Abnormal Obstetrics Edited

8/4/2019 Abnormal Obstetrics Edited

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ABNORMAL OBSTETRICS

RISK FACTORS ASSOCIATED WITH PREGNANCY BLEEDING COMPLICATIONS IN PREGNANCY

First Trimester AbortionEctopic Pregnancy

Second Trimester Hydatidiform MoleIncompetent Cervix

Third Trimester Abruptio/Ablatio PlacentaPlacenta Previa

HYPERTENSIVE DISORDER IN PREGNANCYGestational HypertensionChronic HypertensionPregnancyInducedHypertension

>Pre-eclampsia>Eclampsia

METABOLIC DISORDER IN PREGNANCY>Diabetes Mellitus

MEDICAL CONDITIONS COMPLICATING PREGNANCY>Heart Disease>Anemias>Infertility

Risk Pregnancy is a pregnancy with a pre-existing or developing condition thatthreatens the progression of the pregnancy, labor and delivery of a healthy terminfant.

Risk Factors are characteristics or circumstances of a person or group that areassociated with an increased risk of developing or affected by a morbid process.

At Risk Individual is a person with an increased expectation of disease orcomplication.

Risk Factors associated with Pregnancy: Maternal age factor

Teenage pregnancy of 16 yrs. and below is considered a high risk pregnancyfrom both physical and psychosocial standpoint

Physical Because of the physical task of adolescence

Rapid growth during adolescence Rapid growth of the fetus

Psychosocial Lack of motivation Denial Ignorance Rebellion against authority

Failure to complete education Dependence on others for support Failure to establish a stable family life High rate of marital failure High incidence of repeated out of wedlock pregnancy

Risk Factors associated with Pregnancy: Advanced age of 35 yrs and above is a high risk of pregnancy because of

increased incidence of :


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Placenta previa Chromosomal abnormalities Abruptio / Ablatio placenta Hypertension Toxemia

Low birth weight babies

Parity First pregnancy is the period of highest risk

Second / Third and Fourth pregnancy the risk of death for the mother is at itslowest

Fifth pregnancy marked increase especially when the pregnant mother is over 40 yearsof age.

Civil status and Cultural groups

Unwed mothers and widow Difficulty in providing financial support

Inability to give personal care

Cultural minorities lack information about Sexual behavior Marriage and family life Parenthood and pregnancy responsibilities Nutritional inadequacies Absence of immunizations

Lack of prenatal care

Socioeconomic Status

Poverty the frontrunner of societal ills which stem directly or indirectly the riskfactor of pregnancy

Lack of money is the principal cause of low birth weightinfants that influence morbidity and mortality rate.

COMPLICATIONS OF PREGNANCY

A. FIRST TRIMESTER BLEEDING:1. ABORTION

- THE EXPULSION OF THE PRODUCTS OF CONCEPTION BEFORE THE AGE OFVIABILITY ( FETUS CAN SURVIVE EXTRAUTERINE LIFE)

- FETUS IS LESS THAN 20 WEEKS OR LESS THAN 500 GRAMS

Abortus a fetus that is aborted before it is 500 gms in weight

Blighted ovum a small macerated fetus, (sometimes there is no fetus) surroundedby a fluid inside an open sac

Maceration a dead fetus undergoing necrosis

Fetus Papyraceous a fetus that is so dry that it resembles a parchment

Lithopedion a calcified embryo Occult pregnancy refers to those zygotes that were aborted before pregnancy is

diagnosedCAUSES OF ABORTION:1. ABNORMAL DEVLOPMENT OF THE ZYGOTE WHICH WOULD HAVE RESULTED IN SEVERECONGENITAL ANOMALIES2. ABNORMALITY IN THE IMPLANTATION PROCESS - IUD3. TRAUMA PSYCHOLOGICAL, PHYSICAL4. HORMONAL IMBALANCE ( LOW PROGESTERONE)5. INTAKE OF DRUGS CYTOTEC6. INFECTIOUS DISEASES GERMAN MEASLES, PTB, HERPES


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7. PRESENCE OF VENEREAL DISEASES8. ABNORMALITY IN THE REPRODUCTIVE SYSTEM INCOMPETENT CERVIX8. SEVERE MALNUTRITIONEARLY ABORTION HAPPENS BEFORE 16 WEEKSLATE ABORTION HAPPENS BETWEEN 16 20 WEEKS

Types of Abortion: SPONTANEOUS - UNINTENDED TERMINATION OF PREGNANCY AT ANY TIME BEFORE

THE FETUS HAS ATTAINED VIABILITY.

THREATENED POSSIBLE LOSS OF THE PRODUCTS OF CONCEPTIONS/SX: SLIGHT BLEEDING; MILD UTERINE CRAMPING BUT NO CERVICAL DILATATION ON

VAGINAL EXAMINATION; NO PASSAGE OF TISSUE

Management: Bed rest Save all pads No coitus up to 2 weeks after bleeding has stopped

INEVITABLE OR IMMINENT ABORTION- is a loss of pregnancy that cannot be prevented.Clinical Manifestations:

Moderate to profuse Bleeding

Moderate to severe uterine cramping Cervix dilated Membranes rupture

Management: Hospitalization D & C Oxytocin after D & C Emotional support

TYPES OF INEVITABLE ABORTION:

1) Complete all products of conception are expelled.

Sxs of complete abortion: Moderate bleeding Mild uterine cramping Passage of tissue

Management: Sympathetic understanding & emotional support

2) Incomplete not all products of conception are expelled from the uterus.Signs and Sxs:

Profuse vaginal bleeding Severe uterine cramping Open cervix Passage of tissue Other products are retained

Treatment and MX: D and C Oxytocin after D & C Emotional support Missed Abortion

Retention of all products of conception after the death of the fetus in theuterus

S/Sx:- No FHT


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- Signs of pregnancy disappearManagement:

D & C Septic Abortion

Abortion complicated by infectionS/Sx:

-

Foul smelling vaginal dischrage- Uterine cramping- Fever

Management:- Treat abortion- Antibiotics

HABITUAL OR RECURRENT PREGNANCY LOSS SPONTANEOUS ABORTION IN THREE ORMORE SUCCESSIVE PREGNANCIES USUALLYDUE TO INCOMPETENT CERVIX.

B. Induced Abortion is an intentional loss of pregnancy through directstimulation either by chemical or mechanical means.

Types of induced abortion:1)Therapeutic abortion to preserve the life of the mother2) Elective abortion

Reasons for Induced Abortion: Therapeutic to end a pregnancy that is life threatening to the mother To end a pregnancy of a fetus found to have severe congenital abnormalities that

may be incompatible with life To end an unwanted pregnancy that is a result of rape or incest To end a pregnancy because of womans choice not to have a child yet

Prevention of abortion: Prepregnancy correction of maternal disorders Immunization against infectious diseases Proper early antenatal care Treatment of pregnancy complications Correction of cervical incompetency

Complications: Hemorrhage Sepsis Rh sensitization

ECTOPIC PREGNANCY- ANY PREGNANCY THAT OCCURS OUTSIDE THE UTERINE CAVITY. ---SECOND LEADING

CAUSE OF BLEEDING IN EARLY PREGNANCY.TYPES:

1. AMPULAR 4. CERVICAL2. INTESTINAL 5. ABDOMINAL3. OVARIAN

Predisposingcauses: Salpingitis Peritubal adhesions Previous ectopic pregnancy Previous tubal surgery Multiple previous abortion Tumors that distort the tubes External migration of the ovum Intrauterine device (IUD)

Signs and Sxs:


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Vaginal spotting or bleeding Cul de sac mass Absence of amniotic sac Amenorrhea or abnormal menstruation followed by slight uterine bleeding

Signs of tubal rupture:

Severe sharp knife like pain in the lower quadrant of the abdomen Abdominal rigidity Nausea and vomiting Low hgb. And hct. Sharp localized pain in the cervix on internal examination ( wiggling sign)

Signs of hemorrhage :

- Cullens sign bluish discoloration of the umbilicus due to the presence of bloodin the peritoneal cavity-Hard or rigid boardlike abdomen

. Signs of shock:- Falling BP, rapid pulse- Light headedness- Pallor

- Cyanotic nail beds- Cold clammy skin

Diagnostic Aids: Culdocentesis aspiration of bloody fluid from Cul de sac of Douglas Ultrasound reveals presence of the gestational sac outside of the uterine cavity

Treatment and management: If not yet ruptured:

Salpingostomy removal of a conceptus less than 2 cm located at the distalportion of the fallopian tube by performing a linear incision over the ectopicpregnancy. The conceptus will extrude from the incision & removed manually.

Salpingotomy longitudinal incision is made over the ectopic pregnancy &the conceptus is removed using forceps or gentle suction

Fimbrial evacuation removal of the conceptus by milking & suctioning ofthe fallopian tube

If ruptured:- removal of the ruptured tube because the presence of a scar if tube is

repaired & left can lead to another tubal pregnancy.Surgical treatment:-Salpingotomy-Salpingectomy removal of the oviducts

Prevent and treat hemorrhage which is the main danger of ectopic pregnancy. Blood transfusion Place patient flat in bed with legs elevated Monitor Vital signs, I & O, & amount of blood loss

Prevent infection as the woman who lost so much blood is susceptible to infection

Contraception must be started upon discharge from hospital. Ovulation begins asearly as 19 days or 3 weeks after resection of ectopic pregnancy.

B. SECOND TRIMESTER BLEEDING 1. GESTATIONAL TROPHOBLASTIC DISEASE (HYDATIDIFORM MOLE OR H-

MOLE))

- A benign disorder characterized by degeneration of the chorion & death ofthe embryo. The chorionic villi will rapidly proliferate and become GRAPELIKEVESICLES THAT PRODUCE LARGE AMOUNTS OF HCG.

CAUSES:


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1. SPERM + OVUM + DUPLICATION =46 (COMPLETE( 23) ( 0) MOLE)

2. SPERM + OVUM =69 (PARTIAL(46) (23) MOLE)

3. SPERM( 23) OVUM

+ + ( 23) =69 (PARTIALSPERM MOLE)( 23)

Predisposing factors: 17 years old below and 35 yrs. Above Low socioeconomic status Low protein intake Previous mole Higher incidence in Asian women

TYPES:1. COMPLETE MOLE IF AN EMBRYO FORMS, IT DIES EARLY AT ONLY 1 TO 2 MM IN SIZEWITH NO FETAL BLOOD PRESENT IN THE VILLI.2. PARTIAL MOLE NO EMBRYO PRESENT BUT FETAL BLOOD MAY BE PRESENT. HAS

69 CHROMOSOMES (TRIPLOID FORMATION)

Signs and Sxs: Rapid increase in uterine size greater than gestational age of the fetus Marked increase HCG titer; NV:400,00 iu Excessive nausea and vomiting due to elevated HCG Brownish vaginal discharge around 4th month containing grapelike vesicles No FHT, no fetal movement No fetal parts Bleeding which may vary from spotting to profuse hemorrhage is a common sign No fetal skeleton Increase WBC Hypertension & other sx of preeclampsia Symptoms of PIH before 24th week gestation

**difference bet.H-mole & pre-eclampsia- before 20 weeks =H mole- after 20 weeks up to 2 weeks post partum = preeclampsia

Treatment and management: D and C to remove the mole. ( If the woman is more than 40 yrs old, hysterectomy is

done since she has a higher chance of developing CHOROCARCINOMA Monitor HCG for 1 year ( HCG shld be negative 2-6 weeks after removal of H-mole.)

-when HCG level is normal it is monitored monthly for 6 mos, then every 2 mos until2 years

Chest X ray every 3 mos for 6 mos. The lungs are the most common site of

metastasis of choriocarcinoma Chemotherapy ( Methotrexate) if:

-HCG titers are increased for 3 consecutive weeks or double at anytime-HCG titers remain elevated 3-4 mos. after delivery

The woman is advised not to get pregnant for 1 year, contraceptive method shld NOTbe the pills. Pills contain estrogen which promote regrowth of the chorionic villi.

Hysterectomy is the method of tx for women above 40 yrs old because of the higherincidence of malignancies & to clients who have completed childbearing & requiresterilization.


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Prognosis: Favorable if HCG titers do not recur after evacuation of the mole Unfavorable if malignancy develops and is untreated

Complications of H-Mole:

Gestational Trophoblastic Tumors persistent trophoblastic proliferation after H-mole.

1. Choriocarcinoma most severe malignant complication that involve thetransformation of chorion into cancer cells that invade & erode blood vessels &uterine muscles.

2. Invasive mole locally invasive & is characterized by excessive formation oftrophoblastic villi that penetrates the myometrium. Develops during the first 6months after H-mole.

3. Placental Site Trophoblastic Tumor arises from the site of the placenta.

Management ofall trophoblastic tumors is HYSTERECTOMYNURSING MANAGEMENT:

1. MAINTAIN F & E BALANCE.

2. EMPHASIZE THAT PREGNANCY SHOULD BE AVOIDED FOR 1 YEAR ( GREATER CHANCE OFIT RECURRING & MAY EVEN LEAD TO CHORIOCARCINOMA)3. ADMINISTER BLOOD REPLACEMENT AS ORDERED.4. PROVIDE EMOTIONAL SUPPORT5. USE MECHANICAL EQUIPMENTS AGAINST PREGNANCY ( Ex. Condom)

INCOMPETENT CERVIX OR PREMATURE CERVICAL DILATATION:- PAINLESS CERVICAL EFFACEMENT & DILATATION IN EARLY MIDTRIMESTER

RESULTING IN EXPULSION OF PRODUCTS OF CONCEPTION.- MOST COMMON CAUSE OF HABITUAL ABORTION

CAUSES:1. INCREASED MATERNAL AGE2. CONGENITAL MALDEVELOPMENT OF THE CERVIX short cervix

3. TRAUMA TO THE CERVIX (HISTORY OF REPEATED D & CS; CERVICAL LACERATIONS WITHPREVIOUS PREGNANCIES)

Signs and Sxs: Slight vaginal bleeding Presence of uterine contractions in midtrimester Rupture of the bag of waters Expulsion of the conceptus Presence of painless cervical dilatation Relaxed cervical os on pelvic examination

MX:

1. CERVICAL CERCLAGE MEDICAL MANAGEMENT WHEREIN THE PHYSICIAN SUTURESA CERTAIN PART OF THE CERVIX BETWEEN 14 AND 16 WEEKS GESTATION TO

PREVENT CERVICAL DILATATION.a) MCDONALDS ( temporary) NYLON SUTURES ARE PLACED HORIZONTALLY &

VERTICALLY ACROSS THE CERVIX & PULLED TIGHT TO REDUCE THE CERVICALCANAL TO A FEW MILLIMETERS IN DIAMETER.

b) SHIRODKAR ( permanent) STERILE TAPE IS THREADED IN A PURSE-STRINGMANNER UNDER THE SUBMUCUS LAYER OF THE CERVIX & SUTURED IN PLACE TOACHIEVE A CLOSED CERVIX.

c) After suturing the cervix:a. Place woman on bed rest for 24 hours


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b. Observe for bleeding, uterine contractions, and rupture of BOWc. If BOW ruptures the sutures are removedd. If uterine contractions occur, the woman is given ritodrine to stop the

contractionse. Post-op care: Restrict activities for the next 2 weeks including coitus

Pre-requisites of Cervical Cerclage:

Cervix not dilated Intact membranes No vaginal bleeding & uterine cramping

THIRD TRIMESTER BLEEDING

1. PLACENTA PREVIA - LOW IMPLANTATION OF THE PLACENTA

TYPES:1. LOW-LYING IMPLANTATION OF THE PLACENTA IN THE LOWER RATHER THAN IN THE

UPPER PORTION OF THE UTERUS2. MARGINAL PLACENTA EDGE APPROACHES THAT OF THE CERVICAL OS3. PARTIAL IMPLANTATION THAT OCCLUDES A PORTION OF THE CERVICAL OS4. COMPLETE ( TOTALIS) PLACENTA THAT TOTALLY OBSTRUCTS THE CERVICAL OS

Predisposing factors: Multiparity Advanced maternal age over 35 yo Multiple pregnancy Uterine tumor Cigarette smoking Scarring from previous previous CS

Decreased vascularity of upper uterine segment Past uterine D&C

Signs and Sxs:

Painless, bright red vaginal bleeding during the 3rd trimester Abdomen soft, non tender

Ultrasound reveals placenta previa NURSING MANAGEMENT:

1. MONITOR VITAL SIGNS & BLEEDING ( WEIGH UNUSED PERINEAL PAD, THEN WEIGHPERINEAL PAD SOAKED IN BLOOD, THEN SUBTRACT. THE DIFFERENCE IS THEWEIGHT OF THE BLOOD LOSS.)

2. PROVIDE STRICT BED REST TO MINIMIZE THE RISK TO FETUS.( CBR without BRPs )3. OBSERVE FOR FURTHER BLEEDING EPISODES.( PREPARE FOR BT) ( Hgb & Hct)

4. AVOID VAGINAL EXAMINATIONS ( NO IE). IF IE IS INDICATED, IT SHOULD BE DONEIN A DOUBLE SET-UP ENVIRONMENT. ( MEANING: OR/DR) WHEREIN THE PATIENTHAS ALREADY SIGNED A CONSENT FORM, PRE-OP MEDS HAVE BEEN GIVEN,ABDOMINAL PREP HAS BEEN DONE SO THAT IF THE PLACENTA IS ACCIDENTALLYDETACHED BECAUSE OF MANIPULATIONS, CS CAN BE DONE IMMEDIATELY.

5. PROVIDE EMOTIONAL SUPPORT DURING THE GRIEVING PROCESS.

** CLASSICAL CESARIAN SECTION ( UTERUS IS INCISED IN THE VERTICALSEGMENT) IS DONE IN CASE OF SEVERE BLEEDING.**

** BLEEDING WITH PLACENTA PREVIA OCCURS WHEN THE LOWER UTERINE SEGMENTBEGINS TO DIFFERENTIATE FROM THE UPPER SEGMENT LATE IN PREGNANCY( APPROXIMATELY WEEK 30) & THE CERVIX BEGINS TO DILATE. THE BLEEDING PLACES THEMOTHER AT RISK FOR HEMORRHAGE. BECAUSE THE PLACENTA IS LOOSENED, THE FETALOXYGEN MAY BE COMPROMISEDIMMEDIATE CARE MEASURES:


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** TO ENSURE AN ADEQUATE BLOOD SUPPLY TO THE MOTHER & FETUS, PLACE THEWOMAN ON BED REST IN A LEFT SIDE LYING POSITION.**

Assess fetal lung maturity Observe for PP hemorrhage Observe strict aseptic technique

Complications of placenta previa:

Hemorrhage Infection Prematurity

ABRUPTIO PLACENTA- ABRUPT SEPARATION OF AN OTHERWISE NORMALLY IMPLANTED PLACENTA AFTER 20

WEEKS AOG.TYPES:

1. MARGINAL ( OVERT)SEPARATION BEGINS AT THE EDGES OF THE PLACENTA ALLOWING BLOOD TOESCAPE FROM THE UTERUS. BLEEDING IS EXTERNAL.

2. CENTRAL ( COVERT)PLACENTA SEPARATES AT THE CENTER RESULTING IN BLOOD BEING TRAPPED

BEHIND THE PLACENTA. BLEEDING THEN IS INTERNAL AND NOT OBVIOUS.

CAUSES:1.MATERNAL HYPERTENSION ( CHRONIC OR PREGNACY INDUCED)2. ADVANCED MATERNAL AGE3. GRAND MULTIPARITY MORE THAN 5 PREGNANCIES4. TRAUMA TO THE UTERUS5. SUDDEN RELEASE OF AMNIOTIC FLUID THAT CAUSE SUDDEN DECOMPRESSION OF TE

UTERUS.6. SHORT UMBILICAL CORD7. CIGARETTE SMOKING & COCAINE ABUSE

S/SX:1. SHARP PAIN IN THE FUNDAL AREA AS THE PLACENTA SEPARATES2.PAINFUL DARK RED VAGINAL BLEEDING IN COVERT TYPE3.PAINFUL BRIGHT RED VAGINAL BLEEDING IN OVERT TYPE4.HARD, RIGID, FIRM,BOARD-LIKE ABDOMEN CAUSED BY ACCUMULATION

OF BLOOD BEHIND THE PLACENTA WITH FETAL PARTS HARD TO PALPATE.5. ABNORMAL TENDERNESS DUE TO DISTENTION OF THE UTERUS WITH BLOOD.6. SIGNS OF SHOCK & FETAL DISTRESS AS THE PLACENTA SEPARATES.

CLASSIFICATION ACCORDING TO PLACENTAL SEPARATION:

1. GRADE 0 = NO SYMPTOMS OF PLACENTAL SEPARATION, DIAGNOSED AFTERDELIVERY WHEN PLACENTA IS EXAMINED & FOUNDTO HAVE DARK, ADHERENTCLOT ON THE SURFACE.

2. GRADE 1 = SOME EXTERNAL BLEEDING, NO FETAL DISTRESS, NO SHOCK, SLIGHTPLACENTAL SEPARATION

3.GRADE 2 = EXTERNAL BLEEDING, MODERATE PLACENTAL SEPARATION, UTERINE

TENDERNESS, FETAL DISTRESS

4. GRADE 3 = INTERNAL & EXTERNAL BLEEDING, MATERNAL SHOCK, FETAL DEATH, DIC

MX:1.WHEN PLACENTA ABRUPTIO IS SUSPECTEDOR DIAGNOSED, HOSPITALIZATION IS A MUST.2. BEDREST OR SIDE LYING POSITION FOR OPTIMUM PLACENTAL PERFUSION.3. MONITOR VITAL SIGNS, FHT, AMOUNT OF BLOOD LOSS GIVE MASK O2 IF FETALDISTRESS IS PRESENT.4. DELIVERY:


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** VAGINAL DELIVERY IF THERE IS NO SIGN OF FETAL DISTRESS, BLEEDING ISMINIMAL & VITAL SIGNS ARE STABLE.

** CESARIAN DELIVERY IF BLEEDING IS SEVERE, FETAL DISTRESS IS PRESENT &FETUS CANNOT BE DELIVERED IMMEDIATELY WITH VAGINAL METHOD.COMPLICATIONS:1. COUVELAIRE UTERUS OR UTERINE APOPLEXY INFILTRATION OF BLOOD INTO THE

UTERINE MUSCULATURE RESULTING IN THE UTERUSBECOMING HARD & COPPER COLORED.2. HEMORRHAGE & SHOCK TREATED BY BLOOD TRANSFUSION3. DIC MANAGED BY FIBRINOGEN & CRYOPRECIPITATE

Disseminated Intravascular Coagulation (DIC) Disorder of blood clotting

Fibrinogen levels fall below effective limits ( Hypofibrinogenemia) Symptoms

Bruising or bleeding

massive hemorrhage initiates coagulation process causing massive numbersof clots in peripheral vessels (may result in tissue damage from multiplethrombi), which in turn stimulate fibrolytic activity, resulting in decreased

platelet and fibrinogen levels and signs and symptoms of local generalized bleeding (increased vaginal blood

flow, oozing IV site, ecchymosis, hematuria, etc)

monitor PT, PTT, and Hct, protect from injury; no IM injections HYDRAMNIOS / POLYHYDRAMNIOS

- CHARACTERIZED BY EXCESSIVE AMOUNT OF AMNIOTIC FLUID, MORE THAN 2000ML.

- NORMAL AMOUNT OF AMNIOTIC FLUID AT TERM IS 500 TO 1200 ML CAUSES:

1. MULTIPLE PREGNANCY= ONE FETUS USURPS THE GREATER PART OF THECIRCULATION RESULTING IN CARDIOMEGALY, WHICH IN TURN RESULTS ININCREASED URINE OUTPUT.2. FETAL ABNORMALITIES:

a. ESOPHAGEAL ATRESIA FETAL SWALLOWING OF AMNIOTIC FLUID IS ONEOF THE MECHANISMS THAT REGULATE THE AMOUNT OFAMNIOTIC FLUID. IN ATRESIA, THE FETUS CANNOTSWALLOW

b. SPINA BIFIDA INCREASED TRANSUDATION OF AMNIOTIC FLUID FROM THEEXPOSED MENINGES.

S/SX:1. EXCESSIVE UTERINE SIZE, OUT OF PROPORTION TO AOG WITH DIFFICULTY

PALPATING FETAL PARTS & FINDING FHT PRIMARY CLINICAL FINDINGS2. SHORTNESS OF BREATH CAUSED BY PRESSURE OF THE OVERLY DISTENDED UTERUS

AGAINST THE DIAPHRAGM.3. BACK PAIN, VARICOSITIES, CONSTIPATION, FREQUENCY OF URINATION &

HEMORRHOIDS

DIAGNOSTIC AIDS:1. ULTRASOUND2. RADIOGRAPHY

COMPLICATIONS:1. PREMATURE LABOR & DELIVERY2. ABRUPTIO PLACENTA

3. POSTPARTUM HEMORRHAGE DUE TO OVERDISTENTION4. CORD PROLAPSEMX:

1. MILD TO MODERATE DEGREES USUALLY DOES NOT REQUIRE TREATMENT.


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2. HOSPITALIZATION IF SX INCLUDES DYSPNEA, ABDOMINAL PAIN, DIFFICULT AMBULATION.3. AMNIOCENTESIS REMOVAL OF AMNIOTIC FLUID TO RELIEVE MATERNAL DISTRESS4. INDOMETHACIN THERAPY A DRUG THAT DECREASES FETAL URINE FORMATION.

SE: POTENTIAL PREMATURE CLOSURE OF THE DUCTUS ARTERIOSUS.5. HEALTH INSTRUCTIONS FOR RELIEF OF SYMPTOMS:

1. PLACE IN SEMI-FOWLERS POSITION TO ASSIST IN BREATHING

2. EMPTY BLADDER FREQUENTLY

STOPPED AT SLIDE 89, POWERPOINT!!!

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Abnormal Obstetrics Edited