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LAMBAN, RN, MD
Human Sexuality
Concepts
Stage 4 occurs between ages 13 and 14, hair assumes the normal
appearance of an adult but is not so thick and does no appear to the
inner aspect of the upper thigh
Muscular compositions:
there are three main muscle layers which make expansion possible in every
direction.
Meds:
1. Danazole (Danocrene)
a. to stop mens
b. inhibit ovulation
2. Lupreulide (Lupron)
inhibit FSH/LH production
Myometrium
largest part of the uterus, muscle layer for delivery process
Perimetrium
protects entire uterus
c. ovaries 2 female sex glands, almond shaped.
Function: 1. ovulation
2. Production of hormones
d. Fallopian tubes
2-3 inches long that serves as a passageway of the sperm from
the uterus to the ampulla or the passageway of the mature
ovum or fertilized ovum from the ampulla to the uterus.
4 significant segments
1. Infundibulum
distal part of FT, trumpet or funnel shaped,
swollen at ovulation
2. Ampulla
outer 3rd or 2nd half, site of fertilization
3. Isthmus
site of sterilization bilateral tubal ligation
4. Interstitial
site of ectopic pregnancy most dangerous
B. Male Reproductive System
1. External
Penis
the male organ of copulation and urination. It contains of a
body of a shaft consisting of 3 cylindrical layers and erectile
tissues. At its tip is the most sensitive area comparable to that
of the clitoris in the female the glands penis.
3 Cylindrical Layers
2 corpora cavernosa
1 corpus spongiosum
Scrotum
a pouch hanging below the pendulous penis, with a medial
septum dividing into two sacs, each of which contains a testes.
2. Internal
DNA
carries genetic code
Chromosomes
threadlike strands composed of hereditary
material DNA
Normal amount of ejaculated sperm
3 5 cc., 1 tsp
Ovum is capable of being fertilized with in 24 36 hrs
after ovulation
Sperm is viable within 48 72 hrs, 2-3 days
Reproductive cells divides by the process of meiosis
Spermatogenesis
maturation of sperm
Oogenesis
maturation of ovum
Gematogenesis
formation of 2 haploid into diploid 23 + 23 = 46 or diploid
Menstrual Cycle
beginning of mens to beginning of next mens
Average Menstrual Cycle 28 days
Related terminologies:
Menarche 1st mens
Dysmenorrhea painful mens
Others:
inhibit prod of LH (hormone for ovulation)
inhibit motility of GIT
mammary gland development
increase permeability of kidney to lactose & dextrose causing (+)
sugar
causes mood swings in moms
increase BBT
Menstrual Cycle
4 Phases of Menstrual Cycle
1. Proliferative
2. Secretory
3. Ischemic
4. Menses
Parts of body responsible for mens:
hypothalamus
anterior pituitary gland master clock of body
ovaries
uterus
Initial phase 3rd day decreased estrogen
Functions of FSH:
Stimulate ovaries to release estrogen
Excitement Phase
(sign present in both sexes, moderate increase in HR,
RR,BP, sex flush, nipple erection) erotic stimuli cause
increase sexual tension, lasts minutes to hours.
Plateau Phase
(accelerated V/S) increasing & sustained tension nearing
orgasm. Lasts 30 seconds 3 minutes.
Stages of Sexual Responses (EPOR)
Orgasm
(involuntary spasm throughout body, peak v/s) involuntary
release of sexual tension with physiologic or psychologic
release, immeasurable peak of sexual experience. May last 2
10 sec- most affected are is pelvic area.
Resolution
(v/s return to normal, genitals return to pre-excitement
phase)
Refractory Period
the only period present in males, wherein he cannot be
restimulated for about 10-15 minutes
Fertilization
a. Zygote
- fertilized ovum.
Lifespan of zygote from fertilization to 2 months
b. Morula
mulberry-like ball with 16 50 cells,
4 days free floating & multiplication
c. Blastocyst
enlarging cells that forms a cavity that later becomes the embryo.
covering of blastocys that later becomes placenta & trophoblast
Signs of implantation:
1. slight pain
2. slight vaginal spotting
E. Cytotrophoblast
inner layer or langhans layer
protects fetus against syphilis 24 wks/6 months
life span of langhans layer increase.
- Before 24 weeks critical, might get infected syphilis
F. Syncitiotrophoblast
synsitial layer
responsible production of hormone
b. Amniotic Fluid
bag of H2O, clear, odor mousy/musty, with crystallized
forming pattern, slightly alkaline.
*Function of Amniotic Fluid:
1. cushions fetus against sudden blows or trauma
2. facilitates musculo-skeletal development
3. maintains temp
4. prevent cord compression
5. help in delivery process
polyhydramnios, hydramnios
- GIT malformation TEF/TEA, increased amt of fluid
oligohydramnios
- decrease amt of fluid kidney disease
Diagnostic Tests for Amniotic Fluid
A. Amniocentesis
empty bladder before performing the procedure.
Purpose
obtain a sample of amniotic fluid by inserting a needle
through the abdomen into the amniotic sac;
fluid is tested for:
Genetic screening
- maternal serum alpha feto-protein test
(MSAFP)
- Determination of fetal maturity primarily by
evaluating factors indicative of lung maturity
Diagnostic Tests for Amniotic Fluid
Testing time
36 weeks
decreased MSAFP
= down syndrome
increase MSAFP
= spina bifida or open neural tube defect
Dangerous complications
spontaneous abortion
3rd trimester
- pre term labor
Greenish meconium
Amnioscopy
direct visualization or exam to an intact fetal
membrane.
Fern Test
- determine if amniotic fluid has ruptured or not
- blue paper turns green/grey - + ruptured amniotic
fluid
Phosphatidylglycerol
: PG+ definitive test to determine fetal lung maturity
Placenta
(Secundines) Greek
- Size: 500g or kg
GIT
transport center, glucose transport is facilitated, diffusion more
rapid from higher to lower.
If mom hypoglycemic, fetus hypoglycemic
Excretory System
- artery - carries waste products.
Liver of mom detoxifies fetus.
Circulating system
achieved by selective osmosis
Endocrine System produces hormones
Endoderm
1st week endoderm primary germ layer
Thyroid for basal metabolism
Parathyroid - for calcium
Thymus development of immunity
Liver lining of upper RT & GIT
Mesoderm
development of heart, musculoskeletal
system, kidneys and repro organ
Ectoderm
development of brain, skin and senses, hair,
nails, mucus membrane or anus & mouth
First trimester:
1st month
Brain & heart development
GIT& resp Tract remains as single tube
Second Month
All vital organs formed, placenta developed
Corpus luteum source of estrogen &
progesterone of infant life span end of 2nd
month
Sex organ formed
Meconium is formed
First trimester:
Third Month
Kidneys functional
Buds of milk teeth appear
Fetal heart tone heard Doppler 10 12 weeks
Sex is distinguishable
Second trimester:
FOCUS length of fetus
Fourth Month
lanugo begins to appear
fetal heart tone heard fetoscope, 18 20 weeks
buds of permanent teeth appear
Second trimester:
Fifth Month
lanugo covers body
actively swallows amniotic fluid
19 25 cm fetus,
Quickening- 1st fetal movement. 18- 20 weeks primi, 16-
18 wks multi
fetal heart tone heard with or without instrument
Second trimester:
Sixth Month
eyelids open
wrinkled skin
vernix caseosa present
Third trimester:
Period of most rapid growth. FOCUS: weight of fetus
Seventh Month
development of surfactant lecithin
Eighth Month
lanugo begin to disappear
sub Q fats deposit
Nails extend to fingers
Third trimester:
Ninth Month
lanugo & vernix caseosa completely disappear
Amniotic fluid decreases
Tenth Month
bone ossification of fetal skull
Terratogens
any drug, virus or irradiation, the exposure to such may
cause damage to the fetus
Drugs:
Streptomycin anti TB & or Quinine (anti malaria)
damage to 8th cranial nerve poor hearing & deafness
Tetracycline staining tooth enamel, inhibit growth of
long bone
Vitamin K hemolysis (destr of RBC), hyperbilirubenia
or jaundice
Iodides enlargement of thyroid or goiter
Thalidomides Amelia or pocomelia, absence of
extremities
Steroids cleft lip or palate
CHARACTERISTICS
group of infections caused by organisms that can cross
the placenta or ascend through birth canal and
adversely affect fetal growth and development
O others.
Hepa A or infectious heap oral/ fecal (hand washing)
Hepa B, HIV blood & body fluids
Syphilis
R rubella
German measles
congenital heart disease (1st month) normal rubella
titer 1:10
<1:10 less immunity to rubella, after delivery, mom will be
given rubella vaccine. Dont get pregnant for 3
months. Vaccine is terratogenic
C cytomegalo virus
A. Systemic Changes
1. Cardiovascular System
Normal Values
Hct 32 42%
Hgb 10.5 14g/dL
Criteria
1st and 3rd trimester.
- pathologic anemia if lower,
HCT should not be 33%,
Hgb should not be < 11g/dL
2nd trimester
Hct should not <32%
- Hgb Shdn't < 10.5% pathologic anemia if lower
Pathologic Anemia
- Assessment reveals:
Pallor, constipation
Slowed capillary refill
Concave fingernails (late sign of progressive anemia)
due to chronic physio hypoxia
Pathologic Anemia
Nursing Care:
Nutritional instruction kangkong, liver due to
ferridin content, green leafy vegetable-
alugbati,saluyot, malunggay, horseradish, ampalaya
Alert:
Iron from red meats is better absorbed iron form other
sources
Mgt:
Bed rest
Never massage
Assess + Homan sign once only might dislodge
thrombus
Give anticoagulant to prevent additional clotting
(thrombolytics will dilute)
Monitor APTT antidote for Heparin toxicity, protamine
sulfate
Avoid aspirin! Might aggravate bleeding.
Respiratory system common problem SOB due to enlarged
uterus & increase O2 demand
- exercise
Management|:
Increase Ca diet-milk(Inc Ca & Inc phosphorus)-
1pint/day or 3-4 servings/day. Cheese, yogurt, head of fish,
Dilis, sardines with bones, brocolli, seafood-tahong
(mussels), lobster, crab.
V Chadwicks sign
blue violet discoloration of vagina
C Goodel's sign
change of consistency of cervix
I Hegar's
change of consistency of isthmus (lower uterine
segment)
B. Local Changes
Mgt:
cauterization
Abdominal Changes
striae gravidarium (stretch marks) due enlarging
uterus-destruction of sub Q tissue
avoid scratching, use coconut oil, umbilicus is
protruding
Skin Changes
brown pigmentation nose chin, cheeks
chloasma melasma due to increased melanocytes.
Brown pinkish line- linea nigra- symphisis pubis to
umbilicus
Breast Changes
increase hormones, color of areola & nipple
pre colostrums present by 6 weeks, colostrums at 3rd
trimester
Breast changes
Urinary freq
Fatigue
Amenorrhea
Morning sickness
Enlarged uterus
Chloasma
Linea negra
Increased skin pigmentation
Striae gravidarium
Quickening
Probable
1. Frequency of Visit:
1st 7 months 1x a month
8 9 months 2 x a month
10 once a week
post term 2 x a week
2. Personal data
name, age (high risk < 18 & >35 yrs old) record to
determine high risk HBMR.
Home base moms record. Sex ( pseudocyesis or false
pregnancy on men & women)
Couvade syndrome dad experiences what mom goes through
lihi)
Address, civil status, religion, culture & beliefs with respect,
non judgmental
Occupation financial condition or occupational hazards,
education background level knowledge
3. Diagnosis of Pregnancy
urine exam to detect HCG at 40 100th day. 60 70 day
peak HCG. 6 weeks after LMP- best to get urine exam.
Elisa test test for preg detects beta subunit of HCG as
early as 7 10days
Home preg kit do it yourself
4. Baseline Data: V/S esp. BP, monitor wt. (increase wt 1st
sign preeclampsia)
Weight Monitoring
First Trimester:
Normal Weight gain 1.5 3 lbs (.5 1lb/month)
Second trimester:
normal weight gain 10 12 lbs (4 lbs/month)
(1 lb/wk)
Third trimester:
normal weight gain 10 12 lbs (4 lbs/ month)
( 1lb/wk)
nullipara no pregnancy
Gravida- # of pregnancy
Para - # of viable pregnancy
FUNDIC HT X 7/8=AOG in WK
3mos x 3 = 9cm
4 mos x 4 = 16 cm 1st of preg
5 x 5 = 25 cm
6 x 5 = 30 cm
7 x 5 = 35 cm 2nd of preg
8 x 5 = 40 cm
9 x 5 = 45 cm
tetanus immunizations prevents tetanus neonatum
-mom with complete 3 doses DPT young age considered as TT1 & 2.
Begin TT3
empty bladder
universal precaution
Class I normal
Stage
0 carcinoma insitu
3 pelvis metastasis
Prep mom:
Empty bladder
Position of mom-supine with knee flex (dorsal
recumbent to relax abdominal muscles)
Procedure:
3rd Maneuver: using the right hand, grasp the symphis pubis
part using thumb and fingers.
To determine degree of engagement.
When the brow is on the same side as the small parts, the
head will be flexed and vertex presenting.
(1) Begin at the same time each day (usually in the morning,
after breakfast) and count each fetal movement, noting how
long it takes to count 10 fetal movements (FMs)
Noncreative
Nonstress
Not Good
Reactive
Responsive is
Real Good
Interpretation of results
Reactive result
Nonreactive result
Nutrients
Requirements
Food Source
Nutrients
Essential for:
Fetal tissue growth
Maternal tissue growth including uterus and breasts
Development of essential pregnancy structures
Formation of red blood cells and plasma proteins
* Inadequate protein intake has been associated with onset
of pregnancy induces hypertension (PIH)
Recommended Nutrient Requirement that
increases During Pregnancy
Protein
Requirements
Food Source
Nutrients
Essential for
Growth and development of fetal skeleton and tooth
buds
Maintenance of mineralization of maternal bones and
teeth
Current research is :
Demonstrating an association between adequate calcium
intake and the prevention of pregnancy induce
hypertension
Recommended Nutrient Requirement that
increases During Pregnancy
Calcium-Phosphorous
Requirements
Calcium increases of
1200 mg/day representing an increase of 50% above
prepregnancy daily requirement.
1600 mg/day is recommended for the adolescent. 10
mcg/day of vitamin D is required since it enhances
absorption of both calcium and phosphorous
Recommended Nutrient Requirement that
increases During Pregnancy
Calcium-Phosphorous
Food Source
Nutrients
Essential for
Expansion of blood volume and red blood cells
formation
Establishment of fetal iron stores for first few months
of life
Recommended Nutrient Requirement that
increases During Pregnancy
Iron
Requirements
Requirements
Food Source
Nutrients
Essential for
* the formation of enzymes
* maybe important in the prevention of congenital
malformation of the fetus.
Recommended Nutrient Requirement that
increases During Pregnancy
Zinc
Requirements
Food Source
Nutrients
Essential for
formation of red blood cells and prevention of anemia
DNA synthesis and cell formation; may play a role in
the prevention of neutral tube defects (spina bifida),
abortion, abruption placenta
Recommended Nutrient Requirement that
increases During Pregnancy
Folic Acid, Folacin, Folate
Requirements
4 servings of grains/day
Recommended Nutrient Requirement that
increases During Pregnancy
Folic Acid, Folacin, Folate
Food Source
Minerals
Nutrients
Iodine
175 mcg/day
Magnesium
320 mg/day
Selenium
65 mcg/day
Recommended Nutrient Requirement that
increases During Pregnancy
Additional Requirements
Minerals
Food Source
Food Source
Contraindication in sex:
1. vaginal spotting
1st trimester threatened abortion
2nd trimester placenta previa
2. incompetent cervix
3. preterm labor
4. premature rupture of membrane
Exercise to strengthen muscles used during delivery
process
principles of exercise
Done in moderation.
Must be individualized
a. Psychophysical
1. Passenger
Bones 6 bones
a. Involuntary Contractions
b. Voluntary bearing down efforts
c. Characteristics: wave like
d. Timing: frequency, duration, intensity
4. Psyche/Person psychological stress when the mother
is fighting the labor experience
a. Cultural Interpretation
b. Preparation
c. Past Experience
d. Support System
Pre-eminent Signs of Labor
S&Sx:
- shooting pain radiating to the legs
- urinary freq.
S&Sx:
Abdominal palpations
Premature Rupture of Membrane ( PROM)
Nursing Care;
Administer Analgesics (Morphine)
Sedation as ordered
Danger signs:
PROM
Presenting part has not yet engaged
Fetal distress
Protruding cord form vagina
Cord Prolapse
Nursing care:
Cover cord with sterile gauze with saline to prevent
drying of cord so cord will remain slippery & prevent
cord compression causing cerebral palsy.
Slip cord away from presenting part
Count pulsation of cord for FHT
Prep mom for CS
Irregular contractions
No increase in intensity
Pain confined to abdomen
Pain relived by walking
No cervical changes
True Labor
Assessment:
Dilations 4 -8 cm
Intensity: moderate Mom- fears losing control of self
Frequency q 3-5 min lasting for 30 60 seconds
Nursing Care:
M edications have meds ready
A ssessment include: vital signs, cervical dilation
and effacement, fetal monitor, etc.
D dry lips oral care (ointment)
dry linens
B abdominal breathing
Transitional Phase:
Assessment:
Dilations 8 10 cm
Frequency q 2-3 min contractions
Durations 45 90 seconds
Hyperesthesia increase sensitivity to touch, pain all over
Health Teaching :
teach: sacral pressure on lower back to inhibit
transmission of pain
keep informed of progress
controlled chest breathing
Nursing Care:
T ires
I nform of progress
R estless support her breathing technique
E ncourage and praise
D iscomfort
Pelvic Exams
Effacement
Dilation
Two types:
Face
Brow Poor Flexion
Chin
Breech - Complete Breech thigh breast on abdomen,
breast lie on thigh
Variety:
Shoulder/acromniodorso
LADA, LADT, LADP, RADA
Chin / Mento
LMA, LMT, LMP, RMP, RMA, RMT, RMP
Monitoring the Contractions and Fetal heart Tone
Spread fingers lightly over fundus to monitor contractions
Parts of contractions:
Health teachings
1.) Ok to shower
2.)NPO GIT stops function during labor if with food-
will cause aspiration
3.)Enema administer during labor
a.)To cleanse bowel
b.)Prevent infection
c.)Sims position/side lying
12 18 inch ht enema tubing
Check FHT after adm enema
Nursing Care:
To prevent puerperal sepsis - < 48 hours only vaginal pack
Causes:
1.)Previous classical CS
2.)Large baby
3.) Improper use of oxytocin (IV drip)
Sx:
sudden pain
profuse bleeding
hypovolemic shock
TAHBSO
Physiologic retraction ring
Sx:
dyspnea, chest pain & frothy sputum
prepare: suctioning
end stage: DIC disseminated intravascular coagopathy-
bleeding to all portions of the body eyes, nose, etc.
Sx:
1. premature contractions q 10 min
2. effacement of 60 80%
3. dilation 2-3 cm
Home Mgt:
1. complete bed rest
2. avoid sex
3. empty bladder
4. drink 3 -4 glasses of water full bladder inhibits contractions
5. consult MD if symptoms persist
Hosp:
1. If cervix is closed 2 3 cm, dilation saved by
administer Tocolytic agents-halts preterm
contractions.YUTOPAR- Yutopar Hcl)
150mg incorporated 500cc Dextrose piggyback.
Monitor: FHT > 180 bpm
Maternal BP - <90/60
Crackles notify MD pulmo edema administer oral
yutopar 30 minutes before d/c IV
Tocolytic (Phil)
Terbuthaline (Bricanyl or Brethine) sustained
tachycardia
Antidote propranolol or inderal - beta-blocker
If cervix is open MD
steroid dextamethzone (betamethazone) to facilitate
surfactant maturation preventing RDS
Hyperfibrinogenia
- prone to thrombus formation
- early ambulation
Principles underlying puerperium
A. Physiologic Changes
1. Cardiovascular System
dysuria
- urine collection
- alternate warm & cold compress
- stimulate bladder
3. Urinary tract:
Bladder freq in urination after delivery- urinary
retention with overflow
4. Colon:
Constipation due NPO, fear of bearing down
Psychological Responses:
Taking in phase
dependent phase (1st three days) mom passive, cant
make decisions, activity is to tell child birth
experiences.
HT:
Care of newborn
Insert family planting method
common post partum blues/ baby blues present 4 5
days 50-80% moms overwhelming feeling of
depression characterized by crying, despondence-
inability to sleep & lack of appetite. let mom cry
therapeutic.
Letting go
interdependent phase 7 days & above. Mom -
redefines new roles may extend until child grows.
III. Prevent complications
mgt:
BT- cryoprecipitate or fresh frozen plasma
Late Postpartum hemorrhage
bleeding after 24 hrs retained placental fragments
Mgt:
D&C or manual extraction of fragments & massaging of
uterus. D&C except placenta increta, percreta,
Mgt:
cold compress every 30 minutes with rest period of 30
minutes for 24 hrs
shave
incision on site, scraping & suturing
Infection- sources of infection
Sx:
Abdominal tenderness, pos.
Fowlers to facilitate drainage & localize infection
oxytocin & antibiotic
IV. Motivate the use of Family Planning
determine ones own beliefs 1st
never advice a permanent method of planning
method of choice is an individuals choice.
June 26 Dec 33
- 18 -11
8 - 22 unsafe days
Immediate Discontinuation
A abdominal pain
C chest pain
H - headache
E eye problems
S severe leg cramps
chain smoker
extreme obesity
HPN
DM
Thrombophlebitis or problems in clotting factors
Alerts:
Disadvantage:
Ht:
proper hygiene
check for holes before use
must stay in place 6 8 hrs after sex
must be refitted especially if without wt change 15 lbs
spermicide chem. Barrier ex. Foam (most effective),
jellies, creams
Hemorrhagic Disorders
General Management
CBR
Avoid sex
Assess for bleeding (per pad 30 40cc) (wt 1gm =1cc)
Ultrasound to determine integrity of sac
Signs of Hypovolemic shock
Save discharges for histopathology to determine if
product of conception has been expelled or not
First Trimester Bleeding abortion or eptopic
Unruptured
missed period
abdominal pain within 3 -5 weeks of missed period (maybe
generalized or one sided)
scant, dark brown, vaginal bleeding
Nursing care:
Vital signs
Administer IV fluids
Monitor for vaginal bleeding
Monitor I & O
Tubal Rupture
sudden , sharp, severe pain. Unilateral radiating to shoulder.
Mgt:
Surgery depending on side
Ovary: oophrectomy
Uterus : hysterectomy
Second trimester bleeding
Assessment:
Early in pregnancy
High levels of HCG
Preeclampsia at about 12 weeks
Late signs hypertension before 20th week
Vesicles look like a snowstorm on sonogram
Anemia
Abdominal cramping
Serious complications hyperthyroidism
Pulmonary embolus
Nursing care:
Prepare D&C
Do not give oxytoxic drugs
Teachings:
Return for pelvic exams as scheduled for one year to
monitoring HCG and assess for enlarged uterus and
rising titer could indicative of choriocarcinoma
Avoid pregnancy for at least one year
Third Trimester Bleeding Placenta Anomalies
Placenta Previa it occurs when the placenta is improperly
implanted in the lower uterine segment, sometimes covering the
cervical os. Abnormal lower implantation of placenta.
candidate for CS
Sx: frank
Bright red
Painless bleeding
Dx:
Ultrasound
Avoid: sex, IE, enema may lead to sudden fetal blood loss
Double set up: delivery room may be converted to OR
Assessment:
Engagement (usually has not occurred)
Fetal distress
Presentation ( usually abnormal)
Nursing Care
NPO
Bed rest
Prepare to induce labor if cervix is ripe
Administer IV
Abruptio Placenta it is the premature separation of the
placenta form the implantation site. It usually occurs after
the twentieth week of pregnancy.
Assessment:
Concealed bleeding (retroplacental)
Couvelaire uterus (caused by bleeding into the
myometrium)-inability of uterus to contract due to
hemorrhage.
Severe abdominal pain
Dropping coagulation factor (a potential for DIC)
Complications:
Sudden fetal blood loss
-placenta previa & vasa previa
Nursing Care:
Infuse IV, prepare to administer blood
Type and crossmatch
Monitor FHR
Insert Foley
Measure blood loss; count pads
Report s/sx of DIC
Monitor v/s for shock
Strict I&O
Placenta succenturiata 1 or 2 more lobes connected to the
placenta by a blood vessel may lead to retained placental
fragments if vessel is cut.
Placenta Circumvalata fetal side of placenta covered by
chorion
Placenta Marginata fold side of chorion reaches just to
the edge of placenta
Battledore Placenta cord inserted marginally rather then
centrally
Placenta Bipartita placenta divides into 2 lobes
Vilamentous Insertion of cord- cord divides into small
vessels before it enters the placenta
Vasa Previa velamentous insertion of cord has implanted
in cervical OS
Hypertensive Disorders
Cause of preeclampsia
idiopathic or unknown common in primi due to 1st exposure
to chorionic villi
common in multiple pre (twins) increase exposure to
chorionic villi
common to mom with low socioeconomic status due to
decrease intake of CHON
Nursing care:
P romote bed rest to decrease O2 demand, facilitate,
sodium excretion, water immersion will cause to urinate.
P- prevent convulsions by nursing measures or seizure
precaution
1.) dimly lit room . quiet calm environment
2.) minimal handling planning procedure
3.) avoid jarring bed
Newborn Effect : DM
hyperinsulinism
hypoglycemia
normal glucose in newborn 45 55 mg/dL
hypoglycemic < 40 mg/dL
Heel stick test get blood at heel
Sx:
Hypoglycemia high pitch shrill cry tremors, administer
dextrose
hypocalcemia - < 7mg%
Sx:
Calcemia tetany
Trousseau sign
Give calcium gluconate if decrease calcium
Recommendation
Therapeutic abortion
If push through with pregnancy
antibiotic therapy- to prevent sub acute bacterial
endocarditis
anticoagulant heparin doesnt cross placenta
Class I & II- good progress for vaginal delivery
Class III & IV- poor prognosis, for vaginal delivery, not CS!
Regional anesthesia!
Recommendation:
1.) early hospitalization by 7 months
Recommendation:
Therapeutic abortion
XII. Intrapartal complications
STERILITY - irreversible
Impotency inability to have an erection
2 types of infertility
1.) primary no pregnancy at all
2.) Secondary 1st pregnancy, no more next preg
use of IUD
appendicitis (burst) & scarring
= dx: hysterosalphingography used to determine tubal
patency with use of radiopaque material
Mgt: IVF invitrofertilization (test tube baby)
fundal pressure
episiotomy
forcep delivery