Obstetrics Perfusion IssuesF. Thomas, PhD, RN

Placenta Previa

• Implantation of the placenta I the lower uterus

Classifications

• Marginal• Partial• Total

In what group is previa more common!

Classic Sign

Collaborative Management

• 1. Evaluate the amount of hemorrhage• 2. Electronic fetal monitoring to evaluate fetus• 3. Fetal gestational age

• Conservative management if• Mother’s CV status is stable• Fetus is immature• Reassuring pattern

• What are the advantages to delaying birth?

Home Care Considerations

• No evidence of active bleeding• Maintain bed rest at home• Home location is reasonable distance form hospital• Woman and family can verbalize understanding of risks

Inpatient Care

• Assessment of bleeding• Signs of preterm labor• Periodic electronic fetal mentoring

Excessive Bleeding

• Delivery of fetus• How??

Abruption

• Separation of the Placenta before delivery

Causes

• Cocaine Use• Maternal HTN• Cigarette smoking• Short umbilical cord• Trauma• PROM• History of previous separation

Manifestations

• Bleeding Types• Uterine tenderness• Uterine irritability• Low back or abd. Pain• High uterine resting tone• Other

Major Concerns

• Woman feels powerless and frightened• Fetal hypoxia

Assessment

• Nature of bleeding• Pain• Maternal and fetal vital signs• Condition of fetus• Contractions• Obstetric history• Length of gestation• Lab data• Ultrsasound

Management

• Emergency: need to go to ER and admitted• Focus on CV status of Mother and condition of fetus• Mild condition• Delivery

Interventions

• Monitor for hypovolemic shock• Monitor fetus• Promote tissue oxygenation• Collaborate with health care provider for fluid replacement• Prepare woman for surgery• Emotional support

Critical to remember!

Ectopic Pregnancy

• Called disaster of reproduction

Causes

• Scarring from pelvic infections• Failed tubal ligation• History of previous ectopic pregnancy• Assisted reproduction• IUDs• 40% of EP occur with no identified risk• Delayed or premature ovulation

Manifestations

• Classic• Subtle• Rupture

Diagnosis

• Transvaginal Ultrasound• Beta-hCG is at low levels than expected• Gestational sac cannot be seen• Maternal serum progesterone levels• High resolution transvaginal US • Laproscopy

Management

• Goal• Improve future fertility and preserve the tube

• Medical• If tube is unruptured• Use Methotrexate inhibits cell division

• Surgical• Unruptured involves a linear incision (salphingostomy)• Ruptured requires salpingectomy

Nursing

• Prevention or early identification of hypovolemic shock• Monitor for S/S of rupture• Pelvic and shoulder pain**• Neck pain• Dizziness• Vag bleeding

• Analgesics• Teach SE of Methrotrexate• Emotional support

Hemorrhagic Conditions of Late Pregnancy• Assessment Data

Planning

Monitor for S/S of hypovolemic shock

Interventions

• Monitor for S/S for shock: You know these already!!• Fetal monitoring• Promote tissue Oxygenation• Collaborate with practitioner to replace volume• Prepare for surgery• Emotional Support

• Evaluation