Management of Physiological anemia

• Rest
• Monitor CBC often
• Iron supplement
• Vita B12,6
• Prenatal Check up regularly
• Report should vaginal bleeding occurs – for preterm labor
• Oxygen therapy
• Nutrition
• Encourage client to eat Iron rich food such as organ meats, liver, green leafy vegetables,
sweet potato leaves. – for increasing the production of RBC

Hyperemesis gravidarum – excessive vomiting during pregnancy

DEFINITION
- Hyperemesis gravidarum is defined as unexplained intractable nausea, retching, or vomiting
beginning in the first trimester, incapacitates her in day-to-day activities or sufficient to warrant
hospital admission resulting in dehydration, ketonuria, and typically a weight loss of more than
5% of pregnancy weight.

Etiology
1. Hormonal:
- high human chorionic gonadotropin (HCG) stimulates the chemoreceptor trigger zone
in the brain stem (medulla oblongata) including the vomiting center in the conditions
where the HCG is high as in:
a. early in pregenancy
b. vesicular mole and
c. multiple pregnancy
• High levels of beta-hCG
• High placenta weight
• Psychological and family aspects
Excessive vomiting that persists beyond 1st trimester contains:
- previous food intake
- mucus
- bile
- finally blood. – if the capillaries is already damage
Predisposing factors
- pancreatitis
- biliary tract dse
- decrease Vit B6
- psychological
- drug toxicity Increase HCG hormone
- pregnancy
- multiple pregnancy
- hydatidiform mole
- heredity
- female
Diagnostic Test
- CBC
- Serum Electrolytes Test
1. Serum Potassium
2. Serum sodium
3. Serum Calcium
4. Serum Magnesium
- Albumin – for protein
- serum Creatine – if may problem sa kidney
- BUN
- ABG – problem in acid base balance
- UA

COMPLICATIONS
Maternal
Hypokalemia
Hyponatremia and central pontine myelinosis
Wernickle’s encephalopathy
Vitamin B6/B12 deficiency
Malnutrition
Matlory – Weiss esophageal tears
Venous thromboembolism
Psychological morbidity
Fetal
Growth restriction
Wernicke’s encephalopathy is associated with 40% fetal death
NURSING DIAGNOSIS OF HYPEREMESIS GRAVIDARUM
➢ Actual/Potential Fluid Volume Deficit

➢ Imbalance Nutrition; less than Body Requirements

➢ Fatigue

➢ Ineffective Coping

➢ Anxiety

Hydatidiform Mole
- H- mole
- Molar Pregnancy
- it is a grape-like structure that form without a baby
Table 1 : Clinicopathologic features of hydatidiform mole
Molar Pregnancy type Pathological features
Complete mole Diploid (45, XX; rarely 46. XY)
Absent fetus/ embryo
Diffuse swelling of villi
Diffuse trophoblastic
hyperplasia
Partial mole Triploid (69, XXY, 69, XXX)
Abnormal fetus/embryo
Focal swelling of villi
Focal trophoblastic
hyperplasia
Clinical factors
Vaginal bleeding
Large for dates uterine size
Bilateral theca lutein cysts
Medical complications
HCG often> 100,00 mIU/ml
15 to 20% postmolar GTN
Pre- D and C diagnosis usually
incomplete or missed
abortion
Medical complications rare
HCG rarely > 100,000
mIU/mL
<5% postmolar GTN
Signs and symptoms of H-Mole
• Vaginal bleeding
• Uttering enlargement is bigger than usual pregnancy
• Increase HCG
• Hyperemesis gravidarum
• No FHT/fetal movement

Complications of hydatidiform mole

• Pulmonary complications
- ARDS
- trophoblast embolization – when the trophoblasts will be dislodge and
goes to maternal circulation
• Hemorrhage, uterine perforation
• Thyroid storm
• PIH
• Symptomatic theca lutein cysts
• Malignant sequelae
TREATMENT

• Hydatidiform mole treatment consists of two phases:

• The first is immediate evacuation of the mole,
• The second is subsequent evaluation for persistent trophoblastic proliferation or
malignant change.
- Computed tomography or magnetic resonance imaging to evaluate the liver or brain is
not performed routinely.

- Suction dilation and curettage: to remove benign hydatidiform moles

When the diagnosis of hydatidiform mole is established, the molar pregnancy should be
evacuated
- An oxytocic agent should be infused intravenously after the start of evacuation and continued
for several hours to enhance uterine contractility

Management of H Mole
• Suction evacuation
• Dilation and curettage
• Hysterectomy – removing of the uterus
• Methotrexate: use to stop the rapid growth of H mole
 Nursing Care
• Post D & C
• Monitor for VS q 15 mins for2 hours
• Assess for vaginal bleeding
• Keep Uterus contracted: Massage, ice pack
• Administer Oxytocin post surgical evacuation of Molar
• Administer Antibiotics, prevents infection
• Assessment for shock and infection
• Hydration : IVF
• I &O
• Perineal Care
• Administer Methotrexate

Health Teachings
•Counseling with the client and partner must be done
•Instruct the client about the HCG monitoring schedule
•HCG test monitoring is done to ensure that there was no H mole left in the uterus
•If Still +, another D & C will be done
•Monitoring will last until negative HCG ( a year & more)
• avoid conception while on HCG monitoring as baby in pregnancy with H mole will be
compromised
•Teach about Contraception while on HCG monitoring
•only when the client test negative for HCG will she allowed to get pregnant again, this ensure
safety of the mother and baby
•Comply with HCG monitoring strictly
•Instruct to take Methotrexate as ordered as home medications while on HCG monitoring.
Placenta Previa
- implantation of the placenta at the lower uterine segment
Risk factors pf placental Previa
• Advanced maternal age
• Scared vascularized uterus -
• Multiparity
• Placental abnormality
• Previous uterine surgery – because the previous uterus will create scarring
• Breech and transverse position -
• Endometrial abnormality – if there is hyperplasia or excessive multiplication of the layer
In the uterus
• Post CS/ surgery
• Infection of endometrium
• Large placenta

Signs and Symptoms of Placenta Previa

➢ Painless bright red bleeding – arterial bleeding means naga acarry ng oxygenated blood

➢ Recurrent and heavier as pregnancy progress

➢ No uterine contraction

HALLMARK SYMPTOM: Painless bright red bleeding

Management of placenta
1. – bed rest – elevated foot/ Trendelenburg position
- no sexual contact
- avoid stress
- report if bleeding occurs

2. Steroid- dexamethasone which it hasten lung maturity (5,6.7 month of pregnancy)

- tocolytic – no oxytocin and we give duvadilan -hold the uterine contraction and
promote uterine relaxation
- no sexual contact
- bed rest
3. Delivery, CS, NSVD
Placenta previa Care
P-ainless bright red bleeding
R-eplace blood loss
E-vident in lower segment
V- itals indicative shock – hypotension, tachycardia, tachypnea
I- inspect FHR
A- void vaginal exams

Nursing care
• bed rest with out BRP, provide bed
• hooks client to EFM
• strictly no internal exam
• shock block position of the bed
• monitor for uterine contraction
• monitor fir FHT; fetal distress
• monitor for dilatation effacement
• monitor for vaginal bleeding
• watch out for RBOW
• Start IVF
• Incorporate Duvadilan as sidedrip to the IVF
• Check cardia rate before starting duvadilan drip as it may increase the heart rate