Hyperemesis Gravidarum: Excess vomiting

during pregnancy.

Risk Factors:

Assessment:
Obstetrical History:
Menarche (First Menstruation)
How many days is the menstruation
Expected Date of Delivery (Naegels
rue)
Age of Gestation (AOG) using
McDonalds rule
Gravida
Para
Height and Weight (Nutritional Status
of the mother)

Note: A pregnant woman should atleast have

4 Prenatal visits/check-ups on the first and
second trimester.

Gynecologic History- Picture of the

previous pregnancy of the mother/if
there are complications.
Medical History
Other disease condition that may
affect pregnancy (diabetes,
thyroidism, hypertension).
Psychosocial History- Preparation of
the family if they will reject or accept
the pregnancy. (Preparation to an
unwanted/wanted pregnancy)
Laboratory Exams
Urinalysis
Ultrasound (non-invasive)
- To determine the AOG & Fetal
Position

2. Care of the Client with High Risk

Pregnancy.
Gravidocardiacs: Patients with Heart diseases
during pregnancy.

Rheumatic Heart Disease (Cardiac

condition affecting Pregnancy)

Caused by bacterial (streptococcal)

infection (tonsillitis)
It is not genetic, it is acquired through
tonsillitis

Management for Tonsillitis: Follow up

prescribed antibiotics usually for 9 days to
remove out all bacteria
-

It can affect connecting tissues,

subcutaneous tissues, joints, the
Central Nervous System, and the heart
(specifically, the Mitral valve causing
Mitral valve stenosis)

Signs and Symptoms of the Rheumatic Heart

Disease
-

Carditis (Inflammation of the Heart)

Increase in Heart Rate, Difficulty in
Breathing (SOB), Cyanosis, Joint Pains,
Nodules in CNS, Irritable, Slurd
Speech, Muscle Weakness.

Cardiac Diseases According to Class

1. Class 1
- No limitation to Physical Activity
2. Class 2
- Slight limitation to Physical Activity
which the patient might experience.
- Palpitation
- Dyspnea
- Fatigueability
- Angina/ Chest pain
3. Class 3
- The patient has a moderate limitation
on physical activities.
4. Class 4
- Unable to carry on Physical Activities.
Prognosis:

Class 1 and 2:
Normal pregnancy and delivery
Class 3 and 4:
Poor candidates for normal pregnancy
and delivery.

Signs and Symptoms of Cardiac Diseases:

1. Heart murmurs due to increase of

cardiac volume during pregnancy. These
are interfering sounds
2. Decrease cardiac output
3. Moist cough Danger sign
4. Congestion of the liver and other organs,
caused by the pumping of the heart and
theres not enough blood flowing from it.
5. Congestive Heart Failure

Mitral Valve Stenosis

- Narrowing of the passageway of the
mitral valve.

Diabetes Mellitus (Endocrine disorder)

- Specifically in the Pancreas.
- Impaired
Glucose/Carbohydrate
metabolism during pregnancy.
- Glucose/insulin is infected by the
hormones of pregnancy.

Congestive Heart Failure

Signs and Symptoms:

Dyspnea
Exhaustion
Edema
Chest pain
Cyanosis of the nail bed

Nursing Management for Gravidocardiacs:

th

1. Bedrest (30 week)

2. Diet (Avoid Salty foods)

Medication:

Do not put on lithotomy position to

prevent venous return.
Semi-sitting Is the best position to
facilitate respiration and blood flow.
Turn the patient to a left lateral
position to increase FHT.
Never allow the patient to push
during labor.
Never administer pills because it can
cause embolism.
Never administer oxytocin because it
can promote uterine contraction.

Points to remember:

Temperature:
Thermoregulation
function.
Respiration: Lung condition
Pulse: Goes with Blood pressure

Insulin:
Regulates
body
Glucose
th
hormone. By 10 week, the fetus also
produces
Insulin
but
cannot
compensate the Glucose.
Insulin injection is not useful during
pregnancy.
Hyperglycemia a condition where in
there is an increase of Sugar level in
the blood.
Fetal Macrosomia too large baby

A. Mother is known to be Diabetic.

B. Gestational Diabetes Mellitus

1. Digitalis
2. Iron preparation for Anemia
For Class 3 and 4:

Blood Pressure: Pumping capacity of

the Heart.

Infectious Diseases

Sexually Transmitted Disease (STD)

Syphilis (Treponema Pallidum)
- 2.4 4.8 million units of Penicillin is
given to a pregnant woman
- It can cause mid-trimester abortion
when not treated
- Babies can have congenital syphilis

Signs and Symptoms of a baby born from a

Syphilis-infected mother:
1. The baby is jaundice for the first 2
weeks
2. The baby has anemia
3. The
baby
is
having
hepatospleenomegaly (enlargement of
the liver and spleen)
4. The baby can have coppery rashes
which may appear on the palms or
soles of the feet
2

5. The baby can have deformed bones

and teeth, nose, and joints, and the
central nervous system.
Note: The Child may inherit the disease.
Drug of choice: Benadur. Its a very oily
solution.

German Measles (Rubella)

- This slows down cell membrane
production that can cause congenital
deformities.
- The baby carries Rubella virus during
the 2 years of life.

Signs and Symptoms for German Measles:

Low birth weight

Baby is jaundice
There is petechiae on skin
Thrombocytopenia and hepatomegaly
Sequele (its a defect; after birth
effect)
Eyes can have cataract
Glaucoma
Patent ductus arteriosis
Stenosis o the Heart Valve
Coartetation
Deafness (sequelese for ears)
Mute
Cleft up and dental malformation

- Acquired from the outside environment

- Can be hospital acquired.
- Aerobic Streptococci infection
- Can be acquired from coitus early after
pregnancy.
Infection of the Perineum: Endogenous
Signs and Symptoms:
Pain
Heat or warm
Feeling of pressure
Inflammation of the Suture line
Mother can/may have not fever
Treatment:
Warm compress
Sitz bath

Endometritis
- Inflammation of the lining of the uterus.

Signs and Symptoms:

Nursing Management:
1. Oxytocin management
2. Put mother in a fowlers position to
allow drainage of Lochia

Thrombophlebitis
- Inflammation of the lining of blood
vessels with Cloth formation

Post-Partum Infections

Tenderness of the abdomen

Uterus is not contracted and hard to
touch
Dark-brown foul smelling lochia

Infection of the Perineum

Infection may either be:

Primary
Endogenous or Exogenous

Endogenous (already existing in mothers

condition)
- The normal flora of the vagina is poor.
- The vagina has bacterial invasion.
Exogenous:

Signs and Symptoms:

Pain
Stiffness of affected leg
Positive Homans sign
Skin appears to be whitish shiny skin
(Phlegmasia alba dolens)

Nursing Management:
1. Bed rest
2. Elevate affected leg
3

3. Anticoagulants (Heparin)
Do not give aspirin for patients having
Thrombophlebitis

Mastitis (Streptococcus aureus)

- Inflammation of the breast tissues
- Responds to bacterial invasion

Signs and Symptoms:

Fever
Chills
Tachycardia
Body Malaise
Abdominal pain
Redness of the entire breast
Localized or generalized swelling
Warm to touch and tender

Note: Consider the proximity of the Urinary

meatus from the anus and the vaginal
orifice.
Signs and Symptoms:

Health teaching early in pregnancy

about breast care.
Clean the breast with water only.
Do not pat dry; just let the milk dry on
the breast.
Use support bra.
Teach techniques.

Using aseptic technique

Encourage ambulation (walk) to avoid
calculi formation
Increase fluid intake

Substance abuse and alcoholism

Indication: Persons blood alcohol level is .
10% and more.

Risk condition:
1. Poor fetal development
2. Congenital abnormalities
newborn
3. It can absorbed in the utero
4. Too small babies
5. Fetal death
6. Abortion

Normal Values:
Yellow to Amber yellow urine
pH ranges from 5-9, normal pH of 6.

Sound of the rushing water

Wash/splash water over the organ

If a patient has to be catheterized, prevent

infection by:

Functions of the Renal System:

Avoid unnecessary catheterization

Carefully observe signs of UTI

How to initiate urination:

Anemia
Urinary Tract Infection

1. Where waste products are excreted

2. Balance of fluids and electroytes and
H2O
3. Blood pressure regulation
4. Erythropoetic secretions
- Which stimulates the Bone Marrow in
the production of RBC.
- It can affect the Kidney function
- It can cause dehydration
- Increase in BP
- Fetal Distress

Fever
Chills
Cludy Foul Smelling Urine
Painful urination (Dysuria)
Hematuria (Blood in urine)
Frequency of urine

Prevention:

How to prevent:

It should not contain protein, glucose,

any ketone bodies, blood cells, casts
and crystals.

Rh incompatibility (Rhesys
named from a monkey.

in

factor)

the

Brought abput by:

Mother is Rh + and Father is -, thus baby
is Rh -.

Abortion/miscarriage:
termination
pregnancy prior to the stage
viability/during the first trimester.

of
of

Types of Blood is determined by the type of

protein carried by the blood.

Note that: 20 weeks is the Age of Viability @

500 grams/1.1 pounds were the fetus is able
to sustain extrauterine life.

Rh incompatibilities can cause destruction of

RBC caused by sensitization of Rh bloods.

2 Types of Abortion:

Incompatibilities can happen:

During pregnancy
After abortion
Amniocentesis
Placental abnormality
Placenta previa
Abruptio placenta
Trauma

Causes of Spontaneous abortion:

1.
-

Signs and Symptoms:

Jaundiced baby
Hyperbilirubinemia

Hemolytic diseases (Incompatibilities)

1. Rh: Americans and Africans
2. ABO:
Asians
(Milder
than
Rh
Incompatibility)

Coombs Test: This is to determine whether

there are maternal antibodies in the fetal
cord blood. It gives immunoglobulin/Rhogam
to prevent Rh/ABO sensitization.
Treatments:

Phototherapy
Early feeding to promote
secretion of waste
Exchange transfusion

Spontaneous:
Premature
expulsion/without manipulation
Induced: External factor manipulated
the abortion

fast

High Risk Pregnancy in the First Trimester (13 months)

Fetal Abnormality
Defective embryonic development
Blighted ovum
Faulty ovum implantation
Rejection
of
ovum
from
the
endometrium
Inflammation/infection/chromosomal
abnormality

2. Placental Abnormality
- Premature separation or abnormally
implanted placenta
Notes: Roles of the Placenta (Blood
supply, respiration and nutrition of
babies in utero).
-

Abnormal placental implantation

Abnormal placental function

3.
-

Maternal Factors
Infection (STD)
Severe malnutrition
Abnormalities of the reproductive
system
Example:
Incompetent
cervix
(premature dilatation of cervix).
Endocrine problem (Thyroid gland)
Trauma
Drug
abuse/drug
ingestion
(Abortifacient, meaning, drugs that
induces absorption)

Example: Cytotec,
prematurely.

dilating

4. Chromosomal Abnormalities: Trisomy

21
Signs and Symptoms of Miscarriage:

Interventions (Post-op):

Check vital signs

Evaluate bleeding
Reduce anxiety
Allow patients to express feelings
Never give reassurances
Note odor or vaginal discharges
Ease comfort
Encourage relaxation techniques
Administer medications prescribed

Types of Abortion:
1. Threatened Abortion: experiencing signs
of abortion of pregnancy.
Signs and Symptoms:
Mild bleeding/vaginal spotting
Cramping/pain but cervix is close
Nursing care:

Signs and Symptoms:

Patients

Describe the bleeding, pain and

location
Ask have you passed out anything?
and ask to keep it.
Dilatation and Curettage: Surgical
procedure to remove the fragments
left.
Watch for signs of infection.

Increase Fiber intake not to constipate

Monitor Vital signs
Vulvar care

2. Inevitable Abortion: no one can stop.

Impossible to continue pregnancy.

Uterine Cramping
Vaginal Bleeding: Starts from a dark
spotting to a frank pain (tolerable)
Elevation of BHCG
Placental Fragments

Intervention/Nursing
care
for
manifesting signs for Abortion:

cervix

Moderate bleeding
Painful cramping
Cervix is dilated
Ruptured membrane

Nursing care

Emotional support
Prevent infection
Maintain adequate fluid volume

3. Imminent Abortion: on the process of

abortion
Signs and Symptoms:
Dilated cervix
Presence of uterine contraction
Stages of Uterine contraction
1.
2.
3.
4.

Cervical Dilatation
Fetal Expulsion
Placental Expulsion
1 hour after Placental Expulsion
- Note for bleeding because of Uterus
relaxation and Uterine atony in this
phase.
Nursing Care:

Check for Uterine contraction

Suspect for what has come out (fetus
or placenta).

Assessment:
1. Assess for Vaginal bleeding
2. Assess
for
passage
of
Tissues
(Inspection)
3. Assess for Uterine Contraction

Bed rest
6

(Note: For the 1ST Trimester, measure 3

Fingerbreadths below the umbilicus;
Cramping is experienced)
4. Assess for haemorrhage and shock.
- Can be measured with the use of
Napkins. 500 cc or more of blood/3-4
Napkins soaked with blood is an
indication of Haemorrhage.
5. Check Lab. Results
- A drop of WBC count is a poor
prognosis.

Methotrexate: causes of separation of the

fetus and the placenta from the lining of the
uterus. It is used in therapeutic abortion
(also
in
the
treatment
of
cancer).
Administered via Injection.
Signs and Symptoms:

Signs and Symptoms:

Dropping down of Blood Pressure

Cold perspiration
Disoriented
Pupils are dilated

Misoprostol (Cytotec): Treatment for ulcer. IIt

is orally/vaginally inserted for Uterine
Contraction.
Signs and Symptoms:

Nursing Diagnosis:

Fluid deficit related to Vaginal

bleeding/vaginal haemorrhage
Anxiety related to fear of loss of a
child
Pain related to uterine contraction

Implementation/ Nursing Intervention:

1. Record and monitor blood loss
Example: Count # of napkins
2. Monitor Vital signs
3. Monitor Contraction
4. Stay with the client and provide
comfort
5. Allow patient to discuss feeling
6. Never give prognosis
7. Touch patient (therapeutic technique)
and explain
8. Teach relaxation techniques
9. Never give false assurance
10.Give meals as prescribed by the
doctor
Therapeutic Abortion/Medical Abortion
- Saving the life of the mother by using the
child voluntary abortion. Ex: If the mother
has a heart disease/chicken pox/measles
during the 2nd semester.

Cramping
Heavy Bleeding
Nausea and Vomiting
Diarrhea
Fever

Cramping
Nausea and Vomiting
Diarrhea
Infection

High Risk Pregnancy on the 2nd Trimester

H-mole (Hydatidi form mole): is a

trophoblastic disease (molar pregnancy).
- A disease which is considered as a
complication because of the presence of
the hormones of pregnancy (HCG)
- Rounded grape-like appearance clusters
coming out from the Vagina.

Cause of H-mole: Chorionic Villi (Placenta)

does not develop correctly.
Assessment:
1. Assess for FHT (Audible In 5th month)
2. Assess for Vaginal Bleeding: Bright
red/ dark brown (slight/ profuse/
intermittent)
3. Assess for Vital Signs because of
increase of BP, Edema (fluid retention)
and proteinuria
Edema: Fluid Retention
Types of Edema:
7

1. Pedal edema:
Edema + (Edema at the level of
the feet)
Edema ++ (Edema @ the level of
the knees)
Edema +++ (Upper and Lower
extremities)
2. Anasarca: Edema ++++ (Extremities
to face)
Signs and Symptoms:
Pit (Excavation)
Bigger than the expected size
Elevated HCG
Cloudiness during ultrasound
Nursing Diagnosis Samples:

Signs of Shock:

Systole: Opening of the valves of the

heart
Diastole: Closing of the valves of the
heart
BP: Pumping ability of the heart

1. Assess for pain

2. Assess if patient is Nauseated and
Vomiting
3. Assess for Vaginal bleeding
4. Assess for fever
5. Assess of patient is tachycardic
6. Leukocytosis
7. Decrease in Hemoglobin level
8. Decrease in Hematocrit level
9. Shock

Ectopic Pregnancy: implantation in the

Fallopian tube/can be in the abdomen,
cervix and ovarian fimbrae (invites the
sperm)

Structural factor:
- Defect in the fallopian tube and the egg.
- Poor fimbrial action
- Tubal motility is poor
- Menstrual reflux (something going back)
Functional factor

Signs and Symptoms:

Ectomy: Removal
Otomy: Open
Ostomy: Open, remove, close

Assessment:

Causes:

Anteverted: Normal
Anteflex: Normal
Retroverted: Backwards
Retroflex: Inverted

Points to Remember:

Notes:

Drop of Blood pressure

Rapid RR
Light Headedness
Increase of PR (>100)
Concealed bleeding (di lumalabas)
Couvelaires
uterus
(copper-colored
uterus and no ability to contract)

Remember that a Uterus can be:

1. Alteration in sleep/rest pattern related

to anxiety
2. Anxiety related to fear
3. Fear related to loss of child
Burburigmus sound: Intestinal Sound when
hungry

Pains are severe, sharp, knife-like

stabbing pain
Rigid abdomen (hard)
Positive Cullens signs (bluish umbilicus)
Excruciating pain during I.E.

Implementation:
1.
2.
3.
4.

Do pain scale immediately.

Check for the Vital Signs
Monitor Bleeding
Prepare for Surgery, if there is rupture

Hyperemesis Gravidarum
- Monitor fluid volume
8

Record for the # of times the Patient

vomited
Amount of vomit
Frequency of vomit

Nursing Interventions:

High Risk Pregnancy in the 3rd Trimester

1.
2.
3.
4.

2. If the cervix has already dilated to

4 cm.
3. If the BOW (Bag of Water) has
already ruptured.

Let the patient eat Crackers

Give Ice chips
Drink Soda
Administer IV Fluid replacement as
prescribed.
5. Bed rest
6. Isolate the patient free from draft
(stimulus
such
as
noise,
poor
ventilation, light, dust etc.)

Causes:

Premature Cervical Dilatation

- Dilatation of the cervix earlier than
the active labor.

Abruptio Placenta:
- The placenta separated prematurely.
This is life threatening.

Cause: Incompetent cervix

Signs and Symptoms:

1. Repeated painless abortion
2. Early
progressive
effacement
dilatation
3. Bulging of the membrane through the
cervix

Signs and Symptoms:

Implementation:
1. Fetal Heart Tone
2. Check/monitor Vital signs
3. Provision of the adequate bed rest
Left-lateral,
semi-trendelenburg
position (pillow under buttocks)
4. Prepare for cervical procedure
5. Circlage: procedure so that the cervix
is not open.
- McDonald (temp): Tie cervix and if
in labor, remove the string.
- Shirodskar:
Tie
the
cervix
permanently.
Rules
when
permitted:

McDonalds

is

not

1. Hyperirritability of the cervix: If the

fetus has died in the utero.

Maternal Hypertension
Toximias of Pregnancy
Increased in size and increase of # of
parity
Sudden release of Amniotic fluid
Mother has short umbilical cord
Umbilical cord must be straight, firm
and with wartons jelly @ 25 inches
long.
Hyperbilirubigenemia
Trauma

Abruptioplacenta
Painful vaginal bleeding
Sharp, knife-like stabbing pain in the
fundal area
Hard-rigid abdomen
Board-like uterus

Implementation:
1. Determine the bleeding whether
concealed or external.
2. Assess for shock.
3. Assess for fetal development.
8-9 movement/day is normal
Causes:

Old mother
History of previous abruptio placenta
Myoma
Heaby alcohol use
Malformation of Placenta
Injury of Abdomen
9

Placenta Previa: Abnormal placenta

implantation
- When it implants abnormally in the
areas such as the cervix and isthmus.

1. Total Placenta previa: covers the entire

cervix.
2. Placenta
previa
partialis/partial
placenta previa: partially coverin the
cervix but there is small way in the
cervix.
3. Marginal placenta previa: at the side
of the cervix.
4. Low-lying placenta previa
Causes:
Multiparity (Multiple # of Childbirth)
Painless bleeding (bright red)
Uterus remains to be soft
Unstable FHT

Bandles Ring: Physiologic ring indicating a

contracting area of the uterus.
Causes:

Abruptio
Placenta
First to detach

Placenta
Previa

Dark Red
Hard
Painful

Bright Red
Soft
Painless

Detachme
nt
Bleeding
Uterus
Pain
Complications:

Factors:

Hours of
Labor
Effacement
Dilatation

Primipara
10 hours

Multipara
8-10 hours

100%
10 cm

- No contractions but the Bag of Water have

already ruptured.
Causes:

80%
8 cm

malpresentation

of

Cigarette Smoking
Coitus
Amniocentesis
Incompetent cervix

Preterm babies (early delivery)

- Before it reaches the 38th week or
before the completion of the 37th week.
DEFIERE: Descent, Engage, Flexion,
Internal Rotation, Extension, Restitution,
External Rotation.

Reasons for Dystocia:

Malposition/
passenger.

Multiple deliveries (multipara)

Small baby in good position
Large pelvis
Too much Amniotic fluid

2. Premature rupture of the membrane

1. Dystocia: Difficulty in labor

Hypotonic contraction: shows that the

uterus does not contract enough to cause
dilatation.
Hypotonic
contraction:
shows
fast
ineffective contractions.

1. Precipitate labor/delivery: 1st hours of

labor, the mother has delivered the baby.

Do ultrasound
X- Ray

AP VS. PP

Theres something wrong with the

passageway of the baby.
Theres something wrong with the psych
of the mother.
Power to push.

2 Mechanisms:

To know if Placenta Previa:

-

Types of Placenta Previa:

1.
2.
3.
4.

the

Persistent Occiput Posterior (POP)

10

- Arrest of the Fetal head. The fetus

cannot be expelled because the baby
cannot internally rotate.

Causes:
1. Maternal factors:
- Toximias of Pregnancy
- Mother with Chronic medical disease
- Maternal infertility (E.g.: STD)
- History of Preterm birth
- Incompetent cervix
- Drug/alcohol user
2. Fetal factors:
- Unhealthy fetus
- Multiple gestation
Erythroblastosis
fetalis:
Rh
incompatibility
- Pregnancy (Abruptio, Previa, PROM)

Causes of Fetal Distress:

Low dull back pain

Tightening sensation in the thighs
Pelvic pressure
Vaginal bleeding/spotting

Tocolytic drugs: To inhibit labor

This is only given when:
- There is no bleeding
- No increase in temperature
- No cervical increase > 4 cm
- Effacement is > 50%
Reasons to continue delivery:
1. 37 weeks of pregnancy
2. Rupture of the BOW occurred
3. Maternal disease exists
4. Rh incompatibility
Post-term babies (290 days)
- Greater than 260-280
weeks.
- Unknown cause

1. Monitor Heart Rate

2. Turn the patient into left lateral
position to increase the oxygen supply
as well as increase the pressure on the
left side of the heart to increase
oxygenation in the right side of the
heart.
3. Semi-sitting position to increase
respiration
4. Monitor uterine contraction
5. Relieve stress and anxiety
Types of Twins:
1. Identical Twins: Identical/monozygotic:
One egg and it splits after conception
-Same sex, same eye color, hair color,
looks-alike, same blood tyoe.
2. Nonidentical/fraternal twins: Dizygotic.
Trizygotic (3 fertilized egg)

days/38-40

Ultrasound can detect AOG through the

breadth circumference. It can also dtect
the age of the placenta/placental grade.

Fetal distress related to cord compression

Hypoxia related to insufficient cord blood
flow

Implementation:

Medical Management:

Hypoxia: Decrease of 02 supply

Cardiac abnormality of the Mother
Mother
undergoing
respiratory
dysfunction
Hypertensive mother
If the mother undergoes a surgery,
general anaesthesia was done
An increase or decrease of FHT can cause
fetal distress indicating a meconium
stained amniotic fluid

Nursing Diagnosis

Signs and Symptoms:

Fetal distress: Signals that there is

something wrong with the fetus heart
rate.

PROM (Premature Rupture of Membrane)

Amniotomy: Artificial rupture
Amniotome: Tool used for Amniotomy
Complications
11

LGA (Large for Gestational Age)

Placenta Previa
Abruptio Placenta
Fetal Distress

Hemorrhage
Types of Haemorrhage:
1. Mild Haemorrhage: 15-25% of Blood
loss.
2. Moderate Haemorrhage: 25-35% Blood
loss.
3. Severe Haemorrhage: 50% of Blood
loss.
Vaginal Bleeding

Color
Clotting

Dark red
Doesnt easily
clot

Laceration
Bleeding
Bright red
Easily clots

3. Fore-lying: Can be felt but not visible

during the IE. It comes out together
with the head.
Reasons of Cord Prolapse:

Remember to deliver the baby ASAP so that

the cord will not dry up.
1. Put baby in a Trendelenburg position
(Upper extremities higher than the
baby) to relieve pressure of the
presenting part.
2. Keep the cord moist to avoid infection
by wrapping it in a clan towel at a
certain amount of water to keep it
moist.
3. Check FHT.
4. Dont pinch or squeeze the cord.
5. No to O2 inhalation per doctors order.
6. Explain to the mother.

Factors that affect Haemorrhage:

A. Maternal Factors:
- Dystocia
- Hypertension
Vaginal Laceration
B. Placental Factors:
- Placenta Previa
- Abruptio Placenta
- Retained placental fragments (which
can cause further bleeding)

Risk Factors of Cord Prolapse:

Nursing Diagnosis:

Fluid volume deficit related to Vaginal

bleeding
Pain related to postpartum delivery
Potential for shock related to blood
loss
Prolapse of the Umbilical Cord (Cord drop)

3 Types of Cord Prolapse:

1. Complete: Very visible cord during the
IE and evident changes in FHT.
2. Occult: Cord is not visible. It is
between the cervical lining and the
head of the fetus.

PROM
Very long umbilical cord
Abnormal fetal presentation
Prematurity
Polyhydramus: cord with the rushing
of H2O.

Infection: To avoid it, wash it with 1

tbsp of coconut vinegar and 1 tabo of
Water.

Uterine Rupture
Causes are the following:
Rapid delivery
Unsupported delivery
Fundal push
Untimely delivery of the Placenta
Suture lines who have undergone CS.
Multiple Pregnancy

Risk Factors of Uterine Rupture:

Bleeding
Shock
State of disorientation

Nursing Interventions:
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Uterine Inversion
Check for the Doctors order and look
for an IV immediately and call
laboratory for blood typing. Cross
matching
for
immediate
blood
replacement.
Dilatation and Curettage

Complications:

Amniotic fluid embolism: Amniotic

fluid goes into the blood stream and
blocks
the
wall
and
causes
obstruction. Manifested when the
mother sits down and there is difficulty
of breathing.

Nursing Intervention:

Observe the amount of bleeding by

counting how many napkins have
been soaked.
Position in Trendelenburg position.

Immediately inform the doctor about

the patients complaints.

Amniotic Fluid and its complications

during intrapartal stage
1. Hydramius: too much amniotic fluid
(polyhydramius) There is something
wrong in the swallowing of Amniotic fluid
by the baby.
Amniotic fluid is 500 ml (normal),
colorless, slightly milkfish and contains a
tinge of bilirubin.
Its functions are for:
- Protection
- Termperature control
- Nourishment
Causes: Diabetic mother
Signs and Symptoms:
Gastrointestinal abnormalities
Abnormal swallowing
Heart failure
Congenital infection in the newborn
Composition of the Amniotic fluid:

Fetal urine
Tinge of Bile
Lanugo
Squamous layer of the skin

Amniotic fluid can be Meconium stained:

A. Because of the relaxation of the Anal
sphincter.
B. Pressure in the GI tract
2. Oligohydramous: Less than 500 cc
amniotic fluid (Poor absorption of the
child)
Implementation:
1. Bed rest with slightly elevated head
2. Check Vital signs
3. Check edema of the Lower extremities

Pregnancy Induced hypertension (PIH)

Toximias of Pregnancy
Vasospasms during Pregnancy
Only during Pregnancy (Duh)

High Risk for PIH:

Primipara
Younger than 20 and older than 40
Socioeconomic background (poor)
5 or more pregnancies (multiple
pregnancies)
With Renal diseases
With Cardiac diseases
Types of PIH:
1. Mild HPN/Pre-eclampsia
Factors: HPN with Proteinuria and/or with
edema but no convulsion
Signs and Symptoms:
- Elevated Blood pressure
- Systole> 20 mmHg and the Diastole > 15
mmHg
- Generalized edema (anasarca)
- Proteinuria
- Weight Gain
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2. Severe Pre-eclampsia
- Systole > 160 mmHg and the Diastole >
110mmHg
- HPN with Proteinuria with Edema with
Visual disturbance and severe headache
3. Eclampsia
- Blood pressure of 200/110 mmHg
- With convulsion, tremendous weight gain,
epigastric pain and elevated temperature
TRIAD OF PIH
1. Proteinuria: Protein in Urine
2. Oliguria: Scanty urine within 24 hours
3. Albuminuria: Albumin in the Urine
Implementation for PIH;
Check Vital Signs
Check urine output
Provide safety by putting side rails
Provide tongue depressor for convulsion
Provide adequate bed rest
Medical Management:
Hydralaxine (apresoline)
- It does not affect the fetus and affects
the mother
Post-partum complication
1. Haemorrhage: Most common
A. Early Post-partum: 1st 24 hours
B. Delayed Post-partum: After 24 hours
Causes:
Uterine Atony: complete relaxation of the
uterus
-Prolonged labor
- Overly managed uterus
- Overly distended abdomen
- Use of Oxytocin

Note: Use of oxytocin can cause

Haemorrhage if the mother is hypertensive
and contraction is hypertonic.
2. Uterine Atony: Exhausted uterus.
Causes:
Multiparity
Multiple gestation
Polyhydramius
Factors:
Overused pipocin.
Methyl ergonatime Maliate: Most
commonly used Oxytocin.
Excessive use of Analgesic and
anaesthesia
Chromioamnionitis
To

avoid Uterine Atony:

Good Nutrition
Good prenatal check-ups
Early management of Complications
Avoid massaging the Uterus

Internal Podalic Version: Putting the baby in

the right position before delivery.
3. Laceration of the Reproductive Tract
There are 3 Types of Laceration:
1. 1st Degree Laceration: limits only in
the skin and the mucous membrane
2. 2nd Degree Laceration: Skin, mucous
membrane and muscle
3. 3rd Degree Laceration: Skin, mucous
membrane, muscle, rectal sphincter
Episiotomy: Right mediolateral episiotomy
(RMLE)
Perineal Hematoma: Accumulated blood
because of overmanipulation.

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