of the Fallopian
tube + blood transfusion
Nursing Care- Combat Shock
Elevate foot of the bed
Maintain body heat by hot water bottles and
blankets
Different Procedures used:
•Salpingotomy (or -ostomy): Making an incision on
the tube and removing the pregnancy.
•Salpingectomy: Cutting the tube out.
•Segmental resection: Cutting out the affected
portion of the tube.
•Fimbrial expression: "Milking" the pregnancy out
the end of the tube.

In general, the procedure of choice will be

salpingectomy if future fertility is of no concern, if
the tube is ruptured, if there is significant anatomic
distortion, or if there is overt hemorrhage.
Abdominal Surgery- In this case, you'll
be given general anesthesia and a
surgeon will open your abdomen and
remove the embryo as well as the
ruptured tube, if necessary. You may
need a blood transfusion to replace
lost blood if you were bleeding heavily
before surgery. Afterward, you'll need
about six weeks to recuperate. You
may feel bloated, and have sore
breasts and abdominal pain or
discomfort as you heal.
Medical Management with
Methotrexate
If the hCG level is below a certain
limit and there is no risk of
imminent rupture, the doctor may
prescribe a drug called
methotrexate to treat the ectopic
pregnancy. Methotrexate is also
used in chemotherapy and works to
stop rapidly growing cells from
multiplying. The drug is
administered as an injection.
SECOND
TRIMESTER
BLEEDING
1. HYDATIDIFORM MOLE
- developmental anomaly of the placenta
resulting in proliferation and
degeneration of the chorionic villi
S/Sx- Because of rapid proliferation of
the placental tissues and therefore, high
levels of HCG
-Highly positive urine test for pregnancy
-Nausea and vomiting is usually marked
-Rapid increase in fundic height. Rapid
increase in weight
-No fetal heart tones; TOXEMIA
-Vaginal bleeding seen as clear, fluid-
filled, grape size vesicles
Management
>D & C to evacuate the mole
>Prophylactic course of
Methotrexate, the drug of choice
for choriocarcinoma
>Urine testing for one year to find
out if new villi are developing.
2. INCOMPETENT
CERVICAL OS
= one that dilates prematurely.
It is the chief causes of habitual
abortion ( 3 or more consecutive
abortions)
What is an incompetent cervix? An
incompetent cervix is also called cervical
insufficiency. The cervix is the bottom part
of your uterus (womb). Normally, the
cervix remains closed during pregnancy
until your baby is ready to be born. A
normal pregnancy lasts for about nine
months. An incompetent cervix may begin
to open at 4 to 6 months of pregnancy. At
this time, the cervix may begin to thin and
widen without any pain or contractions.
The amniotic sac, also called the bag of
water, bulges down into the opening of
the cervix until it breaks. This may cause
a miscarriage or premature (early)
delivery of your baby.
What causes an incompetent cervix? The exact
cause of an incompetent cervix is not known.
Some women have an incompetent cervix for
no obvious reason. The following may cause
an incompetent cervix:
1.An abnormal cervix or uterus.
2.Certain medicines, such as diethylstilbestrol
(DES). Your mother may have taken DES when
you were inside her womb.
3.Changes in hormones during pregnancy.
4.Damage to the cervix, such as during surgery
or after a difficult delivery of a baby.
5. Congenital anomalies
What are the signs and symptoms of
an incompetent cervix? There are
usually no signs and symptoms of an
incompetent cervix. The cervix just
slowly thins and opens without vaginal
bleeding or labor contractions. You may
have one or more of the following:
1.Backache.
2.Discomfort or pressure in the lower
abdomen (stomach).
3.Gush of warm liquid from your vagina.
4.Mucous-like vaginal discharge.
5.Pain when passing urine.
6. Sensation or feeling of a lump in the
vagina.
How is an incompetent cervix diagnosed? You may
need the following tests:
Pelvic exam: This is also called an internal or vaginal
exam. During a pelvic exam, Your caregiver
gently puts a warmed speculum into your vagina. A
speculum is a tool that opens your vagina. This lets
your caregiver see your cervix (bottom part of your
uterus). With gloved hands, your caregiver will check
the size and shape of your uterus and ovaries.
Ultrasound: Sound waves are used to show pictures
of the inside of your abdomen. A small handle with
lotion on it is gently moved about on your abdomen
(stomach). The handle may also be placed in your
vagina and can measure the thickness of your
cervical tissue.
How is an incompetent cervix treated? You
may need to rest in bed during the last 4 to 6 months
of your pregnancy. You may also need one or more of
the following:
Pessary: This is a plastic or rubber device that may
be placed in your vagina to elevate and support the
cervix.
Surgery: You may have surgery called cervical
cerclage to tie the cervix closed. This surgery may be
done before you get pregnant or during your
pregnancy.
Tocolytics: These medicines stop or prevent labor
contractions.
Management: CERVICAL
CERCLAGE
a. McDonald procedure
(sutures are temporary) – a cerclage
procedure wherein purse string
sutures are placed around the
cervix on the 14th- 18th weeks of
gestation. These are removed
during vaginal delivery.
b. Shirodkar- Barter procedure
(sutures are permanent) - patient
delivers through caesarean section.
THIRD
TRIMESTER
BLEEDING
1. PLACENTA PREVIA
- low implantation of the placenta
so that it is in the way of the
presenting part.
Predisposing Factors
-Increasing parity
-Advanced maternal age
-rapid succession of pregnancies
Types OR 4 DEGREES:
1. Low lying
2. Marginal / Partial
3. Complete
4. The placenta edge
approaches that of the cervical
os- marginal implantation
ULTRASOUND ( also known as
Ultrasonic Echo Sounding or Sonar
Preparation for ultrasound

1. Explain the procedure to the patient,

informing her that it is painless and there
are no known ill effects

2. Empty the bladder but ask the patient to

take 6 glasses of water afterwards in order
to dilate the bladder. A full bladder
displaces a gas filled bowel and, therefore,
permits better visualization of the pelvis
and its contents.
*Clinical uses of ultrasound
a.Diagnose pregnancy as early as 5-6 weeks
gestational age
b. Can establish that the fetus is increasing
in size and, therefore can predict EDC
c. Can determine gestational age by measuring
the biparietal diameter of the fetal skull ( if it is
more than 8.5 cm., it is more than 2,500 gms.)
d. Can demonstrate size and growth rate of the
amniotic sac
e. Can confirm presence, size and location of
the placenta
Can diagnose multiple pregnancy
Can visualize ascites, polycystic kidneys,
ovarian cysts, etc.
Can determine baby’s sex ( during third trimester
and if in cephalic presentation)
S/Sx –
first and most constant:
painless, bright red
vaginal bleeding due to
tearing of placental
attachment as a
consequence of dilatation of
the internal cervical os
ABRUPTIO
PLACENTA
premature separation of the placenta
a. Predisposing factors
1. Maternal Hypertension or toxemia
2. Increasing parity and maternal age
3. Sudden release of amniotic fluid
4. Short umbilical cord
5. Direct trauma
6. Hypofibrinoginemia
S/Sx
1. Severe, sharp, knife-like, stabbing
pain high in the fundus
2. Hard, board like uterus; rigid
abdomen
3. Signs of Shock
4. Concealed bleeding if extensive,
causes uterus to lose its ability to
contract. It becomes ecchymotic and
copper-colored, called Couvelaire
uterus
Management:

1. IV catheter
2. O2 by mask
3. FHR every 5 to 15 minutes
4. Baseline Fibrinogen
determination
5. Position woman in
LATERAL, not supine
DISORDER DURING
PREGNANCY
TOXEMIA/ PREGNANCY – INDUCED HYPERTENSION (PIH) –

a vascular disease of unknown cause

which occurs anytime after the 24th
week of gestation up to two weeks
postpartum
TRIAD of SYMPTOMS
Hypertension
Edema
Protienuria (specifically albuminuria)
 Predisposing factors
primis under 20 and over 30 years
Gravida- 5 or more pregnancies
Low socioeconomic status (SES)
Multiple Pregnancy
With underlying medical conditions, e.g.
heart dse. hypertension, or diabetes
 CLASSIFICATION of TOXEMIA
I. Acute Toxemia – symptoms appear
after the 24th week of gestation
A. Preeclampsia
1. Mild
2. Severe
B. Eclampsia
 Diagnosis: roll-over test – assesses the
probability of developing toxemia when performed
between the 28th and 32nd week of pregnancy
Procedure
Patient lies in ;lateral recumbent position for 15
minutes until BP has stabilized
Then rolls over to supine position
BP is taken at 1 minute and 5 minutes after
having rolled over
Interpretation: if diastolic increases 20 mmhg or
more, patient is prone to toxemia.
Details
1. PREECLAMPSIA
Underlying Cause:
Insufficient production of blood and platelets
Generalized vasoconstriction and associated
microangiopathy (disease of capillaries)
Abnormal retention of sodium and water by body
tissues
Medical Complications:
Cerebrovascular hemorrhage
Acute pulmonary edema
Acute Renal Failure
Types
MILD Preeclampsia – S/Sx
1. sudden, excessive weight gain of 1-5 lbs. per week
( earliest sign of preeclampsia) due to edema which
is persistent and found in the upper half of the
body (e.g. inability to wear the wedding ring)
2. Systolic BP of 140, or an increase of 30 mmhg or
more and a diastolic of 90, or a rise of 15mm hg or
more, taken twice 6 hours apart
3. Proteinuria of 0.5 gms/ liter or more
SEVERE Preeclampsia-
S/Sx
BP of 160/110 mmhg
Proteinuria of 5 gm/liter or more in 24 hours
Oliguria of 400 ml. or less in 24 hours (normal
urine output/ day = 1500ml).
Cerebral or visual disturbances
Pulmonary edema and cyanosis
Epigastric pain ( considered an “aura” to the
development of convulsions)
●2. ECLAMPSIA – the main
difference between pre eclampsia and
eclampsia is the
presence of
convulsions in eclampsia.

●signs and symptoms as in

preeclampsia plus:
●increased BUN
●increased uric acid
●decreased CO2 combining
power
 3.) Management:
CBR- sodium tends to be excreted at a more rapid rate if the
patient is at rest. Energy conservation is important in
decreasing metabolic rate to minimize demands for oxygen.
Lowered oxygen tension in toxemia is the result of
vasoconstriction and decreased blood flow that diminishes the
amount of nutrients and oxygen in cells. In any condition
wherein there is a possibility of convulsions, bed rest should
be in a darkened, non-stimulating environment with
minimal handling.
DIET
For Mild Preeclampsia- high Protein, high carbohydrate,
moderate salt restriction ( no added table salt, including
“bagoong”, “patis”, “tuyo” can goods, bottled drinks,
preserved foods and cold cuts)
Severe Preeclampsia-high protein, high calorie and salt-
poor (3gms of salt per day)
Medications
Diuretics- Chlorthiazide/ Diuril. Hourly urine output should be
at least 20-30 ml. (normally 50-60 ml per hour)

S/E: Fatigue and muscle weakness due to fluid and

electrolyte imbalance
Nursing Care: closely monitor intake and output
Digitalis- if with heart failure
-Pharmacologic action: Increase the force of contraction of
the heart, thereby decreasing heart rate.
- Important: should not be given if heart rate below 60/min
-Take the heart rate before giving the drug
 Potasium supplements- patients receiving
diuretics are prone to hypokalemia; if digitalis
is given at the same time, hypokalemia
increases the sensitivity of the heart to the
effects of digitalis. Potassium supplements
(e.g. banana) must be given to prevent cardiac
arrhythmias.
Barbiturates- sedation by means of CNS
depression
Analgesics: antihypertensives; antibiotics;
anticonvulsants; sedatives
 MAGNESIUM SULFATE- the drug of choice
Actions
CNS Depressant- lessens the possibility of convulsions
Vasodilator- decreases the BP
Cathartic causes a shift of fluid from the extracellular
spaces into the intestines from where the fluid can be
excreted
Dosage: 10 GMS. initially, either by slow IV push over 5-10
min, or deep IM, 5 gms/ buttock, then an IV drip of 1 gm.
per hour (1 gm/100 ml D10W) IF:
Deep tendon reflexes are present
Respiratory rate is at least 12 per min
Urine output is at least 100 ml in 6 hours
 Antidote for magnesium sulfate toxicity:
CALCIUM GLUCONATE, 10% IV, to maintain cardiac
and vascular tone
Earliest sign of magnesium sulfate toxicity:
disappearance of the Knee jerk/ Patellar reflex

Method of Delivery
preferably vaginal, but if not possible, CS will have to
be done
Prognosis
the danger of convulsions is present until 48 hours
postpartum
2.DIABETES MELLITUS- chronic hereditary disease
which is characterized by hyperglycemia due to relative
insufficiency or lack of Insulin from the pancreas which
in turn leads to abnormalities in the metabolism of
carbohydrates, proteins and fats
.A.Diabetogenic effects of pregnancy- many women
who have had no evidence of
diabetes in the past develop abnormalities in glucose
tolerance.
-Decreased renal threshold for sugar
-Increased production of adenocorticoids, anterior
pituitary hormones and thyroxin,
-Rate of Insulin secretion
 B. Attendant risks
Toxemia
Infection
Hemorrhage
Polyhydramnios
Spontaneous Abortion- because of
vascular complications which affect
placental circulation
Acidosis- because of nausea and
vomiting. It is the chief threat to the fetus
in utero
Dystocia- due to excessively large baby
C. DIAGNOSIS – MADE ON THE BASIS OF THE
Glucose tolerance Test (GTT)

Procedure
NPO after midnight
2 ml of 50% glucose/ 3 kg of prepregnant body
weight is given IV ( oral tablet is not advisable
because of known decreased gastric motility and
delayed absorption of sugar during pregnancy)
Interpretation of results
If less than 100 mg% - Normal
If 100-120 mg % - possible gestational diabetes
If more than 120 mg % - overt gestational diabetes
 D. CATEGORIES – TO PREDICT THE
OUTCOME OF PREGNANCY
Class A – GTT is only slightly abnormal;
minimal dietary restriction; insulin not
needed; fetal survival is high
Classes C to E – have 25% perinatal
mortality
Class F – therapeutic abortion ( in other
countries maybe justified, not in the
Phils.)
 E. MANAGEMENT
Diet – highly individualized. Adequate glucose intake (1800-
2200 calories) to prevent intrauterine growth retardation
Insulin requirements are likewise highly individualized,
requiring close observation throughout pregnancy. Since the
effects of the hormones more pronounced during the 2nd and 3rd
trimesters there is increased need for insulin
Insulin is regulated to keep urine +1 for sugar ( minimal
Glycosuria is necessary to prevent acidosis) but negative for
acetone.
Long- acting insulin (Ultralente) will have to be changed to
regular insulin (Lente) during the last few weeks of
pregnancy.
Often delivered by CS
Baby is typically larger or maybe in distress because of
placental insufficiency
Severe metabolic imbalances in distress because of depletion
of glycogen reserve in the liver and skeletal muscles by
strenuous muscular exertion during labor
Maximum difficulty in controlling diabetes is during the early
postpartum period because of the drastic changes in
hormonal levels
INFANT OF THE DIABETEC MOTHER (IDM)
1. Typically longer and weighs more because of:
a.excessive supply of glucose from the mother
b.increased production of growth hormones from the
maternal pituitary gland
c.increased secretion of insulin from the fetal
pancreas
d.Increased action of adrenocortical hormones that
favor passage of glucose from mother to fetus
2. Congenital anomalies are often seen
3. Cushingoid appearance ( puffy, but limp and lethargic)
4. More often born premature, so respiratory distress
syndrome is common
5. Lose a greater proportion of weight than normal
newborns because of loss of extra fluid
6. Are prone to the following complications
 A. HYPOGLYCEMIA- blood sugar
levels less than 30 mg%. It is the most
common complication to watch for
Cause: While inside the uterus, the
fetus tends to be hyperglycemic
because of maternal Hyperglycemia.
The fetal pancreas thus responded to
the high glucose level by producing
matching high levels of insulin. Following
delivery, the glucose level begins to fall
because the baby has been severed
from the mother. Since there has been
previous production of high level of
insulin, hypoglycemia develops.
Clinical signs of Hypoglycemia
shrill, high-pitched cry
Listlessness/ jitteriness/ tremors
lethargy; poor suck
Apnea; cyanosis
Hypotonia; Hypothermia
Convulsions
Consequence : hypoglycemia, if not treated, can lead to
brain damage and even death
Management: feed with glucose water earlier than usual,
or administer IV of glucose
B. Hypocalcemia- serum calcium level less than 7mg%
a.signs same as hypoglycemia
b.Sequela: same as hypoglycemia
c.Management: Calcium Gluconate to prevent
hypocalcemic tetany
3. HEART DISEASE
1. Classification
Class I – No limitation physical activity
Class II- slight limitation of physical
activity; ordinary activity causes
fatigue, etc.
Class III- moderate to marked
limitation of physical activity; less than
the ordinary causes fatigue, etc.
Class IV- unable to carry on any
without experiencing discomfort
2. Prognosis
1. Classes I&II- normal pregnancy and
delivery
2. Classes III &IV- poor candidates
3. Signs and Symptoms
1. Because of increased total cardiac volume during
pregnancy, heart murmurs are observed
2. Cardiac output may become so decreased that vital organs
are not perfused adequately; oxygen and nutritional
requirements, therefore, are not met.
3. Since the left side of the heart is not able to empty the
pulmonary vessels adequately, the latter become
engorged, causing pulmonary edema and hypertension.
Moist cough in gravidocardiacs, therefore, is a
danger sign.
4. Liver and other organ become congested because blood
returning to the heart may not be handled adequately,
causing the venous pressure to rise. Fluid then escapes
through the walls of engorged capillaries and cause
edema or ascites.
5. Congestive heart failure is a high probability also because
of the increased cardiac output during pregnancy.
Dyspnea, exhaustion, edema, pulse irregularities, chest
pain on exertion, and cyanosis of nailbeds are obvious.
 4. Management – consider the
functional capacity of the heart
PRENATAL PERIOD
1. Promote frequent rest periods and
adequate sleep, decreases stress
2. Teach client to recognize and
report signs of infection
3. Compare vital signs to baseline
and normal values expected during
Pregnancy
4. Instruct in diet to limit weight gain
INTRAPARTAL PERIOD
=Labor increases the risk of congestive heart failure-
milking effect of
contractions and delivery increases blood volume to
heart
1. Monitor maternal EKG and FHT continuously
2. Explained to client delivery is preferred over CS
3. Monitor clients response to stress of labor and watch
for signs of decompensation
4. Administered O2 and pain medication as order
5. Provide calm atmosphere
6. Side-lying/ low- fowler’s position
7. Encourage “open-glottal” pushing during
second stage of labor( forcep and vacuum to
minimize pushing)
 POSTPARTAL PERIOD
Monitor V/S, any bleeding, strict I & O,
daily weight, Rest and diet
Assist ADL as needed
Prevent Infection
Facilitate non-stressful mother/baby
interactions
4. HYPEREMESIS GRAVIDARUM
Excess nausea and vomiting of early pregnancy leads to
dehydration and electrolyte disturbances, esp. acidosis
causes: possible severe reaction to HCG, not
psychological, greater risk in condition where HCG
levels increased. HCG levels peak around 6 weeks after
conception, then begin to decline after the 12th week .
s/sx: nausea and vomiting, progressing to retching
between meals
: weight loss
MGT:
1. Begin NPO and IV fluid and Electrolyte replacement
2. Monitor I & O
3. Gradually re introduce PO intake, monitor taken and
retained
4. Provide mouth care
5. Offer emotional support
Self-help for pregnancy nausea
1.Ginger is a good way to cope with mild nausea.
2. Eat a bland, starchy diet in small, frequent
amounts to help alleviate symptoms.
3.Avoid foods that are fatty or make you feel
nauseous.
4.Try taking vitamin B6 supplements, or increasing
this vitamin in your diet (bananas, potatoes,
watermelon, chickpeas are all rich in this nutrient).
5.Rest frequently.
6.Get regular, gentle exercise.
7.Try sea-sickness acupressure bracelets or
acupuncture.
8.If your vomiting is severe, try electrolyte drinks to
keep up the levels of minerals and salts that you
need.
 Medical treatment for
hyperemesis gravidarum
1.fluids via a drip
2. anti-nausea medication via a drip
3. vitamins and other nutrients that
you may have lost through your
severe nausea
4. rarely, nutrients, via a naso-gastric
tube or intravenously, if you are still
unable to eat and keep food down.
5. POLYHYDRAMNIOS
Definition: excessive amniotic fluid
Etiology:
a. maternal disease – toxemia, diabetes
b. fetal malformation – esophagus not
complete
c. Erythroblastosis – hemolytic anemia in
newborn
d. Multiple pregnancies –
Treatment :
a. Relieve pressure by amniocentesis
b. Delivery
6. URINARY TRACT INFECTION
affect 10 % of all pregnant women
dilated, flaccid, and displaced ureters are a frequent site
E. Coli is the usual cause
May cause premature labor if severe, untreated

s/sx: - frequency and urgency of urination

suprapubic pain, flankpain, hematuria, pyuria
fever and chills

MGT.
1. Encourage high fluid intake
2. Provide warm baths to relieve discomfort and promote
perineal hygiene
3. Stress good bladder-emptying schedule
4. Monitor for signs of Premature labor from severe or
untreated infection
5. Administer and monitor intake of antibiotics, urinary
analgesics)
III . OTHER CONDITIONS AT RISK IN
PREGNANCY
A. ADOLESCENCE
- pregnancy is a condition of both physical and
psychologic risk
-adolescent is frequently undernourished and not yet
matured either physically or Psychosocially
-Serious complications: TOXEMIA & LOW BIRTH
WEIGHT

MGT.
1. Encourage adequate prenatal care
2. provide health teaching-
pregnancy,labor and delivery
3. provide nutritional counseling
4. teach coping skills for labor and delivery
5. teach child care skills
B. DESSIMINATED INTRAVASCULAR COAGULATION
( DIC)
- also known as consumptive coagulopathy
- a diffuse, pathologic form of clotting, secondary to
underlying disease/ pathology
- occurs in critical maternity problems such as abruption
placenta, dead fetus syndrome, amniotic fluid
embolism, preeclampsia/eclampsia, H-mole and
hemorrhagic shock

*MECHANISM
A. Precoagulant substances released in the blood trigger
microthrombosis in peripheral vessles and
paradoxical consumption of circulating clotting
factors
B. Fibrin-split products accumulate, further interfering
with the clotting process
c. Platelet and fibrinogen levels drop
s/sx
bleeding may range from massive , unanticipated blood
loss to localized bleeding ( purpura and petechiae)
Presence of special maternity problems
Prolonged prothrombin and partial thromboplastin times

MGT.
1. Assist with medical management of underlying
condition
2. Administer blood component therapy as ordered
3. Observe for signs of insidious bleeding (oozing IV
site, petechiae, lowered hematocrit)
4. Institute nursing measures for severe bleeding/
shock if needed
5. Provide emotional support to client and family as
needed
C. ANEMIA
-low red cell count maybe underlying
condition
-may or may not be exacerbated by
physiologic hemodilutionn of pregnancy
-most common medical disorder of
pregnancy
s/sx
client is pale, tired, short of breath, dizzy
Hgb is less than 11g/dl; hct less than 37%
MGT.
Encourage intake of food rich in iron content
Monitor iron supplementation
Teach sequelae of iron ingestion
Assess need for parenteral iron
D. PRENATAL SUBSTANCE ABUSE

1. ALCOHOL
=elvates the mood, depresses the CNS
=affects every other system in the body of
the mother
=displaces other nutritional food intake
=greatest risk from high blood alcohol levels
=NO SAFE Level of maternal alcohol use in
pregnancy has been established
=FETUS may display :
>IUGR
>CNS dysfunction and Craniofacial
abnormalities( fetal alcohol syndrome)
2. COCAINE
-power stimulant, very addictive
-causes vasoconstriction, elevated BP, tachycardia
-may precipitate seizures
-affects ability to transport O2 into the blood
-may cause SPONTANEOUS ABORTION, fetal
malformation, abruption placenta,neural tube defects
-NEWBORN- display irritability, hypertonicity, poor
feeding patterns, increased risk of SIDS

3. OPIATES
-produce analgesia, euphoria, respiratory depression
if IV used, foreign substance may cause pulmonary
emboli or infections
-if IV used places mother at greater risk of contracting
HIV, the passing it on the fetus
-NEWBORN - experience withdrawal within 24-72 hours
after delivery
-high-pitched cry, restlessness, poor feeding
 4. OTHER CHEMICALS
( TRANQUILIZERS, PRESCRIPTION
MEDS, PAINT THINNER,AEROSOL)
MAJOR DANGER IS OVERDOSE,
WITH ACCOMPANYING CARDIAC
AND RESPIRATORY ARREST

MGT;
- ALCOHOLICS-ANONYMOUS-based
programs; include family therapy
** WITHDRAWAL is best accomplished
with competent professional help**
IV. COMPLICATIONS OF LABOR AND
DELIVERY
1. PREMATURE/ PRETERM LABOR
Labor that occurs before the end of 37thweek of
pregnancy assoc. with
cervical incompetence
preeclampsia/ eclampsia
maternal injury
infection
multiple births
placental disorders
-Contractions more frequent than every 10 minutes, last
30 seconds or longer,
- assessment

1. uterine contractions( painful/painless)

2. Abdominal cramping (maybe accompanied by
diarrhea)
3. low backpain
4. pelvic prassures or heaviness
5. change in the character and amount of usual
discharge; maybe thicker or thinner,
bloody, brown or colorless, and maybe odorous
6. ruptures of amniotic membranes
-PREVENTION

1. stop smoking- major factor

2. stop substance abuse
3. early consistent prenatal care
4. appropriate diet weight gain
5. minimize psychological stressor
- MEDICAL MGT.
1. MAGNESIUM SULFATE
-Stops uterine contractions with fewer s/e than beta adrenergic drugs
-few serious s/e : initially patient feels hot, flushed, may c/o headache,
nausea, diarrhea, dizziness, nystagmus and lethargy
- FETAL s/e : HYPOTONIA
NSG. AXN- carefully monitor RESPIRATION, reflexes,urinary output
2. BETA- ADRENERGIC DRUGS- TERBUTALINE AND RITODRINE
-decreases effect of calcium on muscle activation to slow or stop uterine
Contractions
-s/e : increased heart rate, nervouseness, tremors, nausea, vomiting,
decrease
in serum K+ level, cardiac arrythmias, pulmonary edema
3. Nifedipine
-calcium channel blocker
-s/e: facial flushing, mild hypotension, reflex tachycardia,
headache,nausea
4. Indomethacin
- prostaglandin synthetase inhibitor
-s/e : n/v, dyspepsia
5. BETAMETHASONE( CELESTONE)
When labor cannot be arrested to promote fetal lung maturity
IM to mother every 12 hrs times 2, then weekly until 34 weeks gestation
2. POSTMATURE/ PROLONGED PREGNANCY
PREGNANCY beyond 42 weeks
FETUS at risk due to placental degeneration and loss of amniotic
fluid(cord accident)
Decrease amount of vernix

3. PROLAPSED UMBILICAL CORD

displacement of cord in downward direction, near or ahead of the
presenting part
may occur when membranes rupture
assoc. with breech presentation, unengaged presentations, and
premature labor
OBSTETRICS EMERGENCY-FETAL HYPOXIA may result in CNS
DAMAGE or DEATH
NSG.AXN.
check FHT
if fetal bradycardia noted, vaginal exam
cord prolapsed= exert upward pressure against presenting part to lift part
off cord, reduce pressure of cord
KNEE-CHEST or SEVERE TRENDELENBURG’S
CORD protrude in vagina- cover with sterile gauze moistened with sterile
saline while carrying out above tasks. DO NOT ATTEMP TO REPLACE
THE CORD.
Notify physician
4. PREMATURE RUPTURE OF MEMBRANES
loss of amniotic fluid, prior to term, unconnected with
labor
danger assoc.= prolapsed cord, infection, and the
potential need for premature delivery
differentiate ph of vagina (amniotic fluid- ALKALINE;
purulent discharge- ACIDIC)
NSG. AXN
1. Monitor maternal/fetal VS esp. maternal temperature
2. calculate gestational age
3. observe for signs of infection
a. if infection (+)- antibiotics and prepare for immediate
delivery
b. if infection (-) – induction of labor may be delayed
4. observed color of amniotic fluid
5. FETAL DISTRESS
common contributing factors are:
1.cord compression
2.placental abnormalities
3.preexisting maternal disease
Assessment finding:
1.check FHR on appropriate basis
2.conduct vaginal exam for
presentation and position
3.place mother on left side, administer
O2, check for cord prolapse, notify
doctor
4.support mother and family
5.Prepare for emergency birth
6. DYSTOCIA
=any labor/delivery that is prolonged or difficult
=usually results from a change in 5 Ps( factors in labor/ delivery)
PASSENGER,PASSAGE,POWERS,PLACENTA and PSYCHE of mother
-Frequently seen causes:
1. Cephalopelvic Disproportion (CPD)= minimal- NSVD =great-CS
2. Problems with presentation
a. any presentation unfavorable for delivery- ex.
breech, shoulder, face, transverse lie
b. posterior presentation that does not rotate or cannot
be rotated with at ease.
c. C/S
3. Problems with maternal tissue
a. full bladder, cervical edema, scar tissue and congenital anomalies
b. empty the bladder may allow labor to continue; other cond. = C/S
4. Dysfunctional uterine contractions
a. contractions maybe too weak, too short, too far apart,ineffective
b. progress of labor is affected; progressive dilation, effacement, and
descent do not occur in the expected pattern.
c. classification:
1. PRIMARY: inefficient pattern present from beginning of labor;
usually a prolonged latent phase
2. SECONDARY: efficient pattern that changes to inefficient or
stops; may occur in any stage
- ASSESSMENT
> Progress of labor slower than expected
rate of dilation, effacement, descent for
specific client
> Length of labor prolonged
> Maternal exhaustion/ distress
>Fetal distress
-NSG. INT.
1. Individualized as to cause
2. Provide comfort measures for client
3. Provide clear, supportive descriptions of
all actions taken
4. Admin. analgesia as ordered
5. Prepare Oxytocin for induction of labor
6. Prepare for C/S
 7. PRECIPITOUS LABOR AND DELIVERY
labor of less than 3 hours
emergency delivery without client’s physician or midwife
ASSESSMENT Finding
As labor is progressing quickly, assessment may need to be done
rapidly
client may have history
desire to push
observe for status of membranes, perineal area for bulging, and for
signs of bleeding

8. AMNIOTIC FLUID EMBOLISM

- escape of amniotic fluid into the maternal circulation, usually in
conjunction with a pattern of hypertonic, intense uterine contractions,
either naturally or oxytocin induced
- OBSTETRIC EMERGENCY: maybe fatal to the mother and to the baby
-ASSESSMENT FINDING
1. sudden onset of respiratory distress, hypotension, chest pain, signs
of shock
2. bleeding (DIC)
3. Cyanosis
4. Pulmonary Edema
NSG. INT.
1. Initiate emergency life support
activities for mother
=Administer O2
=Utilize CPR in case of Cardiac Arrest
2. Establish IV line for blood transfusion
and monitoring of CVP
3. Administer Meds. To control bleeding
4. prepare for emergency birth of baby
5. Keep client/ family informed as
possible
 V METHODS OF DELIVERY
●1. Instrumental deliveries
●Forcep delivery
●Vacuum Extraction
●2. Cesarean Section (C/S)
●3. Induce Labor
 VI. INFECTIONS
A. TOXOPLASMOSIS
- is caused by infection with the
intracellular protozoan parasite
TOXOPLASMA GONDI
- produces a rash and symptoms of
acute,flulike infections in the mother
- is transmitted to the mother through
raw meat or handling of cat litter
of infected cats
- organsm is transmitted to the fetus
across the placenta
- can cause spontaneous abortion
 B. RUBELLA/ GERMAN MEASLES
- is teratogenic in the first trimester
- Rubella causes congenital defects of the eyes, heart and brains
- If not immune (titer of 1:8 or less ), the mother should be
vaccinated in the postpartum period; she must wait at least 3
months before becoming pregnant
Incidence:
Mother- the earlier the mother contacted the disease, the greater
the likelihood that the baby will be affected. The rubella virus slows
down division of infected cells during organogenesis, thus causing
congenital defects.
Newborn- can carry and transmit the virus for as long as 12-24
months after birth

Signs and Symptoms of Congenital Rubella Syndrome

Low birth weight; jaundice; petechiae; anemia; thrombocytopenia;
hepatosplenomegaly
Classic Sequelae:
a. Eyes: Chorioretinitis, cataract, glaucoma
b. Heart: Patent ductus Arteriosus, stenosis, Coarctations
c. Ear: Nerve Deafness
d. Dental and Facial clefts
C. CYTOMEGALOVIRUS

-produces mononucleosis-like symptoms

in the mother
- the mother maybe asymptomatic at
birth: cytomegalovirus causes FETAL
DEATH, MENTAL RETARDATION,
BLINDNESS, DEAFNESS, or SIEZURES
- ANTIVIRAL therapy may be prescribed
 D. GENITAL HERPES
-Affects the external genitalia, vagina and cervix
-herpes causes draining, painful vesicles
-NO vaginal examinations are done in the presence of active vaginal
herpetic lesions
- About half of infants exposed to herpes in vaginal delivery become
infected
-s/sx : PRODROMAL Phase:
Headache, generalized aching, malaise, low grade fever and burning in the
area where vesicles will appear, inguinal and pelvic lymphadenopthy with
pain, pain in urination; vesicles in the labia, vaginal, perianal and
endocervical area for 2-6 weeks; recurrent lesions
-DX Test : Papsmear, viral isolation from the lesion
NSG. AXN.
good handwashing
cleaning of room using universal precautions
C/S delivery
ROOMING-IN AND Breastfeeding
-HEALTH TEACHINGS
1. No sexual activity in the presence of lesions and 10-14 days after
lesions subsided
2. Keep vulva clean and dry in presence of lesions
3. Sitz bath and void in water for urinary pain and retention
4. Use of foley catheter if retention persist
5. Povidone-Iodine douche & ACYCLOVIR (not used during pregnancy)
 E. SYPHYLLIS
Cause: TREPONEMA PALLIDUM
A spirochete which enters the body during coitus or through cuts
and breaks in the skin or mucous membrane
Treatment: 2.4 – 4.8 million units of PENICILLIN – Benzathine
Penicillin= DOC ( Antidote: 30-40 grams ERYTHROMYCIN)
If untreated, syphilis can cause Midtrimester abortion, CNS
lesions in the newborn or even death
THE NEWBORN WITH CONGENITAL SYPHILLIS
SIGNS AND SYMPTOMS:
Jaundice at 2 weeks of life – 1st sign of the disease
Anemia and hepatosplenomegaly
“SNUFFLES”(persistent rhinorrhea); coppery rashes on palms and
soles; mucous patches; condylomas; pseudo paralysis due to bone
inflammation
If untreated, can progress on to deformed bones, teeth, nose,
joints and CNS syphilis
Management: Penicillin IM for 10 days or one long- acting
Penicillin(Penadur LA)
F. VARICELLA- ZOSTER (CHICKEN POX)

- 2% risk of having a child with congenital defects in

pregnancy
-if infection occurs in the last 4 days of gestation and 2
days postpartum, it results in FATAL NEONATAL
INFECTION
-s/sx : vesicles on trunk, neck, face and then the
extremeties. Varicella pneumonia is quite severe in
pregnancy
- TX.
1. Strict isolation during dse.
2. Bathe daily to prevent bacterial infection on the
vesicles
3. Watch out for varicella pneumonia
4. Varicella-zoster immune globulin within 3 days of
exposure to alleviate maternal signs but not alter fetal
outcome
5. May breastfed after the dse.
G. GONNORHEA
- can cause spontaneous abortion,
PROM
- if present during delivery it can cause
BLINDNESS
- profuse and purulent vaginal
discharge, itching of the vulva, painful
urination and positive in a cervical
smear
-DOC= CEFTRIAXONE or
SPECTINOMYCIN or PROBENECID
= 0.5% ERYTHROMYCIN or 1%
TETRACYCLINE ointment for babies
H. CHLAMYDIA TRACHOMATIS
- RISK of PROM, Prematurity, low birth weight and
perinatal mortality
- leads to INFERTILITY, ECTOPIC Pregnancy and may
cause delayed ENDOMETRITIS
- increased yellowish vaginal discharge, painful and
frequent urination, bleeding between periods,
mucopurulent cervicitis, positive on culture and
antigen detection test
- TX.
ERYTHROMYCIN
TETRACYCLINE ( non- pregnant)

I. MONILIASIS
- vaginal irritation, pruritus with white, cheese-like
discharge, yeasty odor dysuria.
- Positive finding in KOH or saline wet mount
-TX.
CLOTRIMAZOLE of antifungal agent used for 7
days
J. TRICHOMONIASIS
- frothy-greenish vaginal discharge,
perineal itching, erythema, alkalinic
vaginal pH, positive motile protozoa
in a saline wet mount
-TX. METRONIDAZOLE treatment
after 20 weeks AOG
- Cervical rest for 2 weeks; NO sexual
Intercourse
K. TUBERCULOSIS
- is highly communicable dse. cause
be mycobacterium tuberculosis

L. ACQUIRED IMMUNE
DEFECIENCY SYNDROME (AIDS)
VII. A. POSTPARTUM INFECTIONS

Blue slides........... pls. open

B.
POSTPARTUM
HEMORRHAGE
Classification
Early postpartum
hemorrhage
1. Uterine Atony – uterus is not
well contracted, relaxed or
boggy; most frequent cause
Predisposing Factors
Overdistension of the uterus-
e.g. multiple pregnancy,
multiparity, excessive large baby,
polyhydramnios
Cesarian section
Placental accidents
(previa or abruption)
Prolong and difficult labor
Management
Massage- first nursing action
Ice compress
Oxytocin administration
Empty bladder
Bimanual compression to explore
retained placental fragments
Hysterectomy- last resort
2. Lacerations

3. Hypofibrinoginemia – a clotting
defect,
Management:
» blood transfusion
Late postpartum
hemorrhage
– Retained placental
fragments-
–
management:
» dilatation and Curettage (D&C)
– Hematoma due to injury
-

to blood vessels in the

perineum during delivery
Incidence:
Commonly seen in precipitate
delivery and those with
perineal varicosities
Treatment
Ice compress during first 24
hours
Oral analgesics, as ordered
Site is incised and bleeding
vessel is ligated
VIII. REVIEW OF GYNECOLOGY
1. Cancer – a neoplasm characterized by the
uncontrolled growth of anaplastics cells that tend to
invade surrounding tissue and metastasized
to distant body sites.
Etiology:
a. STD
Manifestation:
a. bleeding between periods or after intercourse,
douching
b. leucorrhea
Treatment:
a. hysterectomy
b. radiation
c. laser surgery
d. pap smear
2. Endometrium – malignant neoplastic disease of the
endometrium of the uterus.

Etiology:
> medical history of infertility
> administration of exogenous estrogen
> familial hereditary
Manifestation:
a. post menopausal bleeding
b. abnormal bleeding
c. abnormal low back pain
d. large boggy uterus - most often sign of advance
disease.

Treatment:
a. hysterectomy
b. radiation therapy
c. surgery ( salpingo – oophorectomy with abdominal
hysterectomy if metastasized)
3. Pelvic inflammatory Disease (PID)
Etiology :
a. infections
b. venereal disease
Manifestations:
a. vaginal discharge: foul smelling, purulent
b. pain in abdomen and lower back
c. Temperature, nausea and vomiting
Nursing Management:
a. Antibiotic therapy
b. client education
4. Menopause – cessation of menstruation for one year
Manifestation:
> hot flasfes
> palpitations
> diaphoresis
> osteoporosis
Nursing interventions / Treatment
1. Assess psychosocial response
2. Discuss merits of estrogen therapy (estrogen decrease
bone reabsorption)
5. Infertility – decrease capacity to conceive
Etiology :
1. Abnormal genetalia
2. Absence of ovulation
3. Blocked fallopian tubes
4. Altered vaginal ph
5. Sperm deficiency or decrease motility
Diagnosis:
1. Assessment of male
2. Assessment of female
Management:
1. Medication
a. Clomiphene citrate (clomid) or menotropins
( Pergonal) are associated with multiple births
b. hormone replacement
2. Artificial insemination
3. In vitro fertilization
Nursing Management:
1. Provide emotional support
2. Provide client education
XI. REVIEW OF HIGH RISK NEWBORN
1. Premature Newborn – gestational age of less than 37
weeks regardless of weight.
Physical Adaptation:
1. Respiratory
a. may lack surfactant
b. At risk for respiratory distress Syndrome
1. retractions
2. nasal flaring
3. expiratory grunt
4. tachypnea
5. need mechanical ventilation, O2, continuous positive
airway pressure (CPAP)
2. Nutrition ( fluid and Electrolyte)
a. May lack gag and sucking reflex if under 34 weeks
b. Fed by gavage of hyperalimentation
3. Circulatory
a. Patent ductus arteriosus is common
b. Persistent fetal circulation
4. Complications:
a. hypothermia
b. hypocalcemia
c. hypoglycemia
d. hyperbilirubinemia
e. birth trauma
f. sepsis
g. intracranial hemorrhage
h. apnea

5. Nursing Mgt.
a. Monitor v/s
b. Maintain temperature
c. Assess hydration and nutrition
d. Promote attachment and bonding between
parents and newborn
2. Small for gestational Age (SGA)
Definition: = any newborn who falls below the tenth percentile
on thegrowth chart at birth
Etiology :
a. Placental insufficiency
b. PIH
c. Twin pregnancy
d. Poor nutrition
e. Smoking, drugs and alcohol
f. Adolescent pregnancy
Complication:
a. Perinatal asphyxia – severe hypoxia leading to hypoxemia &
hypercapnea, loss of conciousness, if
not corrected, death may occur
.b. Meconium aspiration syndrome
c. Hypoglycemia
d. Hypothermia
e. infections
Nursing Mgt.
1. Support respirations
2. Provide neutral thermal environment
3. Provide adequate nutrition
4. Observe for complication
5. Protect from infections
6. Support parents and bonding
3. Large for gestational Age (LGA)
Definition: =newborn whose weight is at or above 90th
percentile
Etiology:
1. Diabetes
2. Genetic predisposition
3. Congenital defects

Complication:
1. Birth trauma such as fractured clavicle
2. Hypoglycemia
3. Polycythemia – abnormal increase in number of
erythrocytes in the blood
4. Mother diabetic presents same risk and care as
premature infant

Nursing interventions:
1. Assess for trauma
2. Assess for congenital abnormalities
3. Assess for hypoglycemia especially if infant of diabetic
mother (IDM)
4. Jaundice (Hyperbilirubinemia)
Causes :
1. Physiological
a. Never seen during first 24 hours, usually
appears by 3rd day
b. Immature Liver
2. ABO incompatibility
3. Rh incompatibility ( Erythroblastosis Fetalis)
a. Rh negative mother & Rh + baby
b. Kernicterus can lead to brain damage, anemia,
hepatosplenomegaly
c. Treatment:
1. phototherapy, exchange transfusion,
sunlight
2. RhoGAM administered with in 72 hours of
delivery
Signs & symptoms
1. lethargy, poor feeding & vomiting
2. severe neurologic excitation or depression
> tremors
> twitching
> convulsions, high pitch cry, absence DTR
5. Substance Abuse and the Newborn

A. Drug Dependent
1. Manifestations of withdrawal
a. irritability is early symptoms
b. sneezing and nasal stuffiness
c. high pitch cry
d. tremors
e. perspirations
f. feeding problems
g. transient tachypnea
2. Nursing interventions
a. Prevent overstimulation to prevent possible
seizures
b. swaddle, hold infant firmly
c. Medications as ordered
d. small frequent feedings
B. Fetal Alcohol Syndrome
1. Etiology: consumption of alcohol during pregnancy
2. Manifestations
a. feeding problem
b. distinctive facial features
c. CNS dysfunction
d. Withdrawal syndrome
3. Nursing interventions
a. Protect infant from injury
b. administer medication as
ordered
c. monitor fluid therapy
d. decrease stimuli
e. Provide support for parents to care for possibly
difficult infant
f. Provide social service referral
6. Asphyxia Neonatorum
A. occurs when respirations are not well established
within 60 seconds after birth as a result of
anoxia, cerebral damage or narcosis.
B. Therapeutic Interventions:
1. Preventive mgt. = early prenatal care; prenatal
education ; early mgt. of
deviations from a normal
pregnancy
2. Medical mgt. during labor and birth;
resuscitative measures at birth
= keep under observation first 24
hours
C. 2 types :
1. Asphyxia Livida : persistent generalized
cyanosis and good muscle tone
2. Asphyxia Pallida: marked pallor, poor muscle
tone
7. Opthalmia Neonatorum
A. an eye infection caused by Neisseria gonorrhoeae &
Chlamydia trachomatis
B. Organism is transmitted from the genital tract of
infected mother during birth or by
infected hands
C. Chlamydial infections can also cause pneumonia.
D. s/s = perinatal hx of maternal infections
= purulent conjunctivitis if prophylactic tx is not
used; manifested 3-4 days after birth.
= respiratory status with chlamydial infection
E. Prevention: ophthalmic antibiotic instilled at birth after
providing for initial bonding
F. Nursing mgt.
1. Cleanse the eyes with normal saline by wiping
from inner to outer canthus
2. Administer prescribe antibiotics
3. Refer for ophthalmic evaluation
4. Monitor v/s & administer O2
8. Cranial Birth Injuries
A. CAPUT SUCCEDANEUM:
= edema with extravasations of serum into scalp
tissues caused by molding during the birth
process; crosses the suture lines of the bony
plates of the skull;
= no tx is necessary; it subsides in a few days.
B. CEPHALHEMATOMA:
=edema of the scalp with effusion of blood between
the bone and periosteum; stops at the suture line;
=no tx is necessary;
= it disappears within a few weeks to a few months
after birth
C. INTRACRANIAL HEMORRHAGE
= bleeding into cerebellum, pons and medulla
oblongata caused by a tearing of the
tentorium cerebelli.
= occurs in preterm infants and following prolonged
labor
= difficult forceps birth
= precipitate birth or breech extraction
Assessment:
1. abnormal respirations; cyanosis
2. shrill & weak cry
3. Flaccidity or spasticity; seizures
4. restlessness, wakefulness
5. impaired sucking reflex
Nursing mgt.
1. Administer O2
2. Maintain in high – fowlers position
3. Administer prescribed vitamins C
& K to control & prevent
further hemorrhage
4. Institute ordered gavage feedings
when sucking reflex is impaired.
5. Support the parents
9. Meconium Aspiration Syndrome
(MAS)
A. hypoxic insult to fetus that causes
increased intestinal peristalsis with
passage of meconium into the
amniotic fluid;
=the meconium – stained fluid is
aspirated by the infant during the
first few breaths after birth causing
an obstruction in the lung that
results in chemical pneumonia
B. Therapeutic interventions:
1. suctioning after head is delivered
2. oxygenation and ventilation
3. prophylactic antibiotic therapy